New Research Could Help Health Care Workers with Pandemic Stress

As the number of deaths in the United States from COVID-19 surpasses 100,000, the huge toll of the pandemic on individuals and the economy is demonstrated daily in news outlets across the country.

For nurses, physicians, and others caring for the sick, the emotional and physical toll of pandemic-related stress may be less visible but is no less insidious, says Allison Norful, PhD, a research scientist in Columbia University School of Nursing who studies burnout among nurses and other health care providers. 

“Clinicians have endured battlefield-like conditions in caring for those with COVID-19. We have to recognize this is a mass-casualty event for front-line clinicians,” Norful says. “Once the emergency begins to fade, we will begin to see the effects of working in those high-stress environments for a prolonged period of time. We need concrete data about how to promote recovery and help prevent our health care providers from becoming further casualties of this pandemic.” 

CUIMC News spoke with Norful about the research she recently started to learn more about increasing resilience.


What’s different about working with critically ill patients with COVID-19?

Nurses, doctors, and other clinical staff who work with the critically ill are prepared for a certain amount of patient deaths, and they have developed coping mechanisms to deal with the emotions that emerge from that.  

What’s novel about the pandemic is the uncertainty surrounding treatment protocols and the changing landscape of care delivery. For example, several organizations changed their visitor policies to help reduce viral transmission. As a result, most COVID-19 patients can’t have loved ones at the bedside. This means many clinicians have found themselves holding the hands of dying patients or setting up video calls between patients and their families. It’s emotionally draining to serve both roles, and there’s a risk that clinicians will develop compassion fatigue or worse, moral injury—which can surface as apathy, self-isolation, and self-destructive behavior—that won’t be evident until after the pandemic slows down.  

The information gap about the best treatments and, in some instances, limited resources for treating patients with severe illness have quickly catapulted clinicians into an overwhelming environment. Many health care providers have had to make very difficult decisions, which has left some feeling emotionally exhausted. 

What long-term effects could the pandemic have on clinicians?

Before the current pandemic, researchers had begun to report on the negative implications of clinician burnout, including increased risk of chronic pathophysiologic conditions, such as cardiovascular disease, depression, suicidal thoughts, and low workforce retention rates. 

The long-term implications of this pandemic on clinicians have yet to realized. 

In the early stages of the pandemic, clinicians seemed to be running on adrenaline. In our recent survey of clinicians at a major academic medical center in Washington, D.C., clinicians reported an increase in anxiety, worry, and insomnia, but not depression. 

As things settle, we may begin to see levels of depression and post-traumatic stress rise. Chronic medical conditions may become exacerbated by the stress and lack of physical exercise nurses and other health care providers are reporting. We will be following clinicians over time to see what happens. 

Even more alarming is the possibility that many clinicians will leave the profession as they begin to feel the full emotional impact of working during the pandemic. This would create tremendous organizational challenges for hospitals and have a negative impact on public health and our ability to meet the demand for care. 

Can the military provide some lessons?

Both military and civilian health care workers are used to working in high-stress environments, but they are trained to deal with stress differently. 

In the military, medics receive formal resilience training to equip them for battlefield-like environments. Their civilian counterparts, however, often have little to no formal preparation to handle these high-stress conditions emotionally.

There’s currently no gold standard for resilience training. The Ryan Larkin Field Hospital, built inside Columbia University’s Baker Field Athletics complex, gives us a unique opportunity to compare resilience strategies among both military and civilian clinicians who worked in the temporary COVID facility. We are now designing a trial to compare resilience-building strategies. Our plan is to follow the field hospital clinicians, as well as clinicians at other hospitals with COVID patients, over the next two years to see if certain resilience interventions work better than others.   

What we learn may help us increase levels of resilience in clinicians before the next pandemic and other disaster-like events. 

How has social media affected the way health care workers cope with the stress?

One of the interesting findings from our recent study was that more clinicians began turning to social media to report their experiences, exchange information about organizational protocols, support fellow clinicians, and offer tips for clinical care and safety. It appears that increased social media activity among clinicians actually helped foster a sense of solidarity on the front lines. 

Allison Norful, PhD (Columbia University School of Nursing)

This is a departure from the typical hierarchy surrounding the dissemination of research and clinical data. It will be interesting to see if these trans-institutional dynamics persist after the pandemic.


If you are a Columbia University Irving Medical Center employee experiencing stress or trauma related to COVID-19, please visit CopeColumbia for information about resources and services.