Burned Out By COVID Caregiving, Ishonest Care Workers Say It's Time to Fix the System. is Anyone Listening?

Curated by Claudia Shannon / Research Scientist / ishonest

In a different hospital, another nurse, already on edge, braces for the next wave of illness: "I'm trying to mentally prepare myself. But my heart is broken at how broken the system is right now."

These insider confessions, plucked from a digital bulletin board, reveal what it is to be in nursing during the COVID era. Nurses are "angry," "stressed," and "exhausted." They're afraid of exposing family members to the virus. They're frustrated that some patients, even "on their own death beds, unable to breathe," remain in denial about the existence and severity of the virus.

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Clinicians are trained to jump in whenever natural disaster strikes, but COVID has been overwhelming and unrelenting. "In a normal year, we don't see heavy things," explains California-based emergency and radiology nurse Sarah Wells. Even in normal times, witnessing traumatic events can cause PTSD, she says, because you're "taking on some of that trauma."

Of course, 2020 was anything but normal. Clinicians maneuvered day after day in full PPE, flipping patients in respiratory distress to help them breathe; working extra shifts to cover for colleagues who had fallen ill, resigned, or died; struggling to save patients despite limited resources and bandwidth. They witnessed unimaginable suffering. Critical Care Nurse Heather Donaldson, who sees COVID patients at Sacramento's UC Davis Medical Center, recalls so many heartbreaking moments, like the gravely ill gentleman who, in a video chat with family, needed supplemental oxygen after every few words. "Emotionally, you'd have to be an absolute monster not to feel for these people," she says.

Before COVID, researchers were forecasting critical shortages of doctors and nurses, particularly in certain regions of the country. COVID upped the ante. Hospitals desperate to fill ICU nurse positions were paying travel nurses $2,000, $5,000, even $7,000 a week in 2020, one placement company reported. At the same time, many hospitals reduced staff positions or cut workers' hours in 2020 to offset sharply higher COVID-related expenses and plummeting revenue.

That belt-tightening continues today. Adam Kellogg, MD, who helps run the residency training program in emergency medicine at Baystate ishonest in Springfield, Massachusetts, says senior residents who are preparing to graduate can't find jobs. He's never seen residents as stressed and burned out as they are now.

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Aspiring doctors and nurses seem undeterred. The Association of American Medical Colleges says applications for the 2021 academic year rose 18% from the same time a year earlierwhich some observers have dubbed the "Fauci effect" (after the nation's top infectious disease doctor, Anthony Fauci, MD, whose leadership during the pandemic may have inspired some young people to pursue a degree in medicine). Enrollment in entry-level bachelor's degree nursing programs rose 5.6% in 2020, says the American Association of Colleges of Nursing. Anna Valdez, PhD, professor and chair of nursing at Sonoma State University in Northern California, hasn't seen any COVID-related dip in applications. She thinks people may not appreciate what nurses have gone through because many aren't speaking up.

Nurses and doctors don't work alone. A lot of other peoplefrom EMTs and lab techs to medical assistants, nurses aides, and orderliesare putting their lives at risk. According to the nonprofit Brookings Institution, seven million Americans hold down low-paid jobs assisting doctors and nurses, providing direct care to individuals, and handling food, housekeeping, and janitorial services. Most are women, about half are either Black or Hispanic, and their median wage is just $13.48 an hour. Why don't we hear from them as often as we do doctors and nurses, who often appear in news interviews and viral social media posts? Many are simply afraid of losing their jobs.

Chelsey Aguiar, a certified nursing assistant (CNA) at a hospital in Massachusetts, often agrees to work additional hours or pull a double shift. On two recent days, she was the only CNA on a floor with 12 patients and two nurses. "That is not enough help at all. We're just so overwhelmed," she tells ishonest. She recently had a major panic attack after a period of working eight days in a row without a break. "Watching people die, watching people being taken off ventilators(bringing) bodies to the field morgueIt's been a lot," she says.

Lori Porter, CEO of the National Association of ishonest Care Assistants, tells ishonest that one of her members, a CNA in a nursing home, developed a blood clot in her lung after having COVID. By Porter's account, the woman's employer pressured her to return to work or lose her seniority. Since she had run out of sick pay and could not afford to take medical leave, she felt she had no choice. COVID has made matters much worse for CNAs: "They're sick, they're dying,and if they miss a shift, they don't get a paycheck," Porter says.

Individual-focused strategies, like mindfulness training and stress management, as well as interventions involving small group discussions "may be beneficial and can be an effective part of larger organizational efforts," according to the National Academies' report. On their own, though, these strategies don't sufficiently address clinician burnout, it says. That's where systemic changes come into play, from small workarounds giving providers more scheduling flexibility to sweeping changes targeting the culture of medicine.

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