*3.6. Support from the Health Care Team*

Participants talked about the importance of having support from other nurses and health care workers who understood what they were experiencing and the demands of caring for very ill, often terminal, patients. Nurses described strategies that had emerged to provide support such as texting and calling each other throughout the day and after their shift to offer support, establishing a group email to discuss feelings about difficult patient situations, and meeting up for lunch at work. Irena described how the group email strategy helped her cope:

"On difficult days we would "reply all" to a group email at work and start an open dialogue where there was no judgment ... We would read it and know that we weren't alone in it. Even if it was just a quick email like 'I feel like I'm drowning—I don't even want to go back to work tomorrow it's so bad'. People responded and said 'Hey, I'm working tomorrow, let's meet up for lunch. Let me know when you're taking your break'. Just knowing that you have that kind of support, especially as a new nurse and somebody who's brand new at the hospital ... this kind of helped to bring me into a little circle which felt good to be able to get out feelings and frustrations in a no judgment zone."

Family and friends attempted to be supportive but the nurses did not feel that they understood what the nurse had just experienced. Marie commented, "The support at the hospital has been incredible. The way the team and all the nurses have just really been doing an amazing job of coming together and supporting one another, whether it's going into a room to help with a task or it's some mental support at the end of the day. The last couple months were really tough and I think about how much we all have helped one another."

**Box 1.** Participant Irena's unsolicited blog post received via email in advance of interview.

5 August 2020

"Hi,

I thought I would share one of my latest Blog entries with you about my experience with COVID. I share my thoughts and frustrations with a small group of friends and other RNs as I find it helps to be able to have a way to express feelings during this unprecedented time.

Irena (pseudonym)"

"The sweat is running down my back as I blink to try to see through my foggy, streaked face shield. The beeping of the machines just will not relent. My patient is dying, and I know it. I fumble with the phone clipped to my scrubs underneath my paper thin yellow gown, desperate to call for help. I am alone in this isolation room with my patient and COVID 19. The oxygen saturation monitor keeps dropping - 84, 80, 76. I call for help but no one comes right away. Our hospital is bursting at the seams with COVID patients and there is no one to help. After what seems like an eternity, someone enters the room in head to toe protective gear and we start the dance. We begin carefully untangling the lines, tubes, and wires connected to my patient, we need to get him lying on his belly as quickly as we can. The moving is exhausting. My body aches and my patient is in excruciating pain from just turning over because this virus is relentless and unforgiving. I have been doing this for 127 days now. The sweating, the praying, the dancing, and the grieving. My patient is moaning on his belly now, his oxygen is still not improving despite giving him all the oxygen we can. I stroke his arm and tell him to take some deep breaths and that we are going to help him. I know I am lying because I have seen this too many times to count. I make the call to the ICU and when a bed opens up (after someone expires) they will whisk him away to be intubated. I just hope I can keep him alive that long. My other 4 patients are waiting in their own rooms of isolation hell and they are all very sick. They are all on oxygen, COVID positive, struggling to breath, desperate, and all alone. I make the phone call to my patient's family and tell them that their loved one is not improving, and the next step will be intubation. I hear the all too familiar sobbing and begging me to let them speak to the patient, but the patient can't speak through the tight mask blowing life into his lungs.

How did I end up here? A new graduate RN in the middle of a global pandemic. I can only describe it as being on a long, grueling hike up a mountain to finish nursing school and pass the NCLEX exam and when I finally make it to the top, I am thrown off the edge of the cliff. No parachute, no training, no lifeline. Here I am at 41 years old finally working at my dream job of being a Registered Nurse and I am in hell."
