Melanie Mead, an emergency department nurse, remembers the first time she drove the seven minutes to work after nonessential businesses shuttered last year. It was 7 a.m., and no one was on the road.
"I am driving into something bigger than all of us," thought Mead, who works at St. Luke's Hospital in New Bedford, Mass. Those early pandemic days weren't so much busy as full of fear. When she'd get home from a long day, she'd undress outside and sprint to the shower, worried about exposing her wife and two children to the coronavirus.
"During that time, I was just holding on to hope that there was an ending in sight. Is this something that's going to go away?" Mead said. "Obviously it didn't."
More than a year and a half later, she feels vastly different after spending months fighting a surge fueled by the delta variant. Mead's hospital has been overwhelmed by covid and non-covid patients - it's a 62-bed emergency department, not counting beds in hallways, with more than 100 patients squeezing in almost every day, she said.
"We're tired - emotionally, physically, mentally tired," she said. "We're all showing up, day after day. In the beginning, nurses were heroes. Today, we're almost an afterthought."
In interviews, nurses across the country describe plummeting morale during the latest pandemic surge, marked by utter exhaustion and growing workloads. Some thought the availability of coronavirus vaccines would alleviate the burden on hospitals. Instead, emergency rooms were swamped this summer and early fall, often filled with the young and unvaccinated. The crisis has exacerbated staffing problems that existed before the pandemic, leaving nurses shouldering increasing responsibilities as covid-19 patients fill their units. Some nurses are leaving hospital jobs for more lucrative travel nursing positions. Others are leaving the profession altogether.
Mead said nurses at her hospital may now care for five to seven patients at once, sometimes up to 11 on evening shifts. Before the pandemic, it was closer to three to five.
"There might be some days I'm just eyeballing, making sure they're doing OK and medicating them and running off to another patient. Sometimes I don't have that personal connection, and I miss that," Mead said. "I really miss that - we just don't have enough time in the day with the amount of patients, which is difficult."
Nurses repeatedly call themselves resilient but say they're hitting the limits of that strength. A recent study from investigators at the University of California at Irvine's school of nursing and department of psychological science found the weight nurses have been carrying during the pandemic has been overwhelming. In the survey of 234 registered nurses across California, conducted from May 21 to July 6, nearly 13% said they left a position because of "moral distress" during the pandemic, the kind of stress that can come when people witness or fail to prevent something that breaks with their morals and expectations. The findings also shed light on the extent of the psychological distress: 15% reported suicidal thoughts in the prior month.
"As a profession, we work hard, we do things that we say normal people would never be doing," said study author Candace Burton, a UCI assistant professor in the school of nursing. "But this has been beyond anything anyone could have anticipated. The lack of resources, the constant strain and stress and needing to be on and present and going at 110% at all times has just been exhausting."
Nurses are leaving their jobs in droves. The state of Mississippi had 2,000 fewer nurses in July than it did in January and may have lost more in the months since, according to the Mississippi Hospital Association. The association's leaders point to the pandemic and note that some nurses may be retiring, while others are opting for travel positions that it said can pay three to five times what registered nurses made pre-pandemic.
For Lee Seid, the mental and physical toll of working in Mississippi's largest hospital was too much to bear, eventually pushing her to leave a permanent position to become a travel nurse.
Seid, 47, became a nurse in her 30s, switching from a career in finance after taking care of her dying mother. She moved from Oxford, Miss., to Jackson last November and took a job caring for covid patients in a busy hospital. She cared for up to six patients at a time.
After coming home from work, she would take off her shoes and strip down before going inside. Still, "in all reality, we expose our families on a daily basis, so you have to think about that stress," she said.
In April, Seid left one hospital system for another, taking on a permanent position with the University of Mississippi Medical Center in Jackson, the state's largest and only Level 1 trauma hospital, this time caring for mothers and babies.
But the pandemic's impact ripples to every role, Seid found, even when nurses aren't working directly with covid patients.
Before the pandemic, hospitals allowed multiple people into rooms during childbirth. During the pandemic, Seid said, her hospital allows only one person in the room at a time. Often, she said, pregnant patients have been forced to choose between having their partner or their mother with them.
"Who do you pick?" she asked.
With the absence of extended family, nurses are "having to give more emotional support to the person that's in the labor room because their family is not allowed in the hospital," she said.
Because of privacy laws, Seid said she doesn't share much of what happens at work when she gets home. "So I think you bottle so much of that in you," she said.
