Nursing in a Pandemic

by Marie Manthey, PhD (hon), MNA, FAAN, FRCN

We live in a world of polarities—of yin and yang, shadow and light, good and bad. Nursing’s reality during the COVID 19 pandemic is one that embodies the same polarities. Practice today can swing us from unbelievable courage, compassion, love, clinical savvy, the meeting of extraordinary physical demands, and the magnificent teamwork of interdisciplinary and interdepartmental colleagues, to fierce fear, blinding anger, a terrible sense of betrayal, feeling disrespected, feeling like failures, and even fretting about being laid off due to low census.

Many of these feelings and experiences have been part of nursing for a very long time. The difference now is that these rapidly cycling emotions are being compressed into weeks, days, and minutes. We still experience a reality that is at times unspeakably beautiful, tender, and joyful, and at other times frustrating to the point of individuals becoming depressed, raging with anger, burning out, and leaving the profession. This compression of both ends of the polarity of nursing into such a tight timeframe is one of the things that makes COVID 19 unique and quite devastating in the world.

Besides being a novel virus, whose trajectory continues to challenge our knowledge and requires constant modifications of what we think we know about treatment of the disease and care of sick people, this pandemic is like a tornado that picks up a healthcare worker’s life, shakes it, and drops it on a hill a few hundred feet away. Things you thought would break are intact, and things you thought were permanent are shattered. The light, in this devastating time, hits virtually everything in a new and surprising way.

In the many conversations I’ve had with nurses since the pandemic began, I have repeatedly heard the same plea from leaders, to have something—anything—that is solid and steady that they can hold onto in this time, and just as importantly, that they can provide for the people they’re leading. With policies, procedures, structures, and whole systems changing by the hour, what can nurses hold onto?

The answer that has consistently provided the greatest comfort to these leaders is this: The values of the nursing profession have endured, unchanged, for more than a century and a half. They are steady, and sturdy, and they will be the same tomorrow as they were today.

What are these legacy values that will never change? One is Nightingale’s declaration that nursing is both an art and a science. The science of nursing is technical competence, and the art of nursing is the establishing and nurturing of a healing relationship. Nightingale knew that only when a nurse is both technically and relationally competent can that nurse be said to be clinically competent.

The other is Henderson’s definition of nursing:

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge

Henderson’s definition called out nursing’s focusing on caring for vulnerable humans. In doing so, it expanded and clarified the unspoken but well accepted covenant nursing has always had with society. The covenant is well documented by the Gallup poll demonstrating for more than two decades the trust the public has for the nursing profession.

These two legacy values are what earn nurses the privilege of caring for vulnerable humans of every color, every age, and every gender identification to a state of health or to a peaceful death. Why are these values eternal, even in a world where almost everything else is “up for grabs”? My answer is that they will survive anything and everything because they call into play what Abraham Lincoln called “the better angels of our nature.” It is in the nature of every human to care about other humans. And when a person commits to the profession of nursing, that person has taken on something solid, and sturdy, and unchanging—no matter how fiercely the winds of change happen to be blowing.

In this profoundly disruptive time, it is our work to begin reimagining nursing. What will nurse-physician relationships be like after COVID 19? What structures and practices will change? Who will have a voice who perhaps never had one before? As we imagine what is next for nursing, let us stand firmly on our steady, sturdy, unchanging values.