Reflections on the Pandemic One Year Later

Nurses talk about its impact and moving forward

By Heather Stringer
While COVID-19 case counts decrease throughout the nation and many Americans celebrate the lifting of restrictions, nurses are confronting the emotional and physical toll of working on the front lines of the pandemic for more than a year.
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“In the beginning, there was an element of excitement as nurses felt called to do this work and communities supported us with donations and recognition,” said Morgan Shikar, BSN, MPA, RN, Director of Patient Care for New York Presbyterian’s Surgical ICU. “But after months and months of treating very sick patients, nurses are sharing with me just how exhausted, isolated, and frustrated they feel.”
Although there are fewer patients with COVID-19 in the hospital’s ICU than in the winter, the patients still there have usually been on the unit for many weeks and quite often die, she said.
Morgan Shikar, RN
It was important to take a moment to grieve and recognize the trauma the staff had been through.
— Morgan Shikar, RN
Nursing leaders throughout the country are concerned about the long-term effects of working tirelessly for months and witnessing so much death. To date, more than 551,000 people have died of COVID-19 in the United States, and health experts worry that the country may be at risk of a spring surge.
To help her staff begin to heal, Shikar partnered with the hospital’s chaplain to host a memorial service on the unit in March. As part of the service, the chaplain named dozens of patients who had died on the unit in the past year. “It was important to take a moment to grieve and recognize the trauma the staff had been through,” she said.
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Thank you, Nurses!
At MJHS quality care is our mission. We let nothing stand in our way as we raise the bar on healthcare. This commitment to our patients and members motivates the entire team. Even during the most challenging of times this year, our Nurses kept our communities safe. We are thankful for their tireless efforts to always put patients and members first.
Like Shikar, Elizabeth Douglas, MSN, RN, NE-BC, a nurse manager in the Surgical ICU at NYU Langone Hospital-Brooklyn, sees her staff struggling with grief, fatigue, and loneliness, and “part of my healing has been helping them,” she said. Douglas recognized that many nurses preferred sharing their struggles with ICU colleagues who could deeply understand their experiences, unlike family members.
In November, she asked a social worker to start a peer counseling group. Nurses were benefitting from the sessions, but the groups stopped when hospitalizations soared in December. Douglas is eager to resume the sessions, especially as more hospital services reopen and nurses are expected to juggle non-COVID-19 cases with the remaining patients with COVID-19.
Finding ways to foster psychological healing and resilience among nurses also was a priority for Mary Jo Kelly, DNP, ARNP-CNS, CCRN, a critical care clinical nurse specialist for UW Medical Center-Northwest in Seattle. When she was tapped to lead the hospital’s new vaccination clinic in early December, Kelly discovered a powerful path to healing: volunteering for a shift in the clinic.
She started encouraging ICU, med/surg, emergency room, and other nurses treating patients with COVID-19 to work a few shifts in the vaccine clinic. “Instead of taking care of people who are very sick, nurses enjoy getting in front of the virus by providing protection,” she said. “The public is grateful for the vaccine, and they often thank nurses who are administering the shots.”
Elizabeth Douglas, RN
Mary Jo Kelly, RN
Uncovering New Potential
Although many nurses are still grappling with grief, exhaustion, and trauma as a result of their role during the pandemic, nursing managers also are seeing positives emerge from this difficult season.
Many nurses discovered capabilities they may have not been aware they possessed in the past, said Lorraine Sheffield, MSN, RN, CCRN, Associate Director of the Medical Intensive Care Unit at Cedars-Sinai in Los Angeles. When the hospital created a new COVID-19 unit, nurses partnered with epidemiology, environmental, lab, and other staff to develop a plethora of detailed processes to treat patients and keep staff safe.
Lorraine Sheffield, RN
To maximize safety, for example, workers drawing labs from patients with COVID-19 would place the samples in a bag, wipe the outside of the bag with disinfectant, and then call for a clean nurse outside the room. The clean nurse would then hold open a clean bag for the labs. “Administrators trusted the staff who would be doing the work in the unit to set it up, and that built a lot of confidence in the team,” she said.
Nurses’ clinical skills also expanded as they treated a high volume of acute patients who required complex care, said Shikar. “We were doing crazy things to help patients ventilate, like paralyzing, proning and sedating them, and using different ventilator settings and nitric oxide.”
Nurses quickly learned the early warning signs that a patient might be on the brink of declining, said Pablo Vasquez, MBA, RN, NEA-BC, Director of Nursing of the Highly Infectious Disease Unit at Houston Methodist Continuing Care Hospital in Texas. “A subtle change in the respiratory rate was often a signal that the body was starting to decompensate,” he said. “Monitors and EKGs might indicate that the heart rate was normal even though the respiratory rate was increasing.”
At first, it was difficult to measure respiratory rates because the rooms in his unit were not equipped with clocks, and PPE usually covered nurses’ watches. Vasquez ultimately had clocks installed in each room.
Pablo Vasquez, RN
Vasquez also sharpened his training skills when he onboarded 350 staff — 200 contractors and more than 150 Houston Methodist staff — in just six months to work in the new unit. To protect the safety of everyone involved, he addressed any performance concerns quickly — and expected change immediately. “Usually, the problems resolved after an initial conversation,” he said.
Implications for the Future of Nursing
As nurses reflect on the personal impact of working in health care during the past year, many are examining their priorities in life, said Kelly. “I’m seeing some nurses say this past year was too much, and it’s time to find a different career or retire, and I wonder what impact this will have on the nursing shortage,” she said.
For others, the experience of caring for critically ill patients with COVID-19 led to different conclusions. Although there are still many unknowns for nurses about the long-term implications of the pandemic, for Sheffield, the experience deepened her convictions about her career choice. “Personally, I learned that I was absolutely supposed to be a nurse,” she said. “It was really hard, but I wanted to be there in the room supporting the staff who were caring for COVID-19 patients. It felt like a calling.”
About the Author
Heather Stringer is a freelance writer.
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