Hospitals across the country are grappling with nurse shortages as the pandemic continues to change the healthcare system as we know it.
Below, two intensive care unit nurses who left their jobs shared their experiences with Becker's.
Editor's note: Responses are lightly edited for length and clarity.
Becker's talked with Audra Williams, RN, who has nearly eight years of experience as an intensive care nurse and worked in New York ICUs at the onset of the pandemic. She left the profession and is now advocating for other nurses as nurse concierge at healthcare jobs marketplace, NurseFly.
Question: Can you briefly describe what it was like working as a nurse during the onset of the pandemic in New York?
Audra Williams: Working as an ICU nurse in New York during that time felt confusing, intimidating and surreal. I remember seeing the situation unfold on the news and suddenly "hit" my hospital like a flood overnight. One day we had our first COVID-19 case and within a week, COVID-19 patients were filling up our hospital beds quicker than we could treat them and personal protective equipment was running low. Despite being resilient in those early days and quickly adapting, we still didn't fully know what to do or how to protect ourselves.
Q: What was your breaking point, or the moment you decided to leave the nursing profession?
AW: I was already struggling with burnout. In the seven-plus years of working in ICUs, the most time I had ever taken off was 25 days. Failure on multiple levels by leadership, patients not being able to say goodbye to family members, and the decline of staff morale as we all tried to navigate our new day-to-day were what led me to my breaking point.
During a crisis like the pandemic, I expected leaders in upper management positions to lead their team, alleviate stress as much as possible and guide us through this alarming situation. Instead, it felt like things weren't discussed fully with staff, and leadership didn't seem concerned with how we were managing so many patients with such little resources, which led to a decline in patient safety that we, as nurses, couldn't control.
My mental health suffered more than I had ever experienced. Since leaving ICU bedside nursing, I've dealt with anxiety and PTSD — something I didn't even realize nurses could suffer from as a result of working conditions. Mental health in healthcare workers is not talked about enough. There's a stigma around it. And, in a hospital setting, those struggling with their mental health may feel inadequate or even be told they are inadequate by others.
Q: What could have been done, if anything, to make you stay in the nursing profession?
AW: I've worked in 10 hospitals across four states over the last seven years and there are two common themes I've noticed from upper management: lack of staff support and lack of focus on what the staff needs. Most nurses feel unsupported, overworked and underpaid. A true focus on what we actually need from the beginning would have made it easier for me to stay by the bedside and would have helped millions of mentally exhausted nurses and healthcare workers tend to their mental health a little better while treating COVID-19 patients.
This is why I joined the NurseFly team as nurse concierge. In this role, I support and advocate for nurses by helping them find the best job opportunities, pointing them in the direction of helpful resources and acting as a support system.
Q: What advice would you give nursing leaders trying to support their nursing staff?
AW: Patient care will always come first, but when overall staff well-being is ignored, it boils over into the level of patient care workers are able to provide. I urge leaders to get more creative for their staff — put yourselves in their shoes to gain a deeper, better understanding of how to best support them. Ordering lunch for the ICU or giving out gift cards are quick fixes, but they aren't sustainable and won't work long-term. Be present with them, and be on the floor with them as their team member. It's typical for management to drop in from time for a quick visit rather than actually spending time with their staff to see firsthand what they're dealing with day-to-day.
Also pay nurses better. Nurse-to-patient ratios are unsafe for patients and unsustainable for nurses, leaving them overworked, underpaid, unhappy and ready to throw in the towel.
It costs a lot of money to get an agency nurse on a travel contract, and upper management usually doesn't want to bring in additional nurses due to the cost. When nurses inevitably leave, once again the struggle with short staff comes into play. Retention of nurses in hospitals is at an all-time low — a cycle that bleeds into patient and customer satisfaction, which is what management thrives on for reimbursement, grants and money from federal and state funding. Management could fix this by hiring enough nurses and working to retain them.
Haleigh Sullivan, RN, BSN, aesthetic nurse at Aesthetic MdR in Marina Del Rey, Calif., emailed Becker's the following statement regarding her experience as a nurse amid the pandemic:
"Burnout with bedside nursing is occurring rapidly and frequently. The culmination of long shifts, short clinical staffing and often lack of mental health resources available within the hospital setting lead to nurses wanting to find another facet of the profession or seek higher education.
"As a nurse that has a background in critical care from Nashville, Tenn.-based Vanderbilt University Medical Center, I've witnessed and experienced burnout firsthand. A nurse pays an emotional tax with each patient that they meet. Delivery of empathetic, acute care while maintaining prompt, continuous communication with physicians and family, all while ensuring that documentation is accurate and complete, is all in a shift's work.
"I personally experienced my burnout after working for two years in the medical intensive care unit. Long night shifts, nights of being on call and considering getting a second job to sustain my husband and me while he pursued his MBA, all led to my decision to transition into outpatient plastic surgery.
"Amid a job transition and a cross-country relocation, the pandemic struck. I watched the news and ever-increasing case count inundate New York. I took my critical care knowledge and mobilized with hundreds of other nurses to the underserved county hospitals of the boroughs of New York.
"There were many memories, traumas and takeaways that came out of my month in the city, but one stands out. Every protocol and procedure was completely dismissed in April 2020 in the hospitals of New York. It seemed there were a disproportionate amount of administrative staff to actual boots on the ground: nurses, techs, RTs, etc. If the purpose of the administrative staff is to operate a well-oiled machine, why did the healthcare system collapse? The lack of support for clinical staff on a regular basis begs for improvement; throw a deadly pandemic into the equation, and burnout will come at warp speed. It's easy for us to neglect and bury the mental images that are burned into the mind during a 12-hour shift: a trauma patient rolling into the ER, someone watching their family member take their last breath, a young patient with so much life ahead of them on the brink of death.
"All in all, a broken system can only run for so long. If there were better resources or better pay, a nurse would be more inclined to stay. However, when physical, emotional and mental burnout are all factors, the only option is to remove yourself for your own sanity — and that's what I had to do. I believe structural changes need to happen to ensure that nurses are able to continue their care without compromising their own well-being."