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“The little lights in this dark tunnel”: Emotional 
support of nurses working in COVID-19 acute care 

hospital environments 

Jennifer Lapum1, Megan Nguyen2, Sannie Lai3, Julie McShane3, Suzanne Fredericks1 

1Daphne Cockwell School of Nursing, Ryerson University, Ryerson University, Toronto, Ontario, Canada; 2Dalla Lana 
School of Public Health, University of Toronto, Toronto, Ontario, Canada; 3Toronto General Hospital, University 
Health Network, Toronto, Ontario Canada 

Corresponding author: J. Lapum (jlapum@ryerson.ca) 

ABSTRACT  

Background: Working on the frontlines of hospitals during the COVID-19 pandemic has been challenging and 
distressing for nurses. The troublesome nature of these emotions have surfaced because of uncharted territory 
related to this virus, compromised work conditions, unfavourable patient outcomes, and the witnessing of suffering 
and loss. Although there has been renewed emphasis on how to emotionally support nurses, the nature of support 
needed is somewhat unknown considering that healthcare professionals have not experienced a pandemic of this 
magnitude in their lifetime. We explored how nurses were emotionally supported and how they can be better 
supported while working in COVID-19 acute care hospital environments. Methods: In this narrative study, semi-
structured interviews were conducted with 20 registered nurses working in hospitals in the Greater Toronto Area 
and working on units caring for COVID-19+ patients. Results: Our findings reflected three main narrative themes. 
The organic emergence of support was a narrative theme that included camaraderie and emotion-focused coping 
strategies. Intentional forms of support were a narrative theme that included mental health support, information 
support, and resource support. The social justice nature of support was a narrative theme that included advocacy 
and recognition and compensation. Conclusion: These findings highlight the importance of how hospital and 
government leaders should employ a multifold approach in the provision of emotional support for nurses. Some 
strategies relevant to clinical practice include demonstrating visible presence with regular rounding of units by 
leaders, and transparent communication about information and resources. Other strategies are on-site psychological 
support and legitimate support of mental health sick days as well as lobbying governments for financial 
compensation for the risky work involved in being a frontline provider and appropriate provision of personal 
protective equipment. While emotionally supporting nurses, these types of resources can act as “little lights in this 
dark tunnel” of COVID-19 and illuminate a path forward. 

KEYWORDS 
Emotions; mental health; nursing; nurses; COVID-19; psychosocial support; narrative 

FUNDING SOURCE 
This work was supported by the FCS COVID-19 Rapid Response Research Grant, Ryerson University. 

BACKGROUND 

In March of 2020, COVID-19 was declared a global 
pandemic (World Health Organization, 2020). Despite 
the feelings of uncertainty and fear reverberating 
around the world (Smith et al., 2020), nurses have 
been at the frontline caring for patients who test 

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positive as well as supporting their families during this 
formidable time (Rosa et al., 2020). The acute care 
hospital environment has been uniquely challenging 
for nurses considering the dynamic nature of the 
state of science as well as the emotional trauma 



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30 

experienced (Lapum et al., 2020). This pandemic has 
highlighted the role of the nurse as indispensable to 
the functioning of the healthcare system (El-Masri & 
Roux, 2020), but also raised questions about how 
nurses are best supported. In this study, we explored 
how nurses were emotionally supported and how 
they can be better supported while working in COVID-
19 environments in hospitals. 

     Hospital work environments during the pandemic 
have been demanding for healthcare professionals. In 
these environments, nurses are at the frontlines 
spending sustained periods of time with patients and 
deeply engaged in their emotional care as well as 
their families (Lapum et al., 2020; Rosa et al., 2020). 
They are working in compromised work environments 
(Thorne, 2020) wherein their own personal safety is 
at risk (Catania et al., 2020). This has included limited 
access to resources including personal protective 
equipment (PPE) and medical supplies and equipment 
(Bagnasco et al., 2020; Catania et al., 2020; Gujral et 
al., 2020; Rosa et al., 2020; Sim, 2020; Smith et al., 
2020). Additionally, the nature of transmission of 
COVID-19 was unclear during the first wave creating 
a significant amount of uncertainty. As a result, 
frontline providers such as nurses were at highest risk 
for infection (Sim, 2020). Because many countries are 
not collating data, there is minimal information 
related to healthcare workers’ infection rates and 
deaths, but it has been suggested that hundreds of 
thousands of workplace infections have occurred, 
with hundreds of nurses dying (Freer, in press; Huang 
et al., 2020; International Council of Nurses, 2020; 
Pan American Health Organization, 2020; Sim, 2020; 
Zeng et al., 2020). Rising infection rates and the need 
for self-isolation have also resulted in increased 
workload and substandard nurse-patient ratios (Sim, 
2020; Stokes-Parish et al., 2020). These types of 
environments have had a significant emotional 
impact upon nurses. 

      The emotional impact has been multifold for 
nurses working in these environments. The emerging 
literature has reflected feelings of uncertainty, fear, 
anger, helplessness, psychological distress, anxiety, 
and depression (Bagnasco et al, 2020; Iheduru-
Anderson, 2020; Labrague & de los Santos; Shreffler 
et al., 2020). Nurses are experiencing intense moral 
distress when their own values concerning patient-
centred care are at odds with COVID-19 work 
environments that require rapid triage (Rosa et al., 
2020) as well as changes to care models, rationing of 

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resources, and sometimes limiting of contact with 
patients. Because of situations of helplessness 
interwoven with death and loss of contact with family 
due to social restrictions, nurses are at risk for 
psychological and trauma-related symptoms over the 
long term (Lapum et al, 2020; Shahrour & Dardas, 
2020). Existing research has indicated that the 
intensity and persistent emotions that nurses are 
experiencing are akin to post-traumatic stress 
disorder (Blekas et al.; Carmassi et al.; Lapum et al., 
2020). The impact of these emotional and traumatic 
experiences has led to feelings of isolation (Iheduru-
Anderson, 2020) and emotional and physical 
exhaustion (Dykes & Chu, 2020; Gao et al., 2020; 
Gujral et al., 2020; Sagherian et al., 2020). 

