Hospitals have told reporters unvaccinated workers are contributing to the nurse staffing shortage.
But research has found poor work environments and PTSD contribute to whether a nurse will quit.
Traumatized nurses can also make decisions against their self interest, like refusing a vaccine.
Sarah Chan, a registered nurse at St. Joseph's Hospital in New York, did not expect the pandemic to plague hospitals for the last nineteen months.
Chan said she believed the rollout of the vaccine would decrease the number of COVID-19 patients she had. But as cases involving the delta variant of COVID, which is more easily spread, rise and fewer people get shots, hospitals are once again crowded.
Some health systems have blamed unvaccinated healthcare workers for staffing shortages, but the problem with unvaccinated healthcare workers may be overstated: the American Nurses Association found 9 in 10 nurses have received a COVID-19 vaccine or are planning to.
Instead of leaving in protest of vaccine mandates, many of Chan's peers left their jobs caring for patients due to exhaustion, she said. The exodus of nurses has created staffing shortages at her hospital, which means she is working overtime to care for sick patients.
Poor work environments and burnout are putting pressure on already strained nurses - and without better resources, trauma and fatigue will cause a nurse staffing crisis, experts told Insider.
"The stress of working in a COVID ICU, and all the death that I've had to see, altogether, it has really set me back; I'm often very anxious, and angry," Chan told Insider. "So much death weighs heavy on me."
Sarah Chan, an ICU nurse in New York
Dr. Eileen Lake, a professor at the University of Pennsylvania School of Nursing, has been researching the impact nurses' work environments have on staffing for the last 20 years. From her research, Lake has found poor work conditions - characterized by hospitals that don't allow nurses to have a say in their practice, disorganized work environments, and limited resources - leads to burnout and job dissatisfaction.
"That decision to leave I believe reflects system factors that the nurse evaluates and decides are no longer acceptable circumstances for me to work," Lake said.
Her research and other data indicate that staffing shortages now reflect a systemic problem in a hospital or health system that likely began prior to COVID-19.
Nearly every state has no limit on the number of patients a nurse can care for at once, leading many to care for too many people. A recent study by University of Pennsylvania School of Nursing found New York City hospitals - the epicenter of the pandemic back in April 2020 - were understaffed as early as December 2019.
Nurses caring for COVID-19 patients may have PTSD
Along with poor work environments, post-traumatic stress disorder among nurses who cared for COVID-19 patients may be fueling the staffing crisis.
Chan, for instance, said the constant exposure to death has been "gut-wrenching." She said she has tried to cope by emotionlessly go through the motions at work, but the trauma has led to insomnia, fatigue, short tempers, and an inability to focus.
Nearly 40% of 500 healthcare workers experienced symptoms of PTSD in a longitudinal study launched last year, according to Dr. Debra Kaysen, a professor of psychiatry at Stanford University developing strategies for healthcare professionals to cope with treating COVID-19 patients.
In order to be diagnosed with PTSD, patients must be exposed to specific kinds of environments and events, including threatened death, serious injury, or sexual violence. The disorder can also stem from repeated exposure to the adverse effects of a traumatic event, such as death from COVID-19.
Healthcare workers that experience PTSD may have nightmares about the event, avoid people and situations that remind them of trauma, and experience strong emotions like shame, anger, or fear.
Untreated, PTSD in healthcare workers can lead to cardiovascular diseases, as well as suicidal ideation and attempts, Kaysen said. She said trauma among nurses could explain worker shortages health systems are facing.
Kaysen added nurses who experience PTSD may stop trusting institutions, due to feeling betrayed.
Major health systems across the country are blaming unvaccinated nurses for staffing shortages
Upstate University Hospital, the California Hospital Association, and other health systems have begun to point toward unvaccinated workers as the reason for staffing shortages, as many states and private employers have enacted vaccine mandates for healthcare workers. But New York State reported high vaccination rates among hospital staff after its policy went into effect, and one provider in North Carolina that dismissed unvaccinated staff still reported close to 99% of employees had received their shots.
The COVID-19 vaccines have been proven to be safe and effective, so the small number of nurses refusing to get vaccinated might be exhibiting a trauma response, said Dr. Antiqua Smart, a board-certified family nurse practitioner and professor at the University of Loyola-New Orleans.
Smart, who lost several family members to COVID herself, said many non-clinicians forget nurses have to grapple with grief both inside and outside the hospital. That grief, she added, may turn into anger and resentment toward institutions, like those offering COVID-19 vaccines.
Kelley Reep, a registered nurse in North Carolina, said she and her colleagues have grown angrier as the pandemic goes on. They "feel a simmering rage that this is worse than ever and it did not have to be," Reep told Insider.
Smart said nurses refusing the vaccine might be a "type of retaliation, or kind of an anger or coping mechanism part of just being burnt out from seeing people die."
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