Presentation
“HeRoEs WoRk HeRe”: An Exploration of the Impact of Pandemic Virtue Signaling on Nursing Culture
DescriptionBackground: The COVID-19 pandemic significantly impacted healthcare systems and increased risks of moral distress and burnout among nurses. Past research indicates organizational cultural elements like leadership, work overload, role conflict, and centralized decision-making are antecedents to nursing burnout (Cimiotti et al., 2012; Jun et al., 2021; Nabizadeh-Gharghozar et al., 2020). In the US, phrases such as “healthcare heroes” were used ubiquitously to express thanks to nurses and other healthcare workers. While the original intention might have been to appreciate the herculean efforts by nurses, it was commonly perceived as propagating a harmful narrative that these individuals were disposable (Mohammad et al., 2021; Rainbow et al., 2012). We argue that this phenomenon should be classified as a “virtue signal” (Peters, 2015), and that such low-effort expressions of moral support are used to justify a lack of real support to nurses through increased pay and improved working conditions, and that this itself can lead to burnout (Alipio et al., 2023). Overall, to recognize the full impact of the pandemic on nursing burnout, it is necessary to examine how support to nurses by organizations and society at large, during the pandemic differed from pre and post-pandemic experiences, and the cumulative impact on the personal and cultural experiences of nurses.
Purpose: This study explores how the usage of the term “hero” grew to signify frustration over the conditions nurses faced over the course of the pandemic, and how it compared to the usage of other signifiers over the same time period. We present the first step of a “netnographic” analysis of nursing culture by examining social media posts at the r/nursing subreddit website.
Design and Method: Archived Reddit posts and comments on the r/nursing subreddit (Baumgartner et al., 2020; r/Nursing, 2023) between January 2018 and December 2022 were analyzed to track the monthly usage of terms that were associated with the lived experience of nurses over the pandemic. Seventeen terms were selected with our nursing collaborators, including “hero”, “essential worker”, “pizza party”, “work from home”, “salary”, “wage”, “pay”, “wage theft”, “overtime”, “union”, “strike”, “burnout”, “quitting”, “unemployment”, “telehealth”, “turnover”, and “great resignation”. Posts and comments which contained the keywords or common permutations of keywords (e.g., “pay”, “paid”, “paying”) were included. Memes and the natural language used within comments and posts will be qualitatively analyzed to assess the emotional effect associated with keywords, and other pertinent aspects of nursing culture. Data was separated into three time periods: pre-pandemic (Jan 2018 – Dec 2019), early pandemic (Jan 2020 – June 2021, in which the number of new daily cases fell sharply, prior to the “Delta Variant” arriving in the US; CDC, 2022; Mathieu et al., 2023), and late pandemic (Oct 2021 – Dec 2022, which is the last available archived post). The time series reflecting the usage of each term were plotted, and Spearman’s correlation was used to analyze the relationship between time series.
Preliminary Findings: Reddit users in r/nursing were very active over the four-year window, with a total of 11,497 posts containing any keywords, and 181,822 comments on these posts which also contained any keywords. Initial qualitative analysis shows that these posts often describe negative lived experiences related to the usage of the virtue signal “hero”. The title of this paper: “HeRoEs WoRk HeRe”, is a direct quote from one user’s post, where the alternating usage of capital and lowercase letters indicates sarcasm and mockery (https://www.urbandictionary.com/define.php?term=aLtErNaTiNg%20CaPs). “Pay” is the most frequently occurring term across comments and posts. The keywords “hero”, “burnout”, “union”, and “quitting” were selected and compared due to high usage and relevance to the study. These preliminary results indicate a sharp increase in posts and comments containing the keywords in April 2020, with "hero" being the second most frequent after pay (n=51 in posts, n= 642 in comments), followed by “union” (n=27 in posts, n= 530). Around June 2022 (a turning point in the pandemic where new daily infections reached a local minimum in the US), trends appear to shift again with sharp increases in usage of our four keywords, and further stratify into the following months. Across the three pandemic time periods, Spearman’s rank correlation was computed for comment data to assess the relationship between “hero” and “union” due to their similar observed peak in April 2020, between “burnout” and “quitting” due to their observed overlap in the late pandemic period, and “burnout” and “hero” due to the importance of comparing these two concepts. In the pre pandemic period, “hero” and “union” have a small, but statistically significant negative correlation (R(60) = -.51, p = 0.01), but the correlation becomes positive in the early pandemic (R(60) = .68, p = 0.002), and disappears in the late pandemic (R(60) = .46, p = 0.056). For “burnout” and “quitting”, there are no statistically significant correlations in the pre (R(60) = 0.03, p = 0.88), and early (R(60) = .23, p = 0.37) periods, but a strong correlation is seen in the late pandemic period (R(60) = .91, p < 0.001). For “hero” and “burnout”, there is a weak but statistically significant negative correlation in the pre (R(60) = -.46, p = 0.024), pandemic period, none in the early (R(60) = -0.06, p = 0.92) period, but a strong positive correlation is seen in the late pandemic period (R(60) = .77, p < 0.001).
