The Vermont Nurse Connection - May 2022

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Page 10 • Vermont Nurse Connection May, June, July 2022 We’re Not Heroes: Providing Nursing Care during a Pandemic Marcia Bosek DNSc, RN Ann Laramee MS ANP-BC ACNS CHFN ACHPN FHFSA Sue Murdock DNP, DNP, APRN, GNP-BC University of Vermont Medical Center Introduction In March 2020, a state of emergency was declared throughout the United States in response to escalating incidence of the coronavirus (COVID-19). A “Stay Home- Stay Safe” order issued for the state of Vermont closed non-essential in-person businesses, impacting how hospital nursing care was provided (State of Vermont, 2020). A chief nursing officer noted, “Nurses want to tell their stories! We need to research how COVID-19 has impacted nurses and the care they provided during this pandemic.” Method and Design Purpose & Design The purpose of this descriptive phenomenology study was to develop a broader understanding of the perceptions and experiences of the professional nurses providing patient care during the COVID-19 pandemic. The specific aim was: “What was the experience of providing nursing care at a Vermont hospital during the COVID-19 pandemic?” The study was approved by the Research Protection Office. All professional nurses (n=1992) (RNs & APRNs) employed in any role at a Northeast academic medical center were invited to participate.. Data analysis followed Colaizzi’s (1978) method. Actions were taken to increase the trustworthiness of the findings. Findings Participants 173 nurses (8.7% response rate) completed the confidential survey between May 20-June 3, 2020 (see Table 1). Themes Three themes with sub-themes emerged regarding the participants’ experience of providing nursing care during the COVID-19 pandemic (Figure 1). Theme #1: It Was a Rollercoaster Ride The nurses described providing care during the pandemic as being a rollercoaster ride that they never expected to be riding and felt they could not get off. Nurses experienced anticipated as well as unexpected changes, and emotional reactions, which created the perception of contradictions between the anticipated and the unexpected. These contradictions may be perceived as thrilling, stressful or anxiety provoking depending upon the nurse’s personality, experiences, and resources. • “Providing nursing care during the pandemic has been a rollercoaster you can’t seem to get off and something I never thought I would experience in my nursing career. This has been a frustrating, exhausting, confusing, and anxiety provoking time.” The nurses expressed concerns related to job security, finances, separation of family, continued potential exposure to COVID while concurrently experiencing increased collegiality and teamwork and recognition of individual, organizational and community strengths. Sub-theme #1: At First It Was Scary. Participants initially perceived providing care as being unnerving, scary, and stressful due to the many unknowns, social distancing, inconsistent and/or rapidly changing standards/ protocols, and communication issues. However, caring for patients with COVID-19, having resources/PPE available, and learning new protocols decreased their confusion, frustration, and anxiety over time. • “Initially terrifying. Obviously had to work, but I was afraid I would get sick. True panic. It took four to five weeks to just feel like ‘OK, I can do this’. Humbling, scary.” Sub-theme #2: Things Were Unexpected and Surreal. Unlike the traditional roller coaster ride, the participants were forced to respond to competing and often simultaneous stressors. Nurses perceived inconsistencies and/or disconnects between pre and post COVID experiences, policies, and expectations versus the current reality being experienced. The element of risk played a role in how the nurses interpreted these stressors. The participants perceived these conflicts and inconsistencies as being disrespectful to them as individuals and to the profession. As time progressed, nurses experienced frustration when unanticipated nursing lay-offs occurred due to low census, especially after working through the height of the pandemic. • “Feeling like you are…“Choosing” to be a nurse over mother/wife/daughter/sister to keep your family protected.” • “We have a very restricted visitor policy now. It is the complete opposite of our patient and family centered care model which welcomes in families as part of the team.” Sub-theme #3: The Fear of Unknown Continues. When completing the survey, nurses were experiencing exhaustion and other physical effects, due to their workload, stress, and fears of the unknown, and a potential second COVID-19 surge. A few nurses were beginning to move past their fears and starting to evaluate their experience, recognize the importance of teamwork, and imagine their future beyond this COVID experience. • “The uncertainty of the months ahead and the projected