December 16, 2021

Journal of Clinical Nursing publishes study on mental and emotional toll of COVID-19

COLUMBUS – A team of nurse scientists, evidence-based practice professionals and an ethicist from The Ohio State University College of Nursing have published their findings from their multi-site study with first-hand accounts of the psychological and emotional toll that the COVID-19 pandemic has taken on front-line nurses in the U.S.

Focus groups engaging 43 staff nurses at four sites across the country (California, New York, Ohio and Pennsylvania) informed the study, which identified four central themes:

  1. The challenges the nurses faced in their work;
  2. The feelings that dominated their emotional and mental health;
  3. Coping mechanisms with varying levels of success in dealing with the pandemic; and
  4. Ethical issues they were forced to wrestle with in real time as they treated the sickest COVID-19 patients.

“We were asked to perform this study by staff RNs themselves not only to capture the history and emotions of the pandemic as it was happening, but also to learn where there were gaps that must be filled,” said Esther Chipps, PhD, clinical nurse scientist and professor of clinical nursing at The Ohio State University College of Nursing who was the lead principal investigator. “Our front-line nurses are inspirations and heroes for how they have served during the pandemic, and it is incumbent upon healthcare organizations to understand and course-correct where possible to better support them.”

Many of the nurses interviewed for this study consistently echoed similar concerns regarding internal communication issues, ever-changing protocols as the pandemic evolved, overwhelming fatigue, growing stress and anxiety among the nursing population and the ethical dilemmas associated with the magnitude of the illness and death that they witnessed among their patients.

The study, published by the international nursing journal Journal of Clinical Nursing, spotlighted the urgent need for several evidence-based approaches to mitigate the situation that hampered the front-line response to the pandemic, including:

  • Consistent disaster preparation and management guidelines that front-line clinicians can count on.
  • Interventions to build coping and resiliency skills in front-line clinicians who are trying to handle elevated levels of stress, anxiety and burnout as they care for patients such as The Ohio State University Wexner Medical Center’s Mindfulness in Motion, STAR mental health and Buckeye Paws programs, as well as Ohio State’s MINDSTRONG™/MINDBODYSTRONG™ cognitive-behavioral skills-building program.
  • Opportunities to reflect on the current experience and document successes and failures to build a bank of institutional knowledge and memory that includes innovative practices, surge staffing plans, personal anecdotes and other documentation so that future crises of this kind can be met from a better-informed perspective to improve organizational preparedness.

“We cannot afford to repeat the tragedy of this pandemic ever again,” Chipps said. “Part of what we can control is the support infrastructure put into place for clinicians so that they have clarity, consistency and resources available that allow them to focus on: caring for patients and optimizing their own self-care.”

Investigators for this study include leaders from The Ohio State University College of Nursing Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, (Donal O’Mathuna, PhD; Haley Roberts, BS; Sharon Tucker, PhD; Inga Zadvinskis, PhD; Cindy Zellefrow, DNP), The Ohio State University College of Nursing and The Ohio State University Wexner Medical Center (Esther Chipps, PhD), The Ohio State University College of Nursing (Marjorie Kelley, PhD; Julia Smith, EdM), UCLA Health (Pamela Miller, PhD), Columbia University College of Nursing (Allison Norfull, PhD) and Chester County Hospital, Penn Medicine (Cindy Brockway, MSN; Cheryl Monturo, PhD).

September 23, 2021

College of Nursing-led study published in Nursing Administration Quarterly

A new study from The Ohio State University College of Nursing quantifies how the COVID-19 pandemic, coupled with variable workplace wellness cultures and long shifts caring for patients, has severely impacted nurses working on the front lines.

The study was published online ahead-of-print in Nursing Administration Quarterly.

“Clinician burnout and mental health problems were an epidemic in nurses and other healthcare clinicians even before the pandemic hit; COVID-19 exacerbated the problem,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing, who also served as lead author on this study. “What this study did is shed light on the current scope of the problem and how healthcare systems can fix system issues known to cause clinician burnout and invest in evidence-based strategies and resources to help clinicians live healthier lives.”

