Your mask comes first: Nurses overwhelmed by COVID need support

“Put your oxygen mask on first, before helping others,” flight attendants advise passengers in the early moments of a commercial flight. Similarly, nurses need to care for themselves while caring for their patients — particularly with the new omicron variant of the COVID-19 pandemic that continues to put extraordinary stress on nurses in the U.S. and around the world. 

A survey from the Impact of COVID-19 on the Nursing and Midwifery (ICON) workforce finds that nurses report feeling “neglected and betrayed.” The survey reports “high levels of burnout, post-traumatic stress disorder and severe depression among nursing staff.”

Americans are still struggling with their mental health 20 months after COVID arrived in the country. According to a Gallup study, the percentage of Americans who rate their mental health as “excellent” has held at a 21-year low of 35 percent for a second year in a row. 

As nurse educators, we see that educators in this field should implement lifestyle medicine into the nursing curriculum — and beyond.

The nursing profession is founded on compassion for those who need help caring for themselves. Known for advocating for patients and meeting patients where they most need help, nurses comprise the nation’s largest health care profession.

Nurses have been on the front lines of the pandemic since its start. Many are accustomed to a busy working environment, working different shifts, holidays and weekends. However, during the pandemic, nurses also have dealt with new stressors such as early concerns about COVID transmission modes, access to personal protective equipment (PPE), redeployment to new departments, and emotional impacts of sustained exposure. 

As a nurse practitioner, one of us — Simkus — was deployed to the emergency department on Easter Day 2020 to work triage for patients presenting with symptoms of COVID-19. This was early in the pandemic and her concerns regarding transmission, PPE and the potential of bringing the virus home to a breastfeeding infant and two other young children were high. 

But at the hospital, the team of providers — who had never worked together or with the emergency department staff — banded together that day as a team to provide the best care possible.

Yes, health care provider burnout was prevalent prior to the pandemic, but it has accelerated further to a reported one in five leaving their positions as a result of COVID.  

The practice of lifestyle medicine is a possible solution to this burnout. Since its founding in 2017, the American College of Lifestyle Medicine has board-certified 1,586 physicians and 585 other health professionals in the United States. Lifestyle medicine is an evidenced-based practice focusing on guiding behavior changes in diet, physical activity, sleep, stress management, tobacco/alcohol/drug use and social connections. Lifestyle medicine is one of the fastest growing specialties in the U.S. and around the globe.

Guidelines from other specialties also recommend a focus on lifestyle as a primary intervention in patient care. These include American College of Cardiology and American Heart Association 2019 guideline on the primary prevention of cardiovascular disease, the American Cancer Society’s early detection and prevention guidelines, and the American Diabetes Association’s 2021 guidelines for management of diabetes.

A 2020 publication on data from the Nurses Health Study and the Health Professionals Follow-up Study found that low-risk health behaviors included in many of lifestyle medicine’s pillars have the potential to delay or avoid onset of chronic disease. 

Several major national nursing organizations have released guidelines addressing nursing wellness and health interventions, including the American Nurses Association’s Healthy Nurse guidelines, the American Association of Nurse Practitioners’ standards of practice, and the National Student Nurses 2018 association resolutions for the emotional wellbeing of health care providers.   

The American Association of Colleges of Nursing’s Core Competencies, published this year, has a domain addressing the need for nursing curricula to include content on nurses’ self-care and resiliency. 

While teaching courses on wellness to New York University nursing students, one of us — Merlo — notes that creating spaces for conversations around the stresses encountered on the job is sorely needed. The disconnect between the worries at work and home make it difficult for many to navigate feelings and express them to others. 

Many students reported they sat with their patients throughout the pandemic while families were not allowed to visit, and they often served as interpreters and conveyors of information through the masked faces over loud humming of lifesaving machines. 

Families often begged the nurses to pray with their hospitalized loved ones and yet would yell at the nurse in frustration because of the system, the virus, and their feelings of helplessness. 

Because of these experiences, nursing staff often experience secondary trauma, the indirect trauma that many experience when close to a traumatic incident. Some call this compassion fatigue or vicarious trauma. If unprocessed, these feelings ultimately can lead to loss of interest in the job and personal overwhelm. 

Moving into a new surge of infections from the omicron variant, it is urgent that nurses care for their own mental and physical health and that the profession supports them by adopting a curriculum in health care education that makes their personal health a priority — before and while they assist others.

Elizabeth Simkus, DNP, FNP-C is a lifestyle medicine nurse practitioner at Rush University Medical Center, instructor in the Department of Community, Systems, & Mental Health Nursing at Rush University College of Nursing, and a Public Voices Fellow through The OpEd Project.

Gia Merlo, MD, MBA, is clinical professor of nursing at New York University’s Rory Meyers College of Nursing and clinical professor of psychiatry at NYU Grossman School of Medicine.  She is a fellow of the American College of Lifestyle Medicine and author of the forthcoming book, “Nursing Lifestyle Principles and Practice.”