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Health

Health Care Workers Risk Burnout A Year And A Half Into The Pandemic

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Vladimir Fedotov
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RNs face mental and physical fatigue from overworking themselves, pulling 12 hour shifts and putting themselves at risk with the constant flow of unwell people.

At the beginning of the summer, hopes were high that the worst of the pandemic was behind us, at least in the United States. Now, the delta variant surge is again testing the limits of hospital capacity, and many health care providers are once more feeling the pressure.

Last week, Dr. Lance VanGundy, an emergency room doctor in Marshalltown, took to Facebook to share his thoughts:

VanGundy: “I'm pooped and I'm tired. I think most of the world is too, but we are in this together. And when people get political about it and try to pretend this doesn't affect them, they're wrong. Even if you get a mild illness and you pass it on to somebody else, that's a hospital bed that I can't send a hip fracture to or a heart attack to. In my E.R. I had to hold on to a meningitis case, a stroke case, a heart attack and a blood clot in the lung. And these are all people that should have been transferred out to ICUs right away. And there are no ICUs in the state of Iowa. They're all full. So this is bad. It feels like a third-world country sometimes. So get your shots, people. Get your shots, and tell people that you know and love, they need to get their shots. That's the only way we're going to fix this thing. Thanks.”

VanGundy is not alone in feeling frustrated. Iowa hospitals and nursing homes are reporting a widespread nursing shortage, according to a survey from the Iowa Board of Nursing and the Iowa Center for Nursing Workforce. Nearly 58 percent of hospitals in Iowa say finding qualified nurses is challenging right now.

Health care workers from around Iowa talked about these challenges on Talk of Iowa with host Charity Nebbe.


This conversation has been edited for length and clarity.

Charity Nebbe: “We're going to start in Wayne County, down on the Missouri border, population 6,441. Shelley Bickel is public health administrator at Wayne County Public Health Department.

Take me back to the early days of the pandemic. As a public health administrator, it was your job to educate the public and try to keep people safe in those early days in Wayne County. What were things like?”

Shelley Bickel: “In the early days, when everything started out, like in March 2020, we did not see what was going on in the rest of the country, so we really never got hit with severe COVID until probably around Thanksgiving and Christmas of last year. And then it just ramped up. But we still were doing case investigations, contact tracing. We didn't just have the high numbers right away. So we were able to get prepared a little bit more than other parts of the country and the state. But once it ramped up, we were getting like 30 cases a day. We'd have to investigate and contact trace, deal with all the questions. We're a small agency. We have around 10 staff here, and it was just crazy. From the start of the pandemic, I was working seven days a week, until this past May, where I finally got to go back to a couple of days a week. So it was super busy, super burnout.”

Nebbe: “And, of course, once the vaccines became available, that was part of your job to make sure that you're educating the public about vaccination and trying to convince people to get vaccinated. Now, last time you were on this show, it was because Wayne County was the first county in the state of Iowa to open up vaccination to anybody who wanted one, because you found that it was hard to convince people who live in Wayne County to get vaccinated. How has that been going?”

Bickel: “We have 70 percent of our 65 and over vaccinated, which I guess that's a victory, but our rate is still 35.6 percent. As hard as we worked, around May 10, we were at 25 percent vaccination rate, one of the lowest in the state. We're up to 35.6. I'm hoping by Christmas we're up to 40 percent. Little by little, we're getting more people vaccinated. We are doing once a week clinics, and we do anywhere from 25 to 40 people in our office. So more and more people are getting vaccinated.

“But, we're also seeing an uptick in COVID cases. We're getting at least 10 a day that are reported to us from our local clinic and then on our portal that we can go to. And most of them are middle-aged people. We do have young people too, because we still have a hard time down here getting people vaccinated.

"That's all we can do, basically — keep educating."
Shelley Bickel

“I don't even know what we can do. We just keep educating. We're not trying to force it on people, because they don't want that. And so, I guess my philosophy is everybody knows the tools, the resources, and they have to make their decision. And that's all we can do. Basically — keep educating. If we can get one or two people that listen to us each week, then we're happy we're doing that.”

Nebbe: “As you have been encouraging people to get vaccinated, you've also gotten quite a bit of pushback, even attacked for trying to get people vaccinated. Tell me about that.”

Bickel: “We give out numbers. We're reporting data every week, usually on Monday. And there's always comments, people saying this and that. We have decided (we put it on our Facebook page) we try not to answer anyone back. We let them just make their comments. A lot are hurtful. We're doing the best we can.

