(Published in the November 2022 issue of the Journal of Emergency Nursing under the title "Finding Joy: Fighting Nurse Burnout")
At the beginning of April 2020, the Covid-19 pandemic burnt me out. At one point, I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches.
I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team.
The Apex of this pandemic that we were preparing for came much too early. Doctors, nurses, and techs were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, PTSD a real threat.
We were protected, we assured ourselves, but how could you be confident about how safe you are when the Covid fatalities keep on rising? The whole hospital (and the whole city) was in a pandemic chokehold.
It took a few minutes of deep breaths before I could summon the courage to rise from my bed. For the first time in my long nursing career, I was at a crossroads I never thought I could ever be at. I considered myself unshakeable. “Been there, done that; nothing can ever make me turn away from Nursing,” or so I thought.
That morning, I felt burnt out, but I went to work. To fortify myself, I looked up onto the heavens and whispered, “My Lord God, take charge of my life.”
ON THE FRONTLINE
The New York streets were empty. The City that Never Sleeps was in total lockdown since March, and only the essential workers were allowed to travel. Along the Cross Bronx Expressway on my way to work, what was once a traffic nightmare looked more like an apocalypse with nary a car nor a truck in sight for miles on end. Times Square was a ghost town. The silence was both eerie and deafening. I felt like I was going to war, but I was scared and helpless. I hated being vulnerable.
I was on the frontline but felt like a spectator. I was not actually at the bedside giving direct care as I wanted to be. The responsibility of being a Director of Nursing in an emergency department amid a healthcare crisis was overwhelming, but not more than what the ED nurses, techs, medical providers, and other ancillary personnel had to go through. I can only imagine the enormous impact of the unending crisis on their psychological well-being when their best efforts sometimes fail.
My nurses forbid me to go into the rooms, even to help prepare the bodies for the Morgue. They wanted me safe. I even joked that I was not that old, that I could fight alongside them. Just like in Imposter Syndrome, I felt inadequate and not quite pulling my own weight on the battlefield.
All I could do was make rounds, check on the staff, order supplies, request the Incident Command for more staffing help, coordinate travel nursing coverage, handle family complaints, and act as a cheerleader and emotional support for the staff. I followed up with my quarantined staff members for Covid exposure and illness. It was difficult to hear their anxiety and I feared that they could hear the quiver in my voice, so I preferred texting to phone calls.
I saw the patients come through the Triage Area, with no family members to sit by their bedside. The patients were whisked directly to the rooms with high-flow oxygen masks to aid in their breathing. I saw patients inside the isolation room as they lay with apprehensive eyes looking at their oxygen saturation numbers on the cardiac monitors.
I also remember the eyes of the ER staff beyond the masks and their face shields. Eyes that were sad and worried. Eyes haunted by the final goodbyes between the patients and their loved ones on the iPAD. Eyes filled with despair because of the unprecedented challenge wrought by the coronavirus onslaught. These were our darkest times.
I tried to be transparent with my information to the staff. But I grappled with what I could share. So, in my emails and our daily huddles, I talked about the nurse travelers coming in, the other non-clinical activities, and non-emergent procedures that were put on hold to deploy the staff to the ED and the other patient units. My news was upbeat and hopeful as I could possibly communicate to my already disheartened staff. I told them of the other surge capacity activities that the hospital leadership initiated to accommodate the influx of Covid-19 patients.
I did not share my concerns about the grim statistics and the dwindling supplies and equipment (since we compete with other hospitals for resources). I did not share that the Morgue was full and that there were Medical Examiner trailers on our campus. I did not confess that I wanted to quit nursing.
I did not want to stop and answer questions about my state of mind for fear that the tenuous hold on my fragile emotions would break. I did not want anyone to see me ugly-cry because of the sadness in my heart. So, I cried behind the doors.
My priority was that my staff would feel supported so they could take care of the patients who needed their expert help. I had to be the leader that they deserved. I learned how to look confident on the outside, although I was frazzled on the inside. I could not afford to be weak.