     There is renewed emphasis on how to emotionally 
support nurses through intensely traumatic 
experiences such as pandemics. The potential 
consequences of not supporting nurses during these 
times are well known and include compassion fatigue, 
burn-out, and intentions to leave the profession 
(Gujral et al., 2020). Leaders in healthcare 
environments need to collaborate on how to support 
nurses over the short and long term (Bagnasco et al., 
2020). However, first we need to better understand 
how nurses were emotionally supported and how 
better to support them moving forward. As 
underscored in this research, it is our hope that this 
support will offer “little lights in this dark tunnel” of 
COVID-19 (participant quote). 

METHODS 

We based our study methodology on Lieblich et al.’s 
(1998) narrative inquiry approach, which privileges 
the storied quality of human experience and 
understanding this experience through narrative 
accounts. Specifically, we employed the categorical 
content and categorical form of narrative inquiry 
(Lieblich et al., 1998). A categorical approach is 
focused on how components of participants’ stories 
can enhance understanding of a specific 
phenomenon (Lieblich et al., 1998) such as nurses’ 
accounts of emotional support while working in 
COVID-19 acute care hospital environments. This 
inquiry focus upon emotions is theoretically 
grounded in narrative. We draw upon Kleres (2010) 
work that theorizes how emotions are “narrative in 
nature” (p. 188) and that the telling of a story and its 
components constitute these emotions. This is in 
align with our constructivist approach in which the 



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meaning of a narrative is co-constructed during the 
telling of the story. 

     Recruitment occurred from July to October 2020. 
We recruited registered nurses working in acute care 
hospitals located in the Greater Toronto Area and 
working on units caring for COVID-19+ patients. Social 
media and listservs from selected hospital units were 
used to facilitate recruitment outreach using a 
convenience sampling method. We conducted 
individual, semi-structured interviews through a 
combination of audio and/or video-enabled Zoom 
calls. Interview questions were broad to invite 
storytelling, and included items such as: What helped 
support you in situations that affected you the most 
emotionally? How do you think you could have been 
better supported in these situations? Interviews were 
recorded and transcribed verbatim. 

     Using a group approach, we analyzed data based 
on Lieblich and colleagues’ (1998) method of 
categorical content and form analysis. Therefore, our 
analytic focus was on the content of nurses’ stories 
(i.e., what they shared in terms of the context, what 
happened, and who was involved) as well as how their 
narratives were recounted with regard to form and 
nonlexical components of speech (e.g. vocal 
intonation, tone, pitch etc.) (Lieblich et al., 1998).. 
This process involved individually reading the 
transcript to get an overall sense of the narrative 
account followed by a group reading of the transcript 
where we began to identify sections of text that were 
relevant to the research question. In line with 
Lieblich’s approach, when identifying sections of text, 
we examined both the content and the form which 
informed our analytical discussions in terms of how 
we coded these sections of text and then how related 
codes were combined into several narrative themes. 
The team collaboratively established the narrative 
coding structure using an ongoing iterative and 
dialogical approach. It is these narrative themes that 
become the organizing structure to represent the 
study’s findings. 

Ethics Consideration 

     We obtained research ethics board approval from 
the initial hospital recruitment site and from the 
principal investigators’ university. Free and informed 
consent was provided before participation in the 
study. 

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RESULTS 

This research included 20 registered nurses from six 
different hospital institutions in which all nurses were 
working with COVID-19+ patients and all but one 
nurse was working on COVID-19 designated units 
specifically. Sixteen were considered bedside nurses 
and four were in nurse leadership positions on these 
units. We specifically do not identify the leadership 
positions to protect participants’ identity. Seventeen 
nurses were female and three were male. They 
participated in study interviews that were up to 90 
minutes in length. Three themes were identified 
including: the organic emergence of support, 
intentional forms of support, and the social justice 
nature of support. 

Organic Emergence of Support 

     There was an organic emergence of emotional 
support that was not necessarily formalized. This 
type of support included camaraderie and emotion-
focused coping. 

Camaraderie 

     Camaraderie was a form of support that appeared 
as a spirit of community and the sharing of emotional 
experiences which organically emerged among 
colleagues during the pandemic. Several nurses 
remarked “we're all in this together” (P05, P08) and 
explained how they supported one another: “We 
looked after each other … people came together in a 
way that I haven’t seen. Everybody supporting each 
other … what do you need? What can I do for you?” 
(P04). Another nurse explained feeling “safe” because 
of “having your colleagues support each other and 
making sure we're doing our [PPE] checks” (P11). The 
emotional nature of the pandemic brought about a 
camaraderie that was more than the norm. One 
nurse’s narrative reflected the importance of 
“support[ing] each other emotionally … so that we're 
not burnt out at the end of this. I'm taking care of my 
colleague and my colleague has my back as a nurse. 
That was really important” (P11). The linguistic 
phrasing “has my back” suggests that nurses were 
willing to support one another no matter how difficult 
the situation. And this support was described as 
essential “to get the job done. And make sure our 
patients are taken care of and go above and beyond” 
(P27). The emotional support embedded in the 
feeling of camaraderie was evident. One nurse 



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described how nurses were “utterly distraught, just 
breaking down crying … as a group we all tried to be 
as supportive and be there for one another” (P05). 
The support that nurses gave and received was also 
related to the sharing of a unique experience. 

