Almost two-thirds of nurses feel their mental health has deteriorated since the initial peak of the pandemic last spring and that national wellbeing support is still not good enough, reveals a survey by Nursing Times.
Our findings suggest a workforce feeling “utterly broken”, with some warning there is no “safety net” to catch or support them after a gruelling year of Covid-19. Many said they were ready to quit the profession altogether.
Marking a year of the coronavirus pandemic in the UK, Nursing Times has carried out a survey to uncover the current state of nurses’ mental health and wellbeing, and whether things have improved or worsened since it began. The survey updates that carried out last year to help launch our Covid-19: Are You OK? mental health campaign.
Almost 12 months on, in spite of the crisis appearing to show signs of receding, the situation seems largely unchanged, with mental health and wellbeing remaining a major cause for concern. In some ways, it appears things have, in fact, worsened, with a rising number of staff reporting poor mental wellbeing.
Of almost 1,200 nurses who responded to the survey last month, 44% described their mental health and wellbeing as “bad” or “very bad” – a 10% rise on the 2020 survey. In addition, 62% felt their mental health was “worse” or “much worse” now than it was during the early spike in cases last spring.
The levels of stress and anxiety felt by nurses also remained alarmingly high one year on. In total, 84% rated themselves as feeling either “a lot” or “a little” more stressed or anxious than before the pandemic began.
One nurse said: “Times were tough before but, since Covid, I feel utterly broken.” Others described feeling “exhausted, low and under-appreciated”, and said working through the pandemic had been “damaging” to staff.
One respondent warned that the situation was only going to get worse: “There’s no safety net. We are all tired and exhausted as there’s no let-up.” Another said: “Many nurses are forced to shove their issues down. There is no opportunity to stop, or time to think about how it is affecting you until you are in so deep that you don’t know which way to turn.”
Failing to self-care at work by missing breaks or not eating properly, as well as concerns about contracting the virus and the health of their family and friends, were the most common contributing factors to increased stress levels and anxiety among respondents. Almost two-thirds cited both of these reasons.
More than half said failing to provide effective care because of time or staffing pressures had added to stress and anxiety, and just over a third cited dealing with the death of patients who were alone due to coronavirus restrictions. Starkly, 28% said coping with Covid-19-related illness and/or death of a colleague had been a reason for their poor mental health.
In last year’s survey, lack of personal protective equipment (PPE) had been one of the most common causes for concern among nurses. Although widely reported that the situation has improved, one year on, a quarter of respondents still stated that insufficient PPE supply was a contributing factor to their poor mental wellbeing.
Nursing Times also asked for views on the current level of mental health and wellbeing support available to all health and social care staff. Concerningly, findings were slightly worse than last year: as an example, 62% said the support provided nationally was “inadequate” or “very inadequate” – up from 54% in 2020. Meanwhile, the number who said support was “good” or “very good” – just 10% – remained almost the same as last year.
The picture was no better at employer level: 57% rated the level of support provided locally as “inadequate” or “very inadequate”, up from 50% in 2020, while just 13% said it was “good” or “very good” – the same as last year.
Around 40% had received support from a line manager or colleague and felt this had helped. However, more than a third said they had needed support but did not feel able to ask for it and 13% had asked for it but not received any. This was echoed by one respondent who warned that “a lot of nurses are falling through the net”.
Overall, comments made by respondents suggested there was more of a focus on staff wellbeing than a year ago, but that nurses struggled to find time to access the support that was available and some of it came across as lip service only. One hospital nurse said: “We are constantly told we need to have a rest, get support, relax, take a break away from everything – and yet there is no time set aside for us to do just that.”
A community nurse added: “I rush through the emails that talk about staff wellbeing because I don’t have the time to spend on my emails like I used to.” Another respondent said that, while support was available, it was “sporadic and, frankly, a tick-box exercise so managers can say they have offered help”.
Throughout the pandemic, a range of helplines have been implemented to support staff wellbeing, and some organisations have created designated wellbeing, or ‘wobble’ rooms for staff to take a break. But one nurse flagged that they were often unable to use such rooms because of time constraints, staff shortages and a lack of changing or washing facilities.
From the survey results, it was clear the preferred type of support was individual face-to-face contact with a mental health professional (53%). Meanwhile, 40% felt informal peer support from colleagues would be beneficial. In contrast, just 23% voted for a telephone helpline, 21% for online support and 16% for video calls.
Worryingly, a common theme in the survey was that nurses felt pushed to their limits and wanted to leave the profession entirely – an ongoing concern in recent months, especially amid the winter spike in Covid-19 cases.
Several nurses cited the lack of support as driving them away; these included one who said they were “falling apart” and another who had worked for the NHS for 25 years but now needed to “do something completely different” after what they had been through during the pandemic.
One care home nurse described the past 12 months as the “worst year of my 44 years in nursing”. They felt “physically, emotionally and mentally exhausted”, which was compounded by the fear of a further Covid-19 surge. “If I could afford it, I would leave nursing behind because this year has almost finished me,” they said.
A key observation came from a hospital nurse who believed the pandemic had shone a light on the fact that mental health and wellbeing had been an issue for a long time. “Many nurses have mental health struggles and high levels of anxiety, but it is in our nature to put patients’ needs first,” they said. “The pandemic has highlighted that we are burnt out and exhausted, and staff are now at breaking point so have to ask for help or leave.”
Responding to the survey, Rebecca Smith, managing director of NHS Employers, which represents trusts and is part of the NHS Confederation, said the findings “lay bare the painful toll the pandemic has taken on the wellbeing of our workforce”. She highlighted a recent NHS Confederation report that warned the health service “could lose thousands of staff” if they were not given “enough time and space to recover” from the pandemic. Ms Smith vowed that her organisation would work to ensure staff were “properly supported”.
The Laura Hyde Foundation, a charity providing mental health support for clinical staff, was “disappointed, but sadly not surprised” by our findings.
“For over 60% of respondents to feel the current provision of national mental health and wellbeing support to be inadequate is shocking, and something that requires immediate attention,” said charity trustee Imogen Landers. “It is absolutely not acceptable for staff who have worked tirelessly before and during this pandemic to be so woefully under-supported.”
Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, added: “The unprecedented demand on nursing staff during the pandemic is having a huge impact on their own wellbeing. It is vital the support is available where and when it is needed, and that managers encourage and support staff to seek help.”
Unison head of health Sara Gorton said: “Health staff have given their all to take care of people during the pandemic, but, one year on and there’s still no relief in sight.
“The demands on NHS workers are relentless – hospitals are still treating coronavirus patients, while also dealing with the backlog of cancelled treatments and the rollout of the vaccination programme.
“Many staff are close to burnout. They need access to around-the-clock wellbeing helplines, as well as on-site mental health teams to help them cope with the traumas of the past 12 months.”
A Department of Health and Social Care spokesperson said they were “incredibly grateful for the efforts of nurses” and that supporting their mental health and wellbeing was a “top priority”. They urged “anyone struggling” to “come forward” and access support.