Hospital workers face burnout as public support fades and COVID-19 cases rise
Eric Kumor has been a nurse for 10 years, but the last few weeks he finds himself having to gear up emotionally just to walk in the door to work.
“And within 30 minutes, like two of our nurses are already just in tears,” he says.
Sparrow Hospital, where Kumor works, is one of many hospitals across the state facing a crush of coronavirus patients. The hospital is getting so full, they’re starting to move the non-COVID patients out of the main hospital to another campus.
"I've never seen patients get sicker quicker in my career."
And it’s converted Kumor’s unit from regular, inpatient care, to handle overflow COVID patients.
“I've never seen patients get sicker quicker in my career,” Kumor says. “It’s also kind of sad. Because when you walk into the unit and you see suffering, there’s just this feeling of sadness that I’ve never seen in my career before.”
The sadness and stress of handling so many COVID patients is getting to the state’s frontline health care workers, many of whom already struggled to cope in a job with long hours, little gratitude and daily tragedy.
Months into the pandemic, more than 3,500 people in Michigan are now hospitalized with the virus. The state is on pace to break its previous record of COVID-19 hospitalizations by next week. Deaths from the virus have been rising as well. And health care workers worry they won’t be able to keep up with all the new sick people showing up every day. They’re already worn thin. No one knows how long they can hold out.
“People were already at a breaking point,” says Dr. Srijan Sen, a psychiatrist and University of Michigan professor. “And then COVID hit.”
“They need breaks”
Sen researches stress, anxiety and depression among resident physicians. The interest, for him, is personal. He says two of his friends attempted suicide while in medical school. One survived. One did not.
Before the pandemic, Sen says 25-30% of resident physicians showed signs of depression, a rate five times higher than the rest of the population. In the early stages of the pandemic, Sen says mental health for these physicians actually improved.
“We heard reports that physicians felt like this is what I actually became a doctor to do,” Sen says. “And there was a sense of people pulling together that everyone in the hospital and even in the larger society was hailing physicians and clinicians as heroes. And it felt like we were all in it together and working toward a common purpose.”
But the cheers that once greeted frontline health care workers at the end of their shifts faded months ago. The signs signaling support are gone. Some people now say the virus is a hoax. And all the while, these health care workers have been battling it. And in the past few weeks, the situation has gotten much worse. Some health care workers don’t know how they’ll keep up if it continues.
"I'm just really tired."
“I’m just really tired,” says Dr. Ali Rizvi, a traveling physician who has worked in numerous hospitals throughout the pandemic. “I have been working almost nonstop.”
Rizvi says he had to take a break in August, and walked away from practicing medicine for his own mental health.
“I really do like what I do, and I’m very happy to do it,” he says. “But it still takes a lot out of you.”
Adding to the stress is that treating COVID patients is unlike treating any other kind of illness, according to Rizvi and others.
“The last time I was the COVID nurse I remember saying ‘I just want to lay on the floor and not get back up.’” says Gwen Boeve, who works as a nurse in a West Michigan emergency room. Michigan Radio is not identifying the hospital because Boeve did not have permission to speak on its behalf.
Boeve says one area of her emergency room is designated for COVID patients only. She isn’t always assigned to that area, but it’s hard not to notice.
“If you look into where the COVID nurses are sitting, or that COVID zone, they just look exhausted,” she says. “It just doesn’t feel like you stop running when you’re the COVID nurse, because you’ve got all of those extra steps to maintain safety.”
Instead of being able to walk in and help a patient whenever they need it, Boeve says nurses put on masks, gloves and gowns and try to get all of their tasks done at once, to reduce exposure. They can’t spend as much time with their patients, or help them feel comfortable.
“You can’t be the nurse that you want to be,” Boeve says.
But more and more, that’s the nurse she has to be. This past week, Boeve says her hospital was so busy with COVID patients, there were no available beds. So patients had to stay in the emergency room, some waiting in hallways, until space opened up. The hospital has already opened up an overflow area, Boeve says, and a storage space was converted to make space for more beds.
