The importance of community in the experiences of frontline nurses in North Carolina during COVID 19

Written By James Robbins with Dr. Andrea Freidus and Lennin Caro
UNCC Department of Anthropology

"I wouldn't even stop at the store on my way home from work... if you were in scrubs it was like, ‘Oh my God, you are a leper, you must be contagious.’” (HCW 8)*

In the Spring semester of 2020, I was enrolled in a Medical Anthropology Graduate Seminar (my first anthropology course) at UNC Charlotte. COVID wasn’t in the syllabus, but once the pandemic hit, our professor, Dr. Andrea Freidus, pivoted and asked the class to track county, state, and federal policy changes as the pandemic evolved. This was the start of my research collaboration with Dr. Freidus that would expand beyond the class as I volunteered to work on the project, basically, indefinitely. By early June of 2020, we were recruiting and interviewing frontline nurses in North Carolina that worked on COVID floors. 

When taking on the project of documenting the narratives of frontline healthcare workers, we did so with the understanding that they would be some of those most affected by the pandemic; probably negatively. We predicted that different groups, i.e. doctors, nurses, respiratory therapists, would provide differing perspectives on providing care during the pandemic, and that each group would have concerns about policy and programming, and that medical supplies would be of great concern.

With this insight, we began developing questions and rapid qualitative methods that would lead us to our year-and-still-running endeavor to capture the experiences of these healthcare workers. Within the span of 16 interviews conducted via Zoom, our participants confirmed and elaborated on our suspicions: the pandemic affected them negatively. (see Image 1). 

We missed the mark, however, on their concern with policy or supplies as few participants spoke on issues or solutions to either subject. The 15 female nurses and 1 male administrator we interviewed described a situation which exacerbated previously existing struggles and disparities. They spoke on the distribution of work being weighed heavily on nurses before the pandemic. However, this disparity became more significant with the pandemic because some doctors, therapists, phlebotomists, and cleaning and maintenance staff were hesitant to perform their duties on COVID patient floors. This left nurses to navigate many tasks they felt unequipped and unprepared to undertake, and this was in addition to their already labor-intensive job of caring for COVID-positive patients. They detailed the precautions they had to take, the extra workload, the emotional toll of witnessing and at times being the only support for dying patients and trying to facilitate contact with families unable to visit COVID units. They also noted the effect their status as a nurse had on their lives outside their workplace, and the lack of appropriate compensation for enduring what we have taken the liberty of labeling “burnout”. Burnout has classically been defined as severe stress or fatigue related to (and restricted to) work. But, as we find in our research, the burnout experienced by these nurses is very much related to their personal lives as well as their work. (See Image 1)

Image 1:
A notable point we came across in the interviews was the stress which nurses placed on community support. Moreover, they emphasized  the lack thereof in their own communities. The nurses we interviewed described a situation of isolation and hopelessness and of physical, mental, and emotional exhaustion. They reported deep frustration with anti-maskers, with critics of the pandemic response claiming it to be an overreaction (likening COVID-19 to the flu), the condemnation of nurses for aiding in conspiracies to exaggerate the response, and struggling with their own friends and family being unwilling to see them because of their perceived exposure to COVID. One respondent explained, "People will praise us for doing all of this fabulous work but they look at you like 'You're the virus.'" (HCW 6)*. While these wide ranging frustrations need addressing to ensure a robust healthcare workforce, so many issues are difficult to address. However, one recent UK study showed that community support helped reduce stress and burnout in healthcare workers significantly above other factors such as offering counseling and hazard pay (see https://www.rapidresearchandevaluation.com/research).

In the beginning of the pandemic, nurses told us, there were some scattered gestures of support from people and organizations in the community. These gestures of support ranged from receiving free meals or swag bags with goodies in them to being lauded as heroes on social media. But as the pandemic continued, that support diminished and nurses appeared to be annoyed with the hypocrisy of being called heroes but treated as "plague rats" by their community. One travel nurse made the comparison between the treatment of healthcare workers in New York where people would line up along the streets at shift changes and applaud nurses and in North Carolina where people would scoff at or avoid nurses. 

Being the primary point of contact for patients, nurses have a unique insight into the change in healthcare during the pandemic and how those changes affect patients. Many interviewees expressed concern and outrage for patients whose social connections and support networks are cut off while infected with COVID, especially during the final moments of the patients’ lives, leaving them to die alone. They also expressed frustration with the changes in care which depersonalized their interactions with patients. Previously, they would have been able to talk and listen with patients, hear about their struggles, and help where needed, nurses’ interactions and time with patients were limited due to policies limiting time allowed in patient rooms and the substantial amount of PPE they had to don and doff (change) between each interaction. The nurses described demoralization from barely interacting with and connecting to patients compared to pre-pandemic conditions.

In this worldwide pandemic, we have all experienced forms of isolation and loneliness… Our lives have been disrupted and thrown into difficult times because of the constant threat of an incurable and unknown virus. We recognize in this research that nurses have experienced severe changes in their work and home lives as a result of this pandemic. We find that community support has been characterized as sorely lacking, inconsistent, or that communities have actually ostracized the nurses we interviewed. Families and neighbors of nurses have been reluctant to support them as one participant explained, "Our kids haven't really socialized in our neighborhood. they were afraid of our kids having COVID"(HCW 13) However, positive support is necessary for the continued function of our nurses and by extension our healthcare system as nurses seemingly comprise the backbone of healthcare delivery and bear the brunt of caring for those infected. In order to prevent burnout among nurses, community and institutional support must be established to aid them as they care for those afflicted with this pandemic-causing disease.