Rewind. I adjust the strap on my mask and pinch it tightly around my nose and move it just under my lower eyelashes to prevent my goggles from fogging. These days, I am grateful for the face cover as it hides the pallor from six months in and the dark circles from long hours and anxious sleep. I wait at the valet circle for my team. Another SOS text out to them this morning. All hands on deck.

COVID-19’s Impact on Our Nursing Leaders
ONS member Dawn Neuhauser, MSN, RN, NEA-BC, OCN®, EBP-(CH), is the executive nursing director for ambulatory services at City of Hope Medical Center in Duarte, CA

This day is different. Today, the focus is not on the pandemic. It’s the choking smoke and ash from the looming Bobcat wildfire here in California. My team arrives. Their eyes, all I can see of their expression, mirror mine. No smieyes (smiling eyes) these days. They await direction. I watch their spirits sink further when I tell them we are on traffic duty this morning. No questions. Everyone takes their posts and gets through the morning.

I wonder at the resiliency that has gotten us this far and worry about the day when it won’t be enough. As nurse leaders, we are charged with implementing strategies that reduce burnout and increase resiliency among the nursing workforce we support. Yet nurse leaders are susceptible to the same stressors that lead to burnout, secondary traumatic stress, and compassion fatigue.

Burnout at the Leadership Level

Nurse burnout is not a new issue. Much of the work has looked at the impact on direct care nurses; however, burnout and secondary trauma can affect nurse leaders. Three classic symptoms characterize burnout: exhaustion, depersonalization, and reduced personal accomplishment, with emotional and physical exhaustion as the most identified manifestation. COVID-19 had an overwhelming impact on healthcare professionals’ mental well-being. Limited resources, fear of exposure, and longer shifts added to the stress that nurses were already experiencing. And nurse leader burnout is exacerbated by the pressure to be digitally connected at all times.

Burnout and secondary traumatic stress have a negative impact on job satisfaction and job performance for both direct care nurses and nurse leaders, which, in turn, can negatively affect patient care. In a study of nurses during the pandemic, a higher percentage of direct care nurses reported intentions to leave (11.8%) than managers (9.0%) and directors (9.2%); however, nursing leaders reported a higher negative impact from COVID-19.

Healthcare organizations and nursing leadership were grappling with a nursing shortage even before the pandemic. The impact of COVID-19 on nurse turnover has not been studied in the United States; however, researchers in Ontario predicted a 15.6% postpandemic loss of RNs (three times the normal average), which is a daunting forecast of what other countries might experience.

A Cry for Action

It is incumbent on healthcare organizations to develop policies to mitigate burnout and its subsequent negative effects by providing resources that reduce stress and anxiety.

It is also important to understand resilience and its role in overcoming adversities related to burnout. Resilience is the ability to recover or bounce back despite an adverse event and has been identified as a critical attribute of strong healthcare systems following a pandemic or other disaster. Resilience is required to mitigate burnout and influences the organization’s culture and work environment.

Several strategies have been studied that help to promote individual resilience in healthcare workers. These include providing fundamental physiologic needs such as rest, nutrition, and limited overworking, offering services that address traumatic stress such as peer support and employee assistance programs, and modeling and promoting well-being strategies that support personal resiliency.

Fast-forward. Turnover on my team has resulted in three vacancies, one still yet to be filled. Staffing for direct care nurses is at a critical level. My one-to-ones with my team have turned into status check sessions to gauge resilience and to discuss what is needed to “refill” and promote well-being. We have ongoing efforts to provide resources and support to reduce stress and anxiety.

Strategies like these to decrease burnout and increase resiliency need to be implemented at all levels in nursing to maintain a healthy workforce and to motivate future nurse leaders to move into entry-level positions.