EXECUTIVE SUMMARY

Healthcare professionals across the United States, including perioperative nurses, have seen stress levels rise during the COVID-19 pandemic, leading to potential burnout and post-traumatic stress disorder.

  • Research shows perioperative nurses experiencing worse-than-usual emotional exhaustion are at risk of leaving their jobs.
  • One feature of the pandemic that contributes to stress is the uncertainty of when it will end and what will happen next.
  • Perioperative nurses also have experienced furloughs and redeployments to hospital COVID-19 units, which adds to their stress.

The COVID-19 crisis has disrupted surgery centers and the lives of staff, which can contribute to stress and burnout. Nurses and other employees carry the added worry brought by the uncertainty of what will happen next.

Closed surgery centers, furloughs, the redeployment to critical care units (CCUs) in hospital COVID-19 wards, and the fear of becoming infected and transmitting the infection to loved ones all have contributed to their stress.

“The uncertainty of COVID-19 is so challenging,” says Deborah McElligott, DNP, AHN-BC, HWNC-BC, CDE, a nurse practitioner at the Center for Wellness and Integrative Medicine at Northwell Health in Roslyn, NY.

Some ambulatory surgery center (ASC) nurses were redeployed to care for patients on respirators. These nurses may have had to use skills with which they may have been unfamiliar or had not used for years. They may have seen many patients and even some co-workers die from COVID-19.

“All of these contribute to mental and physical strain and moral distress that nurses will feel,” says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, chief executive officer and executive director of the Association of periOperative Registered Nurses (AORN).

On top of that, nurses may have worried about possibly bringing the virus home to loved ones. “They were unable to control what’s happening to them, but they know they have to maintain their income,” Groah says. “In many cases, nurses are the only income producer in the family.”

Cathy Alvarez, MA, RN, CNML, HNB-BC, PCCN, a nursing professional development specialist at Yale New Haven Hospital, says after same-day surgeries were canceled at her facility, many nurses were shifted to intensive care unit (ICU) work. “We wanted to minimize how many healthy patients were coming into the organization [to prevent COVID-19 infections]. Operative areas were turned into ICUs,” she explains. “Perioperative nurses and operating room [OR] nurses had to be trained [on ICU skills] prior to being in that role.”

All Americans are dealing with the combined traumas of more than 170,000 COVID-19 deaths, tens of millions of people unemployed, and a string of police brutality incidents, which have sparked ongoing nationwide protests.

“That combination of crises is really unprecedented. We have very little information to go on [to] understand how people respond to [these] unfolding disaster[s],” said Roxane C. Silver, PhD, professor of psychological science, medicine, and public health at the University of California, Irvine. Silver spoke about mental health in the time of COVID-19 at a virtual Newswise media conference held in June.

In a survey by the American Psychological Association (APA), participants reported a significant increase in average stress levels for the first time in more than a decade. People with children younger than age 18 years and people of color reported the highest levels of stress compared with other groups, according to Vaile Wright, PhD, senior director for healthcare innovation at the APA. Wright also spoke at the virtual Newswise media conference held in June. The ongoing uncertainty of the pandemic’s trajectory is a major part of healthcare professionals’ stress. No one knows what the longer-term economic impact will be. There is little indication COVID-19 cases or deaths are leveling off. Parents and children are coping with the stress of schools opening and reclosing, as well as the loss of in-person professional and social events.

The APA survey revealed that nearly half of parents with children younger than age 18 say their stress level is high, between 8 and 10 on a 10-point scale. (Learn more about the APA survey results here.)

In a recent paper, the authors suggested nursing leaders and managers need to help reduce stress and reassure staff of their personal safety during the pandemic.1 If left unchecked, higher emotional exhaustion can lead to lower job satisfaction and a greater likelihood of quitting a job, according to the authors of another new paper.2

In a study conducted at a Spanish public university hospital, researchers learned important factors in perioperative nurses’ burnout involve personnel and resource allocation, job dissatisfaction, and emotional exhaustion.3 Further, the authors of a 2018 study found 43% of nurses experience emotional exhaustion and 21% feel depersonalized. These factors help predict perioperative nurse burnout.4

“I think my biggest concern is all of this stress turning into mental health issues like depression, anxiety, and post-traumatic stress disorder,” says Jin Jun, PhD, RN, assistant professor at The Ohio State University College of Nursing. “A lot of nurses are traumatized by this whole COVID thing, and, once again, we’re not addressing it. We need occupational-level psychosocial therapy available for nurses.”

Hospitals have those resources, but independent surgery centers should look for resources for their employees, too. “The burden cannot be on the individual nurses alone,” Jun says. “Make the services easy for them to have access.”

More than six months into the pandemic, certain things have improved. Some surgery centers have reopened and are performing elective procedures again — a few at pre-COVID-19 levels. The supply chain of personal protective equipment (PPE) has improved somewhat. Facilities instituted universal precautions and followed strict guidelines on how to prevent contracting COVID-19.

“People are talking about all of the decisions driven by science and data and taking time to reopen and not rushing it,” says Bala Subramaniam, MD, MPH, FASA, associate professor of anesthesiology at Harvard. “All of that has played the primary role of calming people down.”

Subramaniam’s research shows how surgery centers and hospitals can help their operating room staff reduce stress through Isha Kriya, a guided meditation that takes less than 15 minutes to complete.5 “Pragmatically speaking, if we give people [meditation] techniques, we find they pick it up, stick to it, and practice it for the rest of their lives,” Subramaniam says. “Even if you have 30 to 40% of people practicing something like that, it gives you a critical mass in the operating room.”

Although Subramaniam and colleagues conducted their study before the COVID-19 pandemic, Subramaniam believes the techniques his group studied could be even more important today. “Especially during COVID, when there is a lot of talk about the mental health pandemic that’s going to come, all we can do is be vigilant,” Subramaniam says. “This is a chronic issue we’ll deal with for months to come.”

REFERENCES

  1. Shahrour G, Dardas LA. Acute stress disorder, coping self-efficacy, and subsequent psychological distress among nurses amid COVID-19. J Nurs Manag 2020; Aug 7:10.1111/jonm.13124. doi: 10.1111/jonm.13124. [Online ahead of print].
  2. Lee SE, MacPhee M, Dahinten VS. Factors related to perioperative nurses’ job satisfaction and intention to leave. Jpn J Nurs Sci 2020;17:e12263.
  3. Sillero-Sillero A, Zabalegui A. Analysis of the work environment and intention of perioperative nurses to quit work. Rev Lat Am Enfermagem 2020;28:e3256.
  4. Sillero A, Zabalegui A. Organizational factors and burnout of perioperative nurses. Clin Pract Epidemiol Ment Health 2018;14:132-142.
  5. Rangasamy V, Susheela AT, Mueller A, et al. The effect of a one-time 15-minute guided meditation (Isha Kriya) on stress and mood disturbances among operating room professionals: A prospective interventional pilot study. F1000Res 2019;8:335.