Nurses have now worked under pandemic conditions for well over a year and lived under various national and regional lockdowns at the same time. During this time, they have had to manage significant uncertainty, fear and stress – among patients and colleagues as well as personally.
Frontline primary care nurses have taken on a huge extra burden with little or no respite at work or at home: we consistently hear that backfill is unavailable and that staff are exhausted. Nurses have had to cope when colleges are isolating, and step in when other services have been unavailable.
While the Covid vaccines have provided a light at the end of the tunnel, a significant backlog of demand has built up over the past year, so the pressure on nurses is unlikely to ease as patients return in high numbers. Nurses will also play a key role in persuading hesitant patients to accept the vaccine, and in helping to manage those living with long Covid.
Of course, many nurses also have families, with the demands of home-schooling and caring for older relatives adding to the burden.
In this context, is vitally important that nurses take steps to protect their own mental health and wellbeing, and that of their colleagues in the workplace.
Supporting others’ mental health
The mental health impacts of the pandemic are still being studied and services are still adapting to manage them.1
One in four people experience a mental health problem in an average year and the majority of those who get treatment receive it within primary care. One in three GP appointments now involves a mental health component. Not surprisingly, given the huge demands of managing Covid-19, there have been greatly elevated levels of poor mental health among healthcare staff.2
A study, published by Cambridge University Press, which interviewed frontline healthcare workers found the additional workload and responsibilities experienced led to anxiety and confusion about how to support each other.3 Staff ‘neglected their own wellbeing’ the authors said, concluding there was an urgent need to consider and support their mental health.
So what support do staff experience? Is it effective, and how could it be better provided? A University College London (UCL) study interviewing frontline workers found peer support was the most common type, although this could be experienced as a burden.4 Staff interviewed also said they were ambivalent about organisational support, and found access to it was patchy.
There are a number of local and national charities and groups that offer support specifically tailored to nurses (including the Queen’s Nursing Institute – see below), from those working in general practice to others in community and social care settings.
A new peer-led telephone service
As part of its mission to improve nursing care at home and in the community, the Queen’s Nursing Institute (QNI) offers a range of support to nurses in the community and primary care. During the early weeks of the pandemic, the charity responded to the needs of nurses by created a new telephone listening service, TalktoUs.5
The service is a way for nurses to reach out and communicate with others, in complete confidence. QNI chief executive Dr Crystal Oldman describes it as ‘a safe space for nurses in the community, primary and social care to share their experiences and gain emotional support from trained listeners.’
Good communication and listening skills are at the heart of what it is to be a nurse, and the experienced Queen’s Nurses who offer a friendly listening ear all understand the challenges colleagues are facing during the Covid-19 crisis, at home as well as in their professional life.
All have received training in telephone listening skills and can signpost callers to other sources of help. The service has been operating for more than a year and feedback has been consistently positive.
Interviewees in the UCL study mentioned above reported ambivalence about support provided by organisations. This is vital: a supportive workplace environment should prioritise staff wellbeing, a factor recognised at national level by healthcare leaders. The BMA’s mental wellbeing charter calls for a culture that supports the mental health of staff and embeds it into management.6
But if a team is permanently overstretched, or if people do not feel supported in the workplace, this may lead to a permanent state of stress, which is likely to lead to burnout.
The latest NHS Staff Survey found 44% of staff had felt unwell because of stress in the preceding 12 months, while just 33% felt their employer took positive action on health and wellbeing.7 Only 38% thought there were enough staff at their organisation to do their job properly, and less than half felt able to meet conflicting demands on their time.
With the overwhelming pressures frontline NHS staff have faced during the pandemic, there is also a heightened risk of compassion fatigue and lack of self-care.
The British Psychological Society has a range of resources aimed at helping healthcare organisations to provide healthy, supportive and compassionate working environments for their staff as part of its Covid-19 response.8
When approaching your manager to discuss workload or other issues affecting you, bear in mind that this is always a process of negotiation. Remember the pandemic has put everyone under additional pressure but expect to have your fears and concerns taken seriously. The BPS encourages managers to be available, communicative and compassionate.9
Legislation exists to promote fairness at work and to balance the interests of employees and employers. Views about employment and management vary, but discussions should be approached in a spirit of co-operation and partnership.
Many of us spend as much time with our work colleagues as we do with our families and it is in the interests of everyone to make those relationships work. Challenge yourself if you find you are trapped in a negative mindset; reflect on why that might be and what is within your power to change.
Learning to switch off and deal with anxiety
It’s worth developing strategies for switching off outside work, but also in the workplace. This may take some time, some research, and some practice. The BPS recommends staff have access to ‘protected spaces’ in the workplace where possible, and this can be a valuable way to switch off or destress for a short period, either alone or with colleagues.9
Outside work, meditation and mindfulness are well worth exploring, and make time for things that you enjoy and can look forward to. Try to actively stop yourself from thinking about things that are bothering you, by looking for distractions and a change of environment. Exercise or a walk can be beneficial.
We are all familiar with the sense of waking up at 5am with stressful thoughts, all the more so in the middle of a global crisis. In such situations, deep breathing, visualisation or journaling are all methods that can help to defuse the tension.
Take up a hobby
It is well known that many people have dealt with Covid-related anxiety by taking up something new, such as baking or learning an instrument. While nurses have certainly not had the problem of filling the hours during lockdown, a new activity can be beneficial.
Gardening is a healthy way to switch off and the National Garden Scheme (NGS) – a partner charity of the QNI – has plenty of resources for beginners and the more experienced on its website.10
Not everyone has a garden of their own, which is one reason public or shared green spaces are so important. For example, nurses in general practice could work with colleagues to develop a garden at their surgery, which would benefit staff and patients alike.
Recently, the QNI and NGS have joined forces to help them do just that, by developing a new programme. Funding will soon be available for nurses who wish to develop therapeutic gardens and other ideas around gardens and health, as part of one of the institute’s professional development programmes.
Many people enjoy the therapeutic effects of crafts and hobbies like knitting and gardening, because as well as helping you to relax and switch off from your problems, they allow to create something from nothing.
Recently the QNI filmed an online conversation between five Queen’s Nurses and four cast members of BBC’s Call the Midwife programme. One of the questions asked was, ‘How do you relax in your spare time during lockdown?’ The full film can be found here.
Coming out of lockdown
Some recent research for King’s College London (KCL) illustrated the range of feelings people are experiencing as we come out of lockdown and how behaviour is changing and adapting.
While many reported looking forward to returning to a life as close as possible to the norm they experienced before the pandemic, others cannot envisage this and expect their life in future to be very different.
Both responses are entirely natural. Workplaces – and society as a whole – should be prepared to accommodate diverse perspectives in a supportive and understanding culture.2
Financial support for nurses
If your material circumstances have been affected, remember the QNI website has details of financial assistance, including grants for those whose income has been impacted by the pandemic. The institute is grateful for the funding it has received from the Covid-19 Healthcare Support Appeal.
Blogs by general practice nurses
Finally, a valuable way of gaining fresh perspectives on how colleagues are managing the unique demands of the pandemic is to read what others have written about their experiences. The QNI publishes blogs by community nurses on its website, and these include including those of two general practice nurses during the pandemic.
Nurse practitioner Carol Sears reflects on how her nurse-led practice adapted during the pandemic. See her piece here.
And in another blog, Queen’s Nurse Carol Webley-Brown writes about her experiences of general practice nursing during Covid-19 and how services are adapting to meet the needs of patients.
5. QNI’s Talk to Us service