After more than eight years working in a big-city hospital intensive care unit, Michelle Toney has seen a lot — drug overdoses, trauma victims, patients violently lashing out. It was rough, but she loved it: “That stress and adrenaline constant is something I used to thrive off of.”
Now, two years into the pandemic, she’s considering something she never had before: leaving the ICU. “I just can’t do it anymore,” said Toney (a pseudonym Grid is using to protect her privacy).
Across the country, nurses are quitting bedside jobs at an alarming rate — worn out, mentally and physically, from dealing with surge after surge of desperately ill covid patients, fear for their own lives and frustration with people who renounce lifesaving covid vaccines or even deny the virus is dangerous. The nurses who remain are left to care for more people with fewer resources, further fraying the fragile system and harming patients and healthcare providers alike.
Nursing has always been a tough job. A wave of hospital consolidations in recent decades has helped hold down nurses’ pay and contributed to understaffing. But covid has turned a problem into a crisis. More than one-third of nurses plan to leave their current role by the end of the year, according to a survey by Incredible Health, a nurse staffing company. The American Association of Critical-Care Nurses (AACN) recently found that 66 percent of acute and critical-care nurses have considered leaving the profession.
And there are signs that, in the wake of the pandemic, fewer new nurses are entering the profession — creating problems that could outlast the virus. Without systemic changes that address the forces driving the current shortfall, many hospitals simply won’t have the nursing workforce needed to provide good patient care.
“Having to care for so many patients and not being able to provide the care that you know is needed leads to immense moral distress,” said AACN president Beth Wathen. “Nurses have borne a collective, deep burden bearing witness to hundreds of thousands of deaths over the past two years … there’s an overwhelming exhaustion right now.”
Pre-pandemic, between 17 and 38 percent of nurses reported some depression, and female nurses — who dominate the profession — died by suicide at twice the rate of women who aren’t nurses. But “the pandemic has really amplified the burdens on nurses to a level that’s just untenable,” Wathen said.
Toney has vivid memories of her hospital’s first major covid surge, in November 2020. “I would go to work and see death all day,” she said. ICU patients are the sickest in any hospital, but the covid patients who came in needed higher levels of care than the unit’s normal patient load. Nurses began leaving with every new wave of infection, and the unit struggled under a workload that at times tripled.
Toney eventually started taking antidepressants, and she and her colleagues pleaded with upper management for mental health support, including help paying for therapy sessions. But nothing changed. “If more support were given when we were crying for help, maybe I could see myself staying,” she said. “It’s too late now. I just don’t have it in me anymore.”
Pizza parties and pats on the back
Understaffing is one of the major causes of moral distress and burnout. “It both increases the workload of nurses while also making them feel less valued [by their employer],” said Jane Muir, a nurse and nurse researcher at the University of Virginia.
For most hospital settings, “four patients per nurse or less is associated with increased well-being and reduced burnout,” Muir said. Hospitals often breached that ratio before the pandemic, but many have blown well past it during covid surges.
After hearing horror stories from other nurses, Daniel Potter, a nurse who lives in Kentucky, launched HospitalRatios.com in late February. With his 2-year-old child on his lap, Potter put together a basic website where nurses could share information about working conditions. More than 300 nurses had submitted information the first day the site was live. Only about 16 percent said their facilities had adequate staffing.
“For the longest time [during the pandemic] it was a pat on the back, the signs out front, the pizza parties … that worked for the first six months,” Potter said. “But after that, nobody ever really wanted to commit to any kind of increase, like a true long-term increase in pay to retain people.”
