How Are ICU Doctors, Nurses, And Other Professionals Feeling About the COVID-19 Pandemic?
We all see the videos, social media posts, and news reports about what is happening in our nation’s Emergency Departments and Intensive Care Units. We all have gotten a glimpse into the horrific world that is the COVID-19 pandemic, and the horror of what this virus can do to people. Many ICU Doctors and Nurses have shared how they are feeling, and how this pandemic has affected them personally. I certainly have myself.
A new nationwide survey of ICU clinicians, published by the Society of Critical Care Medicine, gives further insight into how ICU Nurses and Doctors are feeling. Between April 7–22, 2020, an anonymous web-based survey was administered to query members of U.S. national critical care organizations. It was a 16-item descriptive questionnaire, and it assessed ICU clinician perceptions regarding current and emerging critical ICU needs, resource levels, concerns about being exposed to SARS-CoV-2, and personal stress.
A total of 9,120 ICU clinicians responded to the survey (I think I took this survey myself, in fact). The respondents represented all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more COVID-19 cases. 7,317 respondents indicated their profession. Of those, 91.3% were ICU nurses, 4.5% were nurse practitioners and physician assistants, 2.9% were physicians, and 0.8% were ICU pharmacists and respiratory therapists. 88% of respondents reported having cared for a COVID-19 patients. So, these clinicians are in the very thick of things.
Here were the main findings of the survey:
- The most critical ICU needs identified were the availability of PPE, specifically N95 masks (38% of respondents said this), and ICU staffing (21.2% of respondents said this). When asked what the second and third most critical ICU needs were, PPE was the #1 response.
- Turnaround time for SARS-CoV-2 testing was also a major concern for ICU clinicians
- 30.9% reported that the most challenging aspect of COVID-19 patient care was minimizing healthcare worker virus exposure.
- Respondents were asked what they anticipated would be future ICU resource limitations, and 40.9% said personnel, 36.4% said therapeutic agents, and 36.1% said ICU capacity (including surge potential).
The survey also asked if ICU clinicians did anything special to limit exposure of COVID-19 to their family members, and this is what they said:
- 71.8% change their clothes before/after work
- 63.8% shower before joining family
- 62.2% regularly clean and disinfect household items
- 57.2% limit physical contact until they decontaminate themselves
- 51.0% use hand sanitizer before entering home
- 45.3% shower and wash their clothes away from family
- 40% developed a plan for what happens if they become ill with COVID-19
- 16.5% stay in isolation from household at home
- 12% stay in isolation with alternative housing away from their household
- 6.8% wear a mask at home
I must admit, I do #1, #2, #4, #5, #6, and #7 routinely. I used to sleep in the basement in the very beginnings of the pandemic.
More than anything else, the fear of giving COVID-19 to my wife and kids is what terrifies me the most.
Furthermore, the survey asked ICU clinicians to rate the level of concern about exposure to COVID-19 and the level of personal stress they had on a scale of 1–10. Here are those answers (median answers are listed):
- Level of concern about personally being exposed to COVID-19: 8.0
- Level of concern about exposing family members to COVID-19: 10.0
- Level of personal stress as a result of COVID-19 pandemic: 8.0
- Level of personal stress before the COVID-19 pandemic: 3.0
These results are very important insights into how ICU Doctors, Nurses, and other Healthcare professionals working the ICU are feeling. There is a great deal of personal stress and fear when taking care of patients with COVID-19, and what was very striking to me was how much worse the levels of personal stress have become as a result of the pandemic. This cannot be good long-term.
I can totally relate to the levels of personal stress reported in this survey. Never before have I taken care of super sick patients that have an illness that could make me very sick, or worse, could make my wife and kids very sick. This — more than anything else — terrifies me the most about taking care patients with COVID-19.
The information in this survey should be essential reading for those in healthcare leadership. We need to ensure that the clinicians on the front lines have adequate PPE and adequate ICU staffing levels. Testing concerns and the availability of therapeutic drugs are frequently beyond the control of hospitals and healthcare systems. But, what is in their control is how they address the very high levels of clinician stress as a result of the pandemic.
Those in leadership need keep an eye on their ICU Doctors and Nurses, ask how they are doing, and make sure that they have ways to cope with the stress they are feeling. We on the front lines also need to keep an eye out for and check in on one another, as well.
Unfortunately, this pandemic is not going away any time soon. Even for me, where the pandemic has slowed considerably, there is always a lingering level of concern about a resurgence of this disease, especially as the Fall and Winter set in. Clinicians are feeling a considerable amount of stress, and it is imperative that whatever is causing this stress is addressed to the best of all of our abilities. If our caregivers are not well, then they will not be able to care for their patients, with our without COVID-19. And then, ultimately, all our patients will suffer in the end.