At New York’s peak, Dorman regularly had at least four patients at a time, instead of the customary one or two, and would work for 12 to 13 hours at a time. There often wasn’t time to go to the bathroom, let alone break for lunch. After six months of working overtime, Dorman became burned out and anxious before every shift. “I found myself worrying which one of the patients might die from COVID-19 each day, and this was extremely difficult,” says Dorman. “Patients with coronavirus are the most critical patients I have ever taken care of, and I have been a nurse for 16 years.” Dorman is one of the many nurses who have worked tirelessly alongside other healthcare workers amid a devastating and uncertain pandemic. Their unimaginable sacrifices have ranged from working longer shifts to becoming infected themselves with COVID-19. The mental and physical toll has permeated nurses’ lives since the beginning. Now, over a year in, the results are clear: Nurses are overwhelmingly burnt out.
Nurses Are Burnt Out and Exhausted
A recent study from the American Journal of Critical Care (AJCC) demonstrated the prevalence of these feelings. Researchers surveyed 771 members of the American Association of Critical-Care Nurses to determine the effects of varied mental and physical well-being and workplace support. Mental health issues are prevalent for critical care nurses, with 53.2% of participants reporting anxiety symptoms, 39.5% reporting depressive symptoms, and 42.2% reporting feelings of stress. Burnout was already a significant problem for nurses before the pandemic. In a February 2021 study, 31.5% of nurses who left their current employment in 2017 reported doing so because of burnout. Factors contributing to this decision included working over 40 hours each week, a stressful work environment, and inadequate staffing—all aspects the pandemic has exacerbated. Even as COVID-19 cases decrease in the U.S., critical care nurses remain in the thick of it. “Those of us working in critical care are still seeing the sickest patients ever, and unfortunately, we won’t have as many success stories to tout, simply because the virus and its sequelae have beaten us in many instances,” says Anne Dabrow Woods, DNP, RN, the chief nurse of Wolters Kluwer, Health Learning, Research & Practice and a per diem weekend critical care nurse practitioner for a large healthcare system in the Philadelphia area. “It’s difficult and saddening to know that many of our patients won’t ever be going home to their families again and that our faces will be the last they ever see,” she says. Reflecting on the mental toll of her ongoing experience during the pandemic, Dabrow Woods homes in on the fear she and so many nurses have felt, especially in the face of so much uncertainty. “Fear we would become infected and bring it home to our families; fear of not having enough PPE, resources, or trained staff, and fear we wouldn’t be able to do enough to save the lives of those in need. Yet, we were compelled to care anyway. We looked COVID-19 full in the face and said we would not be daunted, as hard and as scary as that was,” Dabrow Woods says. “Caring is part of who we are as nurses.”
Further Evidence of Nurses’ Burnout
The AJCC findings echo previous studies focused on the well-being of healthcare workers throughout the pandemic. A February 2021 study found that 22.8% of healthcare workers in the U.S. had probable PTSD. A December 2020 study of 1,119 healthcare workers examined the mental health toll of the pandemic between June and September 2020. Among all healthcare workers, 93% of participants reported feelings of stress. Nurses were more likely than other healthcare workers to report feeling too tired (67% to 63%) and like they did not have adequate emotional support (45% to 39%). Of the 245 nurses surveyed, 40.82% worked directly with COVID-19 patients, and another 48.57% had a risk of exposure. Brook, an RN in the operating room at a Level 1 trauma center, was pregnant when the pandemic began. “Stress and fear have definitely played a huge part in my mental health, especially at the start of the pandemic when there were so many unknowns,” says Brook, who chose to be identified only by her first name. “My anxiety was high because I was worried about not only my own health, but also the health of my unborn child. Thankfully I work at a hospital that did a great job of taking care of me during my pregnancy,” says Brook. After giving birth in June 2020—and as the virus became better known—Brook’s fear and stress levels began to decrease. Physically, however, she’s exhausted—only in part from having a newborn. Work remains her primary source of fatigue, especially with many nurses having left. “ It is the responsibility of the remaining staff to fill in those holes," says Brook. “Our surgical caseload is now pretty busy, so some staff are in procedures for twelve-plus hours, and that can be both mentally and physically exhausting, especially when working multiple days in a row.” Participants in the AJCC study were 