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Unimaginable Health Care Worker Burnout in the 4th COVID-19 Wave

08/25/2021

Close up of  female with mask on and scrubs.

By Elizabeth Even, MSN, RN, CEN, Associate Director, Clinical Standards Interpretation Group

In early 2020, news of COVID-19 and speculations of how it would affect our lives were on every news channel and feed across the globe. Information was scarce and people speculated and filled in the blanks as best they could. There were so many questions and very few answers.  

I work as a nurse in the emergency department (ED)at a large, academic Level-One trauma center and, like everyone else, picked up some additional shifts at my hospital when the pandemic started. I blogged during the early dark days of the pandemic. As frightened as we were then, many of us felt we had no other choice then to show up to work at a time when we were needed the most.

Everyone begged me to quit my job in the ED. After all, it was my second job, and my older mother came to my house every day to watch my young daughter. But I loved it and had been there for more than 15 years, not to mention the fact that being a nurse is a big part of my identity.    

My group texts with co-workers were sprinkled with comments on how we were actually scared to go to work for the first time since becoming nurses. Would we all get COVID-19 and die? I cried for the third time in my career while driving into work amidst all the news headlines swirling in my brain.

Nurses in critical care units had some of the darkest tales to tell in those early days with patients leaving this life too soon and, at times, all alone depending on the visitor policy. Images from New York hospitals and other early hotspots were chilling, and the frontline workers that took care of those early patients will never be the same.  

Adapting After the Initial Panic  
At first, we were all on high alert and everything seemed to take forever. Cleaning took longer, some treatments had to change, staffing shifted, and change as well as communication was constant. We stuck together, we got better, we learned and adapted as professionals and as a country. Crisis mode is not a sustainable state though and many hospitals across the country were short-staffed before COVID-19 entered the picture. Organizations in solid financial standing offered new incentive pay if they were able, but it was short-lived.

At the same time, many organizations placed a hold on vacations and time off to ensure the small group of staff they had showed up to take care of this new influx of sick patients. The mental toll was immeasurable. While we adapted to this new reality, life as we knew it in the hospital would forever be changed.  

First off, COVID-19 was always lurking and could present in new ways every day. It took some time to adapt to masks all day, every day during our 12-hour shifts. Some staff were not allowed to come to work if they were symptomatic early on, and many of these employees had little or no paid time off.  Staff called in sick more than ever. Some call-ins were mandated, others had sick family members. Still others sorely needed a mental break from the new reality that was acute care.  

Eventually, we got vaccinated (see my selfie on The Joint Commission’s Facebook page) and felt a real sense of hope for the first time since the pandemic started. We enjoyed a bit of a “honeymoon period” when life started to open up a little again, but the Delta variant replaced that hope with a tired frustration that is all too common amongst health care workers right now in America.  

4th Wave Frustrations
EDs were already drowning as the safety net of the health care system and COVID-19 is the equivalent of adding lead weights to our feet. Many care providers have moved into other departments or out of the hospital altogether. With increased risk and workload, meager compensation, and mandated overtime for some, many have finally made the tough decision to walk away.

Hospital throughput is a big challenge for many health care systems across the country. Inpatient bed numbers, safe staffing numbers to care for the patients in those beds, and appropriate and timely discharges are some of the key factors at play. COVID-19 has further complicated this issue with longer inpatient stays, more patients presenting for care and less care space available as organizations make efforts to keep patients as separated from others as possible. Wait times in EDs and clinics soar as do wait times for inpatient beds. Nursing and front desk staff take the brunt of patients’ anger and complaints about long wait times as the health care system tries its best to stay afloat.   

We understand the stress of waiting for hours to be seen and it’s an impossible situation when the hospital’s COVID-19 patients are complaining that they can’t breathe with their mask on and there’s literally no place to move them because every nook and cranny is filled. Our hospital is luckier than most because the Chicago area has a high vaccination rate compared to other areas in the country. The Delta variant has resulted in younger patients presenting for care. At the same time, opinions on vaccination seem to come up in almost every patient encounter and it can be exhausting. Sometimes, it seems there is no light at the end of the tunnel.

It’s time to accept the fact that COVID-19 is not only still here, but it continues to adapt. We need to continue to be vigilant. It’s a relief that most of us (that is another story) are vaccinated. It weighs heavily on nurses and all health care workers that many of our patients choose not to be vaccinated, while children under 12 years old cannot yet be vaccinated and remain unprotected. Many of us are trying our best to understand friends and family that have made the deeply personal decision to forgo the vaccine. Health care workers are doing their very best to continue their passion of delivering excellent patient care. That calling has never felt more impossible, nor has it ever felt more important.  

Elizabeth Even, MSN, RN, CEN, is associate director, Clinical Standards Interpretation Group, for The Joint Commission. She is also on staff in the emergency department at Northwestern Memorial Hospital. Prior to this position she managed the emergency department at Northwestern Memorial Hospital and was a clinical educator at Northwestern University Feinberg School of Medicine.  She also has experience in home health and working as a nurse at Wrigley Field in Chicago.