     Nurses’ narratives reflected how the camaraderie 
transpired because their experiences were akin to 
one another. Nurses commented that their 
colleagues “understand” (P02) because “[we are] 
living the same experience … [and] share the same 
feelings” (P06) and as a result, they are “the only 
people who kind of get this … they’re kind of like my 
sisters and brothers” (P03). The familial reference to 
describe their colleagues highlighted the intimacy of 
the support. Nurses described how “colleagues were 
the biggest help … we were able to vent to each other 
and totally understand and validate how we're 
feeling” (P06). This sharing of experiences led to 
mutual understanding and united nurses in a way that 
transcended their differences: 

     There were times where everyone was just so 
emotionally exhausted but also scared that team 
members would come together and pray and people 
would join that prayer, whether they believed in 
whatever religion … it was a way to bond … talking 
about our emotional struggles and what we were all 
going through and how we were going to get 
through it. If we talked about home stresses, 
everybody understood. If we talked about a 
heartbreaking patient story, everybody understood, 
because we were all going through it together (P27). 

     The “sharing of stories” was a positive support for 
nurses and described as “therapeutic, allows us to 
decompress, voice our concerns, and move on” (P11). 
One nurse’s excerpt highlighted how this type of 
support enhanced their capacity to engage in 
emotional management: “they know what's going 
on,and can help me understand my emotions and kind 
of get through it, really helpful” (P17). It was 
commonly noted that camaraderie not only brought 
them “closer as a team” (P28), but they also found it 
“reassuring … you’re not alone” (P06) and it 
“validated” their feelings as they realized that “I 
wasn't the only one feeling all that” (P28). The 
phrasing “all that” suggests that there was a 
considerable emotional burden that nurses were 
attempting to cope with. In addition to camaraderie, 
nurses’ narratives reflected emotion-focused coping. 

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Emotion-focused Coping 

     Another form of support that organically emerged 
is emotion-focused coping which refers to strategies 
focused on regulating emotions. Because of the 
isolating nature of physical distancing, nurses 
referred to the importance of “stay[ing] connected” 
(P15) with others. They commonly described 
“checking” in on family and friends (P15) and noted 
that “spending time with family makes this process a 
whole lot less isolating” (P11). The support they 
received from family and friends was an important 
component of their coping. One nurse commented 
“that was a big emotional part, having them care for 
me … I really appreciated it” (P08). Another nurse said 
“when I could be around my husband and kids like I 
know that I would feel a whole lot better” (P03). 
Another nurse described how their unit received 
letters from children in school about how “we are 
heroes … everyday we would feature a letter … which 
was really nice” (P04). The support from family, 
friends, and society facilitated nurses’ emotion-
focused coping. 

     Other forms of emotion-focused coping included 
mechanisms that could become problematic as well 
as positive strategies. One nurse commented on their 
own “way of coping … every night, I go home, I need 
a drink for this reason. I need a drink for that reason” 
(P04). Others noted “stress eating” (P05, P22) and 
“pandemic weight” gain (P22). However, narratives 
also reflected positive emotion-focused coping 
referring to one’s perspective and engaging in 
activities and nature. Highlighting the importance of 
perspective, one nurse remarked “there's always light 
at the end of the tunnel. No matter how long a tunnel 
might be, just have to focus on one step at a time” 
(P12). Narratives suggested that nurses trained 
themselves to feel an emotion and then release it: 
“trying not to dwell, taking my moment to be scared 
and then to let that go because it wasn't helpful … 
take a deep breath, go forward” (P25). Another nurse 
reflected upon the role of faith in emotion-focused 
support: “my faith … provides an extra layer of 
emotional armor” (P20). Nurses also referred to 
“going outside … enjoy the weather” as a way to 
cope”(P11). They indicated that this helped because it 
allowed them “to go back to work knowing that I've 
decompressed. Balance between work life, and that 
personal time to take care of yourself” (P11). Another 
participant reflected on the importance of self care: “I 
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off work, so that I can feel like a person again … I had 
to find ways to feel whole again” (P05). This excerpt 
suggests that a nurse’s personhood is diminished 
during the pandemic because they become so 
focused on work. It was common for nurses to 
emphasize the usefulness of “disconnect[ing] from 
work” (P16) and “actively distracting” themselves 
“from thinking about the pandemic” (P24). 
Participants referred to many activities such as “going 
for runs”, “reading books” (P06), and “cooking” (P01) 
and how these activities were “good outlets” (P06) 
and “important to handle all those emotions” (P01). 
The organic forms of support were also 
complemented by intentional forms of support. 

Intentional Forms of Support 

     There were intentional forms of support that were 
formalized in the hospital setting including mental 
health support, informational support, and resource 
support. 

Mental Health Support 

     Mental health support referred to structured 
support provided by hospitals. It was noted that 
hospital leaders reminded nurses of counselling 
“resources” (P16), “hotlines”, and “therapists” to 
access “if you are dealing with emotional and 
psychological stress” (P12). Their narratives reflected 
that having those “resources in place as a security in 
case you do need it” (P12) and “having that constant 
support always telling us that they're there for us, 
made me feel better.” Resources varied from hospital 
to hospital, but one nurse commented that they “had 
a person come into the unit … [with] dedicated time 
slots for people to see her” (P04). Another nurse 
remarked: “I applaud my organization for the 
supports they set up. They had psychologists and 
psychiatrists available … a quiet place … just for the 
quietness” (P28). For those who did reach out for 
help, they indicated that it was “helpful … to vent” 
(P16) and “speak with a social worker … to cope with 
the stressors that I was dealing with at work … helped 
me identify ways to destress” (P27). However, there 
seemed to be resistance in reaching out for help. 

