Migrant nurses have to adapt to new ways of working in their adopted country, with different health systems, routines and work cultures. This can cause a roller coaster of emotions that can lead to stress and anxiety. Such emotions have been amplified during the COVID-19 pandemic. At a time when social distancing is mandated, people need support as never before to maintain their emotional health.
The novel coronavirus, which was first reported in China in late 2019 and is now a global pandemic, has highlighted the vital work of health professionals. More specifically, it has drawn attention to the role of nurses in preventing, containing and managing this health emergency.
Coincidentally, the year of the pandemic, 2020, was declared the International Year of the Nurse and Midwife by the World Health Organization (WHO, 2020a). The year 2020 was also the 25th anniversary of the graduation of the 1991-1995 cohort of BSc Nursing students from one of the leading colleges of nursing in Mangalore, Karnataka state in India, and a silver jubilee reunion celebration was planned.
The majority of this cohort of nurses are now working in many different countries around the world, forming part of the migrant workforce. Owing to the COVID-19 pandemic, the plans to celebrate this anniversary with a reunion in the host town were initially postponed and then cancelled. Meanwhile, it was evident that most classmates living away from India were emotionally affected by treating COVID-19 patients and were looking for ways to deal with stress.
Organising the event as a means of support, even through virtual means, had become a necessity as a stress outlet. This article aims to give a brief outline of the event and also emphasises the importance of building resilience by making connections during the pandemic. It also highlights the need for educational initiatives to build resilience among nurses and to prepare them for managing unprecedented challenges in the future.
Nursing in a pandemic
The COVID-19 pandemic has impacted all healthcare workers, both physically and psychologically. Burnout, anxiety, fear of transmitting infection, feelings of incompatibility with the professional role of the nurse, depression, increased substance-dependence, and post-traumatic stress disorder (PTSD) are some of the issues that have affected nurses, and that they are likely to continue to encounter (Dubey et al, 2020; Greenberg et al, 2020).
The ethical obligation of providing professional care to patients with COVID-19, along with the anxiety of putting their own personal and family health and safety at risk of contracting the virus, has had a significant impact on all healthcare staff, including nurses (Tiong and Koh, 2013; Maben and Bridges, 2020). Like other health workers, nurses have experienced considerable stress, not only during the initial outbreak and surges of cases, but also from living and working during a prolonged pandemic. This has had psychological consequences for many (Lehmann et al, 2015; Khalid et al, 2016).
Migrant nurses
Migrant nurses provide an essential service to the healthcare workforce globally (Tayaben and Younas, 2020). A lot is known about the challenges and stressors that impact on culturally and ethnically diverse migrant nurses, even without the added demands of a pandemic (Jackson, 1996; Brunero et al, 2008; Bustamante et al, 2017). The emotional wellbeing of migrant nurses is maintained by support from family members, close friends, religious institutions, and maintaining social visits to their places of origin (Hagey et al, 2001; Parikh et al, 2004). WHO has urged healthcare workers to stay connected with their loved ones through all possible ways, including the use of digital methods during this pandemic (WHO, 2020b).
The authors realised the significance of the COVID-19 pandemic and the profound impact this has had on fellow migrant nurses, including on those who contracted the disease in the line of duty, those who nursed patients and supported their families, and those who supported their own family members in sickness and death. The authors felt that providing an outlet for fellow nurses to express their feelings and connect with their ethnic peers might provide them with some relief. The support of colleagues who have had similar experiences in times of stress can be helpful (Maben and Bridges, 2020). Social support has been shown to promote physical and mental health (Reblin and Uchino, 2008).
To this effect, the authors embarked on a journey to reconnect with and support their peers, including many who had been infected with COVID-19, to share their experiences and provide support to each other.
A virtual reunion event as a coping mechanism
The authors, along with a select group of peers, planned and implemented a virtual reunion with the aim of providing social support to fellow nurses. The following steps were taken to facilitate the event and to make it as enjoyable and supportive as possible.
Planning the event
As soon as it was apparent that the silver jubilee reunion in India was not going ahead, seven classmates living in different countries around the world, came together online to form a planning committee. They met virtually each week over several weeks to design the event. Members took responsibility for planning the items listed in Table 1.
Table 1. Key factors considered for the preparation of the reunion event
| Key area | Items | Purpose |
|---|---|---|
| Ensure full attendance | International time zone considerations | Organise the event within waking hours across global time zones (Los Angeles in the USA to Melbourne in Australia) |
| Invitation | Delegation of responsibilities | To follow up with approximately 50 classmates and academic staff |
| Designing an e-invitation | To invite former heads of department, professors, lecturers and alumni | |
| Personal invitation | To ensure all the former academic staff were invited to the event | |
| Slide show | Create a slide show of photos of college days | To reminisce about college days |
| Assemble a slide show of classmates' family photos on their profiles | To enable self-introduction during the event | |
| Virtual party video | Plan the launch of virtual reunion party | To mark the silver jubilee reunion via a virtual party |
| Create a sample virtual reunion party video | For circulation among the whole group as a model for individual video development | |
| Plan a theme for each classmate | To participate in virtual party video recordings | |
| Collate mini-celebration videos | To involve all classmates in the virtual video | |
| Zoom video-conferencing preparation | Preparation of 25-year reunion Zoom backdrop | For use in Zoom video-conferencing |
| Develop and circulate the agenda and a Zoom engagement etiquette document in advance | To prepare everyone well in advance | |
| One-on-one support | Gaining access to Zoom and orient peers not familiar with Zoom technology and etiquette | |
| Trial run | Multiple trial runs of the event by the planning committee | To resolve any technical challenges and to ensure the smooth running of the event |
| Taking charge | Committee members taking up the main roles—as master of ceremony, Zoom host and co-host | Provide organisational structure, and support to facilitate the successful implementation of the event |
Every step planned was discussed with the whole class group via WhatsApp, which allowed the nurses to unwind from everyday work stress and look forward to an event that would take them back 25 years. The class was asked to give comment via WhatsApp messaging. This feedback was informal, and built a sense of camaraderie. The engagement in planning allowed the group to keep COVID-19 pandemic thoughts on hold for some time while preparing and looking forward to the event.
