Together in Christ: Supporting Nursing Alumni During the COVID-19 Pandemic.

ABSTRACT: The StagsCare program at a Christian university offered support to recent nursing graduates and other alumni during the early days of the COVID-19 pandemic. Faculty of the Egan School of Nursing and Health Studies created the StagsCare program, providing opportunity for alumni spanning over 20 class years to join in community for prayer, reflection, and shared experience. Both new and seasoned nurses, most of whom did not know one another, offered support to one another and strengthened their spiritual foundations as they served on the frontlines of the pandemic across the United States.

Just 10 months after their graduation and pinning ceremony, members of the nursing Class of 2019 began calling, emailing, and texting our staff for advice. The Egan School of Nursing and Health Studies at Fairfield University is within an hour's travel from New York City; many new graduates and seasoned alumni work in the city's 214 hospitals (New York State, 2021). During spring 2020, when New York City was an epicenter for the COVID-19 outbreak (Thompson et al., 2020), these nurses were among the first in the United States to care for COVID-19 patients.

Like other nursing programs, many of our alumni were on the front lines of the pandemic, but this was an additional challenge for members of the Class of 2019. These new nurses had been working only for a few months when the pandemic hit. With limited specialty training and or certifications, these new nurses were at the forefront of the pandemic. Many were placed in labor pools to work in areas of greatest need at their hospitals, including the intensive care units and medical floors overflowing with very sick COVID-19 patients.

On March 24, 2020, a parent from the Class of 2019 alumni emailed our faculty regarding concerns for her daughter, saying:

They converted her floor to a covid floor and moved the oncology patients somewhere else. Maggie∗ was in the middle of getting her chemo certification but has not completed yet. Her floor was split up and only those with chemo certification stayed together with their cancer patients. Each day she goes to work she has no idea where she'll be placed. The hospital is in chaos and the administration has not set out clear directions or plans...she's just been thrown into a war-zone that she wasn't ready for. (Confidential, Personal communication, March 2020)

While in this case, the war zone that the mother was referring to was an invisible enemy—the coronavirus—many looked to Fairfield University for the advice and comfort of their trusted teachers and mentors. We also believed that in this raw moment, they were looking also for God's grace and presence.

CREATING A PLAN

As those first days and weeks of the pandemic passed, the dean and I (Linda) spent countless hours responding to the realities of the pandemic with operational and programmatic decisions for the undergraduate nursing program. To best offer advice and spiritual support, the Director of Undergraduate Nursing and Dean of the Egan School of Nursing and Health Studies, along with the Assistant Director of the Murphy Center for Ignatian Spirituality (See Sidebar), began to formulate a plan. The Murphy Center helps people to explore the sacred aspect of being human and finding God in all things (Fairfield University, 2021a). In this moment of uncertainty, we decided to offer presence and prayer with our courageous alumni. We followed our hearts in the design and quickly implemented a program for our nursing alumni. As we discussed supporting alumni who were at the forefront of the pandemic, the StagsCare program was born.

The StagsCare support program (named after the Fairfield University mascot, the Stag) was offered during the critical weeks of high patient acuity and patient surge in Connecticut and the surrounding region to all Egan School of Nursing alumni. In the four sessions, alumni spanning over 20 class years came together in community for prayer, reflection, and shared experience. Following a prayer and blessing of the nurses, alumni—most of whom did not know one another—offered support to one another as they courageously faced the pandemic across the United States.

With the technology available, we invited all nursing alumni to participate. Outreach was tricky. Despite many of our alumni “following” our university on social media, we were concerned that unintended visitors might join the virtual meeting, as “Zoom bombing” was also occurring at this time (O'Flaherty, 2020). We had to move swiftly as our community needed light. “Spiritual care is not a luxury, it is a necessity for any system that claims to care for people—whether the people are in the bed or draped in protective gear” (Ferrell et al., 2020, p. e8).

