Nurses are used to working in challenging conditions and dealing with stressful situations. But the last year has put nursing staff in all settings ‘under incredible pressure’, says Heather Randle, Royal College of Nursing (RCN) professional lead for primary care.
‘None of us could have possibly imagined what was ahead at the start of 2020 and the impact it would have on us all,’ she says.
Faced with relentless pressures, nurses working in primary care could be feeling overwhelmed and burnt out. ‘Even before the pandemic nursing staff were reporting high-levels of work related stress and burnout,’ says Ms Randle.
‘We entered this crisis with nearly 40,000 nursing vacancies in the NHS in England alone, and the last year has further highlighted the impact this has on our members’ ability to deliver safe and effective care, and their own wellbeing,’ she says.
As yet, there are no exact figures on the numbers of primary care nurses suffering from burnout. However, a Queen’s Nursing Institute (QNI) survey of more than 3,000 general practice nurses conducted at the height of the first wave of COVID-19 in 2020, highlighted respondents were experiencing issues such as anxiety and uncertainty.
Dr Crystal Oldman, CBE, QNI chief executive, says there has been an increase in the number of nurses accessing the QNI’s Listening Service – which offers emotional support by phone – since the pandemic began. And she says many cases of burnout ‘may be hidden’ because nurses work ‘in a culture where it’s not really seen as acceptable to admit you’re finding the job hard’.
Nurses and female healthcare workers are most at risk of experiencing psychological distress during the COVID-19 pandemic, according to a recent study from the University of Sheffield. It concludes that distress among healthcare workers could persist for up to three years after the initial outbreak of the pandemic in 2020.
Burnout a greater issue during pandemic
Burnout has become an even greater issue for the profession during the pandemic, as a growing workload has piled on the pressure. Jenny Aston, an advanced nurse practitioner (ANP) in Cambridge, says at the start of the pandemic a lot of nurses ‘survived on adrenalin’.
‘Then after a few months we realised this was a ‘marathon not a sprint’, and that we’d all have to work a lot harder,’ she says.
Issues associated with staff shortages, such as covering for colleagues on sick leave, have been ‘magnified’ by the pandemic, says Dr Oldman. ‘Not feeling valued or consulted by employers’, not having the ability to have ‘that human contact’ to comfort patients when they are in distress, and constantly having to notify families about the death of loved ones, are also contributing factors to nurses feeling they’re at breaking point, she says.
Nia Charpentier, a counsellor and Member of the British Association for Counselling and Psychotherapy (MBACP), who works with nurses and other frontline NHS workers, says she has seen ‘a high level of anxiety, burnout and post traumatic stress’. She says common themes that come up, when combined, have ‘ created a kind of perfect storm’. These themes include pressures from working long hours, and workers who have had COVID themselves, or are fearful of contracting the virus and passing it on to vulnerable loved ones.
‘Often they haven’t felt able to do the job safely or haven’t felt supported at work, some have had to deal with colleagues off sick with COVID, and in some cases colleagues sadly not surviving. They have all seen a lot more death at work than usual,’ Ms Charpentier says.
‘Add that to home life being more stressful – perhaps relationship problems, the pressure of home-schooling, lack of support through usual things like seeing friends and family.
‘The uncertainty of the pandemic is very unsettling and the sense of not knowing when things will improve has also been very stressful for all. When you’re on the frontline and there is no end in sight, that can really take its toll,’ she says.
Potential signs of burnout
Potential signs that a nurse’s wellbeing is suffering and they might be reaching the point of burnout include, ‘feeling tearful, not being able to sleep and feeling physically and emotionally exhausted,’ says Claire Goodwin-Fee, founder and CEO of Frontline19, which delivers free psychological support to keyworkers.
Ms Charpentier says lots of nurses and other frontline workers she has worked with have told her about having panic attacks. ‘Often they’ve never had one before and suddenly they’re having regular spells where the heart is racing and fear takes over,’ she says.
Other symptoms her clients have talked about are ‘tiredness, irritability, and a sense of fear and dread when thinking about things that didn’t used to bother them, like going to work, or even going to the shop’.
Despite these distressing symptoms, the urge to ‘plough on’ is a common theme among nurses. ‘People who work in caring professions tend to be caring people, putting the needs of others first. And that’s great, but there needs to be a balance,’ says Ms Charpentier.
