The COVID-19 Pandemic Takes an Emotional Toll on Nurses and Their Families

As a nurse and mother of young children, Marousa Nookala, BSN, RN, shares the same concerns as most healthcare workers during the COVID-19 pandemic. She worries about contracting the virus both at work and outside the hospital. “Every choice I make for my family is influenced by possible exposure at work, and my choices outside of work affect my patients,” says Nookala, a clinical nurse on a general pediatric unit at Cleveland Clinic.

Nookala’s husband works from home, and the couple’s two sons – a preschooler and second grader – attend virtual school. “Interactions with those outside of our household have been severely limited and will be even more so as we head into the winter season with COVID numbers steadily rising,” she says.

The emotional toll on Nookala and her family is on the rise, too. She shared some of the challenges that she and other nurses face and offered advice on how to cope for her peers, with one caveat: “There is no guidebook for this pandemic. What works for my family may be completely different for someone else.”

The melding of home/work stress

“No other disease process prior to COVID-19 has blurred the lines quite as dramatically,” acknowledges Nookala. She opted to enroll her sons in online schooling to alleviate the stress of hearing about positive cases at school and fearing her children would contract the virus there.

“I know this is not a viable option for a lot of nurses,” she says. “But eliminating as much exposure outside of work, such as avoiding large gatherings, makes me feel good about going to work. And following all our personal protective equipment guidelines while at work makes me feel safe about the exposure risks for my family.”

Isolation from friends

Early in the pandemic, Nookala had some friends who refused to see her or her children. “As we formed our ‘quaranteam,’ including a couple of families we interact with, the nature of my job remained a factor in any socially distanced play dates for my sons,” she says.

All adults and children masked and strove to maintain the six-foot distance recommendations both indoors and outdoors. “When flu season began, the quaranteam became even smaller, with zero interaction happening outside of our nuclear family,” says Nookala.

Her advice for dealing with fearful friends is to be upfront and honest. “Being forthcoming about the precautions I take at work and removing myself from social situations after any potential exposure helps create trust in those relationships,” says Nookala.

Maintaining vigilance as others become lax

As the pandemic lingers, Nookala has maintained strict social distancing, while watching many family and friends around her become more relaxed about precautionary measures. She will spend the upcoming holidays with just her husband and sons. “As a nurse, I see the risks, and I am terrified of infecting my vulnerable family members,” says Nookala. “I feel the burden of protecting them even when the isolation affects my own mental health.”

To help assuage the loneliness, she and her family are diving into new experiences together.

“We have created the hashtag ‘alonetogether’ and have shifted the focus from all the things we can’t do to all the things we haven’t had a chance to do before,” she says. Every season they create a list of activities to accomplish as a family. For instance, in the fall they completed the Summit County Fall Hiking Spree through the Cleveland Metroparks, a system of nature preserves in Northeast Ohio.

Concerns over job security

While some nursing units, such as intensive care units, face patient surges, others experience low censuses. Some caregivers across the country have taken involuntary personal time off (PTO) or unpaid time off, which can place a financial burden on families.

“Nurses are struggling with feelings of displacement and not having a work home in a time when stability is so important,” says Nookala.

She notes that her nurse manager, Amy Cox, MSN, MBA, RN, CPN, has been supportive during the pandemic, placing clinical nurses on other pediatric units and facilities, when possible. “Open and honest communication is so important,” says Nookala. “When nurses don’t know what the plans are for their unit and their job, then a lot of inaccurate assumptions can be made. Having video conference calls with those on your core unit to discuss things and bring up any issues is so helpful!”

A strain on mental health

“Focusing on mental health during this unprecedented time will be essential to thriving,” says Nookala. “What that means for each individual will vary.” She says the COVID-19 pandemic has affected each of her immediate family members differently, and she will address any behavioral health concerns individually. Cleveland Clinic offers numerous resources to assist caregivers and their families, including a 24/7 COVID-19 caregiver hotline, a well-being online portal and virtual visits with physicians.

“Taking advantage of the in-person and virtual therapy sessions will provide an outlet with a professional to help process all of these big feelings,” says Nookala. “And it applies to adults, children and adolescents.”

The COVID-19 pandemic has thrust all nurses – and their families – into new territory. As we navigate the uncharted terrain, Nookala offers these parting words: “Make decisions that make sense for you and your family without apologies. Even if those closest to you don’t understand, you know yourself and your family best. No matter what decisions you make, trust that they are the right ones!”