Carol Siewert wasn't planning to leave hospital-based nursing for another two to five years. But then the novel coronavirus swept across the globe and into her 39-bed unit in a teaching hospital in Madison, Wis., and she knew it was time to go.
"I left because of staffing. I left because of health reasons, because I had blood clots in both lungs last summer, and I'm concerned that I'm higher risk for COVID complications like blood clots or acute respiratory distress. I also left because I was, quite literally, heartsick at doing my job," she said. "I realized I was experiencing what healthcare people have come to call 'moral injury,' or a kind of PTSD, and that it was best for my health if I left."
Siewert has been a cancer nurse for 17 years and has periodically worked as an in-home hospice nurse. She's seen people dying and comforted them and their families. She loves the work, even though it's emotionally draining. But COVID-19 made the stakes too high.
Siewert isn't alone in making the impossible decision to leave her job to take care of herself. The American Hospital Association doesn't collect data on how many workers are leaving the field — and doesn't plan to add that burden on providers during a pandemic. The association has heard anecdotal reports from health systems across the country that people are retiring early or looking for healthcare jobs that don't involve caring for hospitalized patients, said Nancy Foster, AHA's vice president of quality and patient safety policy. And with each loss, the nationwide healthcare staffing crisis worsens.
"People are tired. They've seen a lot of death. They've seen a lot of people really struggling to get well again and experiencing some of the worst consequences of COVID-19, as well as those celebratory moments of someone walking out of the hospital after being on the ventilator for several days or weeks," Foster said. "It's been sort of a roller coaster for a lot of healthcare staff."
The community and familial effect
Workers also are worried about bringing the virus home to their families.
Juan Anchondo, a nurse in the medical surge unit at Las Palmas Medical Center in El Paso, gets floated to the COVID-19 unit periodically as staffing needs arise.
"I have an 11-year-old son. I don't want to take [COVID-19] home to my family," he said during a news conference held by National Nurses United, a national union of nurses. "The infections keep going up, and it feels like there's no end in sight."
Kenneth Douglas, a valet at at Henry Ford Health System in Detroit, is scared by the dangers of working at a hospital during the coronavirus pandemic and has seen co-workers leave the job from fear and stress.
"When the pandemic first hit, literally there were people, in not only my department, that were like, 'I can't handle this.' A lot of people left," Douglas said. "That kind of made it stressful on everybody because everybody had to rally."
The federal government estimates that 233,013 healthcare providers have tested positive for COVID-19, 836 of whom have died, although that data is incomplete. Kaiser Health News and The Guardian have recorded at least 1,396 U.S. healthcare workers who have died from COVID-19.
As of Tuesday, 1,443 Mayo Clinic employees in the Midwest, 2.6% of the system's staff in the region, were either out of work because of a COVID-19 diagnosis or from exposure. Of those workers, 93% were infected through community spread. Similarly, Cleveland Clinic had about 1,000 employees out across its system because of COVID-19, most of whom contracted the virus through community spread.
"They have to be really concerned about whoever they're interacting with in their own personal life," said Keith Renshaw, a professor and chair of the psychology department at George Mason University.
That burden of getting their own families sick adds another layer of worry for healthcare workers, he said. And they're already feeling stress from prolonged exposure to illness and death, from providing emotional support to patients who can't have visitors and from seeing people not following public health guidance to curb the spread of the disease.
"Some people are able to compartmentalize. But, other people, they can maybe compartmentalize to a degree but just the sheer volume of it all is just becoming overwhelming for people," Renshaw said. "If you're a healthcare worker, you're used to seeing emergency situations but, hopefully, they're more spaced out than that, and, hopefully, you're seeing more successful moments.
The death toll from COVID-19 in the U.S. is more than 250,000 and climbing every day, according to the CDC.
Consuelo Vargas, an ED nurse in Chicago, said she reached a point last week where she was numb.
"I didn't feel tired. I didn't feel happy. I didn't feel angry. I didn't feel frustrated, and I didn't feel sad. I literally felt nothing. And that is a scary place for a nurse to be," Vargas said during a National Nurses United press conference. "And I see it on my coworkers' faces. They're so tired of fighting that they don't have that much more to give."
Nurses are being asked to care for four patients at once, she said.
"We are being forced to choose who we are going to pay attention to first. And where do you want to be on that list?" Vargas said.
Marissa Lee, a nurse at Osceola Regional Medical Center in Florida and vice president of National Nurses United, said nurses are leaving because of staffing levels. At her hospital, the ED has lost 15 nurses, the medical surge units have lost 20, and the medical surge ICU — the COVID-19 unit — is down to four full-time staff nurses, relying on traveling or per diem nurses, Lee said.
"The staffing level has gotten so unsafe that nurses are leaving," Lee said during a National Nurses United press conference.
Hospital leaders say they are trying to address burnout. Some have massage therapists come to the floor. Others are helping workers find childcare if kids are unexpectedly out of school because of the pandemic. And some are offering car services or ride sharing options to those who rely on public transit to get to work but fear the risk of exposure, AHA's Foster said.
"We're trying to make sure our healthcare staff know how much they are appreciated and how their heroic efforts are admired in the community," Foster said. "We are doing everything in our power to make sure that the staff are supported."
Dr. Amy Williams, executive dean of the Mayo Clinic Practice, said she hasn't seen employees leaving out of COVID-19-related stress.
"What I have seen is colleagues becoming very tired and emotionally quite burdened," Williams said.
To help, the Mayo Clinic is trying not to overwork nurses, to provide resources if employees need to talk to someone and to offer respite areas for nurses to have time to themselves, Williams said.
"Throughout this stressful time, supporting our caregivers has been a focus of the organization," said Kelly Hancock, a nurse and chief caregiver officer at Cleveland Clinic.
Cleveland Clinic has provided caregiver comfort stations, mental health support, caregiver meals and expanded childcare resources for employees, Hancock said.
A breaking point
That some workers are leaving their positions "speaks to the level of distress and just sheer sort of professional burnout and being overwhelmed that people are experiencing," Renshaw said. "People get into these fields because they want to help, they want to do something,"
Siewert went into nursing because "it's real work that makes a difference to people at a vulnerable time in their lives." She finds meaning in the job and appreciates the trust people place in her profession.
But COVID-19 turned the hospital into what Siewert called a "healthcare prison." Because of the threat of COVID-19 exposure, patients in her hematology/oncology/bone marrow transplant unit mostly couldn't have visitors, and many were too weak to make video calls. It was "isolation, all in hopes that they'll live through this," Siewert said.
On top of that, staff, let alone patients, could hardly hear the soft-spoken Siewert through her mask and face shield. And she wasn't supposed to linger in patients' rooms for fear of exposure. Because of the PPE, staff couldn't tell one another apart. They wrote their names on their face shields and, when someone was coding, the team leader wore a red hat for identification.
"I usually sit down next to some of my long-term patients and really get to how they are doing," Siewert said. "So, everyone's isolated, patients and staff."
Siewert doesn't plan to leave healthcare. For now, she plans to take on contract and limited-term employment nursing jobs. And, once the pandemic improves, she will look for a non-floor-staffing position. Or, as she quips, she could always become a baker.