increase in cases this fall has me concerned. But the way we have handled and cared for COVID patients has us very prepared for the next expected outbreak.” • “And now, I’m ready to move on with life, using good hand hygiene of course.” Sub-theme #4: I Feel Grateful. Even though the pandemic is not over, the future uncertain, and fear and anxiety persist, the nurses expressed gratitude that they and their families did not get sick with the COVID virus. The nurses were grateful that their hospital and state did not experience the surge of COVID patients and for having meaningful jobs at a time of high unemployment.. • “Now I feel exhausted and yet very grateful. That we are now better and stronger and faster-we won’t be caught off guard again, anytime soon.” Theme #2: I Am Proud to Be a Nurse Participants felt honored and proud of being a nurse. Participants realized it is “kind of exciting to be one of the people who could help others during such a tough time for everyone” regardless of the specific role the nurse fulfilled during the pandemic. Participants concluded “we are amazing at what we do, and we go into healthcare because we want to help people, and this has been our time to shine.” Many nurses provided a pragmatic view of their role during the pandemic, including the idea that nurses have always provided care during pandemics. Sub-theme #1: We’re Not Heroes, We’re Just Doing Our Job. Throughout the pandemic, the media has portrayed nurses as being heroes however, the participants did not accept this metaphor since they were not on “the front lines” in a community experiencing a COVID-19 surge. Participants could not reconcile actions they perceived as disrespectful with their ideal of how a hero should be treated. Nurses are always prepared to provide care during a pandemic, because “it’s what we’ve trained for!” • “It was interesting to see how everyone is all about the “Healthcare Heroes,” but the community was afraid of us in public and questioned our ability to be clean.” • “We are not heroes; we are just doing our jobs. Nurses in COVID affected areas are true heroes. They deserve a praise.” Theme #3: We Adapted to Provide the Best Care Participants reiterated their commitment to “always provide the care you and your family deserve.” Early in the pandemic, the hospital’s visitation policy was changed, and no visitors were allowed. For some, this change was welcomed since nursing units were quieter and less chaotic. However, prohibiting visitors limited communication, decision-making and family support. The nurses became creative in identifying workarounds to meet the needs of patients, family, and the healthcare team. Nurses noted an increase in collaboration and teamwork. • “Nursing care was significantly different. Many workers were restricted to access COVID + patient rooms. As the nurse some days it felt like I was a nurse, licensed nursing assistant, respiratory therapist, environmental services and IT all in one.” Sub-Theme #1: We Would Fill in for Family. Nurses remained committed to providing patient and family centered care even when visitors were prohibited, especially for patients who were dying. • “I cared for a dying patient during the last hours. The family was not present….I found the patient’s phone and figured out how to play music…I was the only reminder in the room that this was a person with a life…now facing death…alone except for me.” Discussion Sample While the participants in this study did not experience an overwhelming surge of COVID-19 patients, their experience is still meaningful (Vermont Health Department, 2020). There were no substantive differences in responses to any of the survey questions between nurses who provided direct care to COVID positive patients and those who did not. It Was Scary While the scared feeling dissipated as procedures became known, communication improved, and routines developed, nurses remained fearful of the future. The fear of unknown continues reflected concerns for a protracted pandemic. The fear related to contracting COVID-19 while working was real and realistic (Mohammed & Lelièvre, 2021). While there were no known cases of COVID-19 transmission from patients to nurses at this hospital, this unfortunately was not the reality nationally (CDCP, 2020). The participants’ experiences were like the experiences described in an ANA-VT on-line survey that occurred in March-April prior to this study. The ANA-VT findings describe nurses experiencing anxiety related to the use of PPE and lack of evidence supporting changes in policies and procedures, concerns about keeping patients as well as their immediate families safe and communication issues (Maltby & Conroy, 2020). Pride Participants experienced pride in their work and in being able to serve. Being resilient and able to “ride the rollercoaster” successfully, helped the nurse cope with the dearth of information one day followed by an