Even before the COVID-19 pandemic started, working in healthcare put people at higher risk for developing mental health struggles especially anxiety and depression. With COVID-19 however, levels for all cases of anxiety and depression have skyrocketed, especially in healthcare workers who feel burnt out, exhausted, angry, and traumatized. 

How is Mental Health Among Nurses Doing?  

According to research, reported cases of anxiety and depression in healthcare workers was as high as 35%, but those who exhibited symptoms of both were as high as 80%. With the stigma that still follows mental health struggles, the number of healthcare providers struggling with them is likely much closer to that 80% statistic. 

With these high levels and no end in sight of this pandemic any time soon, what can we do about it to protect ourselves and our colleagues? Here are some tips to start implementing now and spread them to all your coworkers and friends so that we can all start to recover. 

What Causes Increased Stress and Anxiety in Nursing? 

So why do so many healthcare workers have mental health issues? There can be a lot of reasons that are different for everyone, but a few that I’ve noticed are: 

• Compassion fatigue
• Secondary trauma 
• Overall stress
• Previously undiagnosed/diagnosed anxiety and depression 

Once that is very common and that I personally struggle with is compassion fatigue. 

What is Compassion Fatigue? 

Compassion fatigue is defined as a condition of emotional and physical exhaustion leading to a diminished ability to feel compassion for others. It is sometimes referred to as secondary traumatic stress and can often be confused with burnout. 

As healthcare workers we spend all day caring about others, physically, mentally, emotionally and even spiritually. This is exhausting and when we get home, we feel drained and like we cannot care for anyone else, including ourselves. Sometimes this can be minor and after we practice self care, we feel refreshed and ready to care for others again. Other times, this can be severe, even classified as secondary trauma. It’s estimated that 1 in 4 of nurses alone experience PTSD like symptoms at some point in their career. This can come from a certain experience, like a very dramatic loss of a patient, or slowly and over time with smaller, equally traumatizing events. 

Compassion fatigue is a major cause of burnout and healthcare workers leaving their jobs. It can also lead to more serious mental issues like anxiety, depression, and even suicidal ideations. Healthcare workers in general, and before the COVID-19 pandemic, were almost twice as likely to commit suicide when compared to the general population. 

How Can We Heal From Compassion Fatigue? 

So what can be done about it? The Compassion Fatigue Workbook by Francois Mathieu lays out a step-wise approach to help prevent, lessen, and resolve compassion fatigue and vicarious trauma. Those steps include the following:

1. Pay attention and track your stressors: 

The first step in combating any type of stress is to figure out what is triggering that stress. Without this knowledge, you will continue to expose yourself to that trigger over and over again, doing extensive damage to your mental health over time. 

The best way to do this is reflect. My favorite time of day for a full daily reflection is with my evening journaling and before bed, but do what works for you! These reflections can help you see what you are thinking about, feeling, and what is happening. With this, you can really identify your stressors and what has been truly impacting your mood recently. Once you have identified your stressors, you can work on eliminating them! 

2. Enhance your self care practices and work-life balances: 

The first part of the second step to healing from compassion fatigue is enhancing your self care practices. As I’ve written about here before, self care is hard and no one really knows what it means. To be very simplistic, self care is something that makes you feel good. It can be anything that helps you relax and feel truly rejuvenated so that you don’t feel burnt out. 

So how are your self care practices right now? Most people answer that as “not good,” but don’t do anything about it. And that’s because it’s daunting! And being stressed about it is the exact opposite of what we want when planning our self care practices. When we stress about it, self care then becomes just another thing added to our to-do lists and then we get the exact opposite results of what we want.  

An easy way to get started on this is to make a list of things you enjoy doing or that you USED to enjoy doing and haven’t had time for in a long time. You can do this in one sitting or spend a few minutes every day adding a few more. Once you finish, you have a self care tool box! Every day or every few days try to do one of these activities. You can make a tracker or a board with all the activities listed out and check them off when you’ve done them. The most important aspect of this is to make the activities ones you truly ENJOY and that leave you feeling rejuvenated, not more exhausted. 

The second part of the second step in healing from compassion fatigue is achieving work life balance. This is something that is so much easier said than done. Most nurses and healthcare workers feel guilt when not working as hard as they possibly can. This leads to higher levels of burnout and compassion fatigue and then poor patient outcomes! 

