Utilizing Employer Created Social Support Programs to Assist Frontline Nurses to Cope with the Psychological Symptoms of Trauma-Induced Stress and Burnout connected to Patient Death during the COVID-19 Healthcare Crisis in the United States

By Mitchell A. Kaplan, PhD; Rohan Sumrah, BSN- RN, CCM; Marian Inguanzo, LMSW, ACSW



Kaplan M, Sumrah R,  Inguanzo M. Utilizing employer created social support programs to assist frontline nurses to cope with the psychological symptoms of trauma-induced stress and burnout connected to patient death during the COVID-19 healthcare crisis in the United States. HPHR. 2021;29.

Utilizing Employer Created Social Support Programs to Assist Frontline Nurses to Cope with the Psychological Symptoms of Trauma-Induced Stress and Burnout connected to Patient Death during the COVID-19 Healthcare Crisis in the United States


According to the latest epidemiological data from the National Center for Health Statistics, the total number of confirmed patient deaths at hospitals nationwide associated with COVID-19 between January 1st, 2020 and April 24th, 2021 has reached 569,771, a figure that continues to rise steadily each month, despite government efforts to vaccinate the nation’s population against the disease (CDC tracker data updated, April 2021). Research shows that the effects of the COVID 19 crisis have had a devastating impact on the lives of thousands of health care workers and forced hospitals across the country to operate at maximum capacity, sometimes to the point of overload. Hospitals have given frontline staff, especially nurses, the primary responsibility for providing compassionate first-rate care to these critically ill patients in high-risk infectious disease settings. Nurses caring for patients with COVID 19 have witnessed a high volume of fatalities within a short space of time, which has resulted in severe adverse effects on their mental health. Frequent exposure to unmitigated loss of life on inpatient intensive care units and in emergency rooms nationwide triggered by the escalation of the COVID-19 pandemic is fast becoming a significant source of acute psychological and physical distress for a substantial number of nurses and other frontline service providers engaged in the battle to save the lives during this unprecedented time. A review of the results of studies cited in the nursing literature provides substantial evidence that demonstrates that nurses exposed to a high number of COVID-19 deaths daily are at increased risk for developing symptoms of psychopathology such as clinical depression, severe anxiety, and fatigue that can impair their job performance and lead to burnout (Maharaj et al., 2018, p. 61). The purpose of this article will be to examine the effectiveness of employer-created social support programs as an institutional resource to help frontline nurses deal with the psychological symptoms of trauma associated with patient death resulting from the COVID-19 healthcare crisis.   

Basic Facts about the Epidemiology of COVID-19 Disease and Its Implications for the Nursing Profession in the United States

The term pandemic has received multiple definitions in the medical literature on infectious disease. According to a recent article published on the JAMA open network by infectious disease specialist Dr. Dara Grennan a pandemic is an outbreak of a contagious illness that reaches beyond regional boundaries to substantially affect a significant proportion of the world’s population (Grennan, D., 2019). No natural disaster has been responsible for the death of more people throughout history than the viruses, bacteria, and parasites that cause deadly strains of disease that spread throughout global populations. Over the millennia, epidemics of contagious disease have been mass killers that have had devastating social consequences for humanity. Lethal pathogenic viruses and bacteria strains have caused the proliferation of several waves of deadly diseases such as malaria, smallpox, and bubonic plague that have taken the lives of millions of people worldwide for centuries. Such is the case of COVID-19, a disease caused by a contagious upper respiratory infection known as coronavirus, which originated in the province of Wuhan, located in the People’s Republic of China, in December 2019 (Walsh B. 2020 March 25th).  


Initial reports of the COVID-19 outbreak by the World Health Organization identified the spread of the disease as a public health emergency of international concern on January 30th, 2020, as the global incidence of reported cases began to rise (Who, January 2020). According to epidemiological statistics from the Center for Systems Science and Engineering at Johns Hopkins University, as of September 7, 2020, the total number of confirmed cases of COVID-19 infection has reached 27.3 million in 188 countries and territories around the world (Johns Hopkins University, September 2020). International mortality data reveals that of the more than 889,000 recorded cases of COVID-19 related death that have occurred globally, 80 percent of the fatalities were among patients between the ages of 60 and 75, many of whom were already suffering from one or more comorbid chronic medical conditions such as type 2 diabetes, COPD, obesity, or Mellitus conditions that severely compromised their immune system making it less likely that they would be able to resist the most severe effects of COVID-19 infection  (CDC, August  2020).


