By Dhurata Ivziku, Lecturer Bsc Nursing, UniCamillus University
What have been and continue to be the main challenges, from every perspective, faced by nurses in the fight against Covid-19.
The COVID-19 pandemic has had a significant impact on people’s lives globally, affecting them personally, socially, and professionally. In the summer issue of UniCamillus Magazine it was discussed in detail. Italy was one of the first countries to face the health crisis and identify solutions to complex issues in daily practice. Alongside other healthcare professionals, nurses have been on the front line in the fight against COVID-19 and have encountered several critical challenges during the pandemic.
The pandemic has made us aware of the fragility of our healthcare system. The first major challenge was the imbalance between the need for care and the available resources within the national healthcare system. We experienced firsthand the shortage of staff, of acute care beds, essential medical supplies, of standardised processes and safe pathways. Despite these shortages, nurses have demonstrated dedication, availability, sacrifice, professionalism, ethical values, and humanity in meeting the demands for patient care.
First and foremost, nurses have worked tirelessly with great courage, dedication, and professionalism, putting their own health at risk to save lives, ensuring continuity of care and containing the spread of the virus. Throughout the pandemic, nurses have faced extremely long working hours under exhausting conditions, sacrificing rest days to compensate for staffing shortages. This has resulted in excessive workloads, with a significant physical, mental, and emotional impact.
The media has shared with the public the extent of the pandemic and the sacrifices made by healthcare workers in addressing the problem. However, what was not evident from these accounts was the significant psychological effect of the pandemic on nurses, which goes beyond the hardships experienced by the rest of the population during isolation.
Several studies have collected and documented the perceived difficulties and experiences of nurses during the pandemic, including feelings of helplessness, fear, and the strength to fight back. On the one hand, their accounts highlight the challenges related to work and patient care; on the other, they reveal personal difficulties.
Nurses describe the discomfort, inconvenience, and physical consequences of using personal protective equipment (PPE). We have seen images of healthcare workers with facial injuries caused by prolonged mask usage. Additionally, nurses describe how the pandemic has transformed nursing care. Their accounts are filled with descriptions of the difficulties they encountered in performing patient care activities while wearing gowns and multiple layers of gloves, experiencing sweating, or being unable to fulfil certain physiological needs such as drinking water. The presence of gowns and other PPE hindered their interaction with patients, preventing physical contact, a comforting touch, seeing a smile, or understanding spoken words. While nurses had to maintain distance from patients due to the fear of transmission or contagion, they also became the sole point of reference for isolated patients, cut off from the outside world and their loved ones. Therefore, despite the demanding pace and exhausting shifts, nurses found ways to be a source of support and provide patients with connections to the outside world through video calls.
Another challenge related to work was the uncertainty associated with the hectic scheduling and daily workload. Nurses would start their shifts without any certainty about when they would finish work. Despite the daily and prolonged uncertainty for months, nurses demonstrated strength and a spirit of sacrifice by always making themselves available, despite fatigue, to cover for colleagues who were absent due to virus infection, thereby increasing their working hours and attempting to perform the work of an entire team with only a few individuals. This physical exertion added to the mental stress related to the increased risk of errors and the anxiety of contracting the virus.
In addition to work-related challenges, nurses lived in constant fear of contracting the disease themselves. In the initial phase of the epidemic, 29% of all hospitalised patients were healthcare workers. The emotional impact, in addition to the physical one, was particularly severe when nurses had to assist a colleague who had become infected or died. Despite this traumatic experience, nurses found the strength to persevere in the fight against the virus for the greater good.
Nurses also lived with the fear of transmitting the infection to their colleagues, family, and friends. In their accounts, they also spoke of a sense of discrimination from their communities due to fears of virus transmission. This generated a sense of loneliness and social isolation among nurses, similar to that experienced by Covid-19 patients.
The pandemic exposed nurses to a reality of extreme discomfort and anguish. The increased work pressure, clinical and organisational uncertainty, rising infection numbers, loneliness and fear led to various physical and psychological challenges for nurses. The literature describes an increased risk of psychiatric or cardiovascular diseases, as well as significant anxiety disorders, depression, insomnia, and distress among nurses.
To address and respond to these challenges, nurses describe implementing protective factors such as unity and teamwork among different professionals to minimise workload, resilience to manage stress, and the drive of altruism to help colleagues and patients in need. Nurses mention that they derived strength and motivation to carry on from the positive attitude and recognition of their professionalism by society and organisations, a sense of duty and clarity in their professional role, and feeling like heroes for the nation.
Another challenge highlighted by the pandemic was the need for ongoing training and increased specialisation. In the context of Covid, nurses had to acquire new skills, adapt to new healthcare protocols, and quickly learn to utilise new technologies, in addition to the other difficulties described above. This emphasised the need to improve continuous education so that nurses can effectively and safely manage emergency situations.