I could say something easy like “It’s okay to say no to an extra shift,” but that’s been done. And it is, always. But what else can you do to make sure you do not BECOME your job? Here are some tips for you to try: 

1. Plan your time

This means plotting out your week in advance including time for you, time to exercise, time for your friends and family, and time for rest! Put it on your calendar IN PEN and COMMIT to it 

2. Have set work hours and stick to them 

Maybe this means your three 12 hour shifts and nothing more. Maybe you’re okay adding some extra hours every other week. Do what works for you, write it down, and STICK TO IT. 

3. Maintain your positive relationships, in and out of work! 

Make time for your closest friends. Make time to spend with your family. Hang out with your coworkers! Go to that committee meeting you are passionate about. BUT, notice what relationships aren’t working anymore. Friends or family that are toxic are not worth your time. Committee meetings you hate can be left behind. Do ONLY what makes you happy. 

4. Take breaks 

The U.S. is one of the WORST in taking vacations. So many people don’t take their PTO and let it roll over again and again. DON’T do this. Take your vacations. If you’re feeling burnt out, take a week off. Or just a shift off! Take time away from work to reset your mind, body, and soul. 

5. Reflect daily 

We have discussed this regularly. But, it’s important to check in with yourself regularly. Once a week, ask yourself if you have enough balance in your life and in your work. If not, address it. 

It’s okay to say no to that extra shift. It’s okay to not work overtime every week. It’s okay to stop going to that committee meeting. It’s okay to put you first.

3. Develop resiliency 

The third step in healing from compassion fatigue is developing healthy coping mechanisms and resiliency skills.  

What does this mean? It means you have the skills to overcome a stressful incident instead of spiraling and dwelling on it. It means you can feel the emotion and MOVE ON. This is such an important skill when trying to live your best life and especially when healing from compassion fatigue. Feel your emotions, process them, and let them go instead of letting them fester in your body and affect your ability to take care of your patients. 

So what are some skills that you can practice to increase your own resiliency? Here’s a few ideas: 

1. Nurture your relationships with friends, family, and coworkers. 

Being connected with others helps you see how supported you are and strengthens that support group every day. Having regular access to love, encouragement, and reassurance will increase your own resiliency. 

2. Use Humor 

Having a sense of humor and exposing yourself to humor regularly helps you to see the positive light of things instead of the negative. It helps you stay light and above those irritating events that might have knocked you down before 

3. Taking care of yourself 

Eating right, exercising, getting enough sleep and more is an important aspect to resiliency. If you can take care of your physical self, your mental self will be easier to handle as well! 

4. Being confident in yourself and your emotions 

This is a big one I know, but stay with me. Being confident in your mental and physical self as well as what your feelings are NO MATTER WHAT keeps you resilient to attacks in all aspects. Knowing you can feel these emotions, process them and move on, keeps you from spiraling beforehand. Knowing you can handle it makes you able to handle it! 

5. Be a team player 

Not just in work situations but in life! Always be willing to compromise and work with people to find a solution that works for everyone. Having a team oriented mindset going into a problem or situation helps you keep your goals in mind without getting lost in disagreements. 

6. Find purpose 

Finding a purpose to everything that you do or everything that happens truly helps you rise above the minute details, including your own anxieties, thoughts, and feelings about the situation! 

7. See the big picture 

Stay above the minute details of a situation, especially if they are small and annoying and trying to gnaw their way into your mind. See the overall picture, your overall goal, and you’ll get there unscathed.

8. Be flexible 

Don’t get upset when things don’t go according to plan. Know that things will happen ahead of time, because they always do. 

9. Make realistic goals 

Don’t make goals or plans you KNOW you won’t carry out. That is just fueling your anxieties and stress. Setting a goal you know is possible and that you can do it means you are more likely to actually do it! 

10. Taking care of others 

Volunteer, take care of your family, your parents, your children. This will boost your mood, your energy, your compassion, your SELF compassion, and in the end, your resiliency. 

4. Commit to implement changes in your life 

Now that we know mental health struggles are so common in healthcare, it’s time to make a commitment. 

Commit to start today. Commit to make a change in your life. Commit to making that change so that your mental health will be better. Commit to doing things that make you feel good. Commit to making your life your own. 

Commit to sharing your story. Commit to helping others share theirs. Commit to make our healthcare world SAFER, not only for the patients, but for us. 

Follow these four steps to help your mental health thrive in the difficult healthcare world.