The virtual event
The event took place on the 20 June 2020 at 18:00 Indian time (5:30 in San Francisco and 22:30 in Melbourne and Guam). The virtual celebration was attended by several former teachers and 42 classmates from several countries, including Australia, Canada, the UK, Ireland, India, United Arab Emirates, Kuwait, Oman, Saudi Arabia, Qatar and the USA. Nurses who were rostered on shifts managed to attend parts of the session during their break times.
The most exciting moments were during the initial virtual meet-and-greet session. This lasted nearly 50 minutes before the formal start of the event. At this session, fellow nurses were able to share in the excitement of seeing each other as a whole class after 25 years, and also share some experiences of coping with the pandemic. This meet-and-greet session was a planned activity to encourage the sharing of memories and to debrief challenges experienced during the pandemic. Some graduates from this cohort are active in the frontline and had contracted COVID-19. It was a point of relief to see all our classmates were still alive and coping with the pandemic.
The opportunity provided participants from across the great linguistic landscape of India with the opportunity to come together and bond using commonly used multilingual means. Languages spoken at the event included English, Hindi, Kannada, Malayalam and Tulu. The whole fun-filled event lasted for approximately four-and-a-half hours. The programme schedule is given in Box 1.
Box 1.Programme scheduleSpecific events
- Virtual meet-and-greet session with virtual hugs
- Food and drinks to share virtually
- Formal welcome
- Prayer song
- Self and family introduction, with a background photo slideshow
- College day memories slideshow with narration
- Introduction of teachers and sharing of memories with teachers
- Launch of the virtual party video
- Vote of thanks
- Fun moment (singing and dancing)
Classmates reported that this was a ‘rejuvenating experience’, ‘an unforgettable event’ and ‘a relief in a time of crisis’. The authors believe that this was a way to escape from the stress the nurses experience in the workplace. Many migrant nurses routinely connect with their homeland through regular visits, which was not possible during the pandemic. The authors found that bonding virtually was one way of coping with the work-related stress, burnout, and social isolation of working away from a home country during the pandemic. For over 4 weeks following the event, the nurses continued to reminisce about it and proposed further plans to meet again regularly to maintain emotional wellbeing. Furthermore, the nurses committed to funding a bursary to support disadvantaged students in undertaking studies to become a registered nurse at the authors' former college, the Dr M.V. Shetty College of Nursing, Mangalore.
Reflecting on the event
The authors believe this virtual event united and provided mental health support for those who attended. The main event enabled the nurses to forget about the pandemic for a short while.
Observing the significant impact this has had on the collective mental health and wellbeing of our peers, the authors undertook to share the benefits of maintaining a social connection with significant members of their community as an example of the recommendations of WHO (2020b) to stay connected through all available means.
A retrospective examination of the Zoom recording and subsequent posts on WhatsApp, YouTube and Facebook by the authors identified widespread viewing and dissemination of the recording. Our event, which was promoted on social media, subsequently inspired several similar events hosted by other health professionals and similar peer groups.
The importance of making connections
Connecting nurses during the COVID-19 pandemic via a virtual social event has had a positive effect on the emotional wellbeing of those nurses and their professors who attended. The event also inspired similar peer groups to initiate virtual reunion events via social media channels. These events were hosted in regional languages and enriched by cultural traditions unique to the background of these ethnic groups. Communicating and engaging in native languages reinforces cultural and linguistic identity and a sense of belonging. The virtual reunion has taught the nurses to value fellowships with friends and to make connections with the institution at which they studied and its alumni.
Although times are difficult for everyone during this pandemic, the migrant communities living worldwide face unique challenges that are different to those of the broader population in the host country and which can be overwhelming. They can also face added social, economic, and physical and mental health challenges. Migrant nurses face an added burden of responsibility to provide care directly or indirectly to members of their own communities in their host countries.
Nurses comprise more than half of the skilled workforce of health professionals worldwide. The nursing graduates in our cohort hold varied professional roles, ranging from bedside care, teaching, research and policymaking, all contributing to the betterment of society.
At no time in recent history have nurses gained such public attention. It is vital to consider nurses as a crucial part of the health system and include them in decision making and planning for better healthcare systems. There is much to celebrate in the achievements of the nursing workforce in terms of being resilient and handling the situation to the best of their abilities. However, there are gaps to be addressed and areas to be strengthened to face challenges in the future. It is important to address the needs of nurses in preparation for future disease outbreaks of this magnitude. This pandemic may end, but investment is needed in strengthening the emotional and physical wellbeing of nurses. Although the after-effects of this pandemic are currently unknown, there is a strong possibility of the development of PTSD among some health professionals and patients. In such times, interacting with other people to build a shared understanding and empathy develops strength and resilience, and improves wellbeing across society.
Conclusions
WHO's (2020c) State of the World's Nursing 2020 report states that there is a need to develop the nursing workforce through investing in nurse education and leadership skills. Nurse education should be developed with appropriate programmes and processes in place to support and build resilience among nurses, and helping them to be ready to face similar challenges in the future (WHO, 2020c). Support should include culturally sensitive and appropriate interventions for migrants living in adopted countries (WHO, 2019). Further research is required to explore the educational and psychological needs of nurses and student nurses who have served in frontline services during the pandemic and at leadership levels and to develop culturally appropriate assistance to ensure that they are prepared to face challenges in the future.