Epidemiological studies of the transmission mode of COVID-19 infection in global populations by the World Health Organization and the U.S. Centers for Disease Control and Prevention have determined that the virus associated with the disease is primarily transmitted through respiratory droplets passed person to person through sustained interpersonal contact within a contained social environment (CDC, April 2020).  Like other global epidemics of similar nature, such as Spanish Influenza (1918), HIV/AIDS (1981), and SARS (2003), COVID-19 is just the latest in series of disease pathogens to exact devastating public health and socioeconomic consequences upon the human population of industrialized and third world nations. On March 11th, 2020, noted biologist and public health researcher Dr. Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO), officially designated COVID-19 as a disease of pandemic proportions as the incidence of infection spread across the European and Asian continents and reached the shores of the United States (Cucinotta & Vanelli., 2020, p. 157–160).   


Studies indicate that COVID-19 patients differ significantly in their presentation of symptoms associated with the progression of the disease. Research by Wiersinga et al. (2020) reveals that patients infected with the virus that causes COVID-19 often display a broad spectrum of categorical pathology related to the illness ranging from being asymptomatic or having mild symptoms of respiratory tract infection to showing more extreme signs of severe sepsis that usually results in death.


National health statistics from the U.S. Centers for Disease Control and Prevention reveal the number of incidences of COVID-19 infection in the United States has continued to rise substantially since the first cases were reported over one year ago. The most recent epidemiological data from the CDC shows that more than 7 million people in the United States have been infected with coronavirus, which causes COVID-19 illness, and over 200,000 have died from the disease. The data also shows that the national incidence rate of COVID-19 infection shows no signs of slowing down, with an average of more than 288,000 new cases of the disease reported every seven days (CDC COVID-19 Tracker data, September 25, 2020). Epidemiologists at the CDC and Johns Hopkins University predict an additional 20,000 COVID-19 deaths by mid-October, projected to bring the nationwide number of reported deaths to between 214,000 and 226,000. Public health experts at Johns Hopkins University and the CDC warn that the second wave of COVID-19 illness slated to hit the United States this fall will increase the estimated number of cases of new infection to somewhere between 140,000 to 370,000 as many primary and secondary schools across the country reopen for in-person student learning and many small businesses lift pandemic restrictions on their customer service operations (Moreno & Wilson, 2020).


As the incidence of COVID-19 infection continues to rise across our nation, findings from several recent epidemiological studies suggest that social disparities associated with race, ethnicity, and income play a significant role in determining which patients succumb to the disease. A recent epidemiological study conducted by Professor Samrachana Adhikari and his colleagues in the Department of Population Health at New York University Grossman School of Medicine provides substantial evidence of this relationship.


The researchers examined the effects of racial/ethnic group membership and annual income on cases of COVID-19 related death in ten major U.S. cities New York, Boston, New Orleans, Detroit, Los Angeles, Philadelphia, Atlanta, Miami, Chicago, and Seattle.  Findings revealed that among residents living in non-white urban counties, the cumulative incidence of infection and death from COVID-19 was significantly higher than those of predominantly white urban counties. The data also indicated a significant relationship between the heightened risk of death from COVID-19 and residents’ annual income. Findings revealed that low-income residents living in mostly non-white low-income urban communities were nine times more likely to die from complications related to COVID-19 disease progression than were residents living in the primarily white upper-income urban areas (Adhikari, Pantaleo, & Feldman, 2020).


Similar results were found in a study by investigators at the University of California Los Angeles (UCLA). The study published in the Journal of General Internal Medicine in June 2020 examined the relationship between state-level income inequality and the disproportionality higher rates of COVID-19 infection and mortality in urban communities across the United States. Investigators used two institutional sources to conduct the secondary analysis of the data.  Statewide income inequality was measured using census data from the 2018 American Community Survey. Increases in the number of nationwide cases of COVID-19 death were calculated using epidemiological data from the Center for Systems Science and Engineering at Johns Hopkins University.