EPIPHANY: SELF-CARE
The staff needed mental PPE. We corroborated with the Mental Health Liaison psychologists, who offered counseling and other options for the team to de-stress, decompress, and start healing our broken hearts. My epiphany was that I had to do self-care. How could I help my staff when I was running on empty?
In my personal life, through all life’s ups and downs, I relied on my family and friends, my church, and my writing to endure. I knew I was strong enough to survive my personal travails, but I was unsure if I could remain a nurse amid the challenges that had brought down my other colleagues. I resolved to look for my joy triggers at work. I knew I had to heal myself first before I could lead others.
One day, one nurse asked to speak with me. That nurse broke down crying as soon as we got into my office. The words of pain and despair poured out, and the repressed emotions from the past months finally tumbled out. The nurse was not suicidal but was profoundly sad and depressed. We talked for a long time, but mostly, I just listened. I called one of the mental health counselors and arranged an emergency visit. Then, we hugged, and the nurse thanked me for listening, and for being there. I am glad to report that today, that nurse is now healthy and is thriving well.
FINDING MY JOY
Covid-19 would not be my downfall. Having witnessed the heroism and fortitude displayed by all healthcare personnel during these uncertain times made me realize how much I love the nursing profession. In my little way, I am privileged to have made a difference. That moment of indecision in my nursing career, that short period of burn-out, that temporary insanity is no longer. I have recovered my self-worth. I found my joy and my “why.”
What turned me around? What prevented me from leaving my profession? My healing came as I continued working as a nurse. I poured out my emotions into my daily journal, a catharsis to help me exorcise my negative feelings. My writing brought everything into perspective. Much as there were so many heartaches, I found comfort in our small triumphs. As a nurse, I was part of the army against this virus.
There were numerous things to celebrate. Let me count the reasons why we persevered:
- The clapping and appreciation from the hospital neighborhood and other heroes like the firemen and the cops.
- The outpouring of support from the community with unsolicited food deliveries (which both fed our bodies and our souls)
- The staff working as a team and caring for each other
- The staff comes in extra days so their peers will not work short-handed.
- The deployed staff working in unfamiliar places and doing their very best to help
- Dancing to the music “Call on Me” whenever a patient was discharged.
- Getting a Thank You from a patient and his family
- The staff rising to the challenge, despite the threat of Covid-19
- The knowledge that every single hospital employee was doing their best under the direst of circumstances
- The realization that we were doing God's work
I created a Facebook photo album of pictures from the staff to celebrate the resilient group that they are. It was a way to pay tribute and highlight this particular group on the frontlines of this war. I wanted to preserve in posterity the faces of the brave ones who came to fight the battle against Covid-19.
The FB photo album grew into a photo journal. It was to chronicle the moments of levity captured in-between moments of heartbreak; just before they rush back to the unit to save more lives. Frozen in time, the pictures showed the ED team taking a much-deserved break, a respite from the hard work. Just a little breather. There was a spirit of camaraderie, of having bonded as we worked together. As time went on, the staff started to SMIZE, they smiled with their eyes.
These healthcare workers, heroes of my time, were simply inspiring.
NURSES’ MONTH
Last May 2020, the hospital managed to celebrate the Year Of The Nurse creatively despite the constraints of social distancing and face masks. We danced on the streets, gave out cookies and cupcakes, published our virtual nursing journal, enjoyed the gifts from numerous sponsors, and were treated to an aerial display from the US Air Force and the Navy. The festivities were a harbinger of hope that we would survive. The end of the pandemic would come. And then we prayed for the vaccine, our fighting chance.
In 2022, the American Nurses Association chose the theme, “You Make A Difference.” Nurses in all disciplines and sectors truly matter as we give our patients a chance for a better life. Every Day. Our strength is rooted in determination and dedication to serving those who need help and fortified by the challenges and disruptions of the past years.
Like every single nurse standing strong despite being bruised and shaken by our pandemic ordeal, I am still here. I am proud to be a nurse.
HAPPY NURSES' MONTH!!!