But by ignoring the signs of burnout and not looking after their own wellbeing, Dr Oldman says nurses can become ‘vulnerable to mental or physical illness’ and that it can ‘lead to the disruption of their homelife and relationships’.
Sources of help and support
There are many sources of help and support available to prevent and deal with burnout. Meditation/Mindfulness apps, such as Headspace and Calm can be downloaded to help cope with stress.
Sharing worries and concerns with family, friends and colleagues is vital. Jenny Aston says healthcare staff can be prone to ‘not sharing, and not talking’ – signs that they’re internalising their worries. She says it’s important to ‘take ten minutes at work to have a coffee and a chat, and ask how people are’.
Taking regular breaks at work is a part of self-care – a valuable way of addressing burnout. Outside work, simple health advice that nurses give, but may not follow themselves, include: healthy eating, cutting out or down on alcohol, and taking regular exercise.
Ms Goodwin-Fee recommends good sleep hygiene, which includes switching off from pressures after work, rather than switching on the news as soon as you come home from a long shift. She also advises doing ‘things that make the heart happy’, whether it’s listening to music, or phoning friends.
If you feel burnt out and stressed, ‘something has to give’, says Ms Charpentier. ‘Ask yourself what could you say no to, or delegate to make a little space for yourself? Could you ask someone to help out with the housework or grocery shopping? Could you occasionally say no to that person who is demanding a lot of your time?’
It is also important for nurses working in primary care to be self-aware so that they can recognise when it’s time to seek professional support. ‘See if your workplace offers free counselling, or speak to your GP. Or if you want to find your own counsellor, search the British Association for Counselling and Psychotherapy (BACP) therapist directory,’ says Ms Charpentier.
The DHSC provides ‘a huge array of opportunities for accessing help, including psychological support’, advises Dr Oldman. The RCN offers counselling for members, and the QNI’s confidential helpline is available for emotional support. Nurses could also ask their employers for support, or contact an occupational health service.
As well as nurses themselves taking steps to prevent and address burnout, longer term action is needed to tackle this issue. Heather Randle says: ‘Proper mental and psychological support services need to be made available to all nursing staff including health care workers in independent health and care services.
‘Alongside this rest and recuperation for healthcare staff must be central to decision making on getting patients safely. There must be funded and supported time out – not limited to annual leave – for all staff, regardless of where they work,’ she says.
Dr Oldman says a robust workforce analysis and workforce plan that includes health and social care is needed, and that there are sufficient staff, because shortages ‘are contributing to burnout’.
She says it is important not just to recruit primary care nurses but to ‘retain expertise’ by ensuring they are ‘well led, well supported and well managed’. Failure to do this, she warns, may result in a ‘wave of retirement’.
The Government’s offer of a 1% pay rise has done little to encourage recruitment and retention – Ms Aston describes it as ‘a kick in the teeth for a lot of people’.
She says nurses need to be involved in the planning and decision making as we come out of COVID-19. ‘We need to feel valued. And one of the reasons nurses are burnt out is that they’ve been on a treadmill for a year and they don’t feel valued,’ she says.
To nurses feeling stressed, overwhelmed and exhausted, but not acknowledging how bad they are feeling, Dr Oldman advises: ‘Seek help. It’s ok to say you’re not ok and to call for that help. And you’re not alone.’ As Ms Aston says, it’s crucial to ‘take care of yourself so you can take care of others’, and to also ‘encourage your colleagues to look after themselves’.
‘A lot of people have an awful lot going on below the surface. Be kind, and hear their stories. Listening is important.’
Help and advice available to nurses
● Royal College of Nursing: RCN Counselling Service. https://www.rcn.org.uk/get-help/member-support-ser...
● RCN: Principles for Return to Service. https://www.rcn.org.uk/professional-development/pu...
● Queen’s Nursing Institute: Talk to Us: The QNI Listening Service. Offers emotional support by phone to registered nurses working in the community. https://www.qni.org.uk/help-for-nurses/talktous/
● Mental Health UK: tips for key workers on managing stress. https://mentalhealth-uk.org/blog/managing-your-men...
● Frontline19: Free independent, confidential service delivering psychological support to keyworkers. https://www.frontline19.com/
● British Association for Counselling and Psychotherapy: https://www.bacp.co.uk/
● Mind: mental health charity, information and support. https://www.mind.org.uk/information-support/
Kathy Oxtoby is a healthcare writer