     Although most nurses recognized that it would 
have been “beneficial” and “good for mental health” 
(P05, P06) to access supports, they almost always 
noted they “never reached out” (P06). One nurse 
described it as “an internal battle” in terms of their 

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own vulnerability as a barrier, explaining “accepting 
that I'm vulnerable. I don't like accepting that … if I 
addressed it, I would know that it is an issue for me. 
So, I ignored it which is not the best way to deal” 
(P05). Nurses described both the work involved in 
reaching out and their own assumption that it would 
be futile: “Comes down to the effort of reaching out 
to having a good therapist … I made the assumption 
that they're not going to be able to change my 
situation. All they can really do is lend an ear” (P06). 
Another nurse referred to almost calling but noted “it 
never seemed it would make a difference. I felt I knew 
the questions that they would ask and the things that 
they would tell me to do” (P25). Although nurses 
rarely described reaching out for support, one nurse 
had a revelation during the interview about the 
benefits of talk therapy: 

     I'm accumulating that stress and anxiety within 
me. And then by me not talking about, it is taking a 
toll on me. I’m actually feeling much better now that 
I'm actually sharing this with you. It's actually my 
first time sharing my emotions and the effects of this 
COVID-19 with someone, I thank you for listening … 
this is therapeutic for me (P15). 

     Although the study interview was not a mental 
health intervention, it appeared there was an 
element of talk therapy that emerged for this nurse. 

     Narratives reflected limited time to access mental 
health resources as well as the nature of timeliness 
and ease of accessing these supports. Although 
emails were sent out with links to wellness and 
mental health programs, it was noted that “staff 
didn’t have time to use” the support offered (P01) or 
were too “drained” (P08) to participate. One nurse 
leader commented that staff “needed a lot of 
emotional support” and having “trained” individuals 
“on site” would have been “important” (P01). It was 
clear that support needed to be offered in a timely 
fashion at the moment when nurses were struggling. 
Although management’s availability during 
emotionally difficult situations varied, one nurse 
noted “they weren't aware of what was happening” 
and “if they were around and they saw, I would 
appreciate being pulled aside and asked if I was okay 
… allowing me to talk things out … it’s comforting” 
(P17). The idea of having access to timely support was 
noted by another nurse who said “a debrief” after 
someone dies would be helpful (P03). In the COVID-
19 context, “when somebody dies you just wrap the 



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body and move on to the next person” (P03). Having 
trained counsellors on site was emphasized as 
important: 

     Having a person who knows how to tease out 
people's emotions … identify, you know what, you 
need this type of support … that should be part of 
that code team, instead of having us calling and 
seeking that help. … Having someone constantly 
available on the unit and dedicated for people's 
mental health (P04). 

     Another participant’s comment reflected that 
readily accessible support was needed as opposed to 
“posters around the unit” with numbers to “call if you 
need help”, this nurse elaborated: 

Maybe it's our own reluctance, I don't know anyone 
who's called. Most of my colleagues are struggling … 
a couple have been suicidal … I've been anxious, but 
I've never felt like I wanted to hurt myself. But, I 
don't think there's been a lot of discussion, even 
(P03). 

    It was clearly noted that on site mental health 
supports were essential to nurses. 

     Nurses’ narratives reflected that the type of 
mental support and how it was offered could be 
improved. For some, it was a matter of implementing 
“formal check-ins … somebody saying, are you okay?” 
so that nurses felt “cared for” (P03). It was also 
suggested that “giving space for how we’re feeling” 
would have been important such as use of a virtual 
“message board … where you could share and say, I'm 
really struggling … because there really is no time at 
work to talk about it unless you reach out on your off 
hours” (P03). Another nurse remarked on the 
limitation of daily huddles and management’s role: 

     They did ask how everyone's doing … I just felt like 
it wasn't an environment to allow us to speak how 
we were truly feeling … having more one-on-one with 
our management to see how we were doing or 
something more intimate where you can express it 
(P05). 

     Additionally, nurses referred to the need for more 
formal support for mental health and well being: “we 
needed professional counseling from a psychologist or 
psychiatrist” (P30) and “somebody who actually can 
help you work through anxieties and fears … 
[and 

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access to someone who] we didn’t have to pay out-of-
pocket for” (P02). 

     In moving forth with difficult times in healthcare, 
such as pandemics, there was the sense that 
institutions needed to recognize and respond to 
nurses’ need for mental health recovery. One nurse 
indicated that time-off was not being approved 
because it was an emergency period, but this was 
when “it was necessitated because of the increased 
stress, just to have like a recovery period” (P26). 
Another nurse noted being “worried about what we 
do as an organization” to support “mental health” 
because nurses are experiencing “burnout” (P20). 
This nurse elaborated about the need for institutions 
to formally recognize “mental health sick days” as 
legitimate: 

When staff say, I stopped caring, I don't even care 
anymore. I was like, that's called compassion fatigue. 
You are so tired. Take the sick day … don't say that in 
front of the managers because there are 
repercussions, which means as an organization, we 
don't support, … when you're mentally struggling, 
are you not sick? (P20). 

     Intentional support for mental health was 
important to nurses as well as informational support. 

Informational Support 

     Flow of informational support varied depending on 
the institution and situation. Although there were 
changes “daily, sometimes hourly, there was policy 
behind it” (P27). They explained that changes were 
being “led by good leaders … we got frequent updates, 
whether it was emails, huddles with our manager, 
that helped with an organized aspect of the chaos” 
(P27). As reflected in this excerpt, proper flow of 
information brought an orderliness to what was 
perceived as chaotic in the early days of COVID-19. 
However, some nurses were “frustrated because of 
lack of information” (P28) and felt their “input” should 
have been sought (P17). Another nurse commented 
on the importance of “constant communication … 
knowledge of what’s going on” to support them “to be 
resilient” (P11). One nurse leader described 
distributing “information … [in order] to get people to 
be malleable and adapt to changes” (P01). It was clear 
that proper flow of information emotionally 
supported nurses’ resilience. At the start of the 



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pandemic, nurses “had lots of questions” about safe 
provision of care: 

     Everyone was holding a gun to our manager, we 
want answers … there came a point where instead of 
trying to argue … you know what, we are doing it … 
so let's try to communicate more often … what the 
plan is, what the uncertainties are. Having that 
communication allowed us to work as a unit to take 
care of patients (P12).   