Findings suggest that states with the highest levels of income inequality experienced the most significant uptick in the incidence of mortality associated with COVID-19. This is particularly true in predominantly African American and Hispanic communities nationwide, where a large percent of the population is employed in essential service occupations that place them at a higher risk of exposure to COVID-19 infection. The data further suggests that in communities of color, income inequality also plays a significant role in exacerbating the effects of economic segregation and decreased access to social mobility and medical services, which increases the likelihood of disproportionately higher rates of COVID-19 death in poor minority neighborhoods (Oronce, Scannell, Kawachi, &Tsugawa, 2020).


Another study by investigators at the U S. Centers for Disease Control and Prevention that looked at the relationship between income-based disparities in Utah and the risk of contracting COVID-19 infection further substantiates this association. The study looked at the relationship between income disparities and COVID-19 infection rates in various parts of Utah. Results showed that the odds of COVID-19 infection increased with the level of economic deprivation. Individuals residing in low-income communities of color within the state were three times more likely to contract the virus, causing COVID-19 disease than individuals living in high-income white communities. Findings indicated that rates of COVID-19 transmission were significantly higher in low-income households of color because family members were more likely to have blue-collar service jobs that required them to work outside the home, often in enclosed environments, where social distancing is nonexistent as compared to upper-income white households where individuals were more likely to have white-collar professional positions in organizations that allow employees to work remotely from home. The data also showed a strong correlation between multigenerational low-income households and the increased potential for virus transmission from children to more vulnerable older adults in the family (Nazaryan A, 2020 September 24th).  Results from these and other studies provide substantial evidence that socioeconomic and cultural factors have a significant impact on the disease outcome of patients of color diagnosed with COVID-19, something that needs to be taken into account by frontline nurses overseeing their care.  


The epidemiological research cited in this review supports the premise that the COVID 19 crisis has presented essential workers in the health care community with one of the most unique challenges to patient care in the history of 21st-century medicine. The rapid global transmission of this highly contagious disease throughout human populations, illustrated by the statistics from academic studies, paints a grim picture for those whose profession is to provide quality life-saving care to individuals and families whose lives have been disrupted by these tragic circumstances. As professionally trained caregivers, nurses have been one of the first to respond to what has become a catastrophic emergency of growing proportion. Imposed lockdowns and strict quarantine measures implemented by public health systems have forced nurses to take on non-traditional roles as care providers in medical settings, which they would not have to assume under less stressful circumstances. These unusual circumstances have taken a heavy functional toll on the ability of nurses to provide the exemplary level of patient care for which the profession is traditionally known. 


Observers in nursing education have noted that the course and duration of the COVID-19 pandemic have significant implications for all aspects of clinical practice associated with the profession.  A public statement posted online by Dr. Alicia Ribar, clinical associate professor at the College of Nursing University of South Carolina, provides critical insight into just how much the COVID-19 crisis has impacted the delivery of patient services by nurses at every level of professional practice.  Dr. Ribar conjectures that from students standing at the threshold of entering the nursing profession to more seasoned clinical practitioners to those whose mission is to educate them, the onset of the pandemic has been a test of the innate ability of nurses on the frontline to implement an effective response that enables them to deliver high-quality patient care in the face of adversity.  Dr. Ribar believes that despite the dual professional challenge of caring for critically ill patients with COVID-19 disease while wearing protective equipment to safeguard themselves from infection is daunting; she feels sure nurses are adequately prepared with the professional skills to handle such a dire clinical situation. She recommends that nurses continue to utilize their professional skills to identify those patients at their facilities most in need of urgent care services and triage them accordingly. Dr. Ribar posits that the COVID-19 pandemic has not changed the basics of specialized care that nurses traditionally deliver to critically ill patients at all times. She is confident that in spite of the professional obstacles imposed on the health care system by the present crisis, nurses will continue to fulfill their essential role as dedicated caregivers by providing critically ill patients and their families with the highest level of professional services possible, even at the cost of personal sacrifice during this unusually stressful time (Felder,2020).


