Aug. 22—It used to be that after a patient died, a hospital nurse could take a 10-minute timeout to get re-centered, perhaps in a room with aroma therapy. Nurses might meet up after a shift for coffee or a meal for support. Now, many go home alone.
Since the COVID-19 pandemic hit New Mexico hospitals, the chance for nurses to decompress is diminished, according to New Mexico nursing leaders.
Now, hospital nurses are not only working extra shifts trying to save lives but at times encounter verbal abuse. Some have been victims of physical assault from patients or family members.
And the COVID-19 deaths keep coming.
As New Mexico hospitals face a potential repeat of last year's darkest days of COVID-19 fueled by a surge of the new delta variant, more and more hospital nurses have been calling it quits or retiring. That means hospital beds can sit empty because there are no nurses to staff them.
Travel nurses, who are brought in to work temporarily, are being deployed at almost every hospital in New Mexico, most of which are now "well beyond capacity," state hospital officials said last week.
But such nurses are expensive to hire and harder to come by now as the nation again is gripped with a spike in coronavirus cases and hospitalizations — mostly of unvaccinated patients. Travel nurses are in high demand everywhere.
Hospital nurses in New Mexico who have decided to stick it out often end up working extra hours to cover high caseloads and short staffing. For an already exhausted, stressed-out workforce, life can be an emotional roller coaster.
At least two New Mexico nurses have committed suicide over the past year, according to nurse association leaders.
"I have so many nurses that are very fragile right now because they've had a year of deaths," said Deborah Walker, executive director of the New Mexico Nurses Association. "Burnout is a grave concern."
State Human Services Secretary David Scrase, who is also acting secretary of the state Department of Health, said hospital nurses are under incredible stress.
"They have worked 12 to 16 months continuously (during the pandemic), a shift almost every day. And they say, 'I just can't do this anymore; I need to retire,' or they are pulling back because of exhaustion and the intensity of the work. It's more emotionally draining to be a nurse right now. To have so many people die, and to see patients die alone without their families ... it takes a toll."
"Add to that, you've got the ICUs full of unvaccinated people dying of COVID-19" he said. "... The scene in the ICU units has changed, and it's very stressful."
"It was one thing to provide lifesaving care when there was nothing people can do," Scrase said. But now a COVID-19 vaccine is readily available and can keep most people from becoming severely ill with the virus and hospitalized, he added.
Patti Kelley, University of New Mexico Hospital's chief nursing officer, said nurses at UNMH are "exhausted and at times they're angry that their community is not trying to help them by getting the vaccine."
"The nurses are giving back to the community but some members of the community aren't being appreciative," she said.
Scrase says 90% of New Mexico hospital nurses have been vaccinated, and association officials said last week that they hadn't received any complaints from nurses about Gov. Michelle Lujan Grisham's new vaccine mandate for hospital workers.
For nurses still debating whether to be vaccinated, Walker said their code of ethics requires nurses be vaccinated for preventable diseases.
More than 4,470 people have died in New Mexico of COVID-19 related illness. More than 66% of residents ages 18 and over are fully vaccinated in New Mexico, but state data show more than 500,000 residents who are eligible for the vaccine haven't gotten it.
Scrase said last week that he feared the new rise in cases and hospitalizations could overwhelm some hospitals in the next two months, potentially forcing "crisis standards of care" to be implemented that would ration health care in some circumstances among patients.
Troy Clark, president and CEO of the New Mexico Hospital Association, told the Journal last week, "Right now, staffing is probably our No. 1 concern. We have a very tired, fatigued nursing staff out there."
The employment of travel nurses is "probably at the highest level," Clark said.
"We are using them at every hospital in the state just to keep beds open," he said.
Clark said pre-pandemic rates charged by agencies that supply traveling nurses were from $75 to $85 an hour, but during the height of the pandemic last year, the price occasionally jumped as high as $200 an hour for each traveling nurse.
Now the rates are about $150 an hour, he said.
According to a health care workforce update presented to the interim Legislative Health and Human Services Committee last week, New Mexico needs as many as 6,223 registered nurses and clinical nurse specialists to meet national benchmarks.
Retirements of some baby boom nurses in New Mexico were expected over the past year, but nurse association officials say the added stress of renewing a license and completing continuing education amid a pandemic has spurred departures from the profession.
