COVID-19, which brought the U.S. to its knees and the world at large, has now been in effect for two years. It prompted sudden lockdowns and travel restrictions, as well as work-from-home orders. Next came mask mandates and restaurant closures, crowd size restrictions, grocery shortages, and restaurant closures.
However, the same anxieties led to a commitment to protect one another and a determination to find safe ways to stay in touch with loved ones. And, most importantly, support for frontline workers who risk their lives to help others.
“There was this camaraderie and level of respect for the healthcare workers. When the pandemic hit, it really felt like people recognized that the level of care was at an all time high,” said Dr. Bayo Curry Winchell, the medical director of urgent care at St. Mary’s Hospital in Reno, Nevada.
That respect came in the form of a daily evening applause for healthcare workers, meal donations to emergency rooms and grassroots movements to secure personal protective equipment (PPE) for hospitals that were running low.
However, this respect quickly disappeared. Slowly but surely, that respect began to disappear.
“Nursing was hard before COVID,”Lydia Mobley (travel nurse), who works in intensive care, said that she was happy to help. “Nursing has been pretty hard for a long time. COVID really only exacerbated that.”
Many healthcare workers are reporting increased burnout and worsening mental well-being due to the increasing number of deaths and traumas, hostility towards hospital staff, COVID-19 denial, and the explosion of new viruses.
“It wasn’t just work. It became everything,” nurse anesthetist Dina Velocci explained. “Layers of stress on top of everything really caught the healthcare field in a really hard way.”
Anecdotal evidence suggests that healthcare workers are experiencing a mental crisis. A physician burnout Medscape report that polled more than 12,000 physicians in over 29 specialties found last year that only 49% reported they were happy in 2020, versus 69% before the pandemic. 34% of the polled said they felt unhappy in 2020, compared to 19% in 2019.
Nearly 80% felt burned out before the pandemic. But, only one in five physicians reported feeling burnt out since last year. Even more concerning, a study found that female nurses are twice as likely to take their own lives as other women. The University of Michigan School of Nursing found that female nurses are also 70% more likely to take their own lives than female doctors.
The extraordinary demands that COVID-19 has placed on women–from homeschooling to finding child care–exacerbates the stress these nurses experience,Matthew Davis, associate professor in the U-M School of Nursing, was the study’s lead author. He said the current study did not include data from the pandemic, which means these numbers could be even higher now.
“It’s much higher than I expected,” said study lead author Matthew Davis, associate professor at the U-M School of Nursing. “The takeaway for me is we’ve focused so much on physician welfare that, historically, we haven’t paid enough attention to this huge workforce that, based on our data, is at much higher risk.”
“An Unprecedented Amount of Deaths”
Lydia Mobley, a travel nurse, left active duty in October 2020 to take up short-term assignments in hospitals in need through Fastaff Travel Nursing. She said that the demand for nurses is at its highest and she had originally joined the Navy to become a nurse, but she decided to return to nursing to help.
Mobley was a 14-week travel nurse assignment. She recalled seeing more deaths than she had seen in her nine years of nursing.
“That’s what has taken the largest mental toll on me and all the healthcare workers,”She said. “It’s just an unprecedented amount of deaths.”
The stark spike in deaths have also fundamentally changed the jobs of practitioners who’s jobs did not previously expose them to death, like those who administer anesthesia.
“You’re used to providing anesthesia care and saying to patients in the pre-op area, ‘I’ll give you something to go to sleep. You’re going to wake up, I’ll see you in the recovery room,’”Yana Krmic is a nurse anesthetist. Krmic was also the former president of the New York State Association of Nurse Anesthetists. “Now, [you’re] giving them the same anesthetics and realizing that you don’t know if they’re going to wake up.”
Dina Velocci, the president of American Association of Nurse Anesthesiology, works out of a small hospital near Detroit. She said she was also struggling with the same problem.
“You can’t give them the sense of hope when we do surgery,” Velocci explained. “You almost knew that they were never going to wake up. They were going to die.”
They explained that the COVID-19 most severe patients were treated by nurse anesthetists.
“We would come in, almost like a SWAT team but for the airway,”Krmic explained. “At some points, I found myself being with the patient one-on-one, when everybody had left the room. Looking into the patients’ eyes and realizing that you don’t know the outcome of your care.
“You almost feel the interventions that you’re doing are not helping,” Velocci said.
Those who work in pediatric care also saw their day-to-day changing when the devastating effects of the delta and omicron variants flew in the face of initial reports that children were immune or more resilient against COVID-19.
“We’ve seen a lot of children get sick. Children both with complex medical conditions as well as healthy teenagers. And we’ve seen several children die from COVID this past year,” said Dr. Adam Hill of Riley Hospital for Children in Indianapolis, Indiana.
Hill works in pediatric palliative care, meaning his job is to support children with life-threatening conditions or in their transition to end-of-life care.
“We’ve definitely felt it in the children’s hospitals – the grief, and the tragedy, and at some times, just the anger of it being preventable,” he explained.
Post-Traumatic Stress Disorder
Krmic still wakes up with nightmares.
“I am trying to locate my phone to dial up their family members so they can see them for the last time,” she said of the horrors her mind dreams up. “That is traumatizing enough. The ‘second victim’ effect is a very real thing.”
According to a Yale School of Public Health study, nearly 25% of all healthcare workers showed signs of post-traumatic stress disorder (PTSD).
“A lot of people, myself included, struggled with compassion fatigue before, but now you have full blown PTSD with nightmares and flashbacks,” Mobley explained.