inundation with new procedures the next. The ability to continue to deliver high quality, evidence-based care when so much about COVID-19 practice was unknown was another source of pride. Adjusting practice to deliver care differently, either from a different location (telenursing), in a different care model (tiered staffing), or taking on a completely new role within the health system was another source of pride. Participants consistently recognized that peers, managers, and other healthcare professionals united to meet the pandemic challenges. This sense of being together “in the trenches” was a positive outcome. Hero In the unique scenario of a pandemic, the definition of heroism is not clear. Heroism can be defined as facing one’s mortality, taking significant risks, overcoming major challenges, all while maintaining congruence with one’s principles (Kohen, 2014). While many nurses died during the COVID-19 pandemic, sometimes because of work-related exposures (ICN, 2020), this was not the local experience. In the early stages, when information on how to safely provide care was unclear, nurses felt they were taking significant risks with not only their own health, but the health of those they loved. Concurrently, there were major challenges for nurses to overcome as the hospital set up COVID-19 care systems. Nurses described the burden of rapidly changing practice as a major challenge to feeling safe and prepared to do their work. Taking the time to don PPE was a threat to many a nurse’s self-image. Other participants described promoting community compliance with masking and social distancing as an example of heroic work, which is congruent with Kohen’s (2014) definition of heroism. The hero identity, however, was not universally embraced. Several participants identified that their work was “just doing our jobs,” that responding to this crisis is what nurses were trained to do and should not be characterized as heroism. Since the surge in Vermont was minimal, participants, not directly caring for COVID-19 patients, expressed unease with the hero label, noting the term should be reserved for nurses experiencing a COVID-19 surge. The fact that the community had competing views of nurses during the pandemic (hero vs. a threat to community well-being because of potential exposure) prevented some participants from believing that they were heroes. Stokes-Parish et al. (2020) contend the hero and angel terminology is detrimental to the profession of nursing as it diminishes the value of the “high level of skill and knowledge demonstrated by nurses during the COVID-19 pandemic” (p. 463) and implies nurses’ effectiveness is superhuman or magical in origin. Thus, the angel and hero image might negatively impact interest in nursing
May, June, July 2022 Vermont Nurse Connection • Page 11 as a career, limit nursing workforce diversity, and undervalue the importance of skill development and knowledge in the practice of nursing. Figure 1: Schematic Representation of Themes and Sub-themes Provided the Best Care We adapted to provide the best care, was common among participants regardless of their experience caring directly for patients with COVID-19. Nurses do what nurses do, they stepped up to the challenge and adapted to provide the best care possible (Liang, Wu, & Wu, 2021). The pandemic had a way of narrowing the nurse’s focus so they could prioritize what was truly important. Nurses did this while at the same time putting to the back of their minds all their personal fears and worries. Through working “together as a unified force,” nurses were able to maintain hope and be reassured together they would survive the pandemic. At a time that could be demoralizing and lead to burnout, many nurses shared how their morale was boosted. Nurses described how coming together as a team for the common good of caring for patients gave them hope and lifted them up. Strengths and Limitations The findings are strengthened by the large sample size. Since Vermont did not experience a COVID-19 surge; findings may not generalize to settings experiencing a surge. Nursing Implications Many lessons were learned from this sample, which could inform the journey of nurses working in future pandemics. Strategies to lessen nurse anxiety and fear include: 1) having a unified, concise and scheduled communication plan for disseminating evolving policies and procedures, 2) developing mechanisms for nurses to share their unique experiences and to receive peer support at times of crisis, and 3) providing easily accessible evidence-based protocols for the use of potentially scarce personal protective equipment. Nurses felt conflicted and discouraged when they were not able to give the patient and family centered care they were used to providing. Creating a pandemic visitation policy that would include leveraging technology to improve communication with patients and families would be a way to honor and support