Bridget Otto has been dreading watching her hospital COVID unit fill up once again.
"The last shift that I was there, we lost several people that were very young," Otto said. "There were multiple times on our shifts that we just bawled. Like, we just gave each other hugs and cried."
Otto is a nurse in the Medical Intensive Care Unit at the University of Iowa Hospitals and Clinics. She has been working directly with COVID-19 patients for almost a year and a half. But with the vaccine now widely available, the newest wave has been different — and more difficult.
Her patients are now younger and sicker, she said. Almost always, they’re unvaccinated.
"It's so much harder because now, the grief we're seeing at the bedside — because we're allowing some visitors to come — is regret," Otto said.
She no longer considers herself a "lifer" in the intensive care unit. Otto said the pandemic has strained her love of the profession, which is why she’s heading back to school this fall to pursue a family nurse practitioner degree.
The thought of no longer having to work in a COVID ICU is “enough to keep me going right now," Otto said.
Nurses like Otto have experienced the COVID-19 pandemic up close. In hospitals, they spend a lot of time directly caring for really sick patients, and they’ve had to shoulder the grief of their patients’ deaths when family members were not allowed to be present at their bedsides.
Even before the pandemic, the U.S. was dealing with a shortage of nurses. Now, with COVID-19 hospitalizations rising once again, there’s concern that nurses on the frontlines are at even greater risk of burnout.
‘They’re Just Simply Exhausted’
Nurses are used to death, but not the numbers they’ve seen during this pandemic, said Lisa Caffery, the president of the Iowa Nurses Association.
"It'd be like walking into a mass casualty event every day, and that's kind of what it's like," she said. "That's a difficult thing to sustain over a long period of time."
Caffery said she’s heard of many Iowa bedside nurses quitting or retiring early in the last year. When nurses quit, it pushes those remaining to work extra 12-hour shifts amid the waves of sick patients.
"Normally, you only do that, you know, three days a week," Caffery said. "Well, they're doing that seven days a week in some situations, and they're just simply exhausted."
Nurses aren’t just facing a physical toll from working long hours, they’re facing an emotional one, too.
"A lot of times, patients are very scared, and they're very upset," said Rachel Vaughn, a cardiac nurse who works at a hospital in the Cedar Valley. "And it's kind of up to you, as a nurse, to … relieve that."
Denise Cundy, the chief nursing executive for UnityPoint Health in Des Moines, said her hospital is seeing more patients who have delayed care during the pandemic.
“We're seeing kind of the ramifications of that [because] they're a little sicker" and needing more attention, she said.
Nursing staff turnover has been higher than usual during the past year, Cundy said. She suspects the uptick is due, in part, to the COVID-19 pandemic.
Although applications to nursing programs have increased during the pandemic, many hospitals report challenges retaining new nurses past their first year. According to a survey conducted in 2020 by the staffing agency NSI Nursing Solutions, nearly a quarter of all new registered nurses leave their jobs within a year.
States that pay nurses lower wages could struggle more to retain nurses who could move to other states and make more money. Iowa has one of the lowest average rates of pay for RNs in the country, according to the U.S. Bureau of Labor Statistics. Other Midwest states — including Missouri and Indiana — are ranked in the bottom quarter of states for nurse pay.
Can Greater Awareness Lead To Lasting Change?
The pandemic has amplified long-standing issues facing the nursing profession, said Jessica Rainbow, an assistant professor of nursing at the University of Arizona.
"We, for so long, have really shied away from making legislation about staffing, for example, and really trying to address burnout," she said.
Rainbow is collecting stories from nurses about their experiences working throughout the pandemic. She wants to use those stories to push for more regulations — like patient-to-nurse ratio requirements — which is something Iowa, like most states, doesn’t have.
"The ratios have gotten really out of control to [participants] talking about, you know, 'Before the pandemic, I worked in the ICU and I took care of one to two patients, now, I'm asked to take care of three to four patients,'” she said.
Kylie Olson understands what it’s like to feel overwhelmed on the job. After graduating from nursing school last summer, Olson landed her first job working on the medical-surgical floor at the Pella Regional Health Center in Iowa.
By October, she was working exclusively with COVID-19 patients — an experience she described as: “baptism by fire.”
Olson said her orientation period for her new job was cut short so that she could help care for patients.
"It was one of those things where I felt like I wasn't necessarily the most qualified person to be able to take care of these patients who were really, really sick," Olson said. "But there was no one else there who could do it."
If she hadn’t been transferred to the hospital’s labor and delivery unit in February, Olson said she might have quit nursing.
And among her group of friends from her nursing program, many others report feeling the same way, she said.
"All 10 of us have said that we don't know if nursing is what we want to be doing for the rest of our lives," Olson said.
Despite all the challenges nurses are dealing with now, Rainbow said she is optimistic because more people are paying attention.
"I'm really hoping that this is going to be used as a launching point for actually, hopefully, making things better," she said.
This story was produced by WFYI’s Side Effects Public Media, a news collaborative covering public health.