Ways to Support Health Care Workers During Coronavirus

According to a survey of 1,425 nurses from all 50 states and the District of Columbia conducted in mid-April by Trusted Health, a health care staffing firm based in San Francisco, 65% of nurses reported they were providing direct care to patients with COVID-19.

For nurses -- and other health care workers -- that's been a stressful experience, not just in terms of caring for these often critically ill patients, but also in keeping themselves and their families safe. Eighty-one percent of survey respondents reported being at least "slightly concerned" about contracting the virus, and two-thirds were either "concerned" or "very concerned."

The pandemic has brought into stark relief the stress that nurses and other front-line health care workers are facing during this unprecedented time. It's also exacerbating a pre-existing crisis in mental health among these crucial care workers.

"Burnout was already a trending issue in healthcare that has only been worsened by the COVID-19 crisis," says Dan Weberg, a former ER and trauma nurse and Trusted Health's head of clinical innovation.

Nurses have been hard hit, but so have other health care workers as they've put themselves in harm's way day after day over the past several months. In late April, Dr. Lorna M. Breen, a Manhattan emergency room doctor who'd been infected with the coronavirus, recovered and went back to work, died by suicide. "She tried to do her job, and it killed her," Breen's father reportedly said.

[Read: 10 Ways to Survive the Mental Health Crisis as a Health Care Worker.]

Why This Is So Difficult

A stark example for sure, but Breen's story illustrates the toll coping with this crisis day in and day out is having on so many health care workers across the country.

"For most people, a pandemic is something studied in school as historical events or discussed in theoretical simulations," says Vicki S. Good, chief quality officer central region at Mercy in St. Louis, Missouri. "Prior to COVID-19, few health care workers had faced a pandemic." Many are having to adapt on the fly, and that's not easy.

"This is the first time that each and every one of us goes to work every single day worrying about the threat we face," says Kiersten Henry, director of the American Association of Critical-Care Nurses and an advanced practice clinician at MedStar Montgomery Medical Center in Olney, Maryland. Six months ago, a health care worker's prime concern when heading to work was the threat of violence. "Suddenly, we have been catapulted to the front lines of an entirely different threat."

This threat resembles a war zone in some areas of the country, and health care workers are the soldiers on the front lines. Many are reporting symptoms of post-traumatic stress disorder, a mental health issue related to trauma that tends to be very high among military members returning from a conflict zone.

Trusted Health's survey hints that there could be a coming crisis in mental health for front-line caregivers in the wake of the COVID-19 pandemic. "On a scale of 1-10, nurses rated their current mental health and well-being an average of 5.4, compared to an average of 7.6 prior to the COVID-19 crisis, representing a decline of nearly 30%," Weberg notes.

This is happening across the country, not just in areas hit hardest by the pandemic. But those seeing a vast amount of death and suffering -- and worse, the caregivers who have to make gut-wrenching choices over which patients gets limited resources -- are dealing with situations they never dreamed they'd have to.

"In situations where the mortality rates are high and patients are experiencing the most severe disease, clinicians often describe a feeling of helplessness -- an inability to render care to each and every patient to the fullest extent they would desire," Good says.

"The helplessness also arises from knowing that there are patients who are not able to receive needed care now, in part because of pandemic-related restrictions, such as delaying elective procedures," she continues. "They may also feel a sense of powerlessness, realizing that they are not able to do all things for a patient as they have been trained to do."

[READ: How to Support a Loved One Who's a Nurse.]

Anxiety about this crisis doesn't respect geographic boundaries, either. "Whether a health care worker is in a heavily impacted area or a lightly impacted, there is great fear and anxiety," Good says.

This anxiety is compounded by frequently changing safety protocols. "Recommendations have changed throughout the crisis on how to safely care for patients to prevent contracting the illness yourself. Fear becomes stronger in the face of a lack of information," and while there's been an enormous amount of information surrounding this pandemic, our understanding of the virus and how to stay safe is changing and evolving daily, even hourly, Good explains.

Constantly having to be vigilant about their own exposure is not just mentally taxing, Good says, it's physically exhausting too. "Full personal protective gear can be extremely uncomfortable -- there's no ventilation and it's hot. Wearing masks for the entire shift has left nurses with impressions on their face and skin irritation under the mask." Many have had to devise creative ways to move the pressure of ear loops off the tender skin at the back of the ears.

