New study examines association between nurses’ well-being, workplace wellness cultures and shift length during COVID-19

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.