ICN calls for government action to stop attacks on nurses at a time when their mental health and wellbeing are already under threat because of COVID-19 pandemic

29 April 2020

The International Council of Nurses (ICN) condemns verbal and physical attacks on frontline nurses and calls on governments to act now to protect these vital healthcare staff.

Anxiety and overwork are taking their toll on the mental health and wellbeing of nurses, increasing the risk of post-traumatic and other stress related disorders. But the stigma of working with COVID-19 patients has led to abuse and aggression from members of the public, which is adding to nurses’ distress and must be stopped if they are to be able to carry on their essential work.

ICN President Annette Kennedy said:

“There is strong evidence that nurses are experiencing unprecedented levels of stress and are at risk of burnout, threatening their ability to continue to do their vital work. Governments have a duty of care to their nurses, which should mirror the appreciation and support nurses are getting every day from the vast majority of the public.

‘Nurses are a precious resource at the best of times, and during this pandemic even more so. ICN is calling for action now from governments and healthcare organisations to act to protect them from senseless verbal and physical attacks that are adding to their distress and fear.”

The subject of violence against nurses was raised during a series of ICN webinars, including this week during the webinar with Latin American nurses, and also at the launch of the World Health Organization/ICN/Nursing Now State of the World’s Nursing report.

ICN CEO Howard Catton said:

“It is extremely alarming that nurses are being stigmatised for their life-saving work with patients who have COVID-19. The fact that they are also facing abuse and even violence is staggering. We understand that such stigma, abuse and violence are based on ignorance, fear and a lack of information, but it is totally unacceptable. ICN is calling for zero tolerance policies to be put in place at once, because no nurse should have to endure verbal or physical attacks ever, and especially not now.

‘This issue is a concern everywhere, whether countries are about to come out of lockdown or are just going into quarantine. It is vital that governments ensure that the public is properly informed about COVID-19 so that the generally overwhelming support for nurses that we have seen around the world does not see them shunned in the future because of the contact they have had with patients.

‘Nurses have always worked under intense psychological pressure, but the current pandemic is making extraordinary demands on them both physically and mentally. We must support them right now to deal with any immediate mental health issues, and to prevent some of the mental health consequences that may not be apparent now but may emerge in the future.”

ICN mental health messages for governments and healthcare organisations

  • Retaining and supporting the nursing work force requires a focus on promoting and protecting their physical, mental and spiritual health. 
  • Supporting mental health and well-being:
    • Everyone is at risk of psychological distress, overreliance on negative coping mechanisms, negative emotions and destabilisation of existing psychiatric conditions.
    • For health professionals, these risks are magnified by the deaths of patients and colleagues, making decisions about rationing supplies and resources, psychological conflict and frustration with employment situations, helplessness in the face of danger, and conflicting loyalties about commitment to safety for self and family members, and commitment to the profession, the community and their employer.
    • Healthcare providers are at high risk for full-blown stress response syndromes, anxiety, depression, post-traumatic stress disorder, chronic illness and burnout.

ICN is currently concluding a consultation process with a group of global experts on developing a new Mental Health position statement.

However, ICN recognises that, because of the urgency of COVID-19, there is a vital and pressing need for more mental health support for our frontline nurses. Therefore, below we have drawn together our COVID-19 mental health core guidance and recommendations for nurses, which we aim to expand on in the coming weeks and add to our COVID-19 portal.

ICN Mental Health Core Guidance and Recommendations for Nurses

  • ICN urges nurses to reflect on their mental health and wellbeing and reach out for help when needed. Do not wait till the stress is too much to cope with, prevention is better than cure. Support a colleague who is struggling with grief, anxiety, fear and doubts about practice in the new work environments and practices nurses are facing. Seek support of family, friends, community and colleagues: do not be ashamed to seek out professional support - support yourself so you can support others.
  • ICN recognises the threat the COVID-19 pandemic poses to nurses’ health, mental health and well-being. ICN recognises that, over time, the threat of infection will reduce, and we know the mental health impacts of this crisis are here now and, for some, will remain. In many countries, healthcare workers report symptoms of depression during COVID-19, and complaints of insomnia, anxiety and distress were reported more frequently by women. Research findings in the aftermath of SARS predicted increases in acute stress disorder, alcohol abuse and depression. Too easily, hopelessness and self-destructive thoughts can recur in the face of helplessness.
  • ICN recognises a unified response in this International Year of the Nurse and Midwife has never been more important to prevent and mitigate the mental health consequences of this pandemic. While united in professional commitment, nurses vary widely in personal resilience, resources and the capacity to manage personal stress. For those managing personal mental health challenges and/or recovering from a substance use disorder, a crisis like the pandemic can derail a smooth journey. Nurses are part of a team and a health service system, and to support nurse’s mental health and wellbeing, all parts must be able to respond. To support a nurse’s personal resilience under such stressors requires all parts to actively support and build resilience across teams and the health service system. We must strongly insist on the need for additional help, workplace accommodations and peer support.
  • ICN calls on the world nursing community to come together and unify to support the voice of nurses in this the International Year of the Nurse and Midwife. The voice of nurses must be heard and there is no more important time for all of ICN’s National Nursing Associations (NNAs) to join together to share this message and call for the support nurses require to deal with these stressful times. Nurses need to trust they are safe to seek professional mental health care. Nurses must have appropriate access to counselling and support if we are to maintain and retain a healthy and educated workforce into the future, particularly in the face of the global workforce shortage.

Actions by NNAs, nurse managers, colleagues, co-workers and friends can prevent and mitigate mental health issues:

1. Connect nurses with resources in communities and worldwide:

  • Federal and local agency resources and innovative approaches provide networks of support, hotlines, websites and local action groups.
  • Hotlines and blogs have information, stories of hope and resilience, case studies and useful approaches for different cultures, learning styles and language.
  • Smart phone apps and podcasts for stress-relieving activities, coping tools and tele-psychiatry connect nurses to mental health professionals, including psychiatric/mental health nurse therapists/practitioners, for consultation and follow up. 
  • Online Peer Support groups and Twelve-step programmes.

2. Avoid labels and stigma: do not link the disease to ethnicities or geography, or label persons with COVID-19 as ‘cases’ or ‘victims’.

3. Make information on mental health services easily available to staff and colleagues: early interventions ensure a healthier future

See WHO Psychological First Aid: Guide for Field Workers

4. Support teamwork: experienced and newer workers will respond differently. Assess and assign less stressful work when required. Make sure information on workplans, changes in policy and resources are timely and frequent.

5. Create a ‘safe space’ for all nurses. Everyone is at risk for psychological distress, overreliance on negative coping mechanisms, negative emotions and destabilisation of existing psychiatric conditions. Reach out to staff who are quarantined to decrease the effects of isolation.

6. Stay with facts and trusted sources like NNAs, professional organisations, educational institutions and public health agencies.

See WHO Mental health and psychosocial considerations during the COVID-19 outbreak

7. Use creative strategies to monitor workloads with the aim of reducing fatigue and exhaustion.

See WHO Occupational Safety and Health During Public Health Emergencies – A manual for protecting health workers and responders

8. Encourage, empower and acknowledge nursing leadership. Effective nurse leaders are essential to defuse high pressure work situations and facilitate quick decision making. Build a culture that strengthens resilience for individuals and teams.

Download the press release here