“I think from the very beginning, what I've seen is, because this became political, we don't have a uniform message throughout the state, throughout the country, like we do with other reportable diseases. So every state is operating differently. In Iowa, we aren't doing case investigation anymore (public health contact tracing). We just report to the schools if there's a positive child case. Our border county, Mercer County (Illinois), is having problems because their state is still requiring case investigation and contact tracing. But when the contact is in Iowa, they've told me the contact doesn't want to listen because in Iowa we don't have that anymore. I think that's a big issue - we don't have a uniform message throughout the state or throughout the country.”

Nebbe: “How have you personally been coping with this? As you mentioned, you were working seven days a week for a very long time. You've been encouraging people to get vaccinated with varying success. You're succeeding in very small increments, which is great, but it must be frustrating to feel like your message is not getting across.”

Bickel: “Yes, we are frustrated. I haven't lost any staff. If staff want to be off, I do encourage them to take time off, to have vacation. I personally just took a two week vacation. It's probably the best thing I ever did. The first week was hard to unwind, so I took another week so I could come back and continue to work. And it's really, really hard when you're trying to do your best and people don't want to listen to you, but I guess what I can say is people aren't listening to the physicians down here either. They listen for everything else, but they're not listening about COVID, which is very odd. That's what our medical director has told me, it's hard when they won't listen.

“We try to make a difference and we're doing the best we can, but it's super difficult, and this is a different part of the state compared to like Iowa City or Des Moines. This is a very, very conservative part of the state. So we try to approach it a little differently, and just let people make their choice. And that's all we can do, because if we push it on them, then we get a lot of pushback and people can be very, very nasty.”

Nebbe: “What do you feel your priorities are right now, after all that you've been through in the last 18 months?”

Bickel: “My priorities are still our day-to-day operations, and then we continue to educate people. If the CDC or the Iowa Department of Public Health sends us social media statements to put out there, we try to share that, because that is our job. I think people don't understand that public health is to educate to do what's right. And I feel like it is our job to try to keep people out of the hospital, because I think it's even worse once they get in the hospital with what's going on with our full hospitals. We're trying. But I think I heard over the weekend our local hospital did 70 tests. They got people in the hospital. They're sending them to Des Moines. So it's hitting us down here, and people know what's going on because they've texted me, like, 'Is it really bad down here?' And I'm like, 'Yeah, it's getting worse.' So that's all we can do.”

Nebbe: “What do you want people who live in urban areas of Iowa to understand about what's going on in Wayne County?”

Bickel: “Wayne County just is a different area. It's not like people are crazy or anything down here, they just believe a little differently. I do believe if there's lots of people who go to Des Moines or to the cities, if there's a mask [requirement], they will wear it. They may not want to, but they do. But if you were to come down here, you don't see people continuing to wear masks. There's no masking in the schools.

“I think last year, as a public health agency, and I'm sure a lot of other ones in the state felt this way, we had more control…contact tracing really helped. It was a lot of work. And now we can't do anything. So we're just kind of spinning our wheels, watching people be sick, young people.”

Nebbe: “With me now is Dr. Dustin Arnold, Chief Medical Officer at Unity Point, Cedar Rapids. Hello, Dr. Arnold.

“Can you do a little bit of compare and contrast for me going back to the early days of the pandemic, as things were ramping up in the late summer of 2020, and what your hospital looks like now?”

Arnold: “I think early in the pandemic, everything was a scramble, and now we've learned from that, and have some blueprints, so it's not the scramble day-to-day like it was from that standpoint. We have plenty of supplies and the vaccine has been developed and issued.

"This is panic, much like battle fatigue, where it's new work, it's overwhelming work, and it just it's every day. "
Dustin Arnold

“But the biggest concern is the fatigue of the staff. I don't like to use the term 'burnout' because I think burnout implies that it's the same work that you no longer emotionally are satisfied with. This is panic, much like battle fatigue, where it's new work, it's overwhelming work, and it's every day. You know, I like to describe it like -- living here in Iowa, being an Iowa boy -- it's like driving on an icy highway all day, every day. Does that make sense? That kind of on the edge, always paying attention, not wanting to let your guard down. And that's hard to do every day, all day, and that's taking a toll on the staff.”

Nebbe: “So just that constant vigilance, constant care.”

Arnold: “It is every day, all day.”

Nebbe: “Of course, as we were coming into the summer of 2021, hopes were high, among the public and among health care workers, about what the vaccines could do for us. A lot of people felt like this was really going to be the end of COVID-19. So with this delta surge, what are people saying? What are people experiencing now?”

Arnold: “Well, it certainly is disheartening. First of all, that participation with the vaccine is not where we want it to be. Here in Linn County, we're pretty lucky. I think we're well over 60 percent, which is a great number. I'd like to see it higher, but you're absolutely right, our expectations were very high. The vaccine was a light at the end of the tunnel, if you will, to get back to some degree of normalcy. And with the delta variant, the efficacy, particularly the Pfizer vaccine, has turned out not to be as effective as it was with the alpha or the original variant. And so it feels like the rug was pulled out from underneath you, quite honestly.””

