September 20, 2021
In the best of times, critical care nurses have one of the most difficult and stressful jobs in healthcare. The COVID-19 pandemic has made that immeasurably worse. As hospitals have been flooded with critically ill patients, nurses have been overwhelmed.
"What we're hearing from our nurses is really shocking," Amanda Bettencourt, PhD, APRN, CCRN-K, president-elect of the American Association of Critical-Care Nurses (AACN), told Medscape Medical News. "They're saying they're at the breaking point."
Between August 26 and August 30, the AACN surveyed more than 6000 critical care nurses, zeroing in on four key questions regarding the pandemic and its impact on nursing. The results were alarming — not only with regard to individual nurses but also for the nursing profession and the future of healthcare. A full 66% of those surveyed said their experiences during the pandemic have caused them to consider leaving nursing. The respondents' take on their colleagues was even more concerning. Ninety-two percent agreed with the following two statements: "I believe the pandemic has depleted nurses at my hospital. Their careers will be shorter than they intended."
"This puts the entire healthcare system at risk," says Bettencourt, who is assistant professor in the Department of Family and Community Health at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Intensive care unit (ICU) nurses are highly trained and are skilled in caring for critically ill patients with complex medical needs. "It's not easy to replace a critical care nurse when one leaves," she says.
And when nurses leave, patients suffer, says Beth Wathen, MSN, RN, CCRN-K, president of the ACCN and frontline nurse at Children's Hospital Colorado, in Aurora, Colorado. "Hospitals can have all the beds and all the rooms and all the equipment they want, but without nurses and others at the front lines to provide that essential care, none of it really matters, whether we're talking about caring for COVID patients or caring for patients with other health ailments."
Heartbreak of the Unvaccinated
The problem is not just overwork because of the flood of COVID-19 patients. The emotional strain is enormous as well. "What's demoralizing for us is not that patients are sick and that it's physically exhausting to take care of sick patients. We're used to that," says Bettencourt.
But few nurses have experienced the sheer magnitude of patients caused by this pandemic. "The past 18 months have been grueling," says Wathen. "The burden on frontline caregivers and our nurses at the front line has been immense."
The situation is made worse by how unnecessary much of the suffering is at this point. Seventy-six percent of the survey's respondents agreed with the following statement: "People who hold out on getting vaccinated undermine nurses' physical and mental well-being." That comment doesn't convey the nature or extent of the effect on caregivers' well-being. "That 9 out of 10 of the people we're seeing in ICU right now are unvaccinated just adds to the sense of heartbreak and frustration," says Wathen. "These deaths don't have to be happening right now. And that's hard to bear witness to."
The politicization of public health has also taken a toll. "That's been the hard part of this entire pandemic," says Wathen. "This really isn't at all about politics. This is about your health; this is about my health. This is about our collective health as a community and as a country."
Like the rest of the world, nurses are also concerned about their own loved ones. The survey statement, "I fear taking care of patients with COVID puts my family's health at risk," garnered 67% agreement. Wathen points out that nurses take the appropriate precautions but still worry about taking infection home to their families. "This disease is a tricky one," she says. She points out that until this pandemic is over, in addition to being vaccinated, nurses and the public still need to be vigilant about wearing masks, social distancing, and taking other precautions to ensure the safety of us all. "Our individual decisions don't just affect ourselves. They affect our family, the people in our circle, and the people in our community," she says.
Avoiding a Professional Exodus
It's too early yet to have reliable national data on how many nurses have already left their jobs because of COVID-19, but it is clear that there are too few nurses of all kinds. Earlier this month, the American Nurses Association sent a letter to the US Secretary of Health and Human Services urging the agency to declare the nursing shortage a crisis and to take immediate steps to find solutions.
The nursing shortage predates the pandemic, and COVID-19 has brought a simmering problem to the boil. Nurses are calling on the public and the healthcare system for help. From inside the industry, the needs are pretty much what they were before the pandemic. Bettencourt and Wathen point to the need for supportive leadership, healthy work environments, sufficient staffing to meet patients' needs, and a voice in decisions, such as decisions about staffing, that affect nurses and their patients. Nurses want to be heard and appreciated. "It's not that these are new things," says Bettencourt. "We just need them even more now because we're stressed even more than we were before."
Critical care nurses have a different request of the public. They're asking — pleading, actually — with the public to get vaccinated, wear masks in public, practice social distancing, and bring this pandemic to an end.
"COVID kills, and it's a really difficult, tragic, and lonely death," says Wathen. "We've witnessed hundreds of thousands of those deaths. But now we have a way to stop it. If many more people get vaccinated, we can stop this pandemic. And hopefully that will stop this current trend of nurses leaving."
Avery Hurt is a freelance science and medical writer.