It was one week in November. Every day, Illinois nurse Jacob Forsman had a COVID-19 patient. And every day, that patient died by noon.
“That was for three days in a row,” he said. “That one just broke me.”
Nearly a year later, he had hoped to be finished with COVID-19 body bags. But Forsman, an intensive care unit charge nurse at Northwestern Medicine Lake Forest Hospital, is one of the many hospital workers who continue to treat severely ill COVID-19 patients, a year and a half into a pandemic that many knew would be a slog but most had hoped would ease by now.
“I think the reality has sunk in for me that we’re shifting into the year 2022, and it’s called COVID-19,” Forsman said.
Doctors and nurses and others who help treat and, hopefully, heal, virus patients are still working daily. They still help people breathe, they still hold iPads connected to family members unable to see sick relatives, they still call relatives to summon them for a final goodbye.
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“We’re still intubating people, when you can walk into any Walmart and they have signs that you can get any of the vaccines for free,” Forsman said.
All of this has taken its toll.
The American Association of Critical-Care Nurses recently created a “hear us out” campaign to speak about the “sustained and extreme demands of the last 18 months,” including a survey noting 66% had considered leaving nursing.
“At the beginning, it was fear,” said Dr. Michelle Prickett, a pulmonologist who has worked in Northwestern’s COVID-19 intensive care unit throughout the pandemic. In the spring, vaccines offered hope only to be crushed by delta and slowing vaccination rates. “We’re feeling the strain. It’s just frustrating and exhausting.”
Amid colleagues quitting and continued COVID-19 hospitalizations, health care workers feel burned out.
‘We are just trying to do everything’
Even as they themselves are vaccinated, and in many ways things have improved, multiple Chicago health care workers said they feel this time is the hardest.
“I feel like I’ve been running a marathon and as I approach mile 25, someone moves the finish line,” said Whitney You, an OB-GYN at Northwestern Memorial Hospital. “I’m learning to accept that reality, but it still makes me tired and anxious about what waits around the corner.”
Last fall, amid mask arguments and pandemic fatigue, hospital workers expressed frustrations and even Illinois Department of Public Health Director Ngozi Ezike became emotional while talking about the nearly 10,000 lives lost at that point in Illinois.
Now, however, nurses are working not only with the effects of COVID-19 but also routine appointments like knee replacements or shoulder surgeries that were postponed during shutdowns.
“Everyone’s resources are stretched far thinner, because we are just trying to do everything,” Forsman said. “We’re trying to be there for the people that need the outpatient resources. We’re trying to treat people that couldn’t be treated before, and treat the COVID population.”
Meanwhile, COVID-19 cases keep coming. This summer, Forsman said they saw multiple people hospitalized in a family after all attended a wedding. Not everyone left.
“Everyone came in together. They get sick at the same time, and you’re going to discharge three out of five of them,” he said. “That’s something that’s super hard for us as nurses, and something that we just don’t get over.”
Chicago psychologist Saloumeh Bozorgzadeh, who created a group to help mental health among workers during COVID-19, said she is seeing health care workers even getting physically ill, reporting things like gastrointestinal problems or eye infections, along with mental health challenges like feeling numb, disengaged, apathetic and anxious.
“Some have symptoms similar to PTSD,” she said. “I think many people may not know that these can be the effects of burnout, and some may not know how to cope with it. People think of burnout as just being tired, but there is so much more to it.”
For some, stepping away is the solution.
Doris Carroll retired after 38 years in nursing earlier this year. She moved to Florida to help her mother, but she’s honest in admitting that COVID-19 contributed. “I am relieved to be out,” she said.
Adding to her decision were what she called “dangerously low staffing levels,” and the grief of losing fellow nurses at the University of Illinois at Chicago hospital to COVID-19.
“I didn’t sign up for this,” she said. “Nor did my colleagues.”
UI Health has faced staffing challenges, but those challenges “have not significantly impacted patient care,” said Michael Zenn, CEO of University of Illinois Hospital and Clinics, in a statement.
It’s not only those in COVID-19 units feeling strain. Last year, pediatricians were asked to help provide staff and services for overwhelmed adult wards. This year, with rising RSV cases and young children unable to be vaccinated yet, “I worry that we may have it the other way,” with other staffers asked to help out children’s wards, said Chicago pediatrician Deanna Behrens.
Airica Steed, Sinai Chicago chief operating officer, said as many as 20% of Sinai Chicago’s workers aren’t coming in on any given day because of the mental and physical exhaustion of working through a pandemic, as well as child care challenges and exposure to COVID-19. In normal times, about 5% to 10% of Sinai’s workforce was absent on any given day.
Staffing shortages across the state
Before, staffing challenges centered around COVID-19 wards. Now, it’s staffing for treating COVID-19 patients as well as all whose appointments or procedures were delayed during the pandemic.
