Fourth COVID Wave Swamps Stressed Nurse Corps | Healthiest Communities Health News
Cassandra Alexander remembers the exact date when the “firehose tears” started: April 25, 2020.
An intensive care nurse trained in infectious disease treatment, Alexander had spent some two months working marathon shifts in an ICU ward in the San Francisco Bay Area, just as the first tsunami of COVID-19 patients began. Though she had volunteered, she recalls, the scene was apocalyptic: beds, ventilators, protective gowns, facemasks and even mortuary space were all scarce, but the patients kept coming. And the end was nowhere in sight.
After yet another shift in the “meat grinder” that day, Alexander says, “I had a breakdown at work. I started crying, and I pretty much couldn’t stop. And I basically didn’t stop crying for, like, three or four weeks.”
Intense psychotherapy helped, but the post-traumatic stress disorder was so severe that “stupid things would trigger me to cry,” Alexander says, including a dead houseplant. In chats with colleagues, one question recurred: Why stay in a hard, dangerous, seemingly thankless job?
“Nurses are considered one of the most trusted professions,” Alexander says, but she wasn’t feeling the admiration – not after grueling, marathon shifts, scrounging for personal protective equipment, and self-isolating at home to protect loved ones from infection. “We were like, ‘No, actually, nobody cares if we live or die.’ And that was really stunning for us.”
Photos: COVID Nurses Recount Traumatic Experiences
Alexander’s story, while dramatic, isn’t unique. The nation’s nursing corps – already under pressure due to a staffing shortage that predates the pandemic – is in crisis now that a fourth wave of COVID-19 cases has crashed into the U.S. health care system.
With hospitals in the U.S. again running out of ICU bed space, administrators are dealing with a shortage of nurses, scrambling to fill shifts and offering high wages to those who can help. The problem comes as the crushing workload of the coronavirus pandemic, coupled with external and on-the-job pressures, have led some nurses to simply step down altogether.
Both data and anecdotes confirm that front-line nurses are burned out, fed up and feeling underappreciated. While the shortage in their field has resulted in hospitals paying top dollar for experienced care, a mass exodus of nurses could be on the horizon.
“The bravery and dedication of America’s nurses have been displayed in front-page newspaper stories across the country throughout the COVID-19 pandemic,” according to a May review of the nation’s nursing shortage published by the University of St. Augustine School for Health Sciences. “However, the pandemic has also been a huge strain on nurses and the healthcare system.”
“After being on the front lines, and just witnessing the types of death that have been so, so traumatic and awful, I could certainly see that this would be the point where people were thinking about getting out of direct patient care, or perhaps thinking about a new career altogether,” she says.
A survey of nurses by Vivian, a health care worker marketplace, a year into the pandemic helps illustrate the scope of the problem. Among respondents, 43% were considering quitting, and that share rose to nearly half among intensive care nurses – specialists routinely called on to care for COVID-19 patients.
The increased stress on nurses, experts say, is related to several factors. Bedside nurses typically have close contact with patients, putting them at risk of contracting COVID-19. Adding to the pressure and an already-existing shortage: an expected increase of retirements in an aging nursing workforce and an ongoing struggle to balance an essential, front-line job with the responsibility of caring for young children or elderly parents.
Last year, when the first wave of COVID-19 patients threatened U.S. hospitals, some sounded the alarm about a looming staffing shortage.
“We had nurses that were living in hotels and living apart from their children and making additional sacrifices,” Stimpfel says. “They were not only on the front lines, taking care of patients, but then saying, ‘I can’t go home to my family, I can’t see my children, I can’t see my partner.'”
According to an American Nurses Foundation survey in early 2021, 59% of nurses believed they put their patients’ needs ahead of their own. Less than half of respondents agreed that their employer understood their outside responsibilities and offered support or flexibility to help meet them.
Perhaps encouragingly, while 18% of respondents said they planned to leave their position in the next six months – many because of their work’s negative impact on their health and well-being – just 4% said they planned to leave the profession entirely.
Still, in the 2021 lull after vaccines became available, some nurses quit, and hospitals sought to make up for lost revenue by trimming staff through attrition, Stimpfel says.
“Then they never regained those staffing positions,” she says. “So there’s frustration that administrators may not have been putting enough resources into restaffing when there were staff available.”
During earlier waves, hospitals also sent some nurses into COVID-19 wards to help out even if they were trained for other specialties. But Stimpfel says asking a neonatal nurse to work in the ICU with a COVID-19 patient – a high-risk environment involving possible exposure to a potentially deadly contagion – was a big ask.
“Not all nurses are trained in critical care,” she says. “There are different specialties that nurses are prepared for, and you can’t prepare a nurse to take care of these intensely ill patients, and do that overnight. That was still such a leap for them to be put into that sort of situation.”
Meanwhile, colleges and nursing schools are urged to expand capacity to graduate more caregivers, with experts saying the more trained hands working in a COVID-19 ward, the better. In a recent speech to graduates, McCauley, the Emory nursing school dean, says she compared the class to soldiers on the front lines of a battle: “I said, ‘In ways, you remind me of my colleagues when I graduated: nurses that were serving in the Vietnam War.”
The new nurses “are walking into a workforce where everyone is exhausted,” McCauley says. “These new graduates can hold up that workforce just with their youth, their enthusiasm. They’re willing to go the extra mile.”
Still, McCauley acknowledges that in battling a virus that’s mutated to become more contagious, youthful enthusiasm isn’t a substitute for the “wisdom and professionalism” that comes with experience. And, she says, treating COVID-19 patients who got sick because they chose not to get vaccinated – and may have spread the virus to other people – can be disheartening.
During this fourth wave, nearly all of those hospitalized “are unvaccinated people,” she says. “The saddest thing is the children – unvaccinated children whose parents could not get them vaccinated, even if they wanted to,” because a vaccine isn’t approved for young children yet.
Ultimately, experts say, nurses nationwide will need someone to care for them to help keep more of them on the job.
For those currently in the profession, “there just needs to be a lot more support … to help care for the nurses that are going to carry around this long-term trauma,” Stimpfel says. “It’s just impossible to go through this crisis, and then repeat the crisis, and not have anybody caring and helping the front-line workers to process it, and to get through it in a healthy manner.”
But it could take years before staffing levels get to a better place.
“There are some experts that could probably model it better than I can, but I would say it’s going to be at least six to 10 more years before we get over this,” Stimpfel says. “And that’s because of factors that were already in play before COVID.”
Alexander, the Bay Area ICU nurse, is frank.
“We are all super, super messed up,” she says.