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Nurses' roles in caring for themselves to care for the global population

Published:April 25, 2022DOI:https://doi.org/10.1016/j.apnu.2022.04.009
      The mental well-being of nurses has continued to deteriorate – worsened by the COVID 19 pandemic because nurses have been at the frontline of this public health battle. For psychiatric mental health nurses (PMHN), associated emotional burden maybe even worse because they are expected to care for both patients and others including families, friends, peers, and the public where we live, work, learn, or play. Also, PMHNs' experience the highest rates of workplace violence (
      • Dean L.
      • Butler A.
      • Cuddigan J.
      The impact of workplace violence toward psychiatric mental health nurses: Identifying the facilitators and barriers to supportive resources.
      ). Factors associated with deteriorating mental well-being among nurses include chronic staff shortages, ever-increasing workload, perpetual poor remuneration, as well as bullying, harassment, discrimination, and racism in the workplace (
      • Edmonson C.
      • Zelonka C.
      Our own worst enemies: The nurse bullying epidemic.
      ;
      • Thurman W.A.
      • Johnson K.E.
      • Sumpter D.F.
      Words matter: An integrative review of institutionalized racism in nursing literature.
      ). A study from the National Commission on Racism in Nursing found that 66% of nurses say that racism in nursing affected their well-being (National Commission on Racism in Nursing). A study conducted before the pandemic by the University of Michigan reported that the rate of suicidality in female nurses was twice higher than the general population and 70% higher suicidality than their female doctors' colleagues (
      • Davis M.A.
      • Cher B.A.Y.
      • Friese C.R.
      • Bynum J.P.W.
      Association of US nurse and physician occupation with risk of suicide.
      ). The prevalence of anxiety and depression symptomologies are 70% among health care workers; of these 38% had symptoms of PTSD, and 15% screened positive for suicidality or self-harm (
      • Hendrickson R.C.
      • Slevin R.A.
      • Hoerster K.D.
      • Chang B.P.
      • Sano E.
      • McCall C.A.
      • Raskind M.A.
      The impact of the COVID-19 pandemic on mental health, occupational functioning, and professional retention among health care workers and first responders.
      ). Worse still, the burden of workplace violence and mental illness is higher among nurses. Yet, most investments and interventions on clinician wellbeing have focused largely on individual interventions and physicians (
      • Aryankhesal A.
      • Mohammadibakhsh R.
      • Hamidi Y.
      • Alidoost S.
      • Behzadifar M.
      • Sohrabi R.
      • Farhadi Z.
      Interventions on reducing burnout in physicians and nurses: A systematic review.
      ;
      • Shanafelt T.
      • Goh J.
      • Sinsky C.
      The business case for investing in physician well-being.
      ).
      Although the deteriorating mental well-being of nurses is beginning to garner attention, it is still not the priority topic across health care settings nor has it received system level action (
      • Aryankhesal A.
      • Mohammadibakhsh R.
      • Hamidi Y.
      • Alidoost S.
      • Behzadifar M.
      • Sohrabi R.
      • Farhadi Z.
      Interventions on reducing burnout in physicians and nurses: A systematic review.
      ;
      • Mahomed F.
      Addressing the problem of severe underinvestment in mental health and well-being from a human rights perspective.
      ). Research shows that the single biggest predictor of human happiness and quality of life is deep or meaningful social relation and network (
      • Siedlecki K.L.
      • Salthouse T.A.
      • Oishi S.
      • Jeswani S.
      The relationship between social support and subjective well-being across age.
      ). Therefore, healthcare organizations should foster psychological safety as the norm and strengthen social network for nurses. Kudos to the many professional nursing organizations such as International Society of Psychiatric Mental Health Nurses (ISPN) that launched support programs for nurses in the wake of the pandemic and associated trauma. ISPN Peer Support is a user-friendly platform where nurses can fill out a quick form and connect to peer support within 24 h. The National Academy of Medicine NAM Action Collaborative on Clinician Well-Being and Resilience is an online resources hub center for healthcare systems and individual clinicians—aimed to improve the mental well-being of clinicians. Individual resources include mindfulness training and applications such as MINDBODYSTRONG, a cognitive behavioral skill building (CBSB) platform by Ohio State University; and PeerRxMed, for clinician peer support; as well as resources for Psychological PPE. The American Nursing Association (ANA) also launched a multidimensional platform called Healthy Nurse, Healthy Nation to address nurses' overall health, including mental health, nutrition, safety, and quality of life.
      In conclusion, federal, state, local governments, and healthcare organizations must invest in mental well-being of nurses. Nursing leadership must invest in mental well-being of nurses by creating systemwide changes such as streamlining nursing processes, harnessing skill set of Doctor of Nursing practice (DNP)- prepared nurses to de-implement inefficient workflow processes and foster inclusive work environments for all health care workers. Nurses must strengthen self-agency and self-advocacy skills and behaviors for change – a process that must start early in nursing schools. Fortunately, the American Association of Colleges of Nursing (AACN) has begun this process and our very own, Cheryl Woods Giscombe, PhD, RN, PMHNP-BC, FAAN will serve on a select committee focused on building leadership capacity in new nurses with a special emphasis on developing essential skills in resilience, self-care, and well-being. Dr. Giscombe is the LeVine Family Distinguished Professor of Quality of Life, Health Promotion, and Wellness at School of Nursing, The University of North Carolina at Chapel Hill.

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