How Covid Changed Nursing

Four years ago this week, an eighty-two-year-old patient at a Brooklyn hospital became the first person in New York to die from Covid-19. In the time that’s elapsed since, certain memories of those early pandemic days have been relegated to dusty corners of the brain. An NBA season that was canceled after a player jokingly touched the mics of reporters, before a test revealed he was Covid-positive. The New York City subway shutting down its night service, which remained closed for more than a year. The way some people maniacally banged on pots and pans for health care workers at 7 p.m. daily.

As vaccines started trickling out in 2021, and a ladle hit a frying pan for health care heroes one last time, politicians attempted to usher us all back to pre-Covid life. The CEOs of corporate hospitals followed suit. But a huge chunk of the medical workforce, reeling in the aftermath of the relentless death and suffering they were exposed to on the job, either retired or switched careers completely. Years later, nurses who stayed in the profession say that they are seeing the effects of the pandemic in their patients as well: since so many people put off care during the height of Covid, they are now presenting with more severe forms of illness.

But in addition to trauma and exhaustion, the pandemic also catalyzed a historic wave of organizing among nurses directed at improving staffing levels, low pay, and burnout. One of the earliest strikes after the height of the pandemic involved fifteen thousand nurses in Minnesota, who walked off the job for three days in September 2022. In early 2023, more than seven thousand nurses across two large New York City hospitals also struck for three days. The action has continued apace. In the last six months alone, seventy-five thousand health care workers at Kaiser Permanente walked out across six states; nurses at a medical center in Washington held a five-day strike; and nurses at SSM Saint Louis University Hospital did the same for two days. In December, nurses at a New Jersey hospital finally ratified a new contract after a monthslong strike over unsafe labor practices. 

What follows is a series of interviews with hospital nurses in New York about their experience with burnout during the pandemic, and how some are fighting to improve working conditions today. These interviews have been condensed and edited for clarity.

Jennifer, ICU night shift nurse at Albany Medical Center

[At my hospital,] we were the ones who admitted all those Covid patients who were in overflow from New York City because they ran out of ICU rooms. It was like the end of the world. I still remember very clearly that night: the helicopter was nonstop because the helipad was directly above us. The doors to the ICU had been opening and receiving all these patients all night; we were intubating patients left and right. They could barely have a few minutes to say goodbye, or to talk with their family members. A lot of them were scared, frightened, anxious because they didn’t know whether they were going to live to the next day. They didn’t know whether it was the last time they were going to be able to see their family. 

There are times when I just get quiet. There was a time back then when I was so tired, so exhausted, my heart was breaking so much for my patients, and so much for the family who just lost a family member, that I had to cry in my car. Sometimes I don’t know how to cope. A lot of nurses are the same way. We mask our feelings with humor, we talk with our peers, we vent, we just talk about it because we know, we do understand, that the next time, we are still going to do this all over again.

I had to be with one Covid patient from the moment he came and was admitted in the ICU. I started my shift as a charge nurse at 7 p.m. [Editor’s note: a charge nurse oversees a department of nurses.] I had been with that patient for six hours, until the patient expired and passed away. I have witnessed the helplessness; I have witnessed the fear; I have witnessed the pain. I strived so hard to make sure the patient was comfortable. I was there holding his hand. I was there talking to him and saying, “You will be okay.” But deep inside, we both knew he was not going to be okay, and he was not going to survive that night. And he didn’t.

We’ve been hard hit ever since the pandemic started. A lot of experienced nurses left the bedside because they are not able to deal with the stress of the pandemic. They are not able to deal with the stress of watching patients die daily. It was a rough time for us.

It took me time to understand the importance of being part of a union, but ultimately, I wanted to advocate for my co-workers and address the issues affecting them. We are still fighting for a fair contract here at Albany Med because we wanted the hospital to invest in us, invest in the staff, invest in us nurses. If we want more money and to be recognized, we must go through all this extra education, meaning that we have to jump through these hoops for the hospital, to show that we are good enough. Even though we work every day in the busiest ICU in the area, taking care of patients that other hospitals cannot take care of, we must go to school to prove that we’re valid. So we can prove to the hospital that we are worthy of what?  A few dollars’ raise. And then we get to be a charge. I’m one of the senior nurses, I assume charge nurse all the time, and what do I get? An extra dollar an hour.

We need to improve the recruitment and training of nurses and retain those nurses, and the way to do it is through better working conditions. We need strong staffing enforcement that holds the hospital accountable, because too often hospitals put profits before patients and staff us to the bare minimum.

Sandra, procedural unit nurse at NYU Langone; former ICU nurse

I would have days when I went home thinking, Maybe I should have done this, what could I have done better? You obviously do have people who code and die. Maybe it’s a really long code, and I’ve done it for forty-five minutes, and it’s very physical, obviously, because of the CPR. Then you have to take care of this person’s family and do postmortem care after you’ve been taking care of them all day. At the end of the day, you have another patient too, and you need to go into that room. You can’t be like, “Sorry, I can’t get you your juice because my patient just died next door.” 