     One nurse leader addressed staff’s concerns “with 
evidence. Printing out research articles, highlighting 
results … being honest, transparent” (P01). 
Information transparency was underscored as vital to 
emotionally supporting nurses. One nurse noted that 
“open forums” with hospital leaders allowed nurses 
“to ask questions … clarify concerns … helps with 
uncertainty” (P15). It was indicated that some 
hospitals provided daily updates: “how many COVID 
positive patients, how many people passed away, how 
many staff got COVID ... how much PPE’s left … that 
was the biggest thing, it helped” (P01). Although 
transparency was important, the constant flow of 
information was problematic in some ways. 

     Information overload was challenging in terms of 
the flow of information. One nurse leader 
commented: “the hospital wants new things to be 
implemented to keep everybody safe, but they didn't 
understand there was information overload” (P01). 
This nurse elaborated that was “very difficult to filter 
through hundreds of pages of policies, summarize it, 
and disseminate it to staff in effective ways … nobody 
has time to read. Their expectation of nurses was 
really high” (P01). Frontline nurses were fully 
engrossed in caring for patients and families, and then 
also expected to read about all the changes. One 
nurse noted it was “hard to cope with the amount of 
changes … every day we had huddles on how policies 
are being changed, standards of practice are being 
changed, infection control is being changed … it 
becomes very stressful to deal” (P05). It also appeared 
that being an agency nurse added a layer of 
complexity to responding to the changing 
information: “things were changing so quickly, day-
to-day, and I don't have consistency of knowing the 
staff, the managers … there was lots of movement of 
like materials and I just felt out of sorts, in every unit” 
(P24). In relation to COVID-19, they also elaborated 
that their agency “gave no training … I felt very 
isolated” (P24). In addition to quantity, there was 
also 

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diverse information that affected how they were 
supported emotionally. 

     Nurses’ narratives reflected that different and 
sometimes contradicting information influenced the 
flow of information support: “hospital policies were 
changing by the hour, we were getting a lot of 
different and changing information all the time” 
(P22). They elaborated: 

     It got very confusing … frustrating, one person is 
telling you something, you're getting emails about 
something else … it's conflicting when you have 
supervisors … who you're looking to for directions 
and they cannot come to a consensus (P22). 

     Although the changing information was difficult, 
the contradictory nature was more challenging: 
“every day you'd hear something new” (P06) and they 
referred to “the most unsettling part” as “the 
discrepancies between organizations. You have CDC 
recommendations, WHO’s … anxiety was an all time 
high … then, it's not until like the next day where we're 
acting on it” (P06). Specific to the flow of information, 
some nurses described a “break in communication” in 
terms of the managers, and they found themselves 
questioning “what is the right practice?” (P11).  

     Effective exchange of information or lack thereof 
prompted nurses to question why “upper 
management” had not learned from “SARS and other 
pandemics” (P08). They elaborated: 

     [this] created a distrust between frontline workers 
and management … if they recommended a certain 
way of protecting ourselves, … more kind of an 
evidence-based approach. That would reassure us … 
we don't know where they're getting the information 
from. We don’t know how they're building policies, it 
was very uncertain (P08). 

     Nurses’ narratives reflected how more 
transparency would have been appreciated about the 
reasoning behind decisions. 

     As suggested in nurses’ narratives, information 
transparency would also build trust and enhance 
feelings of support. One nurse commented feeling 
“supported by managers and other times, not as 
much” (P17). They explained: “there were certain 
things that I would find out from my colleagues, rather 
than my manager … almost made us feel unsafe going 



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36 

into a situation knowing we might not have the entire 
picture.” A lot of feelings of trust/mistrust surrounded 
lack of transparency about PPE: “We weren't able to 
find them [PPE] anymore. Management was taking 
them down. They weren't telling us why … they never 
had the conversation with us to tell us and explain 
why” (P22). There were mixed feelings about 
management, stating: 

     Felt like we were being lied to … they kept saying, 
“we have a lot of PPE,” but we were looking at our 
supplies and we were like, it doesn't look like we do. 
They kept covering things up in terms of where they 
were keeping the N95s. It's not fair. We're the ones 
that are wearing it so if we don't have the supplies, 
we want to hear it from you … just felt that trust was 
being affected but at the same time that stress did 
impact our management … I could see it emotionally, 
our manager broke down in tears because of the 
exposure of COVID to one of the nurses (P05). 

     One nurse leader explicated the mistrust felt by 
nurses in a context of dynamic information: “a lot of 
suspicion and mistrust towards the organization, in a 
context when we did not have enough PPE, did not 
know the evidence, was it droplet or airborne” (P30). 
In referring to new policies, they explained there was 
“anxious trepidation and staff questioned when 
educators came … this is going to be how we manage 
a code blue for people who have respiratory 
symptoms.” It was also clear that a lot of the 
information support was related to resource support. 
Resource Support 

     Resource support referred to access to supplies in 
ways that positioned nurses to feel they were safely 
functioning as a unit. Their narratives clearly reflected 
how they were concerned about the lack of resources 
to protect themselves: “[we] didn’t feel like we had 
adequate resources … we felt we were more at risk” 
(P03). They explained that having “an adequate 
supply of PPE … would have diminished some of the 
fear” (P03). Another nurse commented that having 
resources “readily available” was important “so that 
people know … their institution, they all got my back 
… instead of us asking for it, and sometimes begging 
for PPE” (P04). One nurse commented on the 
emotional response to not having sufficient 
resources: 

[With] so many people getting sick and dying, people 
needing ventilators, there's only X number of critical 

IHTP, 1(1), 29-43, Spring 2021     CC BY-NC-ND 4.0 

care beds. There's only X number of ventilators. With 
the amount of people that can get sick, there's 
obviously not enough resources … it's a very daunting 
idea of how the scale can tip. There'll be days going 
to work or coming home from work, I’ll just be 
driving, and breaking down into tears because of fear 
(P22). 