the nurses’ patient and family centered philosophy. Describing nurses as prepared, knowledgeable, and dedicated professionals is more accurate than using the hero or angel image. Research is needed to describe how nurses experience providing care during a prolonged national pandemic and whether a specific role, level of care (acute, ambulatory, long-term care), scope of practice, and direct care for patients with COVID-19 impacts the nurse’s experience. It is unknown whether there are short-term and/or long-term consequences experienced by patients, family and healthcare staff related to the implementation of a no-visitor policy. Conclusion Nurses want to discuss their experiences. Nurses are prepared to provide care during a pandemic. Despite experiencing fear and anxiety, nurses are willing and committed to providing high quality, patient and family centered care during a pandemic. Even in a pandemic, nurses are resilient and able to experience gratitude. However, these nurses did not view themselves as heroes. References Center for Disease Control and Prevention. (2020,October 30). COVID-19–associated hospitalizations among health care personnel — COVID-NET, 13 States, March 1–May 31, 2020. Morbidity and Mortality Weekly, 69(43), 1576–1583. Retrieved from https://www.cdc. gov/mmwr/volumes/69/wr/mm6943e3.htm#F1_down Colaizzi, P. (1978). Psychological research as a phenomenologist views it. In: R. S. Valle & M. King. (1978). Existential phenomenological alternatives for psychology. Open University Press. International Council of Nurses. (2020, October 28). ICN confirms 1,500 nurses have died from COVID 19 in 44 countries and estimates that healthcare worker COVID 19 fatalities worldwide could be more than 20,000. Retrieved from https://www.icn.ch/news/icn-confirms-1500- nurses-have-died-covid-19-44-countries-and-estimates-healthcare-worker-covid Kohen, A. (2014). Heroism and subjectivity. Retrieved from : http://kohenari.net/ post/99653156590/ Liang, H-F, Wu, Y-C., & Wu, C-Y. (2021). Nurses’ experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study. International Journal of Mental Health Nursing, 30, 1684–1692. https://doi: 10.1111/inm.12921 Maltby, H., & Conroy, C. (2020, July). Coalition of Vermont nurse and nurse practitioner leaders responds to the ANA-VT survey on COVID-19: Themes and recommendations. The Vermont Nurse Connection, 23(3), 7. Retrieved from https://assets.nursingald.com/uploads/publication/ pdf/2075/Vermont_Nurse_Connection_7_20.pdf Mohammed, N, & Lelièvre, H. (2021). Lived experience of medicine nurses caring for COVID-19 patients: A quality improvement perspective. Journal of Nursing Care Quality, 37(1), 35–41. State of Vermont. (2020, March 24). Governor Phil Scott issues a “Stay Home, Stay Safe” order, directs additional closures. https://governor.vermont.gov/press-release/governor-phil-scottissues-%E2%80%9Cstay-home-stay-safe%E2%80%9D-order-directs-additional-closures Stokes-Parish ,J., Elliot, R., Rolls, K., & Massey, D. (2020). Angels and heroes: The unintended consequence of the hero narrative. Journal of Nursing Scholarship, 42(5), 462-466 https://doi. org/10.1111/jnu.12591 Vermont Department of Health (2020, June26). Weekly summary of Vermont COVID-19 data reflecting cases identified between March 5 –June 24, 2020. Retrieved from https:// www.healthvermont.gov/sites/default/files/documents/pdf/COVID19-Weekly-Data- Summary-6.26.20.pdf Table 1: Sample Demographics Position n (%) Nurses who had provided direct care to COVID-19 patients n (%) Staff Nurse 145 (84%) 47 (27%) APRN 4 (2%) 1 (0.6%) Other (travel nurse, nurse manager, educator, case manager, etc.) 24 (14%) 5 (3%) Total 173 53 (30.6%) Join Our Team & Make a Difference! All people share a powerful need for the basic necessities of a good life and a place that understands that good health starts with a caring touch and a kind word. For over 50 years, the Community Health Centers of Burlington (CHCB) has provided access to high quality health care regardless of financial status or life circumstance. We strive to improve the health of all within the communities we serve in an environment that conveys respect, offers support, and encourages people to be actively involved in their own health care. CHCB is an innovative Federally Qualified Health Center with sites throughout Chittenden County and southern Grand Isle County. We are an Equal Opportunity Employer and are especially interested in candidates who can contribute to the diversity and excellence of the organization. CHCB is growing and so is our nursing team! We have opportunities for Registered Nurses, Nurse Educators, Clinical Nurse Supervisors, and more! Come join our mission-minded, collaborative, and creative team! Apply now on our Career Center at CHCB.ORG/CAREERS
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The Vermont Nurse Connection - May 2022

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