Many health care workers are also having to live separately from their primary support network -- their families -- as they attempt to prevent onward transmission of the virus they are exposed to every day in the course of their work. "Many are living in hotels or dorm rooms," Good says. Some are living in trailers or other separate spaces near their families. "They have scarified family time to serve the patients that need their care."

[SEE: Life as a Health Care Worker on the Coronavirus Pandemic Front Lines.]

Supporting Health Care Workers

Though the challenges are great, there are some things you can do to help support health care workers at all levels -- from care assistants working in senior living facilities and hospital janitors to doctors and nurses working in emergency rooms and ICU wards.

1. Say thank you. Thank the health care worker in your life. A simple thank you can go a long way.

2. Provide moral support. Good recommends sending a note, making a poster or calling the health care worker in your life to provide emotional support. Sometimes a sympathetic ear is all someone needs to feel a little less hopeless.

3. Make and wear homemade masks. It's now clear that if we all wear cloth masks when we have to go out into the world, that cuts down on the most likely route of transmission of the virus: person-to-person contact. If you can, make cloth masks for others and be sure to wear your own when you go shopping or to work.

4. Deliver food to health care workers or their families. Cook a meal or pick up groceries to cross that task off a health care worker's very long list of things to do.

5. Provide cleaning tools and assistance. Jayne Willis, chief nurse executive and vice president with Orlando Health in Florida, says giving goodie bags or gift baskets filled with cleaning tools, such as disinfecting wipes, hand sanitizer and other germ-killing products is a really useful way of tangibly supporting the health care worker in your life. "Clinicians on the front line didn't have the time to compete for scarce resources," she says, so Orlando Health gave all their front-line workers goodie bags filled with these items as a simple way of saying thank you. "You'd have thought we gave them a winning lottery ticket," she says of how enthusiastically the gifts were received.

6. Encourage self-care. Citing the ubiquitous pre-flight safety briefing, Willis says, "we always tell our nurses, 'you gotta put the oxygen on yourself before you'll be helpful.'" Nurses and other health care workers "don't always think that way. They're selfless and they put their patients and families before themselves." But to be effective, caregivers must take some time to look after themselves.

7. Donate supplies. If you have access to medical supplies, such as gloves, N95 masks, face shields and ear protectors, donate them to your local hospital or other health care center.

8. Assist with childcare and teaching. If you can, consider offering childcare or help with schooling a health care worker's children who are home and also struggling to cope with a very changed world. Health care workers "are caring for the loved ones of other families," says Dawn Day, chair and associate professor of graduate nursing programs at the school of nursing and health sciences at Spring Arbor University in Michigan. "So, when possible, we can set their minds at ease by caring for theirs."

9. Ask how you can help. "Traditionally, health care workers hesitate to ask for help, because we are the helpers," Good says. But ask the health care worker in your life how you can be most helpful and what they need the most.

10. Let the caregiver know it's OK to not be OK. Weberg notes that one of the most powerful things you can do to support a healthcare worker during this pandemic is to "make it OK to show your emotions. When you're a health care worker, you go into work with your armor on and sometimes when you come home you don't take it off." Creating a safe space at home -- or even virtually via a phone call or video chat -- for a loved one to share fears and concerns can go a long way to helping them process what they're dealing with at work.

11. Encourage peer to peer support. It's definitely all hands on deck at many of the hardest hit hospitals these days, and Weberg encourages health care workers to support each other. "We're going to need longer-term programs," he says, but for the time being, health care workers should try to be patient with each other and provide support and assistance as much as they can. Henry says this is one of the potential upsides that she hopes lasts long after the pandemic is over. "Our colleagues have become our battle buddies, as we invest in keeping each other and ourselves safe and healthy like never before. The relentless teamwork, and the moments of pause that we have taken together, to laugh or cry or just debrief, are things I hope we never lose."

12. Stay at home. For the past several months, we've sought to 'flatten the curve' by shutting down group events and practicing social distancing. Even though all states are beginning to open up again, it's still important to avoid crowds as much as possible so we don't see a second spike that could overwhelm the health care system all over again. "I am hearing from nurses that we can support them by staying home, abiding by guidelines set for social distancing," Day says. "This lets them know that we appreciate all that they do and are trying to help by slowing the curve." Continue to do your part to stop or slow the rate of transmission.

13. Be patient. Lastly, Good says it's important to "be patient and supportive and understand that health care workers' priority is providing safe, high-quality care for you and your loved ones." Everyone is having to sacrifice something during this pandemic.