     It was common for nurses to note how “we were 
promised” after SARS to never be in this place again 
in terms of lack of PPE (P03). Nurses often exclaimed 
“nothing was learned from SARS. That's more of 
provincial planning as opposed to specific to my 
organization. If there was more preparedness 
regarding healthcare as a whole within the province 
and Canada, that would have been much better.” 
(P27). It was also noted that it was not just about 
insufficient PPE, but also improper practices being 
advocated related to its use. 

     The degree of feeling emotionally supported was 
influenced by the continued inappropriate mask 
policy use that is not supported by evidence: “the 
mask policy [was] only having two masks … these are 
single use masks, and knowing that that's a financial 
decision by the hospitals and not one that's backed in 
science is troubling” (P24). Some nurses described 
“we didn’t have much resources, less gowns, less 
masks” (P16) while others noted “our unit was not 
short on resources, we didn't have to reuse our N-95s 
longer than that day” (P22). This last nurse’s 
statement appears contradictory considering that 
they were referring to sufficient resources despite 
wearing a single-use mask all day. The restriction of 
access to PPE became an issue in terms of resource 
support: 

     They locked up the N-95s … saying, you could only 
use one per shift. You have to write out a reason why 
you took it out because we're going to audit it … why 
do I have to provide a reason to protect myself … 
people were saying “oh, you guys chose to do this 
job, you have to deal with whatever happens.” I 
chose to do this job, because I was passionate about 
it. And I thought the place that I worked in would 
support me better. I didn't sign up to work with less 
PPE (P16). 

It was clear that many nurses “didn't feel like they 
[the hospital] prioritized first contact persons who are 
actually caring for COVID patients” (P16). This nurse 
elaborated: 



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37 

I felt like they were thinking, how can we save 
resources so we can better spread it out in the 
future? … Our manager came and said, this is an 
article that says you can use your N-95 for two days. 
We were like, what? Use the same mask that came in 
contact with other things? It didn't feel safe. Their 
logic didn't make sense. We had a bin in the back of 
the hospital, throw away your N-95 here … they're 
going to reuse it? We're going to get someone else's 
mask that they washed or disinfected … made me 
feel more stressed. Who’s making these calls? Are 
they having nurses on decision-making teams? Are 
they having experienced people making these 
decisions? It didn't seem fair. It made it more 
upsetting, it made me not want to come to work 
(P16). 

     The inappropriate massaging of evidence to 
reconcile the PPE shortages failed to reflect the reality 
of risk nurses were exposed to, significantly 
undermining the value of their work. Nurses’ 
accounts of resource support also revealed the social 
justice nature of support. 

Social Justice Nature of Support 

     The social justice nature of support related to the 
emotional experience involves the fair, 
compassionate, and equal rights of nurses. The social 
justice nature included advocacy and recognition and 
compensation. 
Advocacy 

     Advocacy involved speaking up for self and 
interceding on behalf of others. One nurse described 
their manager as a “nurse’s nurse … we know they 
have our back … our manager wants to appease us 
first and then deal with upper management” (P02). 
Although it is important to note that study 
participants came from different units and hospitals 
and thus, the feeling of support and advocacy varied: 
“I wouldn't say I'm happy to work for this hospital 
because I didn't feel like they had our backs through 
this whole thing and it's sad … they didn't make us feel 
safe” (P16). This nurse explained that they would 
have felt more supported if the hospital said “you 
signed up to work with us, we have your backs, here 
are your resources. If you need anything, contact us. I 
never felt that support.” (P16). Another nurse 
indicated having a manager who “was fully supportive 
of us using our PPE the way we thought fit. She's 
been 

IHTP, 1(1), 29-43, Spring 2021     CC BY-NC-ND 4.0 

hugely supportive, and that means everything to us. I 
don't think we could have gotten through without this 
manager” (P02). Another nurse referred to their 
manager “fight[ing] for us to be treated right within 
the hospital and for us to receive proper PPE, and 
make sure that we're doing okay in our role … I felt 
really well supported” (P17). In addition to PPE, it was 
also noted how nurse leaders advocated for human 
resource support: “we have a resource nurse so we 
always have somebody to do admissions. That has 
increased morale … we feel a little bit more supported 
… our manager advocated, like pushed for that” (P03). 
As reflected in nurses’ narratives, the role of advocacy 
among managers really acted to emotionally support 
nurses.  

     The nurse leaders’ narratives demonstrated ways 
they advocated for their staff nurses. In referring to 
nurses that did not typically work on the unit, one 
leader noted that “we made sure that the nurse was 
supported … once their shift was done … I emailed 
their manager to say … can you reach out to this 
person to make sure they’re emotionally okay?” (P04). 
Another nurse leader advocated and arranged for 
information sessions with upper management: 

     Staff are very upset because they feel like 
[hospital leadership] are not even on these units. And 
so how are you supposed to make these decisions? 
You don't even assess or get feedback … we had the 
IPAC doctor come. It was like a roundtable where 
nurses asked all types of questions. Why do we need 
N-95 for this and not that? So every single question
they could think of, they asked, and they addressed
it. Then we had the VP of nursing come and answer a
bunch of really tough questions from staff. It was
really effective, but they only did it once. My
suggestion was having people who make the really
tough decisions, come and be candid, be honest
(P01).

     In addition to advocacy, the social justice nature 
of emotional support involved recognition of nurses. 