That same study found that nearly half of all healthcare workers are struggling with alcoholism as well.
Hill, who is now in long-term recovery for alcohol addiction, explained that his work led him down that dark path nearly a decade ago.
“I was really depressed and had really severe anxiety and struggled with coping with the gravity of the work, and the death and dying I was seeing every single day and where to put that,” he recalled. “For me, the outlet was alcohol and what evolved into alcohol use disorder and eventually daily drinking to numb the intensity of being an empath and feeling that so deeply.”
Alcohol use has skyrocketed across the country since the beginning of the pandemic, Velocci said, and she constantly encourages the other nurse anesthetists she represents to find healthier outlets for the stress they face on a daily basis instead.
“Watch what your coping skills are. Are they healthy? And if not, here’s a chance for you to switch it,” she said.
For Hill, seeking treatment and finding healthier coping mechanisms has not only allowed him to become a better doctor, it has also helped him prioritize being a better husband and father to his family. His work today, including writing a book detailing his own journey, revolves around supporting others in speaking out and getting the help they need.
“It’s okay to struggle, and honestly, in 2022, after two-plus years of a pandemic, it is the norm,” he said.
“Is It Too Late to Get The Vaccine”
“The overwhelming majority are unvaccinated and it’s the same story. They’re struggling to breathe, and a lot of the times, they wind up saying, ‘Is it too late for the vaccine?’ in between struggling for breaths,” Mobley said of the patients she treats. “Obviously, it is way too late.”
In addition to the trauma of witnessing an unprecedented level of death, healthcare workers say COVID misinformation, along with the patient pushback to medical advice, is another major stressor they face on a daily basis.
Curry-Winchell, who also goes by Dr. BCW, said that delivering a diagnosis has become a challenge in and of itself.
“How is my patient going to actually receive this information? Is this patient going to get angry at me? Is this patient going to feel like I’m not telling the truth?” Curry-Winchell said. “That has been really difficult for so many healthcare providers.”
She said she believes this shift in attitudes toward healthcare providers is a direct result of misinformation.
“The development of vaccines and the increase of misinformation … really changed people’s perspectives on healthcare providers,” she said. “All of a sudden, it was a level of mistrust.”
And because of the misinformation and mistrust, Mobley said many efforts to support healthcare workers feel disingenuous. “We see these, ‘thank you healthcare heroes’ billboards and stuff,” she said. “You will also notice people not taking precautions very seriously. It is obvious. [you]There are so many people out there who aren’t willing to get vaccinated. It can sometimes feel hollow.”
In addition to facing that tension at work, Hill explained that the pushback against healthcare workers and medical advice leaks into different avenues of his life.
“At one time, we were called healthcare heroes, and all these signs popping up in our neighborhoods,” he recalled. “Six moths later, [I’m] witnessing that same sign being run over by a truck in the parking lot.”
Seeing debates over how best to protect children play out in town hall meetings, amongst parents and teachers, and on social media, has also made caring for children all the more contentious.
“It feels dehumanizing over time that [the] people [who] are trying to advocate for children, take care of children, provide resources and opportunities to keep our kids safe, have been vilified,” Hill said.
And for Mobley, the pushback has sometimes become violent. She once was punched in the ribs by a male patient. “He was totally with it. Not under the influence, no dementia, nothing,” she said.
Another time, she was sent to the emergency room by another patient.
Before the pandemic, nearly 75% of all workplace assaults happen in healthcare settings, according to the American Journal of Medical Care.
About 20% of registered nurses reported an increase of on-the-job violence in late 2020, according to National Nurses United, and a late 2020 study by the University of Rochester School of Medicine and Dentistry found that healthcare workers were about 50% more likely to be harassed, bullied or hurt for reasons related to COVID-19.
“You see cell phone videos of people behaving badly on airplanes, where they would be on their best behavior. That’s when they know there’ll be consequences. That’s where they know that everybody has a camera on them,” she said. “In hospital, there generally isn’t consequences for mistreating healthcare workers. And nobody has a camera, so assaults against healthcare [workers] is extremely common.”
Finding Hope Out of Helping Others
“I do have some challenging days,” Curry-Winchell said. “But I still have this love of healthcare and I love helping people, and that has been my internal drive.”
That has been a sentiment echoed by other healthcare workers, who say they not only entered the field due to a passion for caring for others, but it is that passion that continues to make working through long days and inevitable surges in cases worth it.
In fact, Curry-Winchell dedicates a lot of her spare time to working with community leaders like pastors and priests to build trust within the BIPOC community after having noticed many minority groups were uniquely posited to be victims of COVID-19 misinformation.
“When you think about African Americans and the Tuskegee experiment and how that affected the population … of course, patients are going to feel like ‘Why should I trust a government product, or vaccine, or medication, when you look at how different races and ethnicities have been treated in the past?’” She said. “These inequities and disparities were already present pre-pandemic, and during the pandemic, it really illuminated all the cracks we have in healthcare.”
Through these efforts, she and various colleagues performed successful vaccine clinics, where they delivered nearly 300 vaccines to a community who was once resistant.
“It’s not about race, it’s about inequities and disparities and finding new ways to reach people and change the narrative of delivery and health information,” she said. “Because that trust was built, the misinformation was slightly removed.”
That attitude is what inspires her biggest piece of advice to medical students, residents and those who might be interested in entering the field despite all the challenges and pushback: “You cherish this opportunity to get to know people in their most low points, and you have the ability to help them in so many ways, whether it’s mentally or physically,”She said. “And that’s a gift.”