Christine Kovner, PhD, RN, FAAN, on Work-Home Conflict Associated With Depression, Anxiety Experienced By Frontline COVID-19 Nurses
Home-life conflict and work‑home conflict were major predictors of anxiety and depression experienced by frontline RN nurses during the first wave of the COVID-19 pandemic, according to a recent study published online in Nursing Outlook.
In this video, Christine Kovner, PhD, RN, FAAN, Mathy Mezey Professor of Geriatric Nursing at New York University’s Rory Meyers College of Nursing, New York, discusses the impetus for the study growing out of her work during Hurricane Sandy and the key findings.
In the upcoming Part 2 of this series, Dr. Kovner discusses the impact support services have on depression and anxiety experienced by nurses as well as the need for further academic training on “disaster” settings for healthcare workers.
Kovner C, Raveis VH, Van Devanter N, et al. The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City. Nursing Outlook. 2021 Apr 5:S0029-6554(21)00093-2. [Epub ahead of print].
Christine Kovner, PhD, RN, FAAN, is the Mathy Mezey Professor of Geriatric Nursing at New York University’s Rory Meyers College of Nursing, New York. She is a Professor in the Division of Translational Medicine at the Grossman School of Medicine and affiliated faculty at the School of Global Public Health both at New York University.
Christine Kovner is a public health nurse by training and experience and has been an educator at the Rory Meyers College of Nursing, New York University for over 30 years. During that time, she has taught and advised hundreds of undergraduate and graduate students. She has taught courses such as Community Health Nursing, Nursing Leadership and Management, Professional Nursing, Nursing Policy, and Financial Management. She is the Editor of the journal Policy, Politics and Nursing Practice.
I'm Chris Kovner. I'm the Mathy Mezey professor of geriatric nursing at the Rory Meyers College of Nursing at New York University, New York. I'm a nurse and I spend most of my time doing research, particularly on the nursing workforce and the implications of the workforce on the quality and patient safety of patient care.
Q: What led you and your co‑authors to investigate the impact of COVID‑19 on RN nurses?
A: Our general research focus is on the nursing workforce. That's a topic that we know a lot about, I've written a lot of papers on. In particular, my area is newly licensed nurses.
We had Hurricane Sandy in October of 2012 where our university hospital had to be evacuated in the middle of the night, including babies in the neonatal intensive care unit and other ICU patients, because the hospital got flooded from the East River. It wasn't a hurricane when it hit New York City, but we called it a super storm.
When that happened, my colleagues and I decided it'd be interesting to see how the nurses did, one, during that evacuation, and then what happened afterwards because the hospital was closed for several weeks. The nurses were sent to other hospitals in the city where our patients had been set.If a bunch of patients had been sent to Mount Sinai, we then sent a group of nurses to Mount Sinai to care for them.
When COVID started, we thought, "This is a disaster in many ways."
If you look at the disaster literature, you'll see that people talk about it in terms of a disaster.
Since we had written some papers about what it was like for nurses to deal with the superstorm Sandy disaster, we thought, let's try to find out some information about how these nurses respond to COVID, and compare nurses' response to an epidemic‑type disaster compared to a weather disaster.
Q: Please briefly describe the study method and participants. Then, please briefly describe the most significant finding(s).
A: There was some urgency. In end of February, beginning March last year, my colleague, who had been the lead on the Sandy project, came to me and said, "We really need to study nurses in COVID."
As you all know, going through the human subjects committee at large universities is a time‑consuming process.
Getting hospitals to agree for us to talk to or send surveys to their nurses is a generally long and complicated process. For expedience, we decided we would look at NYU's hospitals. NYU has four hospitals that are part of the health system, a lot of federally‑qualified health centers, and other ambulatory care facilities.
One of those hospitals is a major medical center, one is an urban teaching hospital, one is a specialty orthopedic hospital, and one is a suburban hospital. We went to the head of nursing at the health system and said, "Could we do this study on the nurses?"
She was very supportive and agreed to do that. She was new on the job at the time.
We could quickly write up what we wanted to do. We only had to deal with human subjects committee at one setting. The NYU medical center has its own human subjects committee, and we got permission to do that. We had some money, but we didn't have a lot of money to do the study, so we based a lot of what we did on what we had looked at during Sandy.
As it turned out, which was quite a surprise to me, NYU Langone Health employs about 7,500 nurses. We had a good population to start with. We were able to get the hospital to agree that we could send an email out to all the nurses who were employed at NYU. They didn't give us the actual email addresses.
Because we have email accounts at the hospital, we were able to go into the system and send the survey to a LISTSERV, but we didn't know the identifiers. Therefore, when we did reminders, we sent the reminders to everybody. We got a sample of about 2,500 nurses, which we were surprised at. We collected data between about May 7th and July 10th or so of 2020.
We were surprised that we got a response rate as high as 35%. That suggested to us that these nurses wanted to talk to somebody about what was happening. We were pleased with that.
In terms of what the most significant findings are, I'll go through what some of the highlights are. The more the nurses took care of COVID patients, the more depressed and anxious they were.
I think a lot of people would say, "Duh, of course, that's going to be true."
Not necessarily, because sometimes, what happens to nurses and other health providers is they get numb to what they're doing, because they're doing it day in and day out, over and over again. That was a major finding. Home life conflict and work‑home conflict were major predictors of anxiety and depression.
A home‑work conflict is when, let's say, someone in your family is ill at home, but you have to go to work. Work‑home conflict had a stronger relationship to anxiety and depression. Many of the nurses during this time were sent to the units which they weren't prepared to go to. They didn't know any of the people in the ICU that they were sent to. Often, they were asked to work extra hours.
If you recall, back in the late spring in New York, the hospitals were totally overwhelmed with very ill patients. The strongest positive predictor— or maybe negative is the right word— nurses who had a lot of resilience, in terms of the mastery, in terms of their self‑efficacy, were much less likely to be anxious or depressed than those nurses that did not have this sense of mastery and self‑efficacy.
We asked the nurses what helped them the most in dealing with their response to this very stressful situation. At the top was co‑workers' support. That was important when they knew the group. If they were in a new unit, it was less important. Training in proper PPE was the next most helpful thing. If you remember back to late spring of 2020, there were great shortages of PPE. I don't think NYU had the shortages that some of the other hospitals in the city had, but we did have some shortages.
Support from family and friends was the third most common support that they found helpful.
This is a more minor finding, but for me, because I'm an academic and work in a college of nursing, only 25% of the nurses felt that their nursing education had been helpful.
From our point of view, that makes us look upon how we are teaching the nursing students to deal with both communicable diseases and disasters. In defense of the nursing schools, about half of our sample were less than 40-years-old, but half of the sample were older than 40.
Probably, the people who were over 40, I would suggest, didn't remember back to what they did in school as well as the younger nurses did. It is still a concern that so many nurses thought that their nursing education was not useful.