None of us expected the pandemic to last this long. In March, we rallied against the growing and terrible virus, the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). At that time, we hunkered down, businesses temporarily closed to stem off the rising numbers of infection, and we all kind of figured it would end in about six months. It has not. Crises aren’t supposed to last this long. The nature of this beast is that its danger is unseen; its end is unseen; and its messaging couldn’t be more confusing.

So I didn’t think last April, when my research team and I received a small seed grant from our university called a “COVID Rapid Response Grant,” that the pandemic would be surging in the way it is now, seven months later. In my naivety, I quickly put together an online survey with the major inclusion criterion of having respondents be frontline, critical care nurses. Data collection lasted from mid-June through beginning of September.

My research assistant and I are swimming in the data, tackling a subset of the items, the open-ended responses. This is the qualitative stuff that as Cheryl Beck states (I paraphrase here), puts muscle on the skeleton bones of understanding. It’s rough going. The nurses had a lot to say.

On one hand, it validates so many nurse-specific and nurse-patient specific traumas that I articulate in my theory. Insufficient resource trauma (i.e., not enough personal protective equipment, not enough trained critical care nurses), vicarious trauma (i.e., patients passing alone; families in distress at not being with loved ones); workplace violence (i.e., families frustrated and taking it out on nurses); disaster trauma (i.e., fearful of endangering self and others); and system/medically-induced trauma (i.e., patients being coded and ventilated). These all seem so sterile when I list them but come alive in the narratives that reflect fear for self and fear for their family’s safety if exposed to the virus from them, agony, anxiety, intrusive thoughts, nightmares, isolation, abandonment, suffering, exhaustion. One nurse added: We… will be forever changed.”

They report feeling intense guilt over the limited care they can offer to the patients. I read the texts and re-read them. Then, my eyes see unassuming words buried in the single spaced narratives; a seemingly quiet voice stood out: “We want to live also.”

As I consumed this sentence, I was reminded of the period in my life when I was a full-time writer. I believe in the power of words and of the writer, the truths they can convey. At a visceral level, the writer decides the order of placement, the punctuation for emphasis, the parsimony over emotive phrases, even the phonemic sounds, soft versus hard, such as “puppy” and “paw” versus “dog” and “god.” In this moment, I saw this quote and envisioned an exhausted individual who just wanted to be done with it all and alive to move forward with life. But I think there is more.

This tiny, five-word, soft-sentence encompassed a primary reality: a nurse wanting to exist after this pandemic. The nurse used peripheral words surrounding the statement: the “hospital” viewed nurses as “bodies” to take care of patients, an objectification of the nurse. Beyond the words, the owner of this voice asks, “What about us?” As if to inquire gently, “Have you forgotten about us? Are we an afterthought?” A sentence sends a reminder when there should be none needed, but sends it nonetheless to those who see nurses as “bodies” to care of the sick patients: “We want to live also.”

And perhaps a second message is conveyed by the voice wanting to live – right now – without the trauma, without the fear. The existential plea to the “hospital” to affirm nurses’ right to exist and recognize their right to particular, individual, lived experiences amid a global pandemic. And the system responsibilities to acknowledge that they have provided services and supplies for some individuals to live, but perhaps not all. The “also” after this humble statement is noteworthy: “We want to live also.”

Based on my middle-range theory of nurses’ psychological trauma, one antidote is to use trauma-informed care of self and peers. Demonstrating trauma-informed care principles for self and fellow nurses is a critical piece, especially offering a sense of safety. This is a space occupied only when safety can be authentically assured. Unless organizations step up, safety is scarce. My theory is clear: the solutions to such psychological trauma must be shared between the individual and organization. Resiliency can grow when the environment allows. Fertile soil includes sufficient resources, supportive management, a safe work environment, and mental health services. Importantly, management has to de-objectify nurses and view us as sovereign professionals, individuals who have choices. Second, there will be a time when the pandemic is under control, perhaps when a healing space opens for posttraumatic growth. A few nurses also shared narratives where resiliency and posttraumatic growth existed now. One nurse, who had lived through the “HIV, Toxic Shock, Legionaires, H1N1 and so many other diseases,” seemed able to cope with the current pandemic: “I’ve learned that I can rise above it.” One of the few narratives that contrasted sharply from the majority.

My research assistant, Anna, and I meet virtually to discuss these voices (I can’t call them data right now as they seem so intimate). We discuss our reactions, our general thoughts because I want to authentically make sense of them. I feel responsible to the nurses who offered them to us. Anna is about 30 years younger than me. Yet she and I agree on what we see and feel from the voices, and perhaps within ourselves. There is truth: “We want to live also.”

References

Beck, C. T. (2015). Developing a program of research in nursing. Springer.

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Sigma Theta Tau International Publishing.

Foli, K. J., Reddick, B., Zhang, L., & Krcelich, K. (2020). Nurses’ Psychological Trauma: “They leave me lying awake at night.” Archives of Psychiatric Nursing, 34(3), 86-95. http://doi.org/10.1016/j.apnu.2020.04.011