“We\u27re Not Valued, We’re Not Heard” : Voices of Seasoned Rural Nurses in the Post-COVID Era

For decades, scientists have studied and expressed concern over the impact of job demands in the nursing profession. These demands include heavy workloads, long hours, rotating day/night shifts, the emotional toll of patient care, and workforce shortages. While wellbeing of nurses has gained more attention during COVID-19, it is crucial to recognize the prevalence of compromised wellbeing among nurses even prior to the pandemic. Pre-pandemic many complex factors contributed to nurses having higher rates of chronic illness, more prevalence of obesity, greater mental health concerns, and poorer states of health than the average American. During COVID-19, nurses were tasked with caring for repeated surges of critically ill patients without adequate staffing or sufficient personal protective equipment, during a time of social and political unrest. These pervasive challenges continue today as the country is in its third year of managing COVID-19. Challenges now include care rationing, unprecedented staff turnover, and the toll on the mental, physical, and emotional health of the frontline. The impact of COVID-19 on the nursing workforce is profound. This dissertation explored the wellbeing of nurses in the United States, primarily in South Dakota (SD), since the onset of COVID-19. First, a scoping review is presented in Chapter 2. The scoping review ascertained what was known about the wellbeing of nurses in the early phases of the pandemic and to identify gaps in the literature. Second, an interpretive phenomenological pilot study testing the research question, study design, and data analysis procedures is presented in Chapter 3. This pilot study informed and guided modifications to the final design for the dissertation research study. Chapter 4 presents an interpretive phenomenological research study investigating the wellbeing of seasoned nurses in SD since the onset of COVID-19. The voices of these nurses provide insight into their lives and careers as they establish a new sense of normalcy in the post- COVID era. These chapters synthesize the current state of nursing and provide insight into the wellbeing of nurses and the future of the nursing profession. Important implications for research and policy change to heal, protect, and promote the nursing profession are identified