Finding Balance Post-COVID-19 in the Hospital Setting

By Debra Wood, RN, contributor

COVID-19 has transformed life as healthcare workers and people in general know it. Trying to balance work responsibilities and caring for yourself remains important, yet can prove difficult for nurses and mental health.

“We were able to focus on our families and finding the ‘next normal’ for our children,” said Kiersten Henry, DNP, ACNP-BC, CCNS, CCRN-CMC, a director with the American Association of Critical-Care Nurses (AACN) and AACN Certification Corporation and chief advanced practice clinician at MedStar Montgomery Medical Center in Olney, Maryland. “The balance is still challenging.”

Henry discussed how COVID-19 cases surged at her hospital but have come down now. Will it hold?

“The reduction in census was almost surreal, as if we didn’t trust it would be lasting,” Henry said. “As a leader, I encouraged staff to take time off while the census allowed.”

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Building resilience

Preliminary findings from a study at Johns Hopkins University in Baltimore found people with higher resilience, which is the ability to quickly build back after a challenging experience, were less likely to experience emotional distress during the pandemic, said Johannes Thrul, PhD, an assistant professor at the Johns Hopkins School of Public Health in Baltimore.

Henry helped build resilience among healthcare providers at MedStar by teaching them to practice gratitude. The nurses also became pen pals with a critical care unit in the Midwestern United States and connected with members of AACN to build a web of support. They also communicated with a nurse in Italy who had contracted COVID-19 and was hospitalized for two months.

“We sent him a care package of cards and letters, as well as a T-shirt from our state of Maryland,” Henry said. “The video of him opening our package and reading the letters brought our team immense joy.”

Daily post-shift huddles to debrief and identify three good things that happened that day, also helped with resilience, Henry said. Additionally, the nurses made a mural with each patient having a spot on it. The hospital created “relaxation stations,” so nurses could go to a quiet place to recharge or eat a snack or lunch.

“We still struggle to address the mental strain and the concerns for staff resilience if we experience a second wave,” Henry added.

A resilience team at New Hanover Regional Medical Center has aided in keeping professional caregivers spirits strong, said West Paul, MD, PhD, chief clinical officer at the Wilmington, North Carolina hospital. They posted signs and planned a gratitude celebration with gift cards for restaurants, food and other gifts.

“That group has been remarkable in keeping us in the right frame of mind, because there is fatigue that builds,” Paul said. “We have to keep our workforce and staff at the forefront of this.”

Supporting nurses and mental health

The culture of healthcare often encourages nurses and physicians to “tough it out” and stay strong, and many clinicians seem uncomfortable admitting they are vulnerable,” said Susan J. Noonan, MD, MPH, at Massachusetts General Hospital in Boston, and the author of four books, including Helping Others With Depression: Words to Say, Things to Do.

“Not every person feeling down right now is in need of treatment,” Noonan said. “We have to allow them to feel that. But if it persists and interferes with functioning, it needs attention.”

If experiencing a mental health crisis, Thrul urged people to call help lines and reach out for help.

Self-care can help the individual not in crisis. To build resilience, Thrul recommends finding ways to keep in touch with friends and family, talk with someone you can see every day, and exercise, eat well and get a healthy amount of sleep.

A randomized clinical trial from the National Institute of Mental Health, reported by JAMA Network Open, found mindfulness training during work hours helped to reduce clinicians’ stress.

Playing a board game with friends online, listening to music or nature, having lunch together over Zoom or another platform, avoiding alcohol, staying busy, limiting time spent with the news and using coping strategies that have worked in the past can all help with mental health, Noonan said.

“The challenge for the healthcare providers now is this is not something they can control,” Noonan said. “If we do not manage our own healthcare, that impacts the quality of care we can give to others. We need to have a good balance.”

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