Recognition and Compensation 

     Recognition involves the active acknowledgement 
of nurses or lack of acknowledgement as something 
valid in the context of hospital leadership. One nurse 
explained that as a result of COVID-19, it appeared 
that “society appreciated healthcare more … and the 
importance of nursing” (P01). Another nurse 



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38 

elaborated upon how this recognition emotionally 
supported them and acted as “the little lights in this 
dark tunnel”: 

     We were called healthcare heroes and we were 
quick to be called superheroes … that kind of 
reinforced the fact that we were important in this 
fight … community support that we got was very 
helpful. Like, not having to wait for groceries, on the 
one day off that I have that week, after working 70 
hours because we had to pick up over time because 
we were so short. Like those kinds of things helped, 
and helped us survive (P27). 

     It was also noted how the emotional impact was 
acknowledged by leaders. When their patient died, 
one nurse recalled that their charge nurse was 
“supportive” and told them to: “step away from the 
unit, take a break for yourself. That helped me 
understand that I don't have to put my emotions away 
… I can just let it be, and focus on myself” (P12). One 
nurse leader noted that “it takes listening to their 
[nurses’] feelings, acknowledging that they’re scared” 
(P01) and making sure “we recognize and 
acknowledge the staff so that they don’t feel 
abandoned” (P04). 

     Nurses’ narratives reflected several ways where 
hospital leadership could have better acknowledged 
the work that nurses were doing. One nurse 
commented on the importance of the “visibility … of 
senior leadership” visiting the nurses on “the 
frontlines” to “build up morale”: 

     If our VP would come to the units once a week to 
simply say, you guys are doing a great job and we 
may not have all the answers, but this is what we're 
doing to get them … face-to-face definitely helps 
people cope emotionally and is a good resource 
(P30).  

     Another nurse commented that acknowledgement 
from the senior hospital leaders was “lacking” (P04). 
This nurse elaborated: 

     Why can't we have our directors, our VPs, CEOs 
come in and acknowledge … from a commitment 
perspective, if you think of the long-term and if you 
wanted people to stay in the hospital and give their 
best. … it's like a slap in the face, … you didn't even 
thank us, visit us … and people don't even know now, 
like it's going to be months from now, people won't 

IHTP, 1(1), 29-43, Spring 2021     CC BY-NC-ND 4.0 

even know that this unit, and these nurses cared for 
COVID patients (P04). 

     Although senior leadership may have avoided 
visiting staff because of concerns about cross-
contamination between units, it was clear that some 
form of acknowledgement of the commitment of 
these nurses would have had an influential short- and 
long-term impact.  

     A lack of recognition from the government was 
generally reflected in narratives. Although there were 
expressions of gratitude from government leaders, 
one nurse remarked “talk about the hypocrisy of 
being called healthcare heroes … people are running 
out of PPE” (P26). Another nurse noted “we’re a dime 
a dozen … if they cared … we wouldn't have to sign out 
N-95s every time we use one. It's disgusting and it’s
just exhausting, like you're not worthy” (P02). An
important demonstration of recognition is that
nursing “needs to be valued financially” (P24). One
nurse noted that provincial pandemic pay “pushed us
all to work harder and felt us all to be recognized”
(P27). However, the general sentiment around
pandemic pay was quite negative. One nurse said,
“they want to save healthcare money on the nurse’s
back, it's always been that way. And I'm tired of it …
makes me want to leave the profession” (P02). The
impact of nurses not being acknowledged with
appropriate pandemic pay is summed up by one
nurse:

     It's all good for the government, politically to 
praise us, bang some pans or whatever the heck they 
want. But when it comes down to the meat of it, 
when our government [limits pandemic pay] … it tells 
me that they don't care about nurses, that what 
they're saying to the general public in terms of how 
we're heroes … it's bullshit … makes me very angry. 
You feel like, why am I doing this? Very disheartening 
… that is what put us over the edge, the fact that we 
are completely and utterly not valued. To be given a 
contract that reflects the seriousness of the things 
that we deal with, would have been huge … we're 
risking everything. So what could have been done? 
Pay us what we're worth (P02). 

     The impact of acknowledging nurses for their 
commitment and work was highlighted by one nurse: 
“[it] would also make people a bit more resilient and 
more adaptable” (P04) during a time that not only 



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39 

needed nurses, but needed nurses who were 
emotionally supported. 

DISCUSSION 

In this study, we explored how nurses were 
emotionally supported and how they can be better 
supported while working in COVID-19 acute care 
hospital environments. Although there is no panacea 
for emotional support of nurses working in these 
environments, an important starting point is to 
provide light to illuminate a path forward. Our study 
findings indicate that there was a deep gratitude for 
the many “little lights in this dark tunnel” that 
supported nurses during these emotional and 
traumatic experiences. The implications of these 
findings suggest a multifold approach is needed to 
support nurses including prompt and appropriate 
interventions. This support includes nurturing organic 
forms of support, enhancing intentional forms of 
support, and further activating the social justice 
nature of support. 

     In the early days of a pandemic, such as COVID-19, 
it is essential to systematize a responsive plan that 
implements intentional forms of both information 
and resource support. The findings from our study 
highlight how transparency and flow of information 
act to emotionally support nurses’ resilience. Our 
research expands on Rosa et al. (2020) who indicated 
that transparent communication was important to 
assuage nurses’ fears. Part of transparency is ensuring 
honest communication in which resource support is 
evidence informed and nurses have access to 
appropriate PPE – and this does not mean two masks 
per shift. Like Prestia (2020) noted, it is important to 
provide truthful and timely information particularly 
during difficult times such as when there is a shortage 
of PPE. Our study findings indicate that transparency 
and honesty in communication surrounding 
information and resource support is key.  

