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COVID-19: Managing Staff Mental Health During a Pandemic

Earn .5 credit hours with this CE course — FREE for a limited time

By Melinda Young
This course is .5 credit hours
Course expiration date: April 30, 2024 — This CE module is FREE with coupon code NURSESWEEKCE until June 30, 2022
Course Objectives: Upon completion of this educational activity, participants should be able to:
  • Discuss the consequences of COVID-19 on mental health of healthcare providers.
  • Discuss current scientific research and data regarding moral injury and psychological stress among healthcare providers.
  • Identify self-care tactics to prevent staff mental health issues related to the pandemic. educational activities are provided by Relias LLC. For further information and accreditation statements, please visit The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. Relias LLC guarantees this educational activity is free from bias. See "How to Earn Continuing Education” to learn how to earn CE credit for this module or visit

Take Practical Actions to Help Employees Cope

Reducing Stigma is the First Step

Employers sometimes offer staff tips on self-care to help them cope with stress and prevent depression and other mental health issues. But there also are actions leaders can take to help prevent their staff from becoming burned out or experiencing long-term mental health problems related to the COVID-19 pandemic:
  • Develop mental health resources for staff. Organizations should propose resources that their staff can turn to for mental health counseling, treatment, and support, says Alison B. Comfort, PhD, health economist with the Bixby Center for Global Reproductive Health at the University of California, San Francisco (UCSF).
Researchers recently studied mental health issues among reproductive healthcare staff during the pandemic and suggested that interventions should focus on reducing stigma as a barrier to health providers accessing treatment for mental illness. “Because it [can be] stigmatized to use those resources, we need leaders in organizations to be examples and say they benefited from those resources,” she says. “You need leaders or key influencers within organizations to show it’s OK to use those resources, saying, ‘I really benefited from them, and you can, too.’” It will take some work to make those resources available and destigmatize them, she adds. “Employers should offer mental health resources without penalty, and leaders should say, ‘Why don’t we all use it,’” says Cynthia Harper, PhD, professor of obstetrics, gynecology, and reproductive sciences, and director of the UCSF-Kaiser Permanente Building Interdisciplinary Research Careers in Women’s Health at UCSF. Everyone needs to become aware of how the pandemic may affect employees’ mental health and how they should seek as much help as they need. “All of us need a mind shift about mental healthcare,” Harper says. “Insurance is slightly more likely to cover mental health issues than it was 15 years ago,” she adds. “We have a long way to go before everyone gets the help they need from this global pandemic.”
  • Manage expectations. A potential contributor to stress over the next year will be the expectation that everything will return to normal.
Continuous change and adaptations have been hallmarks of the pandemic. Reproductive health staff should know that these may continue. As one nurse practitioner told researchers, “This is going to be the new ‘normal.’ Not looking forward to how medicine will be done in the future.” Reproductive health providers also need to manage patients’ expectations as things continue with telehealth and other changes. “Healthcare workers had to completely change their workflow, and patients are thinking everything will be the same except for using Zoom, and it’s not. That puts additional stress on clinical interactions,” says Alexander Tsai, MD, PhD, a psychiatrist at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School.
  • Make room for grief. “There have been a lot of deaths that we as a country have experienced,” Harper says. “We have a higher death rate than other countries.”
According to researchers, the pandemic’s overwhelming death toll and healthcare workers’ fears of contracting the virus and infecting colleagues and family have harmed their emotional and psychological well-being.2 Many reproductive health staff personally experienced the trauma of these deaths and COVID-19 illnesses. Some workers’ family members and/or people they knew were infected and harmed or killed by the disease. “We’ve suffered this [crisis] together, and it has really been tremendous the way it has impacted all these different sectors of society,” Harper says. “The first step is to say it really has affected people and to offer to help,” Harper says.
  • Tell the truth: Things will not be the same. Leaders should be frank about the situation and not offer false reassurance, Tsai says.
They can help their staff cope with moral dilemmas and the ever-changing work environment by expressing honesty about what the organization can and cannot do for them. “Don’t present things in legalese or euphemism, but give it to people straight,” Tsai says. “Whenever the epidemic subsides, that brings up anger and bitterness.” Staff will need ongoing support. “They can provide a regular discussion forum for healthcare workers to talk about the challenges they are experiencing, or some sense that employers are aware of these challenges and are trying to do something about it,” Tsai explains. “If they feel like the big boss doesn’t care, that doesn’t feel good. It’s better if the boss does care and there is more of a sense that we’re in this together.” Healthcare workers recognize that their work during the pandemic will be difficult. But they want to know they will be supported as they experience sacrifice and losses. “Seeing employers trying to mobilize support in tangible ways also is appreciated,” he adds. For example, employers can try to arrange for safe child care for their employees during times when schools or daycare centers are closed. “To see an employer try to create safe child care would be greatly appreciated,” Tsai says.
  • Provide aftercare. “What happens when you put people under so much stress for so long is, even when we come out of the pandemic, there could be long-term repercussions for these healthcare workers, who have been under so much stress,” Comfort says.
Employees who do not attend to their emotional health issues now and who delay care may end up with festering problems later. “Providers are delaying taking care of themselves. In the next few years, we’ll see repercussions of that,” Comfort says. Reproductive health sites that destigmatize mental health treatment and encourage staff to seek assistance can help them prevent long-term problems. “It goes back to the superhero idea, where they’re treated as though they’re super human and don’t need help,” Comfort explains. “But they [should] seek care, too.” All healthcare employees will need at least some aftercare when the pandemic ends. “Hopefully, employers and supervisors will mobilize some kind of appropriate response once the crisis is over,” Tsai says. “With aftercare, the idea is to make sure the most common reaction to the issues that have come up during the pandemic is not simply avoidance.” The pandemic will be with the United States and the rest of the world for a long time, but this cannot be an excuse to ignore its mental health repercussions among staff. “It’s important for supervisors, employers, and leaders to create space to reflect on the sacrifice made and the losses so the predominant story is some kind of meaningful story,” Tsai explains. “Acknowledge the sacrifices, the difficulty, and the loss in a way that doesn’t make people feel you are just papering over whatever difficulties that have been encountered.”

