“Heroes work here.” It was a common theme in the early days of the pandemic. Signs were placed in front of the facility, and people would cheer and line the streets as healthcare personnel went to work. Staff felt that they were providing quality care to the most vulnerable population, those most at risk from COVID-19. As the pandemic raged on, the media portrayal of nursing homes changed dramatically. Reports that nursing homes were “death traps” with “top to bottom failures” became all too common. Public opinion of nursing homes and how they handled the pandemic soured. Many family members, already frustrated over not being allowed to visit, became alarmed and suspicious of nursing home environments. Staff members, still navigating the pandemic, had to confront new emotional dimensions to the evolving crisis.
Stacy, a nurse, is working four double shifts weekly on the COVID unit. She fears bringing COVID home to her family. Despite her concerns, she comes to work because there are so many staffing challenges since the pandemic. Although she is coming to work, she is exhausted, frustrated, and experiencing sleep disturbances. She isn’t sure how much more she can handle and is considering leaving nursing. She’s afraid that the care she is currently able to give isn’t the best it could be.
Do you know if this is how your staff feels? If so, what plans do you have in place to help staff cope with all the struggles of the pandemic? This article discusses how to identify staff who are struggling and why interventions to promote coping and recovery are necessary.
Employee rounding is typically done to assess staff satisfaction and engagement. Today, employee rounding requires a bit of a twist: staff need to be asked how they are doing. The stresses of working during a pandemic, coupled with the negative press and public opinion, has taken a significant toll on many staff. Emotional rounding allows facility leaders to check on staff to see how they are feeling, so that stressors can be dealt with promptly. Here is a short list of what we have heard from members working during the pandemic.
“We had to conserve PPE, so we limited the number of times we entered a resident’s room. This isn’t what I thought nursing would be like.”
“Residents were fine one minute, and then they got COVID and died. We lost eight residents in one day. I won’t ever forget how this made me feel.”
“Every day, I feared getting COVID, then I did. While I survived, I had family members who did not.”
If facility leaders have not been checking in on staff and asking them how they feel, they may not know the pain, guilt, frustration, and sadness they are carrying with them. By conducting daily emotional rounds, leadership can identify staff who need support and help them get that support before the burdens become too much. When stressors go unaddressed, staff are more likely to have issues with post-traumatic stress syndrome, addiction, or severe depression, or they might leave the profession altogether. Simply ask staff, “how are you doing with everything,” then listen intently.
Each facility’s experience with COVID differs, but all staff have been impacted in some manner. Even if a facility has never had COVID in the building, the fear of it is still present. Traumatic experiences involve a threat to one’s life or safety, even if one doesn’t experience actual physical harm. A crisis such as COVID-19 left staff facing several traumatic experiences simultaneously. Working without proper PPE, working with less-than-optimal staff, being afraid for one’s safety, concern for one’s own family members’ safety, and watching suffering and death are only a few of the strains staff have experienced during the pandemic. When stressors continue over a period of time, they can turn into lasting psychological trauma. Staff may suffer physical or emotional symptoms from trauma. These may include difficulty concentrating, fear, anxiety, anger, mood swings, withdrawing from others, guilt, or physical symptoms such as insomnia, fatigue, muscle aches, or headaches. This is not an exhaustive list of the symptoms staff might have, but these and others do threaten two important aspects of care: resident safety and staff retention.
Take this example:
Samantha, a nurse on the dementia unit, is having difficulty concentrating. She feels extreme fatigue and headaches. In the last week, she has missed two shifts, stating she is having a headache and cannot work. When she is working, she seems disconnected and gets frustrated easily.
If Samantha continues working under these circumstances, she jeopardizes resident safety; it is also likely, if this continues, she will end up quitting or getting fired for her attendance or attitude.
If the facility had been conducting emotional rounding, leadership would have identified Samantha’s need for help in dealing with stressors and been able to intervene to help expedite her recovery.
Strategies to help staff
Once leaders conduct emotional rounding to find out how staff are dealing with the pandemic, they can put interventions in place that promote healthy recovery. Some ideas include:
Emotional rounding may uncover a plethora of staff needs, which can vary greatly depending on how resilient the individual is. Resilience is the process of adapting well in the face of adversity and trauma, a set of positive behaviors and actions that aid in recovery. Not all staff possess this. The good news is that resilience can be learned. Offering education can help staff build resilience.
Note: For more information on resiliency and steps nurse leaders can take, read “10 Tips for Cultivating Resiliency in Facility Staff.”
Grief or professional support:
Staff may benefit from grief support to help them deal with losses. Loss can manifest in many ways; death is only one type of loss. During the pandemic, the way we normally live our lives has changed, many people are more isolated than ever, and we lost connections with family and friends. Some staff may be experiencing feelings so profound that they could benefit from professional help to get over what they have experienced. If emotional rounding identifies the need for professional help, assist the staff member to get the help they need.
Staff may need to talk about their feelings with someone who has shared similar experiences. This is where peer support might be useful. Often, staff go home and try to share their woes with their spouse, but if their spouse isn’t in healthcare, he or she might not understand what their loved one is going through. Setting up a peer support system can reduce feelings of isolation. Those who participate not only hear how others have similar challenges, but also help contribute to their colleagues’ coping strategies.
Note: It’s okay for nurse leaders to also need support. Share your experience on the DNS Network Community and hear from others who have had similar experiences.
Staff may be managing their trauma and stress in unhealthy ways. Offering self-care workshops can foster healthy coping mechanisms. There are many free online resources that individuals can use. From podcasts to videos, there are numerous options to help promote wellness during stressful times. There are also free phone apps to help with mindfulness and meditation. Connect staff with these resources or ask them to share their favorites with each other.
Establish a culture of resilience:
Facilities that prioritize resilience have a better chance of recovery and staff retention. Having a culture of resilience requires a commitment by facility leaders because they must promote and reward a positive work environment while having zero tolerance for bullying and violence in the workplace. In such an environment that promotes social connections and promotes positivity, employees are better able to contend with challenges.
Basic staff needs:
It may be revealed that staff have specific basic needs the facility can assist with meeting. For example, a facility might offer laundry services to assuage fears of bringing home COVID, or it might offer ride share coupons to keep staff safe when they work long hours. Providing meals while working and meals that can be brought home to share with family members can alleviate some stresses outside the workplace.
Emotional rounding may unveil a number of issues that staff are facing—but critically, it equips facility leadership with the information they need on their employees’ current status. Not knowing what staff need to cope and recover could affect resident safety, staff safety, and increased turnover. For more information on this topic, please join me at this year’s AAPACN Conference this April and join my breakout session, “The Road to Recovery: Moral Distress and Compassion Fatigue.”
For permission to use or reproduce this article in full or in part, please submit a permissions form.