Before the pandemic, if I had a patient [with an airborne illness], like with tuberculosis, they were in a specific negative pressure room, and you’d put on a mask and throw it out when you left the room, that’s it. We did have [personal protective equipment], N95s, but you had one, and you were using it for like two weeks. In the medical ICU, you were doing all these things for people, and nothing was working. So, you were functioning at that level, and it didn’t really matter. I think at the end of that, after watching a lot of people die — also, I have a lot of student loans — watching a unit of travel nurses each make like ten grand a week, when there was not even pandemic pay for nurses who stayed, is hard. 

After the pandemic, I thought I was taking care of myself, but I kept going on these travel contracts where I was being further traumatized, seeing more people die. I was in therapy, but I realized that the feeling that I had was different from normal sadness or depression. I realized with my therapist that it was burnout. I just wanted to sit in silence. Even TV was too stimulating for me. So I was just reading all the time. I just need to be quiet for a while. It was a big reason why I couldn’t go back to the ICU.

The nice thing about the job I have now is, yes, I have to think critically, I have to move fast, I have to take care of patients — but I don’t take it home. At the end of the day, I’m not like, I could have looked at this lab and done things differently.

Margaret, day shift surgical nurse at Vassar Brothers Medical Center

Our patients are sicker than ever. A lot of people delayed care during Covid, so we definitely are seeing an uptick in the acuity of who is being admitted. We are getting patients who typically, a few years ago, would have been considered more of a critical care unit patient than a medical-surgical unit patient. So that has added to the stress of nurses everywhere. Because it is everywhere; it’s not just the Hudson Valley where people might have delayed care during the pandemic. And that is contributing to the burnout that nurses are feeling. Because if you have a patient who is taking up a considerable amount of your time, and they are one of eight patients that you have, then there is only so much time that you can devote to the others in your group.

Eight patients per nurse means you have just seven-and-a-half minutes out of each hour to care for that particular person, if you want to average it out. That’s passing meds, making sure they are taken care of, making sure that all of the documentation is done, that you might have spoken to family to give them updates, that you’ve spoken to doctors to let them know what is going on. You can’t effectively look after people seven minutes out of every hour. It just can’t be done.

It seems to be part of the corporate playbook that understaffing is a good money saver. And every hospital website that you go onto, they always have a mission statement talking about quality patient care and the experience everyone is going to have once you go into that facility. But the truth is different. They are always understaffed. This was a problem before the pandemic; it’s just more exaggerated now because so many nurses left the profession. I think the mindset is: Well, when something needs to be done, the nurses will do it. So if we are short a secretary, then it is okay because nurses are there, and they will see that it gets done somehow. I also think a part of it is just the sheer amount of people who left the health care field because of the pandemic. A lot of people said, “I’m close to retirement, I don’t need to stick around for this,” and they left or opted to go to a position where maybe there wasn’t as much stress.

When the pandemic was considered over in terms of the lockdowns ending, and it seemed to be something that was going to be part of the daily fabric of health care life, the mindset changed to, Okay, we’ve gone through this; now it’s back to business as usual. So there wasn’t a big push to recruit nurses or to retain them, and there still isn’t. We’re fighting to be able to go into our jobs and provide the patient care that we’re qualified to do and trained to do. And that we want to do. That’s where you get a lot of this guilt complex coming in, because you know you can do better. Last year, Vassar hired 158 nurses between January 1 and December 31, and 124 of them left. So the hospital message is that there is a nursing shortage nationwide. But that doesn’t sound like a nursing shortage. That’s a retention issue.

The union has been very good within the hospital. We have open communication with the nurses, they are coming to us and letting us know issues which might just be specific to their floor. Because there’s so many different areas; there could be a completely different scenario in ICU that would never apply to me. We put it on the agenda to discuss with management, and we have a rep that is in house a couple of days a week, and she tries to deal with things quickly. With regards to staffing, we did have the state Department of Health in recently to talk to us about the [Safe Staffing for Hospital Care Act] and its enforcement, and we are waiting for that report to come back from them with the recommendations. We fought many years to get [a bill], but if you’re not enforcing it, then it has no teeth. The behavior will just continue.

We have spoken about retention every month for over three years, and the answer that we used to get was: there are no plans to retain nurses right now. Now, we do have a new chief nursing officer. She started at the beginning of the year. She is trying to change the mindset within the hospital; she is looking to actively retain nurses when she can. The nurses continue to leave. We’re not that far from New York City, the pay is higher in New York City, so nurses will take the train and go down there and get paid more. Their ratios may not be any better than ours, but the thought process is, Well, at least I’m getting paid more for this.