Changed by the pandemic

A resurgent interest in public health and a sharper focus on the mental health of those delivering care are among the lasting transformations resulting from a worldwide crisis.

By Jill B. King ’98

Mindy Close in PPE outside of the emergency room at Salem's hospital
Mindy Close ’08 is one of Oregon’s nearly 104,000 nurses impacted by the COVID-19 pandemic.

The demand on nurses like Mindy Close ’08 has never been greater. Close, a registered nurse and team leader at Salem Health, has spent the past 18 months working long hours in stressful conditions, while filling her free time as a student in Linfield’s Master of Science in Nursing (MSN) program. She vividly remembers being stripped of her regular routines in early 2020 as the hospital focused on treating COVID-19 patients, just as she was starting graduate school.

Salem Health, the largest hospital in Oregon’s capital city, was hit hard early on taking COVID-19 patients from areas as much as 250 miles away. Her previous patients in the wound ostomy department were deferring care, elective procedures were canceled and many departments like hers did not have the patient load to justify their previous staffing. Some nurses were cross-trained in new specializations and others were forced to use vacation time or left the profession altogether.

The irony was not lost on Close: at a time when public health was more critical than ever, nurses and
doctors in some specializations were seemingly being shunted to the sidelines.

On top of uncertainty about their jobs was the worry that time spent in hospitals might make them a risk to others in their families. Close and her husband eventually decided to send their kids to live with grandparents to minimize their risk of exposure.

“Within a week, I found myself longing for a hug from my kids,” Close said. “We weren’t able to celebrate Easter or Mother’s Day as we normally would together. It began to feel like there was no light at the end of the tunnel. It became the loneliest time.”

At one point during those dark days, Close ended up checking on and advocating for a friend in the ICU.

“You understand it as a nurse from a clinical perspective,” she said of the care. But, she said, watching her friend suffer alone, with no family allowed to visit, “the fight becomes personal in your heart.”

It was to be a fight in vain. Her friend’s death, one of the nearly 3,000 Oregonians and four million people worldwide who lost their lives to COVID-19, pushed Close nearly to her breaking point.

“This virus is killing people, and we don’t know who’s next,” she remembers thinking. She was lonely, exhausted, grieving and unsure what the next moment or day might bring.

The importance of public health

Even as frontline healthcare workers like Close continue to battle the disease, the pandemic has had lasting effects on the healthcare system and nursing education programs that will be felt for decades.

The increased focus on public health has coincided with a noticeable growth in interest in public health schools. Although public health education enrollment has grown for the past two decades, the Association of Schools and Programs of Public Health reported a 40% increase in applications to public health programs from March 2020 to March 2021.

Becky Fairhurst ’21 started her Bachelor of Science in Nursing (BSN) at Linfield online in February 2020. She currently co-leads the COVID-19 investigative team in southern Oregon’s Coos County. At the height of the pandemic, Fairhurst was working more than 60 hours a week, balancing life in a blended household with two young children and volunteering in vaccine clinics on days off.

She received her associate degree in August 2019, yet her work as a public health nurse requires a bachelor’s degree, and she quickly realized the benefits of pursuing it.

“I have always had a heart for getting to people before they are sick and having a proactive approach, rather than a reactive one,” she said. “The most difficult thing for me during the associate program and clinicals was that it felt like the patient education was too late.”

With a focus on public health, Linfield’s RN to BSN program has been the perfect fit for Fairhurst.

“I found it intriguing that the BSN program focused on community health in great detail, whereas the associate program hardly mentioned it,” she said.

As the largest segment in the U.S. healthcare workforce, nurses play a key role in public health. The National Academy of Medicine describes nurses as “trusted bridge-builders who collaborate with people, communities and organizations to promote good health and wellbeing no matter one’s background.”

It’s a role that nursing programs like Linfield’s emphasize.

“Nurses connect to people at their most vulnerable moments. They are the human interface between the data, science and patients,” said Kim Dupree Jones, dean of the Linfield-Good Samaritan School of Nursing.

“While data informs decisions, relationships drive decisions. So, when a nurse builds a relationship and invests in the health of one patient, they are also impacting and improving the health of that patient’s community.”

The pandemic has made fundamental public health measures a topic of regular conversations, including handwashing, social distancing, face coverings and vaccinations. It has also spotlighted the need for improved access, equity and emergency preparedness at local and federal levels – something that will keep public health, and the critical need for public-health nurses, in the headlines for years to come.

Addressing the effects of mental health

As Close’s example illustrates, the emotional toll the pandemic has taken on healthcare workers is profound. Levels of anxiety, depression and loneliness are similar to those seen in patients fighting COVID-19 in isolation.

The nonprofit group Mental Health America (MHA) recently surveyed more than 1,000 healthcare workers, and 93% reported high stress while 83% indicated emotional exhaustion. More than half of the nurses surveyed, in particular, reported a lack of emotional support.

“Nurses are driven, caring and want to do everything they can for their patients, and therefore, have an underlying tendency to set high expectations of themselves,” said Sarah Fleischauer, a counselor in Linfield’s School of Nursing. “A profession that allows a pretty low margin for error paired with a self-created pressure to be almost superhuman, it primes nurses for trauma and anxiety – which is the perfect storm for emotional distress.”

For Close, it wasn’t long into 2020 that the emotional toll of the pandemic hit her and her team.

“It’s like running a marathon without adequate training or an end in sight,” she said. “As nurses, our give-a-damn became broken.”

Mental health has an effect on physical health. In the MHA survey, respondents reported trouble with sleep (70%), physical exhaustion (68%), changes in appetite (57%) and physical symptoms like headache or stomachache (56%).

This physical, emotional and mental burnout places an increased importance on nurses to advocate for greater self-care and for organizations and schools to integrate training on nurses’ health and wellbeing into their programs.

“Nurses are proximate to trauma,” said Kaitlynn Durham ’21, a student in Linfield’s accelerated Bachelor of Science in Nursing program and president of the Public Health Club. “We are having to take on a lot of that trauma – holding a patient’s hand, holding phones while loved ones say goodbye. It’s impossible for this not to fall back on you.”

Close’s hospital introduced mental health days, made Peloton bikes available, created access to the Headspace meditation app and trained managers to check in with their frontline staff more often, encouraging breaks and fresh air whenever possible.

Mindy Close sitting outside Salem Health in her PPE.At Linfield’s School of Nursing, two staff counselors offer individual, group and family sessions for free. Through sessions and quarterly workshops, the counselors work with students on coping skills and building plans to support their mental and physical wellbeing.

With the help of Durham’s leadership, the Public Health Club promotes intentionality and thoughtfulness about mental health.

“It’s important to remember that we are more than this,” Durham said. “I am more than a nursing student. I am more than just some experience in the pandemic. I am all of that PLUS.”

At this point in the pandemic, Close is reflective on her own journey.

“There has been a lot of growth, not just in myself, but in the nurses and frontline staff I work with every day,” she said. “We are all changed by what we have witnessed, worked through and felt.”

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