Melnyk and her team surveyed 264 nurses associated with Trusted Health, which places travel nurses at hospitals and healthcare systems across the country, between August – October 2020. Among the key findings:

  • Physical and mental health:
    • The vast majority reported physical health (74.6%) and mental health (80.7%) at a five or lower on a 10-point scale.
      • 53.8% reported that the pandemic made their physical health worse.
      • 79.2% reported that the pandemic made their mental health worse.
    • Substantial percentages of nurses surveyed reported:
      • Depressive symptoms: 29.5%
      • Anxiety: 37.5%
      • Stress: 78.5%
      • Burnout: 65.5%
  • Healthy lifestyle behaviors that a majority of nurses surveyed reported were negatively affected by the pandemic:
    • More than one-third (38.6%) reported increased alcohol intake.
    • Only about one-third (34.8%) slept seven or more hours a night.
    • Only about one in five (22.3%) reported 150 minutes or more of moderate physical activity per week.
    • Only 8% of the nurses consumed five or more daily servings of fruits and vegetables.
  • Workplace wellness support:
    • Those nurses who reported that their workplaces supported higher wellness during the pandemic were:
      • Five times more likely to get at least seven hours of sleep nightly
      • 16 times more likely to eat 5+ servings of fruits and vegetables
      • Less likely to report a negative impact of the pandemic on healthy lifestyle behaviors
      • Three-to-nine times as likely to report good physical and mental health, no/little stress and no burnout
  • Shift length:
    • Those nurses who reported working 12 or more hours per shift during the pandemic were more likely to:
      • Sleep fewer than seven hours per night
      • Get less physical activity
      • Consume fewer servings of fruits and vegetables
      • Use tobacco
      • Experience burnout symptoms
      • Report worsening physical and mental health

In response to these findings, Melnyk and the team referred to a recent systematic review indicating that “effective interventions to improve mental/physical health, well-being and healthy lifestyle behaviors in physicians and nurses include mindfulness, health coaching, deep abdominal breathing, gratitude, cognitive-behavioral therapy/skills building and visual triggers.” Many of these types of interventions are in practice at The Ohio State University and the Wexner Medical Center, with programs such as Mindfulness in Motion, the Buckeye Paws pet therapy initiative and the STAR (Stress, Trauma and Resilience) mental health program available to all clinicians. The Office of the Chief Wellness Officer and College of Nursing also offer the MINDSTRONG™/MINDBODYSTRONG™ cognitive-behavioral skills-building program and the Health Athlete energy management program, which is based on the Johnson & Johnson Human Performance Institute® Performance program.

Beyond these activities, Melnyk advocates strongly for building cultures where well-being is supported and healthy lifestyle behaviors are the norm.

“That healthcare leaders should be alarmed by the findings of our study is an understatement,” Melnyk said. “These trends do not only affect the well-being of our clinicians; they are also associated with the quality and safety of care that clinicians provide to patients.

“Our clinicians cannot continue to pour from an empty cup. Fixing issues known to cause burnout and creating wellness cultures that bring evidence-based programs and resources to bear are the absolute best ways to make positive change and make it sustainable.”

Other authors on the study include Andreanna Pavan Hsieh, MPH; Alai Tan, PhD; Alice M. Teall, DNP, APRN-CNP, FAANP; Dan Weberg, PhD, RN, MHI, BSN; Jin Jun, PhD, RN; Kate Gawlik, DNP, APRN-CNP, RN; and Jacqueline Hoying, PhD, RN.

October 20, 2020

All-virtual summit hosted by The Ohio State University to focus on promoting and protecting the well-being of healthcare professionals and students

VADM Jerome M. Adams, MD, MPH, Surgeon General of the United States, will deliver remarks Thursday morning to kick off the second biennial Summit on Promoting Well-Being and Resilience in Healthcare Professionals hosted by The Ohio State University. Nearly 400 participants from 35 states, the District of Columbia, Canada, St. Martin and Sint Maarteen are expected to attend the all-virtual event on October 21-23.

The summit shines a spotlight on clinician burnout, a public health crisis that has spiked during the COVID-19 pandemic. National experts and practitioners from across the country will join together to share evidence-based strategies and programs designed to promote clinician well-being and build resilience in the face of hardship.

“Clinician burnout and its major impacts – stress, anxiety, depression and suicidal ideation – have become a pandemic within the pandemic,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing at Ohio State. “Burnout does not only affect the well-being of healthcare professionals and health science students, but it also threatens the quality and safety of patient care. Investment in building a wellness culture and providing programs that support and sustain clinician well-being is not a nicety; it is a necessity.

“Our summit will feature some of the best evidence-based actions available. We want to help create a movement centered on evidence and inspiration that protects our clinicians so they can deliver optimal care to patients in every setting.”

The summit is hosted by Ohio State’s seven health science colleges (Dentistry, Medicine, Nursing, Optometry, Pharmacy, Public Health and Veterinary Medicine), the College of Social Work, The Ohio State University Wexner Medical Center and the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience.

May 19, 2020

Videos, additional resources designed to share strategies and approaches for clinicians in distress

Clinicians in Distress: Social Worker and Staff Nurse video thumbnail

Faculty and staff at The Ohio State University College of Nursing have produced a new series of videos that spotlight scenarios, strategies and approaches for addressing healthcare clinicians who may be in distress and thinking of harming themselves.