About 8,480 registered nurses worked in New Mexico hospitals in fiscal year 2021, according to the New Mexico Board of Nursing. No data was available on how many have retired or left the profession during the pandemic.
Officials at the state's biggest private hospitals, such as Presbyterian Healthcare Services, Lovelace Health System and Christus St. Vincent Regional Medical Center, acknowledged the current challenges in staffing.
Shifts in the workforce and the number of people in the workforce likely won't stabilize for at least another year, said Lillian Montoya, president and CEO of Christus St. Vincent.
"This destabilization has led to a more competitive recruitment and retention environment for all health care positions," she said. "Through it all, our health care team has remained nimble in caring for Santa Fe and north central New Mexico to meet patient demand."
Lovelace spokeswoman Whitney Marquez told the Journal, "We are no different from other hospitals in our area and across the country that are experiencing nursing shortages due to COVID-19, but continue to have adequate staffing within our hospital system to care for patients."
Tim Johnsen, chief operating officer at Presbyterian, said, "The most significant impact that can be made to decrease hospitalizations and provide relief to our team is for more New Mexicans to get vaccinated."
The current nursing shortage prompted Scrase on Aug. 13 to call for volunteer nurses currently licensed or anyone with a medical license to help shore up the state's medical workforce. About 70 people have responded.
'Incivility in workplace'
On the front lines of the pandemic, New Mexico's hospital nurses thought they could take a deep breath as COVID-19 vaccinations helped cut the number of related hospitalizations to as low as 62 in early July.
But they never got the chance.
"As COVID-19 went away, unfortunately, the number of beds hospitals were using did not go down," said Gloria Doherty, president of the New Mexico Nurses Association. "That didn't happen because all those chronic patients were coming in. They did not get the care they needed (over the past year), and now with serious exacerbations they were trying to get better."
Nurses still haven't recovered from the first burnout when COVID-19 patients flooded hospitals, said Eleanor Chavez, executive director of the National Union of Hospital and Health Care Employees District 1199, which represents workers at hospitals around the state.
Nurses and hospital staff once saw a light at the end of the tunnel, she said, "but it's almost like at this point in time there is no light because we're going back into it again."
Earlier this year, Chavez said, a number of intensive care unit nurses quit in New Mexico.
"It was enough to make an impact. Maybe at one hospital alone, five or six left. When you have that many nurses leave during a pandemic, that really creates an impact."
Walker said that before COVID, nurses had a support system for dealing with patient deaths but that because of the contagious nature of the disease, many nurses go home alone.
Some nurses also had to move from their areas of specialty in a hospital and be retrained to work in intensive care to treat coronavirus patients.
"In one of our hospital systems, they retrained over 400 nursing staff to leave where they normally practice," she said, adding that "you can only do that so long" before you start evaluating whether you want to continue nursing.
Another factor in the nursing shortage is "violence in the workplace," Walker said.
When she began her nursing career, she said, she dealt with patients who might become violent because of alcohol withdrawal.
"Now nurses (nationwide) are threatened with broken jaws, broken wrists, eye sockets, rapes and shootings," said Walker, who added that she is aware of two incidents in the past two weeks involving New Mexico nurses. One escaped a violent situation; another was assaulted.
"The incivility in the workplace is astounding," Walker said. "We've gone from being the heroes at the bedside to have family members and patients accuse hospitals of giving them the wrong diagnosis to make money."
Quitting or moving to a less stressful nursing job outside a hospital is an option, Chavez said, but the decision "tears them apart emotionally. They understand the impact it will have on their co-workers and their patients."
Chavez knows one nurse who quit "because the staffing was so bad she couldn't handle it anymore. For her it was an ethical question, a moral question ... she felt she couldn't provide the kind of care patients needed."
The state Human Services Department set up a hotline for health care workers and first responders trying to deal with pandemic-related stress. Since April 2020, 471 calls have been received, a DOH spokesman said.
Kelley, UNMH nursing chief, said UNM offers employee wellness and resilience training, and decompression kits to help nurses relax.
"Communication and transparency is what they want the most," she said. "They want the truth, like, 'Do we have enough PPE?' "
Dedication to the job still keeps many nurses going.
"As a nurse who dealt with COVID in the last year and a half," one woman wrote in a recent social media post, "it was really hard for me to watch people suffer and then pass away. As healthcare workers we did the best we could. I don't need to be praised as a hero because that's not why I went into healthcare for. I want people to get better and go home to their families."