Yet despite the apparent optimism of nursing educators like Professor Ribar for a substantial number of practicing nurses on the frontline of the COVID-19 struggle, the daily grind of providing critical care services to an expanding population of patients with severe illness has pushed their physical and emotional resilience to the breaking point. While some nurses and other medical professionals have started to see the light at the end of the tunnel with the recent government escalation of the COVID-19 vaccine distribution initiative around the nation, most still acknowledge that the battle against this disease is far from ended.


Anecdotal evidence suggests that one of the critical lessons that the pandemic has taught nurses on the frontline of this crisis is that caregivers need to work in a supportive, nurturing environment where their self-care needs are acknowledged and viewed as a valued priority of the organizational setting in which they are employed.  It is a lesson that is rapidly gaining considerable professional acknowledgment and support throughout the health care industry, given the fact that the COVID-19 crisis has been a catalyst for the rising incidence of psychological trauma among nurses and other health care providers on a national scale. The proliferation of stress-related psychiatric disorders among health care professionals combating COVID-19  is increasingly becoming a secondary side effect of the crisis, underscored by the expanding number of media reports posted online about physicians and nurses who died by their own hand after contracting the coronavirus while caring for seriously ill COVID-19 patients at their facilities.  For example, a story that broke in the April 28th, 2020 edition of the Washington Post online highlights this emerging secondary crisis among health professionals involved in the fight against this disease. A prominent New York City emergency room physician at New York-Presbyterian Medical Center, Dr. Lorna Breen, was found dead in her apartment by suicide after contracting the coronavirus while providing treatment services to hundreds of dying patients at the center is just one more example of what is fast becoming a silent epidemic among overworked highly stressed providers (Lati & Bellware,2020).


Among nursing professionals, this parallel crisis is even bleaker. Research indicates that the risk of suicide among nurses on the frontline of the COVID-19 crisis is rising.  A review of the results of a growing number of studies reported in the medical literature provides substantial evidence of the global increase in workplace-related suicides among nurses caring for COVID-19 patients in high-stress clinical settings. A study reported in the Journal of Brain Behavior and Immunity in 2020 highlights this emerging mental health crisis in the nursing profession. The researchers examined the medical records of nursing staff who died from COVID-19 related suicide in the United States, Italy, Britain, Germany, Saudi Arabia, India, and Bangladesh to determine risk factors for these fatalities.  They found that stress factors such as fear of illness, a sense of helplessness, and the trauma of witnessing patients die alone were the primary factors that contributed to the increased level of suicide risk among nurses and physicians working in hospital settings internationally (Thakur & Jain, 2020).  Findings from studies like this emphasize that the COViD-19 crisis has placed the psychological health of our frontline nurses and physicians in a severe state of dysfunction that jeopardizes patient care during these unusually trying times. The trauma of witnessing patient death on such a mass scale from this disease for a sustained period has been the trigger that has contributed to the exposure of the psychological vulnerabilities of frontline service providers nationwide that needs to be addressed effectively through organizational intervention.         

COVID-19 Death and the Mental Health of Frontline Nurses

Since the start of the COVID-19 health care crisis in the United States a little more than a year ago, registered nurses have been at the forefront of the battle to save lives at hospitals across the country. As the crisis has continued to worsen, frontline nursing staff at hospitals nationwide are working under substantial pressure to provide a level of high-quality care to the growing number of critically ill patients with COVID-19 disease. The mainstream media have hailed nurses as heroes during this time of crisis because of their selfless professional dedication and personal sacrifices they have made to provide state-of-the-art medical services to very ill patients in a high-risk infectious environment.


Fallout resulting from the COVID-19 crisis presents nurses on the frontline of the battle against this disease with unprecedented challenges in coping with the unforeseen lethal consequences of the illness for patients receiving their professional services. The contagious nature of this highly infectious disease has caused nurses to witness higher than average volumes of mortality in the clinical settings they work in, which significantly affects their mental health. The pandemic has left the four million nurses in this country more susceptible to what some experts are calling psychological injury or trauma, a condition that often goes unrecognized because it is hidden and quietly endured underneath the visible layers of patient services that these professionals provide.


