It has been over a year since nurses around the world were thrust onto the frontlines of the COVID-19 pandemic. For infection control nurses, in particular, the sheer scale of the pandemic has led to a sweeping shift in work scope and processes, as well as a huge increase in workload.
Having to be constantly on their toes, dealing with a non-stop stream of patients and taking on extra shifts, meant many nurses were physically exhausted. But more significant was the mental toll the year-long pandemic took on them.
A study conducted on nurses in Wuhan noted that several factors contributed to nurses’ psychological burden – organisationally, nurses faced “unfamiliar environments, complex workflow, and dangers posed by exposure to COVID-19 patients”, while at the same time, they had to deal with interpersonal isolation. With frontline nurses treating COVID-19 patients bearing the highest risk of infection, because of their close, frequent contact with patients and working longer hours than usual, many have avoided prolonged contact with family or friends in fear or passing on the infection to them. There is thus much lesser social support in place to help them cope with work stress.
Fear of acquiring infections themselves
The combination of all these meant that infection control nurses were more likely to develop negative emotions, such as fear, anxiety, and helplessness.
“Assigning staff who will handle COVID-19 patients was indeed a big challenge. It was difficult convincing them because of their fear of acquiring the virus at work,” said Ms Maria Lourdes Mejillano, infection control nurse and Chief Nurse at Mount Carmel Diocesan General Hospital in the Philippines. “I cannot just assign a staff without their consent because of the risk.”
Manpower shortage was a critical challenge. The reality was that there were just not enough applicants, while at the same time some nurses had decided to resign. Those remaining thus had to grapple with an even heavier work load.
This was a stressful situation for nursing leaders such as Ms Mejillano. On top of managing the resource constraints of the nursing department, these leaders would need to keep themselves closely updated on the latest information emerging on the virus, and quickly put in place or adjust the procedures accordingly.
Ms Mejillano shared that the first few months of the pandemic were particularly difficult. “The results of the RT-PCR (COVID-19 tests) were sent by the Provincial Epidemiological Surveillance Unit via email to me. During the first few months, they were sent during wee hours of the night – I cannot sleep well since I have to keep on checking my emails so I could send it to the nurse stations at once,” she recalled.
Persevering through the challenges
These are not easy problems to solve, in the face of a quick-spreading large-scale pandemic.
A study noted that the care and support from nursing leaders would be key to reducing nurses’ fear. Early identification of negative emotions, and timely intervention in the form of therapy sessions or direct communications from hospital leaders, would allow nurses to relieve the mental burden they carry. In addition, frequent encouragement and additional compensations, would assure them that they are valued and cared for.
Separately, providing work-related support, in terms of adequate equipment and training, is essential in assuring nurses that they are protected and safe in the workplace. For example, nurses should be re-trained and re-orientated on the procedures to handle COVID-19 patients safely, including the techniques for proper donning and doffing of PPE.
After a year of living with the pandemic, the situation has stabilised somewhat for infection control nurses. Ms Mejillano noted that fear levels have dropped, as the nurses have gotten used in handling COVID-19 patients; and with a better understanding of the virus, rate of changes and updates required in SOPs have slowed.
The whirlwind experience has reaffirmed her sense of purpose for the job. “I see my role as taking care of the sick as well as my staff,” she said. “I have learnt that the key is focusing on my job and putting my heart into it.”