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Amid Rising COVID-19 Hospitalizations, Iowa Nurses Face Increasing Risk Of Burnout

Iowa nurses are facing increasing burnout nearly a year and a half into the pandemic.
Vladimir Fedotov
Iowa nurses are facing increasing burnout nearly a year and a half into the pandemic.

COVID-19 hospitalizations continue to rise in Iowa, and among the health care workers who have been vital to caring for the sickest patients are nurses. Now just about a year and a half into the pandemic, many are at risk of burning out.

Bridget Otto said she’s dreading watching her hospital COVID unit fill up once again.

"The last shift that I was there, we lost several people that were very young," she said. "And I mean, there were multiple times on our shifts that we just bawled. Like, we just gave each other hugs and cried."

Otto is a nurse in the Medical Intensive Care Unit at the University of Iowa Hospitals and Clinics. She’s been working directly with COVID patients for almost a year and a half.

But Otto said with the vaccine now available, this newest wave is different and more difficult. Her patients are now younger, sicker - and almost always unvaccinated.

"It's so much harder because now the grief we're seeing at the bedside - because we're allowing some visitors come - is regret," Otto said.

Otto said she used to consider herself a "lifer" in the intensive care unit. COVID changed that.

She said the pandemic has strained her love of the profession, to the point that she’s decided to go back to school this fall to pursue a degree as a family nurse practitioner.

"Something to work towards that I won't be in a dedicated COVID ICU is just kind of, like, enough to keep me going right now," Otto said.

Nurses like Otto have seen the COVID-19 pandemic up close. In hospitals, they spend a lot of time directly taking care of really sick patients, and they’ve had to shoulder the grief of their patients’ deaths when no family members were allowed to be present at their bedsides.

"A lot of times, patients are very scared, and they're very upset, said Rachel Vaughn, a cardiac nurse who works at a hospital in the Cedar Valley. "And it's kind of up to you, as a nurse, to kind of relieve that."

Lisa Caffery, the president of the Iowa Nurses Association, said nurses are used to death, but not the numbers they’ve seen during this pandemic.

"It'd be like walking into a mass casualty event every day, and that's kind of what it's like," she said. "That's a difficult thing to sustain over a long period of time."

Caffery said she’s heard of many Iowa bedside nurses quitting or retiring early in the last year.

She said that’s pushed some of those remaining to work extra 12-hour shifts amid the waves of sick patients.

"Normally, you only do that, you know, three days a week," Caffery said. "Well, they're doing that seven days a week in some situations, and they're just simply exhausted."

Denise Cundy, the chief nursing executive for UnityPoint Health in Des Moines, said they're seeing more patients who have delayed care during the pandemic.

“We're seeing kind of the ramifications of that they're a little sicker," she said. "And they're they're just needing a little more attention than the patients perhaps of the past.”

Cundy said nursing staff turnover has been higher during in the past year than usual. Something she said is likely influenced by COVID-19.

Even before the pandemic, nurses nationwide were in short supply, and Iowa has one of the lowest average ratesof pay for RNs in the country.

Though applications to nursing programs have increased during the pandemic, retaining new nurses past their first year can be hard in general.

According to a report by Nursing Solutions, a nursing staffing agency, nearly a quarter of all new RNs leave within a year.

Kylie Olson graduated from nursing school last summer. She got her first job working on the medical-surgical floor at the Pella Regional Health Center. By October, she said she was working with all COVID-19 patients.

She called it “baptism by fire.”

"I was cut off on orientation early, and it was one of those things where I felt like I wasn't necessarily the most qualified person to be able to take care of these patients who were really, really sick," Olson said. "But there was no one else there who could do it."

Olson said if she hadn’t been transferred to the hospital’s labor and delivery unit in February, she might have quit nursing.

She said her group of friends from school have all felt the same way.

"All 10 of us have said that we don't know if nursing is what we want to be doing for the rest of our lives," Olson said.

Experts said the pandemic has just amplified long standing issues like this facing the profession.

"We, for so long, have really shied away from making legislation about staffing, for example, and really trying to address burnout," said Jessica Rainbow, an assistant professor of nursing at the University of Arizona.

Rainbow's collecting stories from nurses during COVID. She wants to use them to push for more regulations like patient to nurse ratio requirements. Something Iowa, like most states, doesn’t have.

"The ratios have gotten really out of control to [participants] talking about, you know, 'Before the pandemic, I worked in the ICU and I took care of one to two patients, now, I'm asked to take care of three to four patients,'” she said.

But Rainbow said, despite all the challenges for nurses she sees now, she’s an optimist.

"I'm really hoping that this is going to be used as a launching point for actually, hopefully making things better," she said.

Rainbow said now that these issues are getting more attention, she hopes it results in change.

Natalie Krebs is IPR's Health Reporter