The video series is paired with an online library of resources aimed at providing education and information around symptoms of clinician burnout, including depression, anxiety and suicidal ideation. Clinician burnout and its affiliated symptoms can carry consequences from reduced job performance and high turnover rates to medical errors and suicide. The United Nations and World Health Organization both recently addressed the growing impact of the pandemic on mental health and highlighted healthcare workers specifically as a vulnerable population.

“Our heroes on the front lines of healthcare are resilient and brave, but that does not mean they are impervious to the mental health toll of the pandemic,” said Sharon Tucker, PhD, APRN-CNS, EBP-C, FNAP, FAAN, Grayce Sills Endowed Professor in Psychiatric-Mental Health Nursing and director of the DNP Nurse Executive Track at the College of Nursing. “Our team created this online resource featuring ten video scenarios to demonstrate some key elements in how to approach and talk with someone in distress. We are hopeful that colleagues across the healthcare spectrum will find benefit and value in this important work.”

According to the College of Nursing’s “Clinicians in Distress” website, “the COVID-19 pandemic has exacerbated the need for resources to support clinician wellness. Professional organizations across the country are collaborating in response to the urgent need, including the American Nurses Association (ANA).”

“Clinician burnout was a growing public health epidemic before anyone had heard of COVID-19,” said Bernadette Melnyk, PhD, APRN-CNP, EBP-C, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing. “Mental and emotional well-being in our front-line clinicians must be top priority for healthcare systems; it is imperative that we both provide resources such as this video series and evidence-based programming to help healthcare professionals now and invest in support systems that prioritize their well-being in the future.”

The website housing the video series and other resources can be found at u.osu.edu/cliniciansindistress.

April 23, 2020

Health and well-being hub represents an innovative first step towards addressing burnout and associated mental health issues among nurses nationwide

Trusted Health, the career platform for the modern nurse, and The Ohio State University College of Nursing today announced a new initiative to promote mental health and well-being among nurses on the front lines of the COVID-19 pandemic. The program will be piloted with nurses in New York and Michigan -- two of the states hit hardest by the pandemic -- and rolled out nationwide in the coming weeks. 

Even before the current crisis hit, burnout among nurses has been at an all-time high, with some studies estimating that up to 63 percent of nurses exhibit symptoms such as job-induced stress, anxiety and depression. In addition, nurses are at increased risk of suicide. More than half report being in suboptimal mental or physical health, which research shows can lead to more errors in caring for patients. The COVID-19 pandemic has only exacerbated this issue, as frontline nurses find themselves delivering care for a high volume of acutely ill patients, often in situations with limited crisis response training or supplies of personal protective equipment (PPE). 

Trusted and The Ohio State University have come together to help address this issue through a partnership that will provide access to wellness support and evidence-based strategies from nursing faculty and advanced practice nursing (APN) students from The Ohio State University College of Nursing. Nurses employed by Trusted who are working in facilities with COVID-19 patients will be able to access an emotional support line staffed by seasoned nurse practitioner faculty, including mental health experts, and supervised students. Those faculty and students will review stressors with callers and offer coping strategies and stress-reduction techniques.

Nurses who call the emotional support line may then opt to participate in a wellness support partnership program supported by the College of Nursing for a period of four or eight weeks. This will include cognitive-behavioral skills building, motivational interviewing, mindfulness and therapeutic communication aimed at finding sustainable solutions to enhance the nurses’ health and well-being, both during the pandemic and for life.

“Our healthcare professionals on the front lines of this pandemic deserve not only our highest regards for their selfless service, but also our support to handle what they are feeling and experiencing because of this crisis,” said Bernadette Mazurek Melnyk, PhD, APRN-CNP, EBP-C, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing at Ohio State. “Our college’s faculty, staff and students participating in this effort are well-versed in evidence-based interventions that will not only help these nurses survive, but thrive and build the resilience needed to continue to provide high-quality care and save lives.”

“As a nurses-first company, Trusted was founded on a simple idea: Nurses are the backbone of our healthcare system, and we must do more to support them,” said Dan Weberg, PhD, RN, head of clinical innovation at Trusted. “The COVID-19 crisis has pushed this issue into the national consciousness, and we are committed to using this moment to advocate for and identify new ways to support the mental well-being of nurses not just on the front lines, but everywhere.” 

Since the onset of COVID-19, Trusted has been focused on meeting the unprecedented demand for healthcare workers by matching nurses who have raised their hands to help with hospitals battling the pandemic. As a nurses-first company, Trusted was among the first to offer guaranteed quarantine pay for all of their nurses, and has made their Nurse Advocate team -- former bedside nurses who offer guidance throughout the job search process -- available 24/7 to support the needs of Trusted nurses working on the front lines. Over the last several weeks, nearly 40,000 nurses have signed up via Trusted to work on the front lines of the crisis. 

