1. Chen, Leon L. DNP, AGACNP-BC, FCCP, FAANP (Clinical Program Manager, Research and Simulated Learning, Nurse Practitioner, and Clinical Assistant Professor)

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"We can beat them, forever and ever. We can be heroes, just for one day."


-David Bowie, "Heroes," 1977


America loves heroes. Movies and television are dominated by images of seemingly invincible people who take on unthinkable missions and ultimately single-handedly turn the tide. We see heroes as people who are brilliant, strong, and altruistic. They are fearless, without weakness, forever remembered in their moment of glory. I, like many others, grew up watching and idolizing extraordinary individuals who are able to do what others can not. Heroes, in a single moment of glory, are our modern-day mythology. They are idealized and used to fulfill our desire to solve intricate problems. However, in real life, the hero label can be isolating and dehumanizing (Carroll, 2011). We forget that people who perform heroic acts can be left vulnerable and traumatized. The aftermath of their heroism often require additional support and the circumstances that created the initial need for heroes have to be examined. Unfortunately, these matters are usually complex, comparatively dull, and thus are often lost in time[horizontal ellipsis] like tears in rain.


I vividly remember on March 1, 2020, New York City reported its first confirmed case of the novel coronavirus (COVID-19). I had trepidation, but had enough trust in the institution that this virus can be contained and life would go on without interruption. I was a new father, excited for the future of my growing family. Days later, the World Health Organization declared COVID-19 as a global pandemic. In an effort to contain the virus, the United States and the rest of the world took the unprecedented action of locking down society. New York City soon became the epicenter of the global pandemic. Throughout the pandemic, frontline health care workers (HCWs) including nurse practitioners (NP) worked tirelessly to treat COVID-19 patients while risking their own safety due to lack of personal protective equipment (PPE) (Nguyen et al., 2020). As a Critical Care NP in New York City, I sent my wife and then 6-month-old infant away to mitigate their risk of infection from me, as have many other HCWs. At the time of separation, we had no clear idea how long the crisis would last. I remember the days pondering my own mortality and its impact on my family while putting on a strong face for them through FaceTime. I also remember the anxiety, fear, and loneliness. Looking back, those days still seemed surreal and the experience remains traumatic for me and my family. These memories are now forever a part of me.


For many people, images of masked, face-shielded HCWs rushing to save patients are enduring symbols of inspiration and resiliency during the pandemic. The public yearned to show their appreciation for frontline HCWs. In New York City as well as many places around the world, folks gathered and clapped on their balcony, rooftop, and streets at 7 p.m. as a show of support. Media embraced the HCWs as "heroes" narrative and this ideal spread to corporations and healthcare institutions (Lipworth, 2020). Companies offered "healthcare hero discounts" and banners thanking healthcare heroes were erected outside businesses. Hospital units were inundated with donated food. Hospital systems were quick to display signs showing "heroes work here" and many of those themes remain a central part of many hospitals' advertisement campaigns. I have no doubt these platitudes from the public were borne of genuine gratitude toward the frontline HCWs. People want to cheer for the uniformed individuals who appear fearless and ready to tackle the invisible enemy. For many HCWs on the frontline, including myself, these displays elicited complex feelings. Although these performative actions may have provided heartwarming images for news media and allowed the public to feel a sense of contribution, in actuality they may have caused significant harm.


Institutions calling HCWs "heroes" without providing them with adequate PPE seemed like a cynical strategy to divert attention away from their failure to protect their staff. The continued labeling of HCWs as heroes by these institutions further distracts from their responsibility to perform structural changes that would support HCWs, including, but not limited to, safe staffing ratio (Cox, 2020). It should also be understood that HCWs are regular individuals that are performing feats that are certainly heroic. Yet, not delineating the person from their action overlooks their human needs (Lewis et al., 2020). HCWs including NPs who have been at the frontline throughout this pandemic are facing profound mental health trauma. Among HCWs, there is an increased rate of anxiety, depression, post-traumatic stress disorder and suicide (Law, 2020). Additionally, labeling HCWs as heroes places the onus of handling the pandemic exclusively on them and shuts down conversations on their needs (Halberg et al., 2021). Therefore, when the general public was asked to shoulder the burden of controlling the pandemic by getting vaccinated, resistance and anger emerged. Many HCWs are now facing increasing distrust, hostility, and threats of physical violence from patients due to misinformation (KKaiser et al., 2021). A dialogue from the movie "The Dark Knight" seems oddly accurate: "You either die a hero, or you live long enough to see yourself become the villain."


Twenty months into the COVID-19 pandemic, many deficient areas of healthcare have been exposed and warrant exhaustive examination and research. There should be a thorough evaluation of system flaws that led to government agencies and hospital systems being caught grossly off guard. There is also a critical need for improvement in both public health infrastructure and messaging. Preparations should be made so that in the future, HCWs would not be placed in a situation where they have to care for patients without the capacity to protect themselves (Gostin, 2021; Lewis, 2021). More importantly, HCWs need institutional support for their mental health. There was an existing epidemic of burnout within the healthcare field and this was further exacerbated by COVID-19. Issues contributing to burnout include unjust practice culture leading to moral distress, perceived powerlessness, grueling work hours, inadequate reimbursement, and uncompetitive benefits (Dyrbye et al., 2017). Systemic changes should be made to address these factors, and institutions cannot simply lay the responsibility squarely on the HCWs to improve their "resilience" when confronting a broken healthcare infrastructure (Cox, 2020; Halberg et al., 2021). Although data exist regarding burnout among physicians and nurses, specific research on NP burnout is relatively scarce (Dyrbye et al., 2017). Nurse Practitioners face unique practice challenges and therefore warrants more NP-focused/NP-led research to understand how to provide proper support (Corbridge & Melander, 2019). These studies should then be followed by actionable plans for structural change. The only meaningful way we can truly support our HCWs, who have been performing heroic duties, is with positive changes to the system, and this requires much more than applause.


Viewpoints shared are those of the writer and not the editorial team, the AANP or JAANP.




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