The challenges encountered were also evident from an organisational point of view. Top and middle management in healthcare institutions worked tirelessly to redefine spaces, build or demolish walls to create dedicated pathways for the separation of clean areas from contaminated ones; suspend some services and launch new ones from scratch; and prepare clear procedures for professionals, and clear pathways for patients. They had to procure sufficient personal protective equipment (PPE) to protect healthcare workers, recruit or redeploy various healthcare professionals to provide care in COVID settings.
Nurse managers found themselves reconfiguring spaces and reallocating resources within their settings, providing training to nurses, continually adjusting work schedules to ensure continuity of care and balance competencies within the shift. Additionally, they effectively took on the role of mentors, emotionally supporting nurses, creating cohesive interdisciplinary teams, and motivating them to persevere, striving to balance shifts to ensure an adequate work-life ratio whenever possible, and listening to professionals to alleviate pressure and stress.
Furthermore, many healthcare institutions supported nurses and other frontline workers by offering overnight accommodation and food to isolate them from their families and prevent contagion. It was not easy, but this collective effort improved the bond between top management and healthcare professionals and strengthened nurses’ commitment and engagement with their organisation.
The pandemic also created numerous difficulties in nursing education and degree programmes. University education in nursing involves extensive hours of professional internships that enhance students’ knowledge and practical skills. During the pandemic, degree programmes had to modify internship schedules, abruptly interrupting clinical practice and organising educational programmes based on simulation instead. Many healthcare facilities and hospitals decided not to allow students to continue their internships and access care settings due to uncertainties about virus transmission and a shortage of PPE. This, along with online teaching activities, caused various challenges and dissatisfaction in both teachers and students, creating a gap in nursing students’ skill development.
The Covid-19 pandemic has also brought to light some positive aspects for nurses like, for example, the need for greater attention to the profession and greater investments in nursing education and recruitment to meet the healthcare needs of the population.
Furthermore, the critical health situation has partially rehabilitated the image of nurses in society, emphasising their professional role and their key role in care, health promotion and disease prevention. Nurses have worked diligently to vaccinate people, educating them about risks and prevention measures, and played an important role in ensuring that vulnerable communities had access to medical care.
Despite the traumatic event they faced, nurses have managed to seize an unprecedented opportunity for personal and professional growth. The pandemic has led to new innovations in nursing practice, such as the use of new technologies for patient monitoring, telemedicine, and online education.
More significantly, the pandemic has strongly influenced nurses’ professional identity. Professional identity is a critical issue for the profession due to its close association with topics such as nursing roles, responsibilities, values, and ethical standards that are unique to the profession. The heroism and dedication demonstrated by nurses in facing the pandemic have made their deep vocation to care for others and safeguard public health more evident.
The extraordinary and challenging circumstances in which nurses have operated have raised new questions about their identity and the meaning of their work. During the pandemic, nurses have faced extreme situations, made difficult decisions, and confronted emotionally intense situations every day. This has led to a deeper reflection on the essence of the nursing profession and the qualities that define a nurse. It has strengthened nurses’ professional identity as essential members of an interdisciplinary team, capable of providing integrated care and collaborating for the well-being of patients.
Despite the various challenges, nurses have shown extraordinary dedication, professionalism, and sacrifice in providing high-quality care during this crisis. Their professional identity has been strengthened, consolidating the image of committed, compassionate, and indispensable professionals in caring for and supporting the community.
Addressing the challenges experienced by nurses and highlighted by the pandemic is of vital importance for several reasons. First, it creates awareness about the challenges that nurses have faced and continue to face during this health crisis. This enables healthcare institutions, policy makers and all stakeholders involved in healthcare to fully understand the needs and pressures that nurses face on a daily basis.
Second, addressing challenges provides an opportunity to recognise and appreciate the work of nurses, highlighting their commitment, dedication and courage in withstanding extreme situations. This recognition is essential for promoting the health and well-being of nurses themselves, providing them with the necessary support to cope with difficult situations and prevent professional burnout.
This also enables the development of effective solutions to improve preparedness and future response to similar health crises. Through deep reflection on the difficulties encountered by nurses, it is possible to identify areas for improvement in healthcare policies, resource allocation, and healthcare workforce training.
Finally, it can offer an opportunity to promote open and inclusive dialogue among nurses, healthcare professionals, administrators, and the community. This allows for a greater mutual understanding and collaboration to create a safer, sustainable, and person-centred care environment.
In conclusion, addressing the challenges posed by the pandemic is crucial to recognising and addressing current issues, in order to ensure the well-being of nurses and the safety of patients in the future. It is only through collective commitment that we can overcome difficulties and build a resilient healthcare system capable of properly addressing health emergencies and promoting people’s health.
→ For further information about this topic, you can read the articles published in the new summer issue of our UniCamillus Magazine.
References
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