Samantha (Sam) Bulchand is the President of the Nursing Undergraduate Society (NUS) at the Bloomberg Faculty of Nursing at the University of Toronto. She earned her first undergraduate degree from U of T in neuroscience and anthropology. Sam is passionate about working directly with people, both as a nurse and in her role at NUS. Sam is currently in her second and final year of the accelerated BScN program.
The COVID-19 pandemic has shed light on flaws in our healthcare system, and nurses, who are commonly referred to as the “backbone of healthcare,” have had enough. The healthcare system is plagued by systemic issues such as unfair compensation, inadequate personal protective equipment (PPE), unsafe nurse-to-patient ratios, and staffing shortages thus creating high-risk environments for healthcare workers and patients¹⁻³. The use of social media platforms like Youtube, TikTok, and Instagram has become a widespread method for nurses to cope with the harsh realities of their careers by sharing feelings of fear, guilt, and burnout as they work through the pandemic²⁻⁵. While social media can be used to advocate for the well-being of nurses, for nursing students about to enter the profession, consuming this content can be intimidating, overwhelming, and extremely discouraging⁴⁻⁶.
When I entered nursing school, I realized that our formal education focuses on developing thorough assessment skills and learning how to build therapeutic relationships. As a result, I felt there was a gap in my knowledge about the current challenges nurses face and express on social media, and how nursing students can navigate these issues. Upon taking a course on critical reflexivity, I have grown to understand the broader-scale issues of the healthcare system which impact how I view the world of healthcare today. In addition, my positionality as a final-year nursing student with over 600 hours of clinical experience in various settings provides me with significant insight into the realities of the nursing profession.
The purpose of this blog is to introduce nursing students to the broader systemic forces behind the issues expressed on social media and more importantly, the actions students can take to minimize feelings of burnout, fatigue, and anxiety. I will explore the hero discourse and moral distress because these concepts have the greatest impact on the majority of nursing students, new-grad nurses, and seasoned nurses ²⁻⁴𝄒 ⁷
The Toxic “Hero” Discourse
As a nursing student in their final year, I learned that one of the challenges that nurses face is the concept of the “hero” discourse. The government, the public, and the mass media position nurses as “heroes” to describe their dedication to providing front-line care during the COVID-19 pandemic⁸𝄒 ⁹. Many nurses are challenging the hero discourse because it distracts the public and policymakers from upstream issues that impact the healthcare system²𝄒 ⁴𝄒 ⁸𝄒 ¹⁰. While this rhetoric makes nurses feel misunderstood, it is particularly harmful because it disregards and normalizes the conditions under which nurses are forced to work and inaccurately situates them as soldier-like characters entering a war zone¹⁰. Issues such as unsafe redeployment to unfamiliar units, poor communication, lack of PPE, staffing shortages, and high nurse-to-patient ratios lead to burnout, health anxiety, depression, and for some nurses, these conditions cost them their lives ²𝄒 ¹¹.
Initially, I endorsed the hero discourse, but after learning about the deeper toxic impacts this rhetoric has on the lives of nurses I stand behind the nurses who are challenging this perspective. When working as an extern, I experienced how systemically-rooted issues, such as high nurse-to-patient ratios, can strain the quality of care leading to extreme guilt, sadness, and fatigue because I value providing equitable and high-quality care to all of my patients. I feel that labeling nurses as heroes silences their concerns, and makes them feel expendable and overlooked. Therefore, discussion of this topic is particularly important for nursing students to ensure that they do not feel alone when struggling to work in today’s healthcare system. In addition, awareness of this harmful rhetoric encourages nurses to work together to challenge the risks and constraints associated with today’s healthcare system⁹𝄒 ¹².
Experiences of Moral Distress
The current climate of our healthcare system during the pandemic introduced high levels of moral distress in nurses. Moral distress occurs when nurses are knowledgeable about the right thing to do but are forced to act in a certain way due to institutional constraints⁷𝄒 ¹³. Systemic-level issues, that are concealed by the previously mentioned hero discourse, place a variety of emotional and physical constraints on nurses. Feelings of distress are amplified when the constraints are avoidable with the right policies and leadership at a system level⁷𝄒 ¹³. Moral distress particularly impacts nursing students because formal education, in my opinion, fails to incorporate realistic scenarios such as the reduction of certain medical treatments, supplies, and inadequate staffing which leads to decreased quality of patient care, which many nursing students do not expect⁴𝄒 ⁷. Facing these realities can be extremely distressing for nursing students and new-grad nurses, particularly when they are called “heroes” during these afflictions⁴.
As someone who is a first-generation university student, I strived to put all of my efforts into doing the best I can in my studies and extra-curricular activities. Growing up with this mentality has caused moral distress while working in nursing because I rarely feel like I am “doing enough” due to the pressures of the current healthcare climate. For the nursing students who have felt this way, or are worried they may feel this way upon entering the workforce, you are not alone.