About Trusted Health

Trusted is where modern nurses go to build their careers. Nurses are the backbone of our healthcare system and yet their options for finding new roles are cumbersome and outdated. Trusted is on a mission to change this by matching the nurses on our platform with a range of flexible jobs that meet their preferences and career goals. With support from a dedicated Nurse Advocate and unmatched insight into compensation and contract details, Trusted makes it easy for nurses to navigate the job search process and manage their careers with confidence. 

Trusted supports hiring in all 50 states and has connected the nurses on its platform with thousands of opportunities. Based in San Francisco, CA, Trusted has raised $25 million in funding from Craft Ventures, Felicis Ventures, and Founder Collective, as well as healthcare innovators like Texas Medical Center and Healthbox. For more information, visit trustedhealth.com.

About The Ohio State University College of Nursing

The Ohio State University College of Nursing exists to transform health and improve lives through top-tier teaching, research and innovation, grounded in evidence-based practice and a powerful culture and support system to foster optimal personal well-being.

The college’s nationally-ranked academic programs taught by world-class faculty offer top-notch programs for future and current nurses and healthcare leaders. U.S. News & World Report highly ranks our university-wide online bachelor’s including RN to BSN (#1), online master’s (#4), traditional master’s (#6) and online Doctor of Nursing Practice (#8). Majors include both nursing and programs in healthcare and wellness innovation, along with certificates that range from school nurse and primary care to nurse education and nurse/health coaching.

The college’s two research centers – the Martha S. Pitzer Center for Women, Children and Youth and the Center for Healthy Aging, Self-Management and Complex Care – seek innovative solutions to real-world healthcare issues. The college received approximately $10.7 million in research awards in FY2019, including $4.3 million in NIH funding – #6 among public institutions and #13 overall. Its Helene Fuld Health Trust National Institute for Evidence-based Practice (EBP) in Nursing and Healthcare promotes EBP worldwide and offers the first globally-recognized certificate of added qualification in EBP.

February 13, 2020

Proposal asks policymakers, healthcare leaders to support needs for culture change, resources

A new evidence-based policy brief released today addresses an alarming level of healthcare clinician burnout – and its consequential impact on patient care – and asks state policymakers and healthcare leaders to take urgent action to ensure safe and high-quality care.

A partnership of the Health Policy Institute of Ohio (HPIO) and the Helene Fuld Health Trust National Institute for Evidence-based Practice (EBP) in Nursing and Healthcare at The Ohio State University College of Nursing crafted the policy brief. It points to research that finds high rates of depression, anxiety, addiction and suicide among healthcare clinicians, which in turn can lead to dangerous medical errors and costly turnover:

  • Medical errors were the third-leading cause of death in the United States, resulting in more than 250,000 deaths per year, according to a 2016 analysis. While clinician burnout is not the only factor contributing to medical errors, it does pose a significant threat to patient outcomes.
  • Burnout is estimated to be responsible for approximately $4.6 billion in costs related to physician turnover and reduced clinical hours.
  • Total estimated costs associated with nurse turnover for an average hospital were between $4.4 million and $6.9 million in 2018.

“This important partnership between our Fuld National Institute for Evidence-based Practice and HPIO spotlights the critical issue of clinician burnout and how we can improve population health, patient outcomes and healthcare quality across our state,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing at The Ohio State University. “Healthcare professionals of all disciplines cannot take great care of their patients and families if they do not prioritize taking great care of themselves. However, healthcare organizations also must be proactive in supporting clinicians and addressing burnout and depression from a holistic perspective, including shift length, providing resources and building a culture that promotes well-being.”

“Our analysis of the research literature found that clinicians and health professional students face serious problems related to their health and well-being,” said Reem Aly, vice president of HPIO and co-author of the report. “Understanding the relationship between clinician well-being and patient care and safety enables state policymakers and healthcare leaders to implement evidence-informed policies and programs that improve outcomes for clinicians and their patients.”

The brief outlines several evidence-informed action steps that legislators, state agencies, health professional licensing boards and other leaders can champion to stem the tide of clinician burnout, including:

  • Advancing an organizational culture that supports wellness
  • Promoting wellness programming that reduces burnout and fosters resiliency in health professional clinicians and students
  • Providing confidential mental health screening, referral and treatment services for clinicians and students
  • Supporting policies that reduce stigma, including confidential monitoring and treatment programs as alternatives to discipline programs
  • Monitoring and tracking data on health professional clinician and student wellness

The full report and resource page can be accessed at www.hpio.net/a-call-to-action.

July 31, 2019

The National Academy of Medicine’s (NAM) Action Collaborative on Clinician Well-Being and Resilience released a comprehensive and groundbreaking case study today about how The Ohio State University is working to stem the growing epidemic of clinician burnout in healthcare settings.