Critical Care Nurses’ Experiences During the COVID-19 Pandemic: A US National Survey

Abstract

Background Given critical care nurses’ high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the ICU workforce. Objective To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States. Methods Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic. Results Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses’ feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent. Conclusions Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses’ experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

Nurse experience during the COVID-19 pandemic

“…26 A study in the US found that nurses perceived inadequate leadership support and inequity within the healthcare team. 3 Theme two: Balance of meeting patient and nurse needs and managing exhaustion. The agency described in this article used numerous support strategies including employee assistance for childcare and stress reduction programs.…”

“…1 Nurses have experienced practice changes, fear for themselves and their families, and moral distress from the inability to provide optimal care. [2][3][4] Throughout this time, it has been important for nurse leaders to provide the needed support to nurses.…”

“…22 In a survey of critical care nurses in the US with 285 responses collected from October 2020 through January 2021, participants reported a variety of negative physical and emotional symptoms. 3…”

Ethical Lessons from an Intensivist’s Perspective

“…The sheer numbers of patients, as well as the time needed to put on and remove personal protective equipment, meant that the time available for each patient was inevitably less than normal, and many staff members felt they were unable to provide the quality of care that they would under non-pandemic conditions. Lack of effective treatments, difficulties communicating with patients and their relatives, the need to make rapid, complex ethical decisions regarding which patients to admit or when to withhold or withdraw treatment, responsibility for new, non-ICU-trained members of the team transferred from other units, and fears about catching the virus and passing it on to their own family members, all added to the psychological burden on ICU teams with high rates of insomnia, depression, anxiety, post-traumatic stress disorder, and burnout [ 38 , 39 , 40 , 41 , 42 , 43 ]. Various strategies have been proposed to try and limit some of the psychological impact, including adequate training and senior support for new or re-allocated staff, availability of clinical psychologists for individual assessments and consultation, and regular team debriefing and support sessions [ 44 , 45 ].…”

Difficult Times Without Easy Solutions: Nurses Want to Be Heard!

“…A national US survey of critical care nurses reported physical and emotional symptoms of exhaustion, anxiety, sleeplessness, and moral distress. 1 Working conditions have become increasingly demanding during the pandemic, patient acuity is high, the nursing shortage continues, nurse-to-patient ratios regularly exceed recognized standards, nurses are working extreme amounts of overtime, and many nurses have seen too much death, feel disrespected and undervalued, and are frustrated that they cannot provide the level of excellent care required for positive patient outcomes. In other words, many of you are working in unhealthy and unsafe work environments.…”