Other hospitals throughout West Michigan have scrambled to add space as the number of COVID patients rises rapidly. And more health care workers are facing mandatory overtime shifts, working 16 hours at a time with no end in sight.
Hundreds have fallen sick themselves, which creates even more problems for those left to care for patients.
“That wreaks havoc on scheduling and staffing,” says Dr. Rizvi. “And that further degrades people’s emotional states. They need breaks, and they’re not getting the breaks they need.”
Caring for the caregivers
Breaks are in short supply in Michigan hospitals right now. Workers say they’re already burning out, and they expect the situation will get even worse in the coming weeks.
“We haven’t seen a light at the end of the tunnel yet,” says Dr. Sen.
The first piece of advice he has for people on the frontlines: If you’re stressed and feeling overwhelmed, talk about it. Take advantage of the mental health services available at your hospital. Talk about what you’re going through with your colleagues, and get professional help if you can.
And he says, if someone else tells you you’re burned out, you probably are.
"As nurses, we're the carers. We want to care for everyone else. We want to care for our communities. But we're terrible at caring for ourselves."
“I think sometimes it’s hard to see these things in yourself,” Dr. Sen says. “When others around you notice these things and point them out, that’s often the sign.”
Taking time off might not seem like an option, but it’s important to find some way to decompress, says Mike Hastings, president of the Emergency Nurses Association.
“As nurses, we’re the carers,” Hastings says. “We want to care for everyone else. We want to care for our communities. But we’re terrible at caring for ourselves.”
Hastings is an emergency room nurse, and a manager in the Seattle area, one of the first in the nation to see COVID patients. He says no matter how busy or stressed frontline health care workers get, everyone has their own ways of unwinding. For him, it’s mowing the lawn, or watching silly videos online – the more mindless, the better.
The ENA, along with other nurses associations, has been hosting online conversations, for nurses to be able to talk to others facing the same situations across the country. Hastings says people outside of health care often don’t understand what nurses face. Talking with peers, even at other hospitals, can be a better outlet.
"I wish I could go door to door and tell everybody how real this is."
But you don’t have to be a health care worker to be able to help people on the frontlines right now.
The nurses and doctors who spoke for this story all said there’s one thing more than any other that can help them right now: Take the virus seriously.
“The frustration with people that don’t take it seriously is turning more into anger for a lot of us,” says Boeve.
She and others say it adds to the stress of the job when health care workers race to keep up with the crush of COVID patients, only to hear from some who still think the virus is no big deal. Inside the hospital, Boeve says, nurses bite their tongues.
“And that gets harder every day,” she says. “Because the more people you see who are sick and need hospital services, alongside somebody telling you that they don’t think it’s real, just starts to get under your skin.”
“I wish I could go door to door and tell everybody how real this is,” says Eric Kumor, who works at Sparrow Hospital in Lansing. “That we might have a bed for you. But it's going to be a real challenge to give you the care that we want to give you because of how sick people are.”
But with cases in the community still rising, hospital workers are preparing to see even more COVID patients in the coming weeks. Some worry the flu could make things even worse.
Hardly anyone expects to return to the days when thousands of people put up signs in their yard, supporting health care workers. And, even if people wanted to send food like in the spring, many hospitals no longer allow it. The virus has made it impossible for nurses and doctors to gather together in a room to share a warm meal.
There are still ways for people in the community to show they care, though.
“Even just sending a card into the departments and saying, ‘Hey, thanks for everything you do,’” says Mike Hastings, of the ENA. “Those cards get posted out where your staff are able to read them. And that’s meaningful. It’s something small, but it’s so meaningful to the staff to let them know that people are there supporting them and saying thanks.”
The Detroit Free Press, Bridge Michigan and Michigan Radio have teamed up to report on Michigan hospitals during the coronavirus pandemic. If you work in a Michigan hospital, we would love to hear from you. You can contact Kristen Jordan Shamus at firstname.lastname@example.org, Robin Erb at email@example.com or Kate Wells at Katwells@umich.edu.