“I wanna go back to the beginning of Covid...

where people were nice to us and only came in for emergencies and brought us food and stuff.”

My coworker said this after a patient threw a full urinal at her because his meal tray hadn’t arrived yet. He ate dinner at 5 every day and it was 5:15. Never mind that she had no control over meal tray delivery and had spent the better part of an hour giving multiple units of blood. He was also angry because he’d spent over a day in the ER because there were no beds upstairs. 

Meanwhile, the COVID zone had been full since early morning, also with patients waiting for beds, and now multiple zones had COVID patients as well. The whole ER had come to a standstill. There were no available beds anywhere, nor any pending discharges upstairs. Multiple facilities in the area were on high volume, notifying EMS by commenting on their availability status, “no inpatient beds, no monitored beds, critical staffing, no ICU beds, ED at capacity.”  The next closest trauma center was on TCD diversion and closed to trauma. 

I had two hours left on my shift and al I could think was, I can’t do this anymore. I don’t want to be a nurse anymore. As I was thinking this, one of the most reliable and upbeat nurses came to tell me his patient wanted to complain to the charge nurse because he had also been waiting for a day and he also wanted to complain about the visitation policy and not having a private bathroom and to be moved into an ER room and out of the hallway if he was going to wait any longer.

After he delivered the bad news, one of the ER doctors walked by muttering “I hate it here.” Someone else said “SAME.”

The burnout happening among emergency departments is intense, and spiraling out of control. As hospitals hit capacity again and again and again, the emergency departments are overloaded and overwhelmed. They’re running patient care out of any available spaces. Chairs in hallways. Treating in the waiting room. Setting up tents outside. A good friend of mine was assaulted in one of these tents for taking too long. 

I surveyed the disaster area I was responsible for managing and knew I could get through two more hours. Problem was I wasn’t sure I could get through two more twelve hour shifts. At the peak of the second and third surges, I sleep in snatches. I have nightmares. I wake up at 3 am and wonder what I can do about the admit holds today. Can I beg pediatrics to spare some space? Can I move a quartet into the waiting room and place privacy screens around them? Can we utilize doubling up in the larger rooms? Will we be able to provide telemetry monitoring to those who require it? What if I miss something? What if someone dies because an alarms beeping and no one is around? What if someone’s dying and no one has time to face time? What are my nurses ratios going to be? How long can they keep doing this? What if someone calls in? What if it’s worse? What if a hallway patient tests positive for COVID? They’re really short this weekend, how do I leave them to do it alone? Should I work more than 60 hours a week? Is it more unsafe for me to be exhausted or for them to run 1:8 ratios?

Hospitals have long relied on nursing’s ability to work overtime, to not leave their teams stranded and short staffed, to come to see themselves as so vital they think not picking up a shift will make it their fault their coworkers have a crappy shift. Every time I have a conversation about my burnout and how much I’m working someone will say, “just don’t go in.”

And to that I’ll say, “people ARE DYING. It’s a fucking PANDEMIC. I HAVE TO.”

I mean, sure, I don’t have to. But who’s going to step in? I’m a veteran nurse. I’ve been doing this gig for nearly twenty years. The average life span of an ER nurse is 3-5 years. Because it’s a mostly thankless, grueling, ass kicking job. Right now, the veteran nurses are carrying heavy loads. We’re the ones who can take three to four critical patients and keep them alive. We’re the ones who recognize a third degree block across the room. We know how to put in an IO (intra-osseous needle, into the marrow of a bone for fluid access) in about ten seconds and we can throw a Lucas device (a machine that does CPR for you) on about the same amount of time. I need my veterans. When I’m charging, I need the nurse that came take full traumas and post codes by themselves. 

When I see open shifts, I don’t just see short staffing. I see the patient who waits to be helped for the bathroom so long they’re incontinent. The little old lady who’s scared and confused and no one has time to reassure her. 

What about the new nurses? Starting in the middle of a pandemic, leaving nursing school where you’re trained to spend time with patients and cate for them with the utmost dignity and privacy? How do you wrap your head around doing a pelvic exam in a supply room because there’s NOWHERE ELSE. How do they manage assignments that an experienced nurse would struggle with? What do they do when they see there’s only three nurses scheduled on a shift that calls for seven? Of course, we, veterans and newbies alike, are going to pick up that shift.

