Due to COVID-19, patients have experienced a reduction in access to quality healthcare, whether it be through their primary care provider or outpatient management of chronic diseases. Since nurses are considered the primary caregivers, this has resulted in acute care nursing burnout, and an even more uncertain future for the healthcare industry. This especially applies to nursing care provided in the hospital setting.
Throughout the pandemic, the lack of close outpatient management for non-COVID patients has led to hospital admissions that may have otherwise been avoided with possibly even sicker, decompensated patients. While caring for COVID-19 patients admitted to the hospital, the standard nurse-to-patient ratio increased. Nurses are spending less time in their patients’ rooms to limit exposure. Many hospitals have the majority of nurses working twelve hour shifts that are often longer, which can add to their emotional and physical stress. Caring for more patients than usual, including those diagnosed with a virus not seen before, with rapidly progressive symptoms, requiring a high level of treatment, can take its toll.
While hospitalized, both COVID-19 and non-COVID-19 patients have not been permitted to have visitors at most institutions. This has added significant stress to the individual patient and their families, and also placed an addition burden on the bedside nurse. In these already stressful and unprecedented situations, the bedside nurse has been forced to provide additional emotional support to their patients while advocating for them, with less support systems in place for the patients and nurses. This has included critically ill patients, as well as those that were dying alone without the presence of their family members.
Teamwork in nursing has also been negatively affected by COVID-19. The physical nature alone of bedside nursing requires multiple individuals to care for each patient. This is amplified when a patient is in an ICU or is acutely ill. Again, to limit exposure, many times only one nurse enters the COVID-19 patient’s room to provide direct care. This has limited the ability to provide good care, while increasing moral stress and physical strain on the nurse. In addition, it’s added to the feeling of isolation from fellow nurse colleagues that could provide much needed support during this stressful time, increasing nursing burnout.
Due to these factors and of course the stress of personal COVID-19 exposure at work, nursing burnout is increasing, and many of the acute care nursing workforce have looked to leave bedside nursing altogether. This is a large group, including many highly experienced nurses that provide invaluable leadership, training and support to other nurses. This stress especially weighs heavily on aging acute care nurses who carry additional COVID risk factors. Any loss of nurses from this group will unfortunately increase the known nursing shortage affecting healthcare at all levels.
The typically very heavily regulated, high-quality, patient safety-centric nursing practice has drastically changed during this ongoing pandemic. The nursing profession and patient safety have been synonymous over the years with the empowerment of nursing. However, with less patient interaction, less support systems and teamwork, and the diminishing workforce, the negative downstream effects of COVID-19 will lead to a long term and different way of caring for patients. So many of the effects of COVID-19 on nurses are evolving and still unknown. And it is evident in the cases our team is already reviewing, that COVID-19 has resulted in an increased number of medical errors.