Conclusions: Preliminary analysis demonstrates some of the nuance in nursing culture that is expressed on r/nursing, that there are observable relationships between culturally-relevant keywords that appear in nurses’ posts and comments, and that these relationships changed over the course of the pandemic. We believe this shows some evidence that nurses perceived “healthcare heroes” as a virtue signal in the later pandemic period, and this is at least a partial explanation for why “hero” became more associated with terms that signify negative experiences and dissatisfaction. Future work will explore individual posts in further detail and attempt to describe causal relationships using sentiment analysis. It is our hope that these findings can inform strategies to mitigate nurse burnout.
References:
Centers for Disease Control and Prevention. (2022). CDC museum COVID-19 timeline. 2022.
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486-490.
J. Baumgartner, S. Zannettou, B. Keegan, M. Squire, J. Blackburn, The pushshift reddit dataset, in: Proceedings of the international AAAI conference on web and social media, Vol. 14, 2020, pp. 830–839.
Jun, J., Ojemeni, M. M., Kalamani, R., Tong, J., & Crecelius, M. L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review. International journal of nursing studies, 119, 103933.
Mohammed, S., Peter, E., Killackey, T., & Maciver, J. (2021). The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis. International Journal of Nursing Studies, 117. https://doi.org/10.1016/J.IJNURSTU.2021.103887
Nabizadeh-Gharghozar, Z., Adib-Hajbaghery, M., & Bolandianbafghi, S. (2020). Nurses’ job burnout: a hybrid concept analysis. Journal of Caring Sciences, 9(3), 154.
Peters, M. (2015). Virtue signaling and other inane platitudes. The Boston Globe, 24.
Phillips, J., Alipio, J. K., Hoskins, J. L., & Cohen, M. Z. (2023). The Experience of Frontline Nurses during the COVID-19 Pandemic: A Phenomenological Study. Western Journal of Nursing Research, 45(4), 327–334. https://doi.org/10.1177/01939459221129944/SUPPL_FILE/SJ-PDF-1-WJN-10.1177_01939459221129944.PDF
Rainbow, J., Littzen, C., & Bethel, C. (2021). Nurses don’t want to be hailed as “heroes” during a pandemic – they want more resources and support. The Conversation. https://theconversation.com/nurses-dont-want-to-be-hailed-as-heroes-during-a-pandemic-they-want-more-resources-and-support-167763
r/Nursing. Reddit, 18 September 2023, www.reddit.com/r/Nursing.
Roser, M., Ritchie, H., Ortiz-Ospina, E., & Hasell, J. (2023). United States: Coronavirus pandemic country profile. Our World in Data.
Purpose: This study explores how the usage of the term “hero” grew to signify frustration over the conditions nurses faced over the course of the pandemic, and how it compared to the usage of other signifiers over the same time period. We present the first step of a “netnographic” analysis of nursing culture by examining social media posts at the r/nursing subreddit website.
Design and Method: Archived Reddit posts and comments on the r/nursing subreddit (Baumgartner et al., 2020; r/Nursing, 2023) between January 2018 and December 2022 were analyzed to track the monthly usage of terms that were associated with the lived experience of nurses over the pandemic. Seventeen terms were selected with our nursing collaborators, including “hero”, “essential worker”, “pizza party”, “work from home”, “salary”, “wage”, “pay”, “wage theft”, “overtime”, “union”, “strike”, “burnout”, “quitting”, “unemployment”, “telehealth”, “turnover”, and “great resignation”. Posts and comments which contained the keywords or common permutations of keywords (e.g., “pay”, “paid”, “paying”) were included. Memes and the natural language used within comments and posts will be qualitatively analyzed to assess the emotional effect associated with keywords, and other pertinent aspects of nursing culture. Data was separated into three time periods: pre-pandemic (Jan 2018 – Dec 2019), early pandemic (Jan 2020 – June 2021, in which the number of new daily cases fell sharply, prior to the “Delta Variant” arriving in the US; CDC, 2022; Mathieu et al., 2023), and late pandemic (Oct 2021 – Dec 2022, which is the last available archived post). The time series reflecting the usage of each term were plotted, and Spearman’s correlation was used to analyze the relationship between time series.
