Study of University Hospitals Nurses Offers Lessons for the Next Pandemic, Other Crises

UH Clinical Update | August 2023

Just a few weeks into the COVID-19 pandemic in Ohio, nurse scientists at University Hospitals knew that it would be a challenging, unprecedented event – and something that should be thoroughly studied and understood.

“Within probably three weeks of March 17, 2020, which was the date of the first patient in Ohio at UH, we were having a discussion about what was happening and its impact on nursing,” says Patricia Beam, DNP, RN, NPD-BC, Pediatric Nursing Professional Development Specialist at UH Rainbow Babies & Children's Hospital.

 “We were all making observations of the stress on the nurses in the clinical setting, and we were concerned,” adds Susan Mazanec, PhD, RN, AOCN, FAAN, Nurse Scientist at UH Seidman Cancer Center. “Over the next several months, we decided to move forward with investigating not just the negative aspects of the pandemic on the mental health of the nurse, but also whether or not there was any positive growth that might occur as a result of this stress.”

A Unique Investigation

The group’s study – one of the first in the country to examine stress-related or post-traumatic growth among American nurses during the COVID-19 pandemic – was recently published in OJIN: The Online Journal of Issues in Nursing.

Its results are not especially surprising, given the demands of the pandemic on nurses. They show that of the 1,009 nurses who completed the UH team’s online survey in late 2020 and early 2021, almost 70 percent reported anxiety symptoms, with 38 percent having scores at the moderate or severe level. Higher levels of stress and anxiety were reported by those participants who were younger and had fewer years of RN experience.

Growth was low among survey participants, somewhat unexpectedly. However, nurses who scored the highest on stress and anxiety had the most positive growth, especially in the area of appreciation of life.

Interpreting the Findings

Study co-author Mary Anthony, PhD, RN, Director of Nursing Research and Innovation at UH Cleveland Medical Center, says the survey tool used in the study only measured growth at that moment in time, and was perhaps unable to capture the growth that occurred among nurses as the pandemic progressed.

“We asked ourselves, was it too early to measure growth?” she says.

It could also be that UH programs such as Helping Hands, services provided through UH4YOU and the support of individual nurse managers helped keep things on an even keel.

“Perhaps, for many nurses in this sample, coping mechanisms were working adequately to keep pandemic-related stress from escalating to the level of a major stressor or crisis,” explains Janet Kloos, RN, PhD, APRN-CCNS, CCRN, Clinical Nurse Specialist in Cardiology at UH Cleveland Medical Center.

“We did actually find that the role of the nurse manager was very instrumental,” adds Dr. Anthony. “Those findings are still to be recorded.”

Implications for Nursing Practice

All the UH nurse-scientists involved in this study agree that it points to a need for additional mental health screening and support for nurses – especially younger nurses with less experience. A simple, two-question anxiety screen, for example, could be used by a nurse manager in a crisis to identify nurses who need further assessment and mentoring.

“The nurse manager is often so close to their staff that they may be in the best position to pull out things from a general toolbox that might work for each individual nurse,” Dr. Anthony says.

“Each nurse was impacted differently,” Patricia Beam adds. “For some of them it was the fear of taking COVID home to family. It was individual, but the nurse manager was there, at the bedside and helping them.”

Nursing peers can also work to support each other when times are hard. And while the chances of having another once-in-a-generation pandemic are slim, nurses will find themselves in other challenging situations – and some will need extra support.

“The very work of nursing is to be always fluctuating with changes that are happening,” Dr. Kloos says. “COVID was just sort of the peak of what we're generally working with. Yes, it was harder, but that's part of our wheelhouse, so to speak. In these situations, I think we’ve shown in this study to just be more aware of who is vulnerable and who you’re working with every day.”