      We would be remiss in not discussing the social 
justice nature of support in terms of the importance 
of advocacy and recognition during emotionally-laden 
situations such as COVID-19. Our study findings 
indicate that recognition of nurses’ dedication to the 
frontlines was valued and nurse leaders played an 
instrumental role in this type of emotional support. 
Others have highlighted the important role of 
courage and advocacy among nurse leaders so that 
those at the frontline are supported (Daly et al., 2020; 

IHTP, 1(1), 29-43, Spring 2021     CC BY-NC-ND 4.0 

Markey et al., 2020). However, our work highlights 
how this recognition also needs to include advocacy 
and action so that nurses’ risky work is appropriately 
compensated. As others have found, nurses are the 
ones at the frontline who are most at risk for 
infection, exposed to distressing patient and family 
suffering, and experiencing a trauma that is described 
as some as immeasurable (Rosa et al., 2020). Our 
research highlights how authentic recognition 
involves advocacy as well as the presence of 
leadership. 

     The presence of leadership in its many forms is vital 
to help nurses feel supported and navigate their 
emotions during emotionally-charged times such as 
the COVID-19 pandemic. Similar to Raderstorf and 
colleagues (2020), we found that maximizing physical 
presence of leadership on COVID-19 units was vital so 
that recognition of nurses’ work, their emotions, and 
connecting with them was optimized. Our work aligns 
with Rosa et al. (2020) noting that regular rounding by 
nurse and hospital leaders ensures that nurses feel 
seen, validated, and also provides opportunity for 
their concerns to be articulated and addressed. 
Although this physical presence may sometimes be 
restricted, consistent communication and 
information and resource transparency becomes 
even more important during these times. As Bookey-
Bassett (2021) and Shahrour and Dundas (2020) 
noted, it is important that leaders are accessible to 
nursing staff. Similar to others, we also found that this 
presence of leadership is linked with advocacy for 
personal safety measures as paramount (Daly et al., 
2020; Shahrour & Dardas, 2020). The active presence 
of leaders provides opportunities for nurses to be 
supported in terms of their resilience and ability to 
thrive in their daily work (Daly et al., 2020). 
Additionally, there is a positive ripple effect of 
effective leadership and support that flows from 
leader to staff and beyond (Prestia, 2020). Our study 
findings reflect how this ripple effect can also be 
reciprocal in which the resilience of all of those 
involved, particularly in emotionally difficult 
situations such as those caused by the pandemic, is 
nurtured. 

     The findings of our study reflect how organic forms 
of support also act to emotionally support nurses. The 
unique emotional support from other nurses in the 
form of camaraderie was notably meaningful to 
nurses particularly when they were lacking support 
from leadership. The sharing of these unparalleled 



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40 

experiences validated their feelings and lessened the 
sense of isolation. Similar to other research, we found 
that nurses felt like they were in it together in terms 
of fighting this pandemic as a team (Catania et al., 
2020). In addition to camaraderie, emotion-focused 
coping is valuable to the support of nurses. Our study 
highlights that engaging in activities that create 
“good” feelings and counteract some of the difficult 
feelings is important to emotionally support nurses. 
Others have found that emotion-focused coping such 
as humour and religious activities can have a positive 
affect on healthcare providers (Phua et al., 2005). In 
fact, our research highlights how prayer brought 
nurses together at the start of a shift no matter what 
their religion or if they were religious. Our research 
also underscores the importance of outdoor activities 
as part of emotion-focused coping. This may be of 
special relevance with COVID-19 considering its 
isolating nature across the globe. 

     Access to appropriate and comprehensive forms of 
mental health resources are fundamental to the 
emotional support of nurses. Similar to our research, 
it has been commonly noted that psychological 
support plays an important role in the therapeutic 
support of nurses (Gao et al., 2020; Shahrour & 
Dardas, 2020; Viswanathan et al., 2020). However, 
the need for psychological support is not something 
new as others have underscored its importance 
particularly since the SARS epidemic (Smith et al., 
2020). Researchers have found, the psychological 
distress and trauma that nurses are experiencing is 
intensified for frontline providers during COVID-19 
(Jackson et al., 2020; Lai et al., 2020; Labrague & de 
los Santos, 2020; Lapum et al, 2020; Reger et al., 
2020). In our study, nurse leaders specifically noted 
how frontline staff were struggling and they recognize 
that they should not be the ones attempting to 
provide counselling. Like others, we found that 
institutions must engage in the provision of 
psychosocial support of nurses to reduce stress and 
support their well-being (Catania et al., 2020; 
Shahrour & Dardas, 2020). Rosa and colleagues 
(2020) noted that “healing from the effects of the 
pandemic can't rest on the shoulders of those at the 
frontlines” (p. 33). This statement closely aligns with 
our findings in that many times nurses are suffering in 
silence and often will not reach out for help. This 
finding is critical in how institutions must actively 
reach out to nurses in terms of providing on-site 
psychological support and possibly require formalized 
one-on-one check-ins to assess whether additional 

IHTP, 1(1), 29-43, Spring 2021     CC BY-NC-ND 4.0 

support is needed. This type of support can help 
nurture resilience particularly during high-demand 
situations such as COVID-19 (Henshall et al., 2020) 
and ensure that nurses know that their well-being 
matters (Rosser et al., 2020). 

CONCLUSION 

There was deep gratitude shown for what could be 
described as the many little lights in a dark tunnel that 
acted to emotionally support nurses during COVID-
19. However, it was also troubling and traumatic
particularly during the times when these lights did not 
seem to flicker - when nurses were emotionally
drained and did not feel supported and as such felt
isolated. And there were times when these lights
shined a little brighter helping to illuminate the path
forward and support nurses’ emotional journey and
resilience. In moving forth, strong beams of light are
needed during some of the darkest times of
pandemics. And it is clear that nurse leaders, hospital
leaders, and government leaders as well as frontline
nurses themselves can be instrumental in the
provision of this emotional support.
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