While dealing with the grief, exhaustion compounds as permanent nurses continue to leave, she said.
Seid remembers the moment she decided that she, too, had to leave her permanent role. In desperate need of a mental break, she put in a leave request for a vacation months in advance. It was denied, she said, because of a nursing shortage. She soon left UMMC for a traveling job.
She said hospitals can make up for those leaving by hiring more permanent nurses, but there's a lag time while new nurses train.
"By the time you get a nurse trained to actually go out on her own, you've had four more leave . . . you're always struggling to catch up," Seid said. "That creates more workload on the nurses that are still there."
Kathy Haff, an emergency room nurse at Community First Medical Center in Chicago, said she has to remember to eat before leaving the house.
"I'm not getting a break, and I'm not getting anything to eat until I get home, and I'm never getting home on time," she said. "It's always two to three hours over."
When the pandemic began, Haff said, she was working five days a week. As the exhaustion intensified, she scaled back, now working three or four days per week, with eight-hour shifts that she said frequently drag to 10 hours.
When they're short-staffed, it can take longer to move patients out of the emergency room and into other units, she said.
Patients are "waiting days for beds upstairs because there's no place to put them, because there's no nurses upstairs," she said. "And the ambulances don't stop, and the people don't stop coming in, and it's chaos, it's really hard."
Katrina Wood, a chief nursing officer at the Medical Center at Bowling Green in Kentucky, said the emergency room can get backed up because covid-19 patients are staying so long.
There are patients in hallways, patients in the rooms, patients in the lobby, Wood said.
"With covid patients, we really try to minimize how many people are in the room," which leaves nurses to do more of the care, she said. "Where previously maybe lab would come in and do some of the care . . . physical therapy would be in working with them, more of that duty is coming on the nurse."
The amount of work is wearing down nurses, the UCI researchers said, and leaving them with a level of compassion fatigue that's worsened during the pandemic.
Alyson Zalta, a study co-author and assistant professor in UCI's department of psychological science, said the investigators saw a "significant decrease in the degree to which nurses feel they can be personally connected to patients and have enthusiasm for their role."
Alicia Hume, a registered nurse at the Medical Center at Bowling Green, noted another adjustment for nurses during the summer surge: The patients were younger.
Earlier in the crisis, many of the covid patients were elderly and chronically sick. Now, they are "a lot of times your age, your friend's. Then it would be your daughter's age and your grandkid's ages," Hume said.
It's a wake-up call, and it's often crushing.
She described a patient, a young woman, who came into the hospital and begged the nurses: "I have young kids at home, don't let me die."
The woman was short of breath when she got there and probably should have come in weeks earlier, Hume said, but she needed to take care of her kids. She was also unvaccinated.
When she died, it was gutting. There were debriefs for workers as some needed time to process it. In morning huddles, nurses still want to talk about it.
"Stuff like that really takes a toll on you," she said. "Sometimes they just want to talk about it. They want to relive it and try to talk about what could have been done different."
Mead described the terror some of her patients feel when they are very sick.
Through tears, she acknowledged that sometimes, "there's only so much that we can do besides hold their hand and reassure them. And many times their families aren't going to be there with them - but we're there."
"I love what I do, it really is a privilege to be a nurse, it really, really is," Mead said, pausing for a deep breath. "But a lot of my colleagues and I - we've seen so much."
Mead's short drives to work are less quiet these days. She blasts Foo Fighters to pump herself up "because I feel like I don't know what I'm walking into, but I know I'm walking into pure chaos."
On her way home, she prefers silence, a moment to decompress before reentering her home as a mom and wife.
But many nurses said they can't escape the pandemic at home. It's on TV, and it's on the radio, and there's chatter online, as people spread misinformation about the vaccines many hoped would carve a quicker path to the pandemic's end.
"And then it's on social media - people arguing over your social media about whether to get a vaccine," Hume said. "And you can't really say, 'Hey I have a 30-year-old that's dying and didn't get the vaccine, maybe you should think about that.' You can't really ever escape it."
Zalta, from UCI, said that as the pandemic continues, "there's kind of a sense of the never-ending nature of this, and that's leading to a really strong sense of hopelessness."
Wood recalled talking to people last year about wanting to erase 2020 from their memories.
"We're at the end of 2021 now . . . and again with this surge being worse, it came on faster, the people are younger," she said. "With all that, there's the unknown of when's the next one coming?"
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Fowler reported from Jackson, Miss. Firozi reported from Washington.