A System Ready for Change
Many nurses are leaving the profession, and if large-scale changes are not made, the healthcare system will continue to suffer and institutional constraints will continue to cause widespread moral distress among nurses. If nurses’ voices continue to be silenced through harmful rhetorics like the hero discourse, nurses will continue to face burnout, health anxiety, and depression. The healthcare system is in a time of significant change, and there are many opportunities for students to change the course of nursing history.
The healthcare system is in a time of significant change, and there are many opportunities for students to change the course of nursing history.
I envision that the nursing profession will thrive when systemic-level barriers are addressed. Through this, I foresee that there will be higher levels of retention and recruitment leading to better nurse-to-patient ratios, and nurses will receive adequate compensation for their role in the healthcare system. I predict that there will be decreased levels of moral distress and burnout due to increased mental health support, safer work conditions, and thorough consideration of the upstream forces that presently make the world of nursing challenging for students entering the profession.
In order to correct the systemic issues in our healthcare system that lead to these difficulties, it is important to start at the individual level. My intersecting identities as a nursing student and someone who struggles with mental health make me particularly attuned to the negative impacts that the challenges in the healthcare system have on the mental well-being of nurses. As a result, I feel that nursing students should prioritize their mental health as they enter the world of nursing. This can be done by seeking professional therapy and mobilizing peer support. In addition, engaging in continual self-development by reflecting on your personal needs, beliefs, and values is one way to challenge damaging rhetoric like the hero discourse.
My social position as the president of the Nursing Undergraduate Society allows me to communicate with faculty members to advocate for students and their needs. Being passionate about leadership, I believe that nurses should involve themselves in positions in order to make broad-scale changes in the healthcare system and challenge power dynamics in the healthcare infrastructure. For instance, nurses can help identify a clear definition of the problem at hand given their lived experience. Using social media to educate and empower nursing students in a similar position is another technique to reach many individuals to advocate for meaningful change⁵.
For nursing students about to enter the profession who are overwhelmed about what is to come, I want to remind you that you are not alone, you can do this, and I can’t wait to see what you do in the field of nursing.
As a nursing student in their final year of nursing school, I am often faced with the question “Why would you want to be a nurse in today’s climate?”. Despite the many challenges in the profession, I respond to these questions by sharing how I am grateful and excited to enter this profession, and be present during a time of meaningful change. For nursing students about to enter the profession who are overwhelmed about what is to come, I want to remind you that you are not alone, you can do this, and I can’t wait to see what you do in the field of nursing.
References:
Einboden, R. SuperNurse? Troubling the Hero Discourse in COVID Times. Health (London) 24, 343–347 (2020).
Kane, J. ‘Do not call me a hero.’ Listen to an ICU nurse’s plea for fighting the coronavirus. PBS NewsHour https://www.pbs.org/newshour/health/do-not-call-me-a-hero-read-an-icu-nurses-plea-for-fighting-the-coronavirus (2020).
Tran, H. Don’t call me a hero. The Voice of Pelham and Central Niagra https://www.pelhamtoday.ca/local-news/dont-call-me-a-hero-6347932 (2021).
Lewis, C. I’ve only been a nurse for eight months. The chaos is killing me. Macleans.ca https://www.macleans.ca/society/health/ive-only-been-a-nurse-for-eight-months-the-chaos-is-killing-me/ (2022).
Yalamanchili, B., Donelle, L., Jurado, L.-F., Fera, J. & Basch, C. H. Investigating #covidnurse Messages on TikTok: Descriptive Study. JMIR Nursing 5, e35274 (2022).
Casey, K., Oja, K. J. & Makic, M. B. F. The lived experiences of graduate nurses transitioning to professional practice during a pandemic. Nursing Outlook 69, 1072–1080 (2021).
Morley, G., Ives, J. & Bradbury-Jones, C. Moral Distress and Austerity: An Avoidable Ethical Challenge in Healthcare. Health Care Anal 27, 185–201 (2019).
Boulton, M., Garnett, A. & Webster, F. A Foucauldian discourse analysis of media reporting on the nurse-as-hero during COVID-19. Nursing Inquiry 29, e12471 (2022).
Mohammed, S., Peter, E., Killackey, T. & Maciver, J. The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis. International Journal of Nursing Studies 117, 103887 (2021).
Gagnon, M. & Perron, A. Nursing Voices during COVID-19: An Analysis of Canadian Media Coverage. Aporia 12, 109–113 (2020).
Ali, S. Why some nurses have quit during the coronavirus pandemic. (2020).
Halberg, N., Jensen, P. S. & Larsen, T. S. We are not heroes—The flipside of the hero narrative amidst the COVID19-pandemic: A Danish hospital ethnography. Journal of Advanced Nursing 77, 2429–2436 (2021).
Peter, E., Mohammed, S., Killackey, T., MacIver, J. & Variath, C. Nurses’ experiences of ethical responsibilities of care during the COVID-19 pandemic. Nurs Ethics 29, 844–857 (2022).
The nursing blog series aims to promote critical reflection on various topics related to nursing practice, education, and professional development. The views expressed in the nursing blog posts are those of the respective author and do not necessarily reflect the official policy or position of UTIHI or affiliated organizations.
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