Each evening's virtual session started with a reflection and prayer. The “floor” then opened for discussion. Although most participants did not know one other and lived in different areas of the country, the nursing alumni had a powerful sense of the significance of being “welcomed home” during this period of great uncertainty in their personal and professional lives. Shared conversations highlighted the challenges: not having enough personal protective equipment (PPE), or the weight of being the only individual that a patient had contact with during a 12-hour shift. Some participants voiced the struggle of being told to limit their time in each patient room to hourly rounding and care but felt they needed to be present for their patients. Other emotions and feelings emerged during the sessions. Each time, participants were virtually met by their fellow alumni and our team, listening and offering support.

Gratitude for family and friends who supported these nurses so they could continue their important work on the front lines was clear. Unlike the many who pivoted to online work, our participants encountered other obstacles. Challenged by the uncertainty of caring for COVID-19 patients and finding solutions to the difficulties this presented in personal lives were common themes.

In a time of physical distancing, the StagsCare program enabled groups of nurses to listen, encourage, and find solidarity. It was also a clear reminder that even in the darkest of times, God is with us. “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand” (Isaiah 41:10, NIV). Participants sometimes turned off their cameras and microphones to put children to bed but returned to experience the warmth and support of the group. Although we only held four sessions of former relationships were rekindled and others were ignited. Conversations continued offline, but one thing was clear—we had connected and were grateful for time together.

In nursing, we recognize the importance of holism in practice (Fairfield University, 2021b). Spirituality is significant in healthcare because it promotes coping strategies for stress, aids recovery and resilience, and prevents burnout (Roman et al., 2020). The COVID-19 pandemic reinforced that this is true for our patients and is certainly true for our providers. Nurses will not have all of their needs met by their employers. As we saw during the spring and summer 2020 months of the pandemic, employers were overwhelmed with the insurmountable challenges of lack of PPE and staff, evolving patient care protocols, and high acuity patient surges (Labrague & Santos, 2020). An opportunity existed for nursing program administrators and faculty to partner with their colleagues in religious ministries to offer their alumni support and connection. The StagsCare program did this.

IMPACT

The literature is chronicling nurses' experiences during the pandemic; a primary source of anxiety in nurses at this time was the fear of becoming infected or unknowingly infecting others (Labrague & Santos, 2020). During the pandemic, negative emotions experienced by nurses included fatigue and helplessness resulting from high-intensity work, fear, anxiety, and concern for patients and family members (Sun et al., 2020). Healthcare workers experienced high levels of depression, anxiety, insomnia, and distress and nurses were disproportionately affected (Shaukat et al., 2020). Nurses reported more severe degrees than other healthcare workers of measured mental health symptoms and burnout during the COVID-19 pandemic (Lao et al., 2020). Early studies support that nearly half of nurses reported high levels of burnout during the first wave of the pandemic (Matsuo et al., 2020).

The COVID-19 pandemic catapulted the historic heroism of nursing to the forefront, but we knew the toll it would take on our newly graduating students as well as those who've been in practice for years. As ICUs filled and the worldwide death toll rose, so did the stress throughout the nursing profession. Even the most rudimentary psychosocial theories support that emotion cannot be suppressed for long. Left untended, the stress tears holes in the fabric of our strength and sneaks around the margins of our reserves. Without attention to this stress, our alumni and the profession suffer. Both immediate and long-term action were needed. Until that first evening gathering of the StagsCare Program, when alumni began to share their stories, we didn't know the full impact. It became clear that a multidimensional and long-term strategy to care for the profession that cares for the patients of the pandemic is necessary. We began with our strengths to support our community with the spiritual supports we could offer.

In the early moments of the pandemic, my (Linda) thoughts first went to my family, current undergraduate nursing students, and fellow colleagues in clinical practice. Soon, I received my first text message from a Class of 2015 alumnus, a New York City pediatric intensive care unit nurse, and my focus shifted. This nurse told me how frightened she was to care for adult patients with COVID-19 in the medical intensive care unit and asked me if I would pray with her. She did not ask me to pray for her; she asked me to pray with her. I had a close professional mentoring relationship with her that started when I was her pediatric clinical instructor; however, we did not talk about our faith. Receiving that text forever changed me as an educator, a nurse, and a person.

