Almost two years after working in a temporary Covid intensive care unit at the hospital of the University of Pennsylvania, Kim Bishop, a critical care nurse, can still remember which patients were in which rooms.
“When you walk back on these units, you know which patient survived in which room and which ones didn’t,” said Bishop, who still works at the Philadelphia hospital and moves among different units. “I thought we closed that chapter once we closed that unit, but now walking back into it, it’s almost like a slap in the face.”
Bishop’s feelings are not unique among providers who treat Covid patients in the US. Many are leaving the field.
Recent research indicates that healthcare workers and first responders are displaying post-traumatic stress disorder symptoms like veterans who served in combat.
Healthcare providers and researchers now say that if hospitals continue to be overwhelmed with patients who have not been vaccinated against the virus and administrators don’t find a way to provide relief to medical staff, many will leave areas where they care for Covid patients – or exit healthcare altogether. That would worsen staffing shortages and further strain hospitals’ capacity to provide necessary care.
“It’s important to take care of and think of healthcare workers because they matter as people, and also it has really significant implications for our healthcare system,” said Dr Rebecca Hendrickson, a VA Puget Sound Health Care System clinical psychiatrist and lead researcher of a new study on healthcare workers. “You actually can’t protect your healthcare system without protecting the workers.”
The Journal of General Internal Medicine study published in December surveyed more than 500 doctors, nurses and first responders and found that 15% said it was “not at all likely” they would still work in the field in five to 10 years. Among nurses, the figure was 20%.
That’s largely because of the deterioration of healthcare providers’ mental health. Seventy-four per cent of respondents reported symptoms of depression; 37% reported symptoms of post-traumatic stress disorder; and 15% reported thoughts of suicide or self-harm.
A significant contributor to their recent distress, Hendrickson said, was the duration of the pandemic. Earlier in the pandemic, workers knew they were facing a real risk of becoming ill but understood there was no other option to provide care to patients. Vaccines were not yet available, and there was a limited quantity of personal protective equipment.
Now, more than two-thirds of hospital workers are vaccinated, according to a September report in the American Journal of Infection Control, but they treat Covid patients who in most cases are severely ill because they have not been vaccinated. Hospitals also still sometimes ask nurses to use less personal protective equipment than they feel they need because of the cost or patients’ complaints, respondents said.
“Even when objectively the risk level may be lower” because they are vaccinated and the Omicron variant is less severe than earlier variants, “when they were asked to take risk that no longer felt necessary, that was actually harder to handle and caused more distress”, Hendrickson said.
Every day that Kadee Klafka works as a cardiac intensive care nurse at Ball Memorial hospital in Muncie, Indiana, she speaks with the families of Covid patients on ventilators, almost all of whom have not been vaccinated, she said. She often must inform them that their loved ones’ lungs won’t recover.
“We have done every single thing we can,” she tells them. “Right now, they are just suffering, and the best thing we can do for them is make them comfortable.”
Klafka wishes she could wear a GoPro camera to illuminate nurses and patients’ experience.
I felt like there was a light at the end of the tunnel, especially with the vaccine. I felt like we were getting back to normal, being able to go out and celebrate holidays and other life events with family
“I have had to learn to cope with the anger that continues to rise and fall based on people who will not get vaccinated,” she said.
Patients are often angry too because of how long they wait in the emergency room before they can get a bed, Bishop, the Philadelphia nurse, said. In 2021, 71% of medical practices saw an increase in the number of incidents with disruptive patients, according to a January poll from the Medical Group Management Association, which represents large physician groups.
Bishop is also drained by two years of worrying about infecting her family, she said. She said the Omicron surge is even harder to manage than previous waves.
“I felt like there was a light at the end of the tunnel, especially with the vaccine. I felt like we were getting back to normal, being able to go out and celebrate holidays and other life events with family,” said Bishop, who became a nurse because of her interest in the human body. “The staff is already mentally and physically exhausted, and this is pushing all of us to our breaking point.”
Since February 2020, 30% of US healthcare workers have lost their job or quit, and the most common reason was the pandemic, according to an October survey by Morning Consult.
Carol Wilcox worked as a discharge planner on a Covid floor at Saint Anne’s hospital in Fall River, Massachusetts, but retired 17 December, after four decades as a nurse.
At the start of the pandemic, Wilcox, 65, woke up each day sick to her stomach and petrified. She and other staff weren’t allowed to wear masks because, like at other hospitals, supplies were limited and administrators “were afraid we would make people nervous”, she said.
Before she retired, she felt worn out “just going in to see a patient and putting on the protective gear”, she said.
In one case a couple months ago, Wilcox saw a woman who weeks earlier lost her husband to Covid and now had to decide whether she wanted to be on a ventilator. She said no and died. Neither were vaccinated.
“We are giving people the best we can,” said Wilcox, who hopes to work part-time from home in case management. “I don’t know how long people can sustain. There is an underlying frustration with people who aren’t getting vaccinated because it’s just so sad.”
But there are, perhaps, encouraging developments. Nurses can now make significantly more money than before the pandemic, particularly if they sign up to become travel nurses, due to increased demand.
Enrollment in undergraduate nursing programs increased by 5.6% and by 4.1% in master’s programs in 2020, according to an American Association of Colleges of Nursing survey.
At Sister Claire Tynan school of nursing at Holy Name in Englewood Cliffs, New Jersey, 171 people applied to attend the school in 2019; in 2020, there were 325 applicants, and in 2021, there were 292, according to the school.
“I think people are realizing that they can contribute to the positive effects in a hospital, that they have something to offer and that they will always have a career,” said Michele Acito, Holy Name chief nursing officer.
Chloe Sneyer, 26, started her career in Holy Name surgery and cardiac units and then became an intensive care unit nurse during the pandemic. She now has more confidence in her skills, she said. “It made me realize I can learn something new every day that I go to work, and I can figure it out,” Sneyer added.
Early in the pandemic, the hospital also tried to help nurses like Sneyer by having a psychologist host “resiliency rounds” over Zoom where staff could talk about a work experience; becoming sick with Covid; or the loss of a family member, among other topics, said Acito.
In one recent case, an unvaccinated young man with Covid died after being on a ventilator. He had been in the hospital for weeks and become close with some staff, Acito said.
“Two of our newer staff were very upset, so we made sure they had time to sit, to talk to other staff members,” recalled Acito. “They went outside; they took a little break … and then other staff members called them that night, so it’s that kind of support that has really strengthened that bond.”
In addition to providing counseling, Hendrickson also said it’s important that hospitals seek input from healthcare workers on how to manage the risks they are facing, such as what personal protective equipment staff should wear or how food should be handled in inpatient units. “The more that can be actively listened to and reflected in policy decisions in a transparent way, those details make a huge difference for how it feels on the frontlines,” said Hendrickson.
But much of healthcare workers’ wellbeing depends on the virus, which remains unpredictable.
Wilcox said she fears for the healthcare system if the pandemic stretches on many more months or years. She told her former colleagues that she would return to visit.
“But I don’t want to go back,” she said. “I really don’t. It is a war zone.”