“We’re now expected to battle the pandemic and meet the needs of people who are not only very sick and needy, but have gone without necessary care for nearly a year and a half,” said Liz Somone, a nurse at the University of Illinois Hospital.
Prickett said it’s not that people are “leaving in droves,” but rather that when anyone leaves, “You can’t train people fast enough to do this.”
“People are certainly saying, ‘Am I going to do this for the next whole year?’” she said. “It gets to be a lot.”
Hospitals have long dealt with a shortage of nurses, but the pandemic has exacerbated the problem, experts say.
It can be difficult to tell exactly how many nurses Illinois hospitals and clinics may have lost over the last year. As of September 2021, there were 258,225 active nursing and advanced practice registered nurse licenses compared with 263,513 the year before, according to the state.
But not everyone who is licensed is actually working, and nurses had to renew their licenses last year, which often leads to a dip in the numbers.
Part of the problem is it’s now more difficult for hospitals to get temporary nurses from staffing agencies, as they often did in the past in times of need. Agency nurses are temporary workers who are sent to hospitals to fill in gaps. COVID-19 surges across the country have created greater demand for those nurses, driving up prices for them, Steed said.
Steed has seen agency nurses make as much as $50,000 for one month of work — making it difficult to afford those nurses and prompting some of Sinai’s own nurses to leave for agency jobs.
“We’re finding ourselves paying four and five times that of the typical rate just to get temporary personnel in,” Steed said. “Certainly, that’s not a sustainable scenario.”
Exhaustion and burnout from COVID-19 have also led many nurses to leave hospital jobs.
“We have a very resilient staff, but how can you not have employees feel burnout after going into wave three,” said Susan Mitchell, chief human resource officer at Edward-Elmhurst Health.
Hospitals are trying a number of different tactics to entice nurses to stay. Sinai has been giving bonuses to those who pick up extra shifts or work in short-staffed areas, as well as ramping up its recruitment tactics. Edward-Elmhurst added in-person employee support coordinators to give workers people to talk with, if they need help. And it has set aside “lavender rooms” — spaces with dim lighting, soft music, zero gravity chairs and the scent of lavender where workers can go if they need a few minutes to relax.
In Southern Illinois, where hospitals have been especially hard-hit by COVID-19, the state has already sent more than 250 temporary workers to hospitals short not just on medical workers but also on custodians and dietary workers.
“Within the region, we just have an overall shortage of manpower that we’re just not able to fill locally,” said Arien Herrmann, regional hospital coordinating center manager for the southernmost part of Illinois.
“If you can make the same money working at Taco Bell, and not have the additional stress” people are choosing those jobs, he said.
Fighting delta and vaccine hesitation
Last year, health care workers were fighting the virus. This year, they face additional opposition in delta, the strain that has complicated the recovery from the pandemic, and vaccine hesitation and misinformation.
By the time patients arrive in an intensive care unit, many are unable to speak. But Forsman said many express regret about not having gotten vaccinated. Nurses say many people assume they are healthy and will be fine even if they get the virus; others simply think precautions like staying home or wearing masks will be enough.
As someone who became a father during the pandemic, Forsman said it is hard to see patients in their 40s and 50s, parents of young children, with people’s “whole world just crashing around them.”
“That was the hardest, to see families,” he said. “You feel like you’ve let down multiple people when someone passes away.”
Even some who lose family members still do not seek vaccination, said Lindsey Gradone, a Northwestern nurse practitioner who has worked in Northwestern’s COVID-19 unit since the pandemic began.
“To be facing this wave with so much vaccine hesitancy and almost every one of our patients that came in was unvaccinated, or they had been compromised, it’s just been really hard,” Gradone said.
Both situations are difficult. With unvaccinated patients, it is hard to see patients panic and family members grieve as they realize how sick they are, and knowing patients did not get something that could have helped. For those vaccinated but with health conditions that still made them vulnerable in a persistent pandemic, “They did everything right,” Gradone said. “It’s gutting.”
Thomas McClure is a travel nurse who worked in Illinois at the beginning of the pandemic and is now in a trauma intensive care unit in Colorado.
Like others, he says he feels placed in a situation where he’s unable to give the highest level of care he’d like.
“Delta cases are sucking up beds we can’t staff,” he said. Their unit typically keeps beds open for patients from things like car crashes; instead, they are filled with COVID-19 patients. “My biggest fear in all of this right now is that my wife will get in a crash in the mountains and not have a hospital bed in town,” he said.
Meanwhile, the days when health care workers were lauded as “heroes” and applauded nightly feel far away.
Like many, Gradone has sought out help and support. Also like many, she finds herself wondering about alternatives.
“I love what I do,” she said, “and I’m staying. But it’s this idea of, is this worth it if it’s taking this much of a toll?”