 In his book, The Influence of Psychological Trauma in Nursing, published in 2019 shortly before the onset of the COVID-19 pandemic, psychiatrist Dr. John R. Thompson and nursing professor Karen J. Foli examine the types of psychological trauma that nurses experience as part of their professional role as caregivers to critically ill patients. The authors point out that psychological trauma is an embedded part of nursing practice and may sometimes express itself in the form of uncomfortable or confusing professional interactions with patients and colleagues.  They argue the symptoms of psychological trauma such as feeling unsafe, low self-esteem, anxiety, grief, depression, and loneliness are not unique to the experience of nurses themselves; patients dealing with life-threatening illnesses also exhibit many of the same behaviors. They contend that when nurses observe these types of trauma-induced actions in patients they care for, it is essential that they learn how to listen to and empathize with what patients are experiencing for holistic healing and recovery to take place (Thompson & Foli, 2019).


Further evidence of the reality of the significant risk of psychological trauma in nursing practice is found in the Research of Maunder et al. 2006, Moudi et al. 2017 and Maharaj et al. 2018. The findings of these three studies suggest that due to the nature of their work, nurses are at a substantially higher risk of developing symptoms of psychological distress, posttraumatic stress disorder, and death anxiety due to increased exposure to patient mortality, which can significantly impair their job performance and ultimately lead to medical errors and burnout that jeopardizes patient care and safety.


 The introduction of expanding numbers of patients with COVID-19 infection into clinical settings nationwide has exacerbated these trauma-induced reactions among frontline nurses and other medical staff who have endured more frequent and prolonged exposure to the severe physical and psychological consequences of caring for patients dying from this disease. Studies cited in the nursing literature provide considerable evidence that substantiates this premise. Research by Mealer et al. 2009 suggests that nurses caring for critically ill COVID-19 patients tend to experience the incidence of psychological symptoms of posttraumatic stress disorder (PTSD), such as depression and anxiety, at much higher levels than the rest of the general population.  A study by Mo et al. 2020 revealed that nurses on COVID-19 units who worked long hours with heavy workloads and insufficient resources tended to experience high levels of stress subject to the demands of their job that negatively affected their physical and mental health.


Research conducted by Tan et al. & Lai et al. 2020, using samples comprised of nurses, physicians, and allied healthcare workers in Singapore and mainland China found a high incidence rate of trauma-induced symptoms of anxiety, depression, posttraumatic stress disorder, insomnia, and distress among hospital staff particularly nurses who were caring for COVID-19 patients during the pandemic. The high rate of trauma-related psychological symptoms among frontline nurses engaged in the battle against COVID-19 disease is a significant issue of concern that needs to be strategically addressed by healthcare facilities worldwide. Employers need to develop on-site interventions that can effectively manage trauma symptoms and promote an institutional environment that fosters positive mental health and productivity for frontline nursing staff.     


In addition to symptoms of psychological trauma that negatively affect the job performance of frontline nursing staff fighting COVID-19, a secondary work-related issue that employers need to pay closer attention to is physical fatigue resulting from working long hours and extra shifts without a break during the worsening healthcare crisis. Findings from a study by Johnson et al., 2018 suggest that increased demand for physical, cognitive, and emotional activity by employers during the COVID-19 crisis can potentially cause unsafe levels of physical and emotional fatigue among nursing staff that can impair their clinical judgment resulting in medical errors that endanger the health and safety of patients. Other studies by Barker & Nussbaum 2013 and Alharbi et al. .2019 further corroborate the significance of this issue among nursing staff during the pandemic. Findings from both studies indicate that longer shifts that increase the number of hours nurses work per week strongly correlate with higher physical and total fatigue levels. The studies also suggest that different types of occupational fatigue had a negative correlation with perceived levels of job performance reported by nurses engaged in providing services to very sick patients with COVID-19 disease who were often entering the terminal phase of their illness.  Many nurses in the studies also reported having reached the threshold of their physical and emotional endurance. They were experiencing compassion fatigue brought on by having witnessed extreme suffering and death related to the disease.


