Five Years After COVID, Are Nurses Ready for the Next Pandemic?

Melissa Powell, PhD’24, RN, knows a thing or two about nursing burnout. In fact, her entire dissertation here at the Duke University School of Nursing was focused on the experience of nurses during the COVID-19 pandemic. Since graduating Powell has published four studies related to trauma and burnout in nurses. In conducting her research she has found some common throughlines and come to some conclusions about what needs to be done to prepare the nation’s nurses for the next pandemic.

Before embarking on her PhD at Duke, Powell's clinical background was rooted in oncology, specifically in hematology and bone marrow transplant. She also worked with patients participating in clinical trials receiving CAR-T cell therapy. Her career then transitioned to healthcare administration at an oncology hospital, where she served as a quality improvement and patient safety program manager. Reflecting on the COVID-19 pandemic, Powell identified key things that went wrong during the pandemic that negatively impacted nursing, as well as key things that hospital systems or agencies did right.

We spoke with Powell about her research, findings, and recommendations.

This conversation has been edited for length and clarity.

Duke University School of Nursing (DUSON): What was the impetus for focusing so much of your work on nursing trauma?

Melissa Powell (MP): When I worked in quality and patient safety at an oncology hospital, I quickly realized that healthcare workers (including nurses) were often traumatized after a challenging medical error or patient event. Although managers and staff would follow up with a healthcare worker after the event, it was not often focused on their psychological well-being. Limited emotional first aid exists across health organizations to triage the needs of healthcare workers that promote their well-being. These initial ideas led me to apply to the PhD program at Duke in 2019, and I knew Duke was the right fit to explore these challenges.

DUSON: You personally interviewed nurses and then also reviewed other publications for your research—what were some of the common themes or concerns you saw?

MP: My dissertation work included a review of the literature via a concept delineation and two separate qualitative studies to understand the ongoing psychological impact nurses experienced in the aftermath of the COVID-19 pandemic. At the time, research was often limited to the concept of “burnout,” and we found that the trauma nurses experience is often more complex, long-lasting, and includes second victimhood, compassion fatigue, and moral injury. Continued research of the many facets that contribute to nurses’ experiences is needed to ensure we understand the contributing factors and desired solutions for support that promote well-being.

From my dissertation, we found the nurses’ ongoing struggles often fall into two large categories: organizational factors and individual factors. Organizational factors impacting nurses included workplace conditions, staffing ratios, and limited manager support. Individual factors included personal life challenges, mental health conditions, and a lack of forums to support their recovery. Healthcare organizations today may only be working to solve one set of these factors, and the answer likely includes addressing both sets of factors together since both organizational and individual factors are impacting nurses. For example, while improving staffing may help at the organizational level, having group sessions for individual reflection and sharing may also be beneficial. The healthcare systems that nurses work in are quite complex, and that suggests that our solutions must be multipronged to address all the complexities nurses face at work.

DUSON: For many Americans the COVID-19 pandemic might be a thing of the past. How do you see the pandemic still impacting nurses today?

MP: I have often found myself saying “While the world has moved on, nurses have not.” I believe this to still be true five years beyond the start of the COVID-19 pandemic for a subset of the nursing profession. Experiences of burnout and compassion fatigue can lead to long-lasting and chronic effects on nurses’ well-being. The road to recovery will require both healthcare leaders and organizations to act within healthcare systems to provide safe working conditions and well-being interventions that support the nursing profession. Lastly, growth and recovery are not linear, and ongoing challenges occurring globally today may further set nurses back on their recovery journeys. Many world events, natural disasters, and global and political challenges can infiltrate healthcare systems and the nurses working in them. These ongoing issues must be considered as we provide well-being resources to the nursing profession.

DUSON: Are you able to identify some key things that went wrong during the pandemic that negatively impacted nursing? Were there any key things that hospital systems or agencies did right?

MP: The COVID-19 pandemic was uncharted territory for healthcare leaders, organizations, and the nursing profession. This lack of certainty, or fear of the unknown, with waves of the COVID1-9 pandemic led to intense psychological and emotional challenges for nurses. This type of major world event helped highlight how challenging working conditions (i.e., supply shortages, staffing ratios, turnover, patient acuity) can become in healthcare systems, which will hopefully lead to ongoing improvements for the nursing profession. Improvements to staffing ratios and compensation across many healthcare organizations rightfully occurred later in the COVID-19 pandemic, but continued assessment should be prioritized as the world and new challenging events occur.

DUSON: Pandemics are obviously in our future—based on your research, what are some recommendations you would make for individual nurses and for hospital systems in order to avoid some of the trauma and burnout that happened with this pandemic?

MP: I would encourage healthcare leaders and organizations to remain agile and diligent when considering the implementation of interventions needed to prioritize nurse well-being. Ongoing assessment of nurses’ experiences and perspectives will allow for a better understanding of their ongoing challenges and support needs. Some traumatic events that occur in healthcare settings are inherent to the work, but how we respond and support nurses is something we can work on through continued research, quality improvement, and well-being interventions.

Powell is currently a postdoctoral fellow at University of California Los Angeles in the National Clinician Scholars Program. Her position is funded by UCLA Health, and the focus of her work is the implementation of a formalized peer to peer support pilot program in nursing. This program focuses on providing emotional first aid and well-being resources to nurses who have experienced a challenging clinical or patient event. In the future, she hopes to continue exploring additional well-being interventions for nurses that can be implemented across healthcare organizations.

Powell’s studies on nursing trauma and the COVID-19 pandemic:

Powell, M.A., Walton, A. L. Scott, S.D., Allen, D., & Oyesanya, T. O. (2025). Nurses' journey towards recovery: Describing suffering during the COVID-¬ 19 pandemic to present day. International Journal of Mental Health Nursing.

Powell, M.A., Walton, A. L., & Scott, S. D. (2024). Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic. International Journal of Qualitative Studies on Health and Well-Being.

Powell M.A., Oyesanya TO, Scott SD, Allen DH, Walton A. (2024). Beyond Burnout: Nurses’ Perspectives on Chronic Suffering During and After the COVID-19 Pandemic. Global Qualitative Nursing Research. 2024;11.

Powell, M.A., Oyesanya, T., Scott, S.D., Allen, D., & Walton, A.L. (2024). Traumatized Nurses’ Desired Support Needs for Continued Recovery After the COVID-19 Pandemic: A Qualitative Descriptive Study utilizing Photovoice. Journal of Advanced Nursing.

 Nurse scientists and researchers at Duke University School of Nursing are leading the charge to address healthcare challenges here in North Carolina and across the globe. Learn more by visiting our Center for Nursing Research. 

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