92.2% female and 83.4% non-Hispanic White. However, healthcare workers of color have experienced more COVID-19 infections than their White counterparts. An October 2020 review from the Centers for Disease Control and Prevention (CDC) found that Black hospital personnel made up 52% of hospitalizations between March 1 and May 31, 2020, compared to 27.4% of non-Hispanic White hospital personnel. According to a September 2020 report from National Nurses United, 24.1% of U.S. nurses are people of color. However, 58.2% of the 213 registered nurses who died of COVID-19 before September 16, 2020, were people of color—a significantly disproportionate figure. For example, Filipino nurses only make up 4% of registered nurses but made up 31.5% of deaths up to that point. In comparison, 75.9% of registered nurses are White but accounted for 39.4% of those deaths. Alvin Cantero, DNP, FNP, a graduate of Walden University’s Doctor of Nursing Practice and Master of Science in Nursing programs and CEO of Alvin Clinica Familiar, an urgent care and walk-in clinic in Houston, previously worked as a physician during epidemics such as dengue fever and cholera in his native country of Cuba. “While nothing compares to the novel coronavirus pandemic, my prior experiences helped to mentally and physically prepare me to face the current pandemic,” he says. Throughout the pandemic, Cantero has seen 65 to 80 patients daily during 12- to 16-hour shifts, including weekends. He feels physically strong but mentally tapped. “It has also been draining to realize that the poor risk perception of this pandemic cost so many lives that potentially could have been saved,” he says. Cantero blames the long hours, increased workload, and frustrations for burnout and post-traumatic stress disorders in healthcare workers. As an Idaho-based pediatric COVID-19 ICU nurse explains, “Night shifts can be hard on me physically. It affects my sleep, obviously, which can affect mood, metabolism, and immunity pretty easily.” These factors can not only harm workers but create potentially dangerous situations. “In the worst cases, providers who are burned out may be more likely to make mistakes, which can negatively impact the patients,” says Cantero. The AJCC study found that nurses reporting poor physical or mental health were significantly more likely to make medical errors. Dabrow Woods concurs: “Nurses must realize, we can’t care for others if we don’t care for ourselves first.”
How to Help Nurses
Taking steps to prevent burnout hasn’t been very feasible for nurses navigating long shifts and increased patients. While nurses might start to have some bit of time to take care of themselves, as is the case for non-healthcare workers, they may face barriers such as cost and access. The sentiment is clear among nurses: they need help. “I think the nurses who are and have been caring for COVID-19 patients should be checked on and offered free programs so that they can talk about what they are doing,” says Brook. Dabrow Woods wants employers to offer counseling from experts trained in disaster, burnout, and post-traumatic stress. “Patient outcomes are optimized if the staff feels valued, has adequate resources, is properly trained, and feels safe in their work environment—both physically and emotionally,” says Dabrow Woods. “Healthcare systems need to foster resilience by investing in their workforce’s well-being. It’s more important now than ever.” Nurses hope therapy is one of many steps taken to support them and their hard work. “Therapy programs are wonderful, and I’m glad that mental health is becoming more mainstream, but at the end of the day, nurses need places to live and food on the table, so a raise that actually kept up with the cost of living would be most appreciated,” says the Idaho nurse, who is a talent advocate at Incredible Health and asked to remain anonymous. As cases slow, Cantero hopes workers can take extended breaks to “spend more time with their family members and get proper rest after everything they have endured over the past year-plus, he says. Like Cantero, over two-thirds of participants in the AJCC study reported that their workdays were longer than 12 hours. As for how everyday people can show their support, Brook recommends asking a nurse how they’re doing or feeling to show you care about their well-being. Medical systems need to address the collective burnout nurses are experiencing and quickly. “Failing to change with the times will force nurses to go elsewhere, retire early, or leave the bedside or the profession altogether,” says Dorman. “However, not all facilities are the same, so there is not a one-size-fits-all answer.” Brook echoes the sentiment: “I think this pandemic has forever changed health care and healthcare workers. I’ve seen and heard of several nurses leaving health care altogether and choosing other professions because they are so burnt out. I think we will continue to see a nursing shortage in all specialties for some time.” The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