Given that during this pandemic, frontline nurses and other medical staff work many more hours than usual under increased occupational stress. It is not surprising that they are feeling the symptoms of psychological trauma and fatigue resulting from work overload that impacts their job performance. Three studies by Halbesleben et al.., 2008   Saleh et al., 2014, and Dyrbye et al., 2019 provide significant indications that nurses suffering from trauma-related symptoms such as depression and occupational fatigue from an increased workload are at a higher risk of having comprised job performance resulting in unsafe nursing practices such as medication administration errors, burnout, emotional exhaustion, and depersonalization that have the potential to harm the health and wellbeing of patients under their care. This situation is increasingly becoming the norm at hospitals around the United States as the COVID-19 pandemic expands, and the system is inundated with thousands of critically ill patients needing emergency care. The next section of this article will examine the types of supportive interventions that employers can implement to assist frontline nurses in dealing with the effects of psychological trauma associated with the COVID-19 pandemic.

Social Support Programs for Frontline Nurses Combating COVID-19

It is well documented in the nursing literature that social support programs implemented by employers can have a positive effect on the mental health of frontline nursing professionals caring for patients with critical illnesses such as COVID-19.  Research by Potter et al., 2013 examining the impact of resiliency education on oncology nursing staff suffering from symptoms of compassion fatigue found that the relaxation exercises and self-care skills that nurses learned from their participation in these type of employer-supported intervention programs significantly improved their relationships with colleagues at work and with their family members at home. Similar results were found in a study by Naushad et al., 2019 that looked at the effects of employer-supported intervention programs on the mental health of nurses providing care to critically ill patients in natural disaster situations. Results suggested that these types of employer-supported intervention programs substantially benefited nurses caring for critically ill patients in these kinds of extraordinary circumstances. Another study by Hu et al. 2020 that examined the relationship between social support intervention and occupation-related psychological symptoms of burnout, depression, fear, and anxiety among a sample of frontline nurses caring for COVID-19 patients in Wuhan, China, revealed that even though only moderately correlated supportive interventions did play a significant role in helping nurses to cope with these symptoms under unusually stressful and demanding clinical situations.     


Three other evidence-based supportive services that employers can implement to assist frontline nurses in coping with trauma-induced psychological symptoms associated with caring for patients with COVID-19 disease are the creation of multidisciplinary teams of mental health specialists comprised of psychiatrists, clinical psychologists, psychiatric nurse practitioners, and psychiatric social workers who can provide therapeutic intervention to frontline nursing staff as needed.  Implementing an employer-supported telephone hotline staffed by a team of well-trained psychiatric specialists can offer emotional assistance to frontline nurses in crisis. Employers can also provide social support to frontline service providers by creating shift schedules that allow nurses to rotate in highly pressurized work environments and access online resources that can provide them with up-to-date medical information on COVID-19 disease (Kang et al., 2020).


Research by Schmidt & Haglund, 2017 found that implementing regular employer-promoted debriefing sessions is an effective means of providing frontline nurses engaged in the COVID-19 healthcare crisis with a work environment that is educational and socially supportive. Structured debriefing sessions provide nursing staff with opportunities for social interaction with their colleagues that allow them to reflect on and share their professional experiences in a relaxing and self-healing atmosphere. The researchers recommend that structured debriefing sessions be a continuous option for all frontline nursing staff on every shift. It is a proven method of relieving trauma-based symptoms of occupational stress, improving job performance, and preventing burnout. 


Research has shown that structured programs of employer intervention can significantly reduce trauma-based psychological symptoms experienced by frontline nurses caring for patients with COVID-19 disease. A review of the results of several recent studies in the nursing literature substantiates the tangible benefits of these programs for nursing staff dealing with the symptoms of psychological trauma and occupational stress associated with the COVID-19 crisis. Findings from studies by Rushton et al., 2015, Salvarani et al., 2019, Badu et al., 2020; Xiao, 2020; and Shahrour & Dardas, 2020, provide considerable evidence that employer-based intervention programs that emphasize increasing levels of self-efficacy and resiliency in frontline nursing staff are the ones most beneficial to their mental health.


