The COVID-19 pandemic has changed the world in so many ways.

Not just the way we live our lives, but the way we view life too.

Our priorities have changed, as have our perspectives, and the ripple effect has been a greater appreciation for those around us.

Our gratitude for frontline workers has skyrocketed, particularly in relation to health professionals, and more specifically, nurses, who have developed an almost superhuman persona.

According to Registered ICU Nurse Dr Jessica Stokes-Parish, the media has spearheaded this notion, quickly adopting an ‘angel and hero’ narrative to express support and gratitude for those who put their lives on the line to protect their communities.

While well-intended, Dr Stokes-Parish believes labelling nurses as angels or heroes can have unintended negative consequences.

“Firstly, it undermines the high level of training that nurses have obtained to practice,” she says.

Nursing literature exploring the ongoing stereotyping of nurses, found that the public considered care and compassion as the two most important characteristics of nurses.

“While this is certainly not a bad thing, it creates a perception that skill, education, knowledge, and discipline are not as important,” says Dr Stokes-Parish.

“However, we know this isn’t true – as an educated nursing workforce reduces mortality and morbidity.”

The other issue, says Dr Stokes-Parish, is the dismissal of safe working environments as a top priority. 

“There is a cost to working in a pandemic – the risk of injury, unsafe working conditions, and working hours.

“Framing nurses as heroes distracts from the need to ensure access to safe work conditions, such as inadequate personal protective equipment or flexible work rosters.

“It also suggests that nurses must go above and beyond what is reasonable – forcing them to act outside of the norm to ‘protect and defend’.”

The result can be detrimental to the health professionals this narrative aims to elevate, particularly when it comes to mental health and moral injury.

“This perfect storm of expecting behaviour above and beyond the norm (the hero) with the altruism of helping or healing (angel), pushes nurses to act outside their values or ethics,” says Dr Stokes-Parish.

“For example, overrun hospitals mean that nurses cannot give the same care that they would in pre-pandemic settings.

“Moral injury can also occur from being exposed to traumatic events or transgressions that others make – such as not allowing visitors to see patients in high-risk areas because of the risk of infection.

“This repeated impact creates moral distress and ongoing psychological injury – not dissimilar to post-traumatic stress.

“The ongoing stress can lead to a sense of disillusionment, feelings of rage, worthlessness, shame and much more.”

It’s now been more than a year and a half since the pandemic reached our shores, and the current situation seems unlikely to change in the near future.

Therefore nurses, particularly those working in the high-pressure areas of ICU and critical care, must take active steps to care for their own mental health.

But the responsibility must not fall solely on individuals, says Dr Stokes-Parish.

“First and foremost, healthcare organisations should consider their role in preventing moral injury,” she says.

“It’s often the de facto response to consider individual actions, but workplaces need to consider the need to manage high levels of staff that may be morally injured  – and be prepared for it.”

Dr Stokes-Parish says preparation should include reducing the risk of moral injury through safe workplaces and access to wellbeing support services. 

“A safe workplace includes organisational strategies such as clear communication in a timely manner, identifying clear roles, appropriate skill mixes for rostering, reducing fatigue, and other organisational level activities such as team debriefs.

“Wellbeing support services should include access to psychological support, support for nurses’ families, access to time off for recovery and so on.

“When the systems are set up well, then individuals are better placed to access personal stress reduction strategies such as mindfulness, socialisation, eating well, moving, and resting.”

A recent report, produced by Randstad, underpins the importance of self-care, and the need for nurses to proactively nurture their own mental health.

Interviewees involved in the Building a Resilient Healthcare Workforce report talked about the importance of stepping away from work, and finding ways to relieve the stress as they look to strengthen wellbeing and build resilience.

“I’ve started gardening, and people are taking up little hobbies, and baking sourdough bread, and being immersed in these activities,” says Nursing Manager Tracy Churchill.

Ms Churchill believes it’s important that nurses are taught to place a strong focus on self-care early in their career, so when these things happen, there’s already a sense of instilled resilience to draw from.

Equally as important is a positive internal support network, where nurses who are struggling feel comfortable seeking help from colleagues who can properly understand what they’re going through.

“Teams that have people in them that really care about each other and reach out, just work so well in times like this,” says Ms Churchill.