The risk of burnout right now seems especially high.
Even before this crisis hit, burnout levels among clinicians were escalating at alarming rates. Last year, I served on the committee for a National Academy of Medicine report looking at these issues. This pandemic has stressed an already stressed health care system.
What I know about clinicians is that in a crisis, they show up. What's most concerning now are the long-term consequences. It's not only post-traumatic stress but this feeling in some people that they're acting against their own consciences in certain actions during the crisis. The fallout of that is significant moral distress or moral injury, which accumulates over time. And we can't wait to take measures to manage that distress. We must begin now.
How can it be managed?
I've written about the concept of moral resilience for health care workers. Some strategies include using tools for ethical analysis to determine the best course of action. We also need to build our neural pathways for self-awareness and self-regulation, through practices like mindfulness. This helps our nervous system regain balance so we don't become stuck in fight, flight, or freeze. It also involves self-stewardship — prioritizing what nourishes our bodies, minds, and sprit, and engaging resources that have supported us through ethical challenges before.
Nurses also really benefit from finding outlets. At Hopkins, we've offered the Mindful Ethical Practice Resilience Academy for frontline nurses. And just this week, we created a new program, Moral Resilience Rounds, a virtual gathering of clinicians who work in all variety of settings, who can share ethical challenges they're facing and learn from each other.
Can you tell us about the new Frontline Nurses WikiWisdom Forum?
I was very concerned about nurses saying they felt isolated and didn't have safe spaces to share their experiences. So I reached out to colleagues to create this resource. It's a moderated, crowd-sourced forum, and we're inviting nurses on the front lines to join and share.
So far, it's a range of nurses who are outraged at the lack of guidance at the national levels and lack of personal protective devices; and those who are worried about risks to their own families. Then there's also incredible posts about the importance of community and solidarity so nurses can be inspired by each other's courage. Here's one post (used with permission):
"The nightmare is real – and it has come home. … As a fourteen-year veteran of the emergency department I stand poised with my colleagues at the pier — reining in a river with a Dixie cup — and I have never been more proud to call myself a nurse." - Stacy N.
At the end of this crisis, we'll identify key participants and summarize themes to create a report for the American Journal of Nursing. We want to provide recommendations from frontline nurses to inform our health care system's future responses to crises so we are never unprepared in the way we are with COVID-19.
What is giving you hope right now for nursing?
I think this pandemic only highlights and elevates the central role that nurses serve in health care. We're seeing the many different ways nurses can contribute, adapt, and take the lead.
I recently listened to some of our graduates from the Johns Hopkins School of Nursing talk about how they're adjusting to "the new normal." To hear them talk about their growth, and the stretching they're doing, is really inspiring. In that there's hope.
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