The implementation of such evidence-based programs by nurse managers at health care facilities around the country has been shown to increase levels of resilience and stability, decrease levels of acute depression, stress, and anxiety, improve levels of sleep quality, increase the development of coping and mindfulness skills, and promote improved levels of emotional regulation which enhances the ability of nursing staff to display empathy for critically ill patients with COVID-19 disease as well as other chronic illnesses. Results also indicate that participation in social support intervention programs that emphasize the development of self-care skills that increase the acquisition of these positive protective psychological characteristics facilitate the reduction of emotional exhaustion and burnout, improve job performance, and ultimately contribute to better mental health outcomes for frontline nursing staff coping with the unprecedented occupational demands of the COVID-19 pandemic.


A meta-analysis of the beneficial effects of social support intervention programs that focus on Mindfulness-Based Stress Reduction (MBSR) described in the professional literature by Ghawadra et al., 2019 provides further evidence of this contention. Findings reveal that MBSR interventions that significantly reduce the primary symptoms of stress, anxiety, depression, and burnout associated with occupation-related psychological trauma are things that employers need to focus on when designing training initiatives that enhance mindfulness among nursing staff engaged in the COVID-19 crisis. For example, Magtibay et al., 2017 studied the effects of blended learning alternatives on a group of frontline nurses taking part in a Stress Management and Resiliency Training initiative known as the SMART program administered at a local hospital. The investigator used three self-selected formats internet-based learning, independent reading, facilitated group discussion, dispensed the learning objectives, and followed training information to the nurses participating in the study. The data showed that nurses that completed the SMART program reported increased levels of resiliency, mindfulness, personal happiness, and professional adjustment.  Similar results were attained in a study by Joyce et al. 2018 that compared the efficacy of several different resiliency training intervention programs. Findings suggest that intervention programs that combine cognitive behavioral therapy with structured mindfulness training activities are the most successful in raising the resilience level of frontline nursing staff.


In summary, the COVID-19 healthcare crisis is having significant traumatic effects on frontline nursing professionals’ psychological health and wellbeing around the world. Confronted with a growing influx of critically ill patients in need of care, nurses face unprecedented occupational challenges that experts believe have devastating consequences for their professional ability to cope with the trauma-induced symptoms of escalating patient death. To meet these challenges, hospitals and other health care facilities need to invest in establishing employer-administered program services that can help nursing staff build self-resilience and mindfulness skills that will enable them to handle the psychological consequences of the current range of highly stressful and demanding clinical circumstances.


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About the Authors

Mitchell A. Kaplan

Mitchell A. Kaplan is a research consultant and professional writer in private practice in New York City. He received his doctorate in Sociology from the City University of New York Graduate Center. He was also the recipient of a Postdoctoral Research Fellowship from the National Institute on Drug Abuse. Dr. Kaplan has worked as a research scientist and consultant for several non-profit social service and city government agencies and is a regular contributor to professional journals, academic textbooks, magazines, and newspapers. 

Rohan Sumrah

Rohan Sumrah is a registered nurse in New York State since 2014. His professional credentials include a BSN in Nursing from the College of New Rochelle, a B.S. in Health Services Administration. From Lehman College, and a case management certification from the Commission of Case Management (CCM). Mr. Sumrah is currently a graduate student at New York University, College of Nursing, working on his master’s degree. During the height of the COVID-19 health care crisis, Mr. Sumrah worked as a frontline nurse at Elmhurst Hospital Center in Queens and as a case management/care coordinator at New York Columbia-Presbyterian Medical Center in Manhattan.

Marian M. Inguanzo

Marian M. Inguanzo is a licensed clinical social worker in New York City. She received her MSW from Hunter College Graduate School of Social Work. Ms. Inguanzo has worked for community-based social service agencies for 25 years implementing programs that have provided essential services across the public health system. Ms. Inguanzo is also a regular contributor to professional journals in social work and public health, magazines, and newspapers and has given presentations at national and international social work education conferences.