REFLECTIONS

StagsCare program participants felt supported and encouraged through their online interactions with fellow alumni. Seeing faces of other healthcare workers, without masks and PPE, created a safe place for community during a time of social distancing and extreme stress.

During one session, an oncology nurse leader shared Hebrews 11:1: “Now faith is confidence in what we hope for and assurance about what we do not see” (NIV). This spoke to the moment, both then and now, as we continue to face challenges with the pandemic.

One participant, an operating room nurse, shared her reflections about the StagsCare program. She noted that it was “a good way to connect with alumni during an isolating time that was particularly difficult for those of us who had less than a year of nursing experience and were forced into different roles than what we were oriented to do.”

Another 2019 graduate stated that the program helped her feel like she had a group of senior nurses who would listen to her. “My regular co-workers and I were separated from one another to work in different areas where we were needed. Every time I went to a new area, there were new people. They didn't know that I was pretty much a new grad, and I was really scared. They were too busy to ask. I didn't feel like there was anyone I could share my feelings with. The [StagsCare] program really helped.”

FAITH DURING A PANDEMIC

According to Nelan (2020), by working during the pandemic, Christian healthcare workers have demonstrated the presence of Christ, exemplifying character traits of faith, hope, and love that will endure beyond this current storm of the COVID-19 pandemic. Protecting healthcare workers' well-being through appropriate measures is crucial in a national emergency public health response (Shaukat et al., 2020). “The masked face of a young nurse holding her own gloved cell phone as a faith leader remotely offers a blessing to a dying patient from afar is a frequent image that offers both comfort and angst” (Ferrell et al., 2020, p. e8). A critical care nurse shared that she prays before going to work, seeking the Holy Spirit's help to love and care for the patients she will see that day, as she must be ready to help them die (Hrbacek, 2020). Arming current and future nurses with the skills to persevere during the most sacred moments amid unimaginable challenges is essential.

CONCLUSION

During dark times when we can feel helpless, it is essential to remember to turn our hearts and minds toward God. For quite some time, nurses' reactions to caring for others during the pandemic received little attention. Hospitals were overwhelmed with the demands of providing equipment and supporting staff related to the care of COVID-19 patients. Our nursing faculty had introduced these nurses to our profession. It was only fitting that we came together again when these alumni needed support. The decision to create StagsCare came through our time praying and asking God how we could help. We were placed where we needed to be in those moments.

Opportunities to welcome nursing alumni “home” for support are vast. Options for other such programs may be considered when nursing faculty want to support alumni but are unsure where or how to begin.

Sidebar: Finding God in Horror and Hope

The pandemic remains a singular event in the life of our Fairfield University nursing graduates, our families, and our nation. I was immediately drawn to join in this StagsCare endeavor to listen and to support our young and seasoned nurses in finding God amidst the horror and hopes of their daily shifts.

Our Ignatian heritage instills in our students the deepest desire to serve with excellence and compassion. I saw this group-sharing opportunity as a blessing and a challenge. Our students' studies hopefully provide tools to exemplify the Ignatian ideal of living out faith and promoting justice in their nursing practice. The pandemic's complexity as a physical and social disease became evident in our ongoing listening sessions. Hearing the stress and confusion of our nursing graduates was a profound experience. Allowing these nurses to share their deep feelings and frustrations in a safe and caring environment led to better insights and meaningful connections.

The outreach of our professional colleagues was a remarkable witness to the depth of commitment that Fairfield University places on God's desire to be present in our work and in our prayer. I found myself deeply enriched in listening and praying with these healthcare heroes. As the pandemic continues to affect us all, I believe further outreach to be an essential and enduring quality of developing our graduates in a holistic manner.

St. Ignatius of Loyola, the founder of the Jesuits, gives us the spiritual tools and insights to be servants of love and compassion. I heard repeatedly in our conversations with these nurses this deep longing of their hearts. As Ignatius prayed often: To seek and not to count the cost; save only that we are doing God's work, with love and compassion.

—Fr. John Murray, S. J., Assistant Director, Murphy Center for Ignatian Spirituality, Fairfield University