You’re always have some bad shifts. 

But now there’s COVID. There’s people dying and you can’t do anything for them. Mixed with this increase in dissatisfied patients waiting for beds and increased staffing ratios and psychiatric emergencies. 

Two of our new hires left during orientation. 

Over two hundred nurses have left another facility alone, a facility that had a huge COVID surge. 

I took a PTSD quiz the other day and surprise surprise I’m at “extreme high risk”. Yeah, so is everyone else I know. What keeps us going is the need. Nobody has time to have a breakdown right now. We’re all relying on compartmentalization and disassociation and avoidance and dark humor to keep us going. But what happens IF the vaccines work and then we return to normal? We’re in crisis mode now, but when the crisis abates, the trauma won’t. 

Most of the time I would say I’m pretty pissed off about how this has all been handled. At the hoax bullshit, and the anti maskers, and the way everyone else seems like their world just keeps moving on and I’m stuck in the seventh circle of hell where there’s never any goddamn beds and the crush never stops coming and no matter HOW FUCKING HARD I WORK it doesn’t seem to make any difference. It’s climbing a mountain that never ends, every day, and breaking camp exhausted, bitter, burnt out, only to face the never ending ascent that comes again. 

We’ve been doing this for nearly a YEAR. 

It’s very difficult to think about the fact this was something that was preventable and containable. Not now, that it’s spiraled out of control. But in the beginning, we could have just not been self centered and buckled down for a few weeks and made a difference. 450,000 people dead and the number keeps rising. 450,000 and people are still going out without masks. Arguing the visitor policy. Saying it’s just a bad flu. 

What we do? Who’s responsible for my therapy costs? And my coworkers? As healthcare workers leave the field, who will replace them? How do we go on in a world where we’ve stepped up and worked ourselves to the point of utter exhaustion and what about those of us who experience physical illness as well as mental and no one seems to give a shit? Who wants to offer free mental health services to those of us who watched not just our patients die but our friends and coworkers? What about the nurse that had a caseload that was TOO MUCH and made a mistake and has to live with it? Who bears responsibility? The government? The facility? The nurse? 

What is this going to look like next year?

What about the suicides in healthcare? Substance abuse? Self harm behaviors? All of these are on the rise. What about divorces? The time missed with children and family? All of these things are a result of being a healthcare worker during COVID. And it’s hard to talk about, because it’s really hard to say “I’m upset because my life has been ruined by working in healthcare during COVID.” Because I’m alive. I didn’t suffocate to death like the patients I cared for that didn’t make it. I didn’t get COVID as bad as some of my coworkers. I feel selfish bringing up the trauma I’ve experienced, because if it’s a contest, people that didn’t make it through had it worse.

But the things that are happening every day are causing healthcare workers a significant amount of distress. A pervasive sense of loneliness, hopelessness, and anger. 

I cannot foresee a future where this ends and I just go back to my previous life. For me, leaving a shift where people died from COVID and walking into a gas station where half the customers and one of the clerks were maskless made me feel as if I’d seen a dark side of humanity that does not care about others, that is unwilling to compromise and do simple things to protect others, and it left me asking if people are really good. I’ve always believed that most of us are. But that core knowledge has been shaken. I’ve come to question my existence, and what I’m supposed to be doing with my life, and what I’ll do when this is over. I’ve thought maybe I’ll leave the field, when this is done. 

At the very least, mental health care should be covered for healthcare workers experiencing COVID trauma. It should be either covered by the federal government or mandated that it’s covered by employers, though many people will no longer be at their employer they had during the pandemic. 

One more thing—

I’m really begging the public to be kind to their healthcare workers. It’s not our fault there aren’t hospital beds available. We are doing the best we can. We already feel like we’re failing most of the time, and getting yelled at and berated for things completely out of our control is making everything ten times worse. We don’t pick people we don’t like to occupy hallways spaces. If you’re not contagious, and don’t require continuous monitoring, you might be in a hallway. We would always give private rooms if we could. We don’t think you’re not sick. We just have to treat the sickest first. Please be cool about it. 

—- the Midwestern One