Copy of One More Scoop: Increased Demands on Nursing During a Pandemic

Nursing is defined by providing care for the sick, further defined by Florence Nightingale as utilizing our environment to provide care for the sick to aid in their recovery.  Even back in 1856, Nightingale saw the connections between environment and health, health and community, community and environment: “The health of the unity is the health of the community.  Unless you have the health of the unity, there is no community health.”  What happens when that environment is suddenly altered and the role of the nurse is not only expected to adjust quickly but heroically?  COVID-19 has generationally and essentially increased the demands placed on the field of nursing.  It is also just as important to note that the pandemic placed emphasis on the importance of the health of the nurse as well as the patient.  Nurses know there is no room for error to ensure patient safety and adaptation is not just the survival of our patients but of our identity.  Our battlefields stretched from the treatment rooms to our living rooms as we save our patients, our families, and last but not least, ourselves, from a new and deadly illness.  The emotional complexities we nurses face on a regular day were doubled once the pandemic was declared and the mental health of the field was overlooked and compromised.  The demands of our job were layered in endless injunctions from administration and our communities alike. It felt as if the kids were left alone at the ice cream shop and ordered all the flavors and toppings with no regard as to whether the cone could withhold their whims—administration demanded compliance to capricious protocols, patients demanded safety in a state of uncertainty, and friends and family wanted on-the-spot explanations and assurances of new and developing science.  As the ice cream melts and the toppings avalanche, the cone is depended on to hold fast through the disaster.  One more scoop could have done us in.  

Nurses are resilient, however.  Nursing found a new rhythm in the grooves the pandemic etched out in the healthcare system.  Each day I arrived to work and was handed a single surgical mask from a security guard.  I answered the same questions on the employee health questionnaire, the same questions from patients, I even began answering the same questions from management, “Can you come in for extra shifts, even for just a few hours,” desperate to cover the holes in the schedule.  I came home from each shift, shoes outside, and my seven- and four-year-old both knew not to touch mommy until I stripped down and showered with my scrubs safe inside the washing machine (sterile cycle, extra detergent).  We nurses acted with scientific brains knowing scared eyes were watching our every move as we awaited peer reviewed journals to be written with evidence-based instruction.  With each exposure we learned more about the transmission of Sars-Cov-2 and the symptoms of COVID-19:  Fever, loss of taste, fatigue.  But there was something else that wasn’t listed as a symptom, wasn’t asked on the health questionnaires but was something we nurses observed.  Sars-Cov-2 infection rates fluctuated over the next two years but resignations, staffing issues, and call-outs did not.  What we observed was nursing burnout, the final symptom of this disease.    

In the field of nursing, burnout is easier to find than a specimen cup.  That resiliency I mentioned earlier is a placeholder for reform, which seems more like a fairytale each fiscal quarter.  The demands that this pandemic placed upon an already troubled system put stress upon the essence of care and its delivery.  This compromised the validity of the meaning of both “health” and “care” in and of itself.  We saw a lot of “Nurses are Heroes” and “Heroes Work Here” signs that covered the holes in the wall that any real estate agent would ask you to either fix or stage before a showing.  We nurses know that when the cheering stops and the signs come down, the repairs that were not made will continue to fall on the shoulders of the essential worker.  And the solecism disguised as solidarity in the form of pizza and the like won’t cut it, not even eight ways.  Yet it seems to be a universal way to lasso in lassitude at the end of a hard shift, just to encourage nurses to show up again.  Even the Clintons sent pizza during the pandemic to a local New York hospital, it’s what you do to support your healthcare workers, right?  Add more ice cream, pile on the toppings, and hope the cone holds fast.  And we do.  But, one more scoop could have done us in.                

When my patients are diagnosed with cancer, the rest of their lives do not slow down or take a break.  Each oncology patient can still get the flu or break their arm or become a parent or get a promotion.  The same is true for the nurses taking care of those patients.  We come to work drying tears of exhaustion from being up all night with a sick toddler, ready to redirect those same tears, patience, and empathy to our patients.  We are finishing homework assignments and getting engaged.  We are buying new homes or being newly diagnosed with cancer ourselves.  A pandemic may have slowed down social life for a moment but it never stopped the spinning world of events we live each day.  "Anything is possible" is the old quip.  Anything is possible and it is possible to save lives and want to quit your job.  I have received many more thank-yous from strangers in the past two years when I wear my scrubs in public as compared to the last twelve years of my practice as a nurse.  However, I am still “just a nurse” and still female.  So the same challenges exist in a field where at times patients devalue my knowledge base as a nurse and speak inappropriately to me as a young female while still demand safety and professionalism from me.  Rest assured readers, your safety concerns have not fallen upon deaf ears but into deft hands.  The further I continue my oncology career the more I realize I have the privilege to work with some of the most caring, knowledgeable, experienced, and also damaged nurses the field has to offer.  Field exposure to death and dying prepared us for a pandemic in ways that had isolated us from “normal” life before.  Oncology nursing demands your emotional support be as good as your IV insertion and your understanding of chemotherapy pharmacokinetics be as on point as your small talk (If you frequent elevators you can respect this skill set).  The mental and emotional investment we put into our careers is compromised when we see nurse after nurse we spend a majority of our waking hours with quit.  One day I learned a dear nurse who was just promoted put in her resignation.  When I exclaimed “Victoria, but you worked so hard for your promotion!,” she replied that she was emotionally bankrupt from our job and I understood.  She watched a close friend come to our unit and receive treatment during the pandemic.  Recently diagnosed, recently married.  Due to visitor restrictions from the pandemic, he came alone.  He sat for hours every week alone, hours he and his wife will never get back together but coming for chemotherapy was his bargain for more time with her.  Maybe he will go into remission.  Maybe he will get stronger.  Maybe he will meet their child.   

From time to time I look up from my assignment and take inventory of the impact of the pandemic on our department.  There are too many resignations and leaves of absences.  I agree to stay overnight during a snow storm to ensure staffing the next morning and the following week am diagnosed with COVID-19 myself.  Partially vaccinated but fully frustrated, I quarantined from my children for ten days, who I already spend so much time apart from.  The unit is further short-staffed and the cycle continues.  Upon return I answer the same health questionnaires, the same requests for extra shifts.  I accept the overtime as more nurses are leaving clinical care.  Melissa accepted a job for a department that she can work from home and be with her children, Jennifer transferred back to a slower-paced community hospital, both nurses that are pregnant went into preterm labor and are on bedrest because the physical demands and the stress of this job are not suitable for third trimester, Lana went to part time and Danielle went to per diem, David extended a medical leave and Kyra transferred to office practice.  There is a difference between occupational safety and infection control and there has been a hyperfocus on infection control in the midst of a viral outbreak.  Occupational safety, particularly the mental and social wellbeing of staff, has been sidelined and burnout pursued.  Our COVID-courtship with struggle and grace risks having changed nothing if burnout continues at this rate.           

I believe the pandemic has not only changed the forefront of nursing but also the definition of nursing.  Nursing is more than ever adapting and utilizing our environment to provide skilled care for the sick to aid in their recovery.  That adaptation has been deeply personal for nurses and a change for the survival of the field.  We have adapted professionally, fighting to keep our communities safe and we have adapted personally, learning to take care of ourselves before we can take care of our patients.  Nurses have experienced a vulnerability throughout this pandemic that we have not felt before.  We have felt replaceable before COVID-19 but now with grave emphasis as we watch this revolving door fan the flames of burnout.  But just one more scoop, and you will see what we are made of.