Watch Out for Moral Injury and Psychological Distress Among Staff

Staff Need Education, Coping Tools, Therapy

Research into psychological distress and mental health issues during crises suggests that the world’s healthcare workers will face challenges through the pandemic and for years afterward.
New data from the Centers for Disease Control and Prevention (CDC) and an online survey revealed that one in 10 respondents seriously considered suicide within the past 30 days, and about one in five essential workers considered the same.
Frontline professionals, and other healthcare workers to a lesser extent, are witnessing traumatic events that could lead to moral injury. As the authors of one new paper suggest, a big contributor to this problem is their frustration and sense of powerlessness. Nurses and others affected by the pandemic’s trauma need education, coping tools, and therapy to help alleviate the adverse effects.
The frontline workers in intensive care units (ICUs), caring for dying COVID-19 patients, are tired and swamped and may experience moral injury, says Alexander Tsai, MD, PhD, a psychiatrist at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School.
“‘Moral injury’ is a term coined by a psychiatrist who worked with combat veterans in the Vietnam War,” Tsai explains. “He defined it as being party to the perpetration or not being able to transgress these acts, such as the Vietnam War atrocities.”
People who have experienced moral injury are harmed for years after the event. They can include journalists, chaplains, healthcare workers, and others after large-scale disasters or mass violence, he adds.
Just as Vietnam War soldiers were helpless to prevent atrocities, healthcare workers in all settings have been helpless to prevent COVID-19 deaths. “Moral injury is an important issue that factors into distress among healthcare workers,” Tsai says. “A study of healthcare workers in New York City, at the time of the surge, polled them about occupational hazards, what factors ranked highest in their mental health, and they identified ‘not having control.’”
Other factors were the lack of support and being redeployed to do work outside of their specialty. “Those are the occupational factors. There were other things, like being fearful about being infected with COVID-19 or having to work despite having symptoms and not having personal protective equipment,” Tsai says. “There is a long list of factors associated with mental healthcare in the epidemic, and working long hours is low on the list because they’re used to long hours.”
Burnout, anxiety, and depression among healthcare workers are caused by factors other than hard and long hours of work, he adds.
For all healthcare workers in the pandemic era, a big stressor involves anxiety about contracting the virus. “We saw a lot of stress and anxiety around illness,” says Cynthia Harper, PhD, professor of obstetrics, gynecology, and reproductive sciences, and director of the UCSF-Kaiser Permanente Building Interdisciplinary Research Careers in Women’s Health at the University of California, San Francisco (UCSF).
In a study, Harper and co-investigators found that reproductive health professionals were worried about bringing illness home to their families. They also were worried about finding child care, which was scarce during pandemic surges. “Some were able to do telemedicine and have their shifts remote,” Harper says.
Iconic images of the pandemic show healthcare workers with capes or being saluted by Superman — as an Ohio COVID-19 poster shows — or as masked hospital staff walk down a hallway, Marvel and Justice League superheroes bow to them. (The images can be found here.)
“We see these health workers as heroes who can take on everything,” says Alison B. Comfort, PhD, health economist with the Bixby Center for Global Reproductive Health at UCSF. “They have to show up for work, and we count on them for so much. In San Francisco, we have ads that say, ‘Not all superheroes wear capes,’ and they show healthcare workers.”
But what these tributes to their work during the pandemic miss is the emotional health toll of their struggles during the pandemic. “We depend on them, and yet we’re putting them under so much pressure. They’re human and not sleeping and are constantly stressed and worried about their families,” Comfort says. “We call them superheroes, but they’re going through these very real, challenging situations.”
Comfort says she was compelled, in part, to study this topic because of the tragic examples of physicians taking their own lives after months of caring for COVID-19 patients.
“We need to acknowledge [their difficulties], support them, and not make them do impossible jobs that put them under so much strain,” she says. “They’re not super human; they’re human.”
Go online to read the full course
The online course provides more information about how the pandemic has affected mental health and what can be done to help staff cope.
Use the coupon code NURSESWEEKCE until June 30, 2022, to take the course for free.
Sign up for Unlimited CE.
This course was written by Melinda Young, who has been a health care/medical writer for 25 years. Previously, she worked for daily newspapers, winning national awards for investigational journalism. Currently, she writes about human research protection, case management, ambulatory surgery, and contraceptive technology. Consulting Editor Chairman Robert A. Hatcher, MD, MPH, is Senior Author at Contraceptive Technology, and Professor Emeritus of Gynecology and Obstetrics at Emory University School of Medicine in Atlanta, Georgia.
How to earn continuing education
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Relias LLC is also an approved provider by the Florida Board of Nursing, and an accepted provider through the Arkansas Board of Nursing, District of Columbia Board of Nursing, Georgia Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing, and West Virginia Board of Examiners for Registered Professionals (provider # 50-1489). Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.