Nurses are burnt out. Can hospitals change in time to keep them?

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Calling It Quits is a series about the current culture of quitting.

One morning, in fall 2020, Francesca Camacho pulled away from her 12-hour night shift as a critical care nurse at Rush University Medical Center in Chicago and tried to merge onto the highway. The day’s work was, in her words, “absolutely awful”. This was not unusual at the time: The Cook County area was experiencing the highest level of Covid hospitalizations it had ever experienced, only to be overtaken by an Omicron variant wave the following year.

She was talking on the phone with her parents, a ritual she developed as a way to decompress after a shift, when she noticed what appeared to be a teenage driver in front of her.

“I remember thinking, what is this girl doing that justifies her not letting me in?” Ms. Camacho, now 27, was recalled. “And I just felt this surge of anger.” She hung up the phone and screamed and cried for the rest of the drive home.

The next day, he asked his co-workers if anything like this had ever happened to them; They all said yes. Lunchtime therapy sessions with fellow nurses turned into professional therapy sessions. She recently said, “It was really a sense of anger that I felt, and I think a lot of deep sadness about what I was seeing and what we were all going through.”

Last August, he quit his job. She is now a first-year law student at Boston University and plans to use her law degree to advocate for change in the medical field.

Burnout has always been a part of nursing, an effect of working long hours in physically and often emotionally taxing environments. The Covid pandemic exacerbated those factors and added a few of its own: staff shortages, increases in violence and hostility toward health care workers over masking mandates, and a rise in deaths, especially in the early months of the pandemic. In a study by the American Nurses Foundation released last month, 57 percent of 12,581 nurses surveyed said they felt “burnt out” in the past two weeks, and 43 percent said they felt “burnt out.” Only 20 percent said they felt valued. (Those numbers were largely consistent during the pandemic.)

“Burnout and our current issues have been going on for decades,” said Jennifer Mensick Kennedy, president of the American Nurses Association. “So what have we learned from the past few years? We need to ensure that we implement programs and processes to reduce burnout and improve the work environment. Because Covid is not the last pandemic, or the last major issue to happen.”

For some, the well-intentioned change can’t come soon enough: Forty-three percent of those surveyed by the American Nurses Foundation said they were at least thinking about changing jobs. Some, like Ms. Camacho, have given up on the profession. Other roles are changing.

Kelly Schmidt, 52, spent 25 years working in the neonatal ICU at a hospital near her home in San Anselmo, California. To protect them and heal them”—and found himself doing everything he could: riding in the back of ambulances, flying in transport planes over the Pacific or flying in helicopters through Bay Area fog.

She loved her job, her patients, and her co-workers, but other challenges emerged over the years. The transition from physical charts to electronic medical records took her away from her patients’ side, and as the pandemic hit, the transition into a management role left her and a coworker tasked with overseeing a staff of more than 90. As nurses themselves began to fall ill and remain in quarantine, tensions rose and the ranks of healthy staff dwindled, and Ms. Schmidt said she “began to feel like a robot emotionally.”

Then, last May, she found herself on the bottom mattress of her daughter’s bunk bed, sick with Covid and isolated from the rest of her family. She found herself re-evaluating the two-hour commute, the emotional labor of the job, the compartmentalization. She looked at a job listing for a nearby school nurse position, scoured and updated her 23-year-old resume, and applied on a Sunday night. The district called her on Monday, interviewed her on a video call on Tuesday (“I was practically in a coma by then,” Ms. Schmidt recalled) and offered her a job by the end of the week.

“I don’t want people to think about the job I quit,” she said. “It was time for me to leave. Other colleagues of mine have said, ‘I don’t want to leave my job hating it,’ so they retire early. I didn’t want to quit my job hating it. I wanted to leave on a high note. And now I have pictures of helicopters on my desk and I can interact with little kids and try to find out if they’re sick.

Some hospitals recognized there was a problem before the pandemic and tried to fix it. Kathleen Littleton, 35, of Baltimore, not only worked at Johns Hopkins Hospital (and earned her master’s degree in nursing science at her university), but also as an instructor at the school of nursing. The hospital used research by Cinda Hilton Rushton, professor of clinical ethics in the school of nursing, specifically “The Mindful Ethical Practice and Resilience Academy,” a program that focuses on mindfulness and meditation to combat burnout, with some success. Together.

Then came the pandemic and, Ms Littleton recalled, practically speaking, there was no time to meditate or think about it.

As the Johns Hopkins ICU began to fill up in the spring of 2020, Ms. Littleton’s mental health declined. By November she had transferred to the labor and delivery wing of the hospital, thinking it would be less stressful. Instead, she saw a handful of Covid-infected mothers go straight from C-sections to life support systems.

In October 2021, she left Hopkins for a travel-nurse job that paid her three times her previous role, but also brought her face to face with various tragedies: gunshot wounds, car accidents, Stabbing, train accidents. She was regularly falling apart, she said, looking at her hands and wondering whose they belonged to. One day while taking a bath, he imagined a light above him falling into the tub and he felt electrocuted.

“Whenever people casually ask — like, ‘How you doing?’ — nobody really wants to hear the answer,” Ms. Littleton said. “It’s nearly impossible to tell your friends or family members who aren’t involved in health care about what happens in the hospital. And it’s hard to talk about mental health. In nursing, sometimes when people Says, ‘Oh, I’m feeling so jealous.’ It’s almost like a shameful way.

At the suggestion of his doctor, he checked the days until his contract expires in May 2022. With the extra money she had saved from the pay bump, she took an extended honeymoon through Spain, Portugal and the Netherlands. She now works for an insurance company that does health promotion and engagement.

“Now I find myself randomly making blueberry scones at 9:30 at night, or deciding to go with my husband so our friends can spontaneously play music at this bar,” she said. “I have become very little … hardened.”

That said, she is also in therapy for post-traumatic stress disorder, and like every other nurse interviewed for this story, she has felt some degree of guilt for her decision to leave her job.

“I feel very guilty that I am not still in hospital, and I really mourn the loss of my critical care career as well,” Ms Littleton said. “I’m not disappointed in myself – because it’s not fair to blame myself – but I’m really disappointed that I can’t do it anymore.”

One thing that isn’t an issue, said Dr. Mensick Kennedy of the American Nurses Association, is interest in the area. Conventional wisdom – and Dr. Mensick Kennedy’s own expectations – would hold that with these intense levels of stress and burnout, interest in nursing would wane. According to the ANA, 60,000 qualified nursing applicants were turned away from nursing schools last year.

As experienced nurses leave the profession, there are fewer opportunities for students to receive the hands-on, hospital training that is essential to the profession, causing nursing schools to fail to graduate enough to fill the gap. Can’t create. Fix the burnout and staffing issues, Dr. Mencik Kennedy said, and the infrastructure can once again support the required amount of new graduates needed to fill the nursing gap.

The most important way to start, she said, is to measure nurses’ stress levels regularly, just when they begin to ascend and turn to the glory of working without a break.

For Ms. Schmidt, a former NICU nurse, the stress has eased with her new role. “It’s still hard work,” she said. “It’s still good work. I’m still super busy. But it’s not always life and death.

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