Preliminary Findings: Reddit users in r/nursing were very active over the four-year window, with a total of 11,497 posts containing any keywords, and 181,822 comments on these posts which also contained any keywords. Initial qualitative analysis shows that these posts often describe negative lived experiences related to the usage of the virtue signal “hero”. The title of this paper: “HeRoEs WoRk HeRe”, is a direct quote from one user’s post, where the alternating usage of capital and lowercase letters indicates sarcasm and mockery (https://www.urbandictionary.com/define.php?term=aLtErNaTiNg%20CaPs). “Pay” is the most frequently occurring term across comments and posts. The keywords “hero”, “burnout”, “union”, and “quitting” were selected and compared due to high usage and relevance to the study. These preliminary results indicate a sharp increase in posts and comments containing the keywords in April 2020, with "hero" being the second most frequent after pay (n=51 in posts, n= 642 in comments), followed by “union” (n=27 in posts, n= 530). Around June 2022 (a turning point in the pandemic where new daily infections reached a local minimum in the US), trends appear to shift again with sharp increases in usage of our four keywords, and further stratify into the following months. Across the three pandemic time periods, Spearman’s rank correlation was computed for comment data to assess the relationship between “hero” and “union” due to their similar observed peak in April 2020, between “burnout” and “quitting” due to their observed overlap in the late pandemic period, and “burnout” and “hero” due to the importance of comparing these two concepts. In the pre pandemic period, “hero” and “union” have a small, but statistically significant negative correlation (R(60) = -.51, p = 0.01), but the correlation becomes positive in the early pandemic (R(60) = .68, p = 0.002), and disappears in the late pandemic (R(60) = .46, p = 0.056). For “burnout” and “quitting”, there are no statistically significant correlations in the pre (R(60) = 0.03, p = 0.88), and early (R(60) = .23, p = 0.37) periods, but a strong correlation is seen in the late pandemic period (R(60) = .91, p < 0.001). For “hero” and “burnout”, there is a weak but statistically significant negative correlation in the pre (R(60) = -.46, p = 0.024), pandemic period, none in the early (R(60) = -0.06, p = 0.92) period, but a strong positive correlation is seen in the late pandemic period (R(60) = .77, p < 0.001).
Conclusions: Preliminary analysis demonstrates some of the nuance in nursing culture that is expressed on r/nursing, that there are observable relationships between culturally-relevant keywords that appear in nurses’ posts and comments, and that these relationships changed over the course of the pandemic. We believe this shows some evidence that nurses perceived “healthcare heroes” as a virtue signal in the later pandemic period, and this is at least a partial explanation for why “hero” became more associated with terms that signify negative experiences and dissatisfaction. Future work will explore individual posts in further detail and attempt to describe causal relationships using sentiment analysis. It is our hope that these findings can inform strategies to mitigate nurse burnout.
References:
Centers for Disease Control and Prevention. (2022). CDC museum COVID-19 timeline. 2022.
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486-490.
J. Baumgartner, S. Zannettou, B. Keegan, M. Squire, J. Blackburn, The pushshift reddit dataset, in: Proceedings of the international AAAI conference on web and social media, Vol. 14, 2020, pp. 830–839.
Jun, J., Ojemeni, M. M., Kalamani, R., Tong, J., & Crecelius, M. L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review. International journal of nursing studies, 119, 103933.
Mohammed, S., Peter, E., Killackey, T., & Maciver, J. (2021). The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis. International Journal of Nursing Studies, 117. https://doi.org/10.1016/J.IJNURSTU.2021.103887
Nabizadeh-Gharghozar, Z., Adib-Hajbaghery, M., & Bolandianbafghi, S. (2020). Nurses’ job burnout: a hybrid concept analysis. Journal of Caring Sciences, 9(3), 154.
Peters, M. (2015). Virtue signaling and other inane platitudes. The Boston Globe, 24.
Phillips, J., Alipio, J. K., Hoskins, J. L., & Cohen, M. Z. (2023). The Experience of Frontline Nurses during the COVID-19 Pandemic: A Phenomenological Study. Western Journal of Nursing Research, 45(4), 327–334. https://doi.org/10.1177/01939459221129944/SUPPL_FILE/SJ-PDF-1-WJN-10.1177_01939459221129944.PDF
Rainbow, J., Littzen, C., & Bethel, C. (2021). Nurses don’t want to be hailed as “heroes” during a pandemic – they want more resources and support. The Conversation. https://theconversation.com/nurses-dont-want-to-be-hailed-as-heroes-during-a-pandemic-they-want-more-resources-and-support-167763
r/Nursing. Reddit, 18 September 2023, www.reddit.com/r/Nursing.
Roser, M., Ritchie, H., Ortiz-Ospina, E., & Hasell, J. (2023). United States: Coronavirus pandemic country profile. Our World in Data.
Event Type
Oral Presentations
TimeMonday, March 252:30pm - 2:50pm CDT
LocationSalon A-1
Hospital Environments