Nebbe: “We do know that the vast majority of people who are hospitalized with COVID-19 are unvaccinated. Although we're seeing breakthrough cases, they don't tend to be as severe. And still, the most recent statistic that I saw is that you have a one in 5,000 chance of having a breakthrough case. So we know that these vaccines are still working.

“With your staff, with doctors and with nurses who are caring for patients in the hospital, it's not just COVID-19 patients that they're caring for. Tell me a little bit about what you're seeing now. I know we're seeing an uptick in some other kinds of health problems.”

Arnold: “Yeah, just for example, we started the day with 99 percent of our beds full in medical surgical units. And they're not all COVID-19. And I really think that we delayed routine and preventative care early on in the pandemic because we didn't know what was going to happen. We canceled elective surgeries, delayed colonoscopies, delayed care of diabetes and heart failure. And I think that is contributing to the higher volumes that we're having in the pediatric population and respiratory syncytial virus, which people know as RSV, has come a little bit early this year, usually you don't see it until late September, and it started in July. That is putting pressure on the system.

“I think one of the other things is that we had a nursing shortage going into the pandemic, and that has only worsened. When you have fellow team members that are out in quarantine because they were exposed, or they're actually out sick, that even makes the staffing more difficult. It's really not a space issue, so much, as it is we don't have the staff. We don't have enough people to care for the patients. Each day we're strategizing how to do that. When you have reassignments of people, and they end up outside the area they're comfortable with (for example, a surgical nurse may have to cover a medical floor), that puts a strain on the system and on the staff.”

Nebbe: “You're still filling your beds, so that means that nurses are stretched, are caring for more patients than they normally would be?”

Arnold: “We try to keep the ratio within that realm of safety, and that's very important. And we factor that in every day, but sometimes they're taking care of patients, a patient population, they don't take care of on a regular basis. So it's a new assignment, and that adds to the stress. And at one point we were using makeshift units for caring for patients. We're not doing that this time, but it's also stressful when you don't have the normal tools or they aren't where they are on your home unit.”

Nebbe: “I mentioned that the nursing shortage has grown, and we're going to talk a great deal more about nursing with our next guests, as well. But are you finding that people are leaving?”

Arnold: “I think some are leaving. I think what we've had is some that are retiring, some attrition. You know, inpatient medicine, hospital or medicine, is nurse-driven, physician-guided. The nurses are with those patients 24/7. They develop an emotional bond with that patient. They have a tremendous sense of ownership. And as we've seen younger people die, it stresses people out. Critical care nurses, I mean, they're like the SEAL Team Six of the hospital. They're the best nurses that we have, as far as skill sets. And we just don't have time. It takes time for a new nurse to get to that level. So we're not replacing the nurses that are leaving.

“And obviously the opportunity to travel and work for an agency and get paid, you know, three times what you're making at baseline, that's very attractive to the younger nurses.”

Nebbe: “I can imagine. I can also imagine that having traveling nurses come in to fill a need, that can be a little demoralizing to the nurses that are already there, if the nurse that they're working alongside is getting paid several times as much as you make.”

Arnold: “And doing the same work, and maybe not as experienced. Yeah, that's disheartening.

“And then you throw the overwhelming number: about 85 percent of our admissions are non-vaccinated, 15 percent are breakthrough. That will drop down about 10 percent, up 12 percent, but it hasn't gone greater than 15. That's disheartening, when if they were vaccinated, they certainly wouldn't be as critically ill or they wouldn't have been admitted to the hospital.”

Nebbe: “How do you cope with that? As a physician, the beliefs of the patients that come to you have never been something that really have concerned you in the past. It doesn't usually affect their health care choices in such a specific way. So when somebody comes to you and is very ill and has chosen not to get vaccinated or may not even believe that COVID-19 is real, how do you cope with that?”

Arnold: “You have to compartmentalize it, and understand that we do respect the patient's autonomy, even though we might not agree with it. And you deal with that with other conditions — you know, the patient with emphysema that continues to smoke, the diabetic that doesn't follow a diet. But you compartmentalize that, and you treat each patient with dignity, like you should, and you try to get them better. It's frustrating and it's disheartening.”

Nebbe: “I read an editorial written by a general practitioner talking about how his patients come to him, still, for care, for diabetes, for heart disease, for all of the regular things. They trust him to provide that care and to know what they need, but they don't trust him when he talks about COVID-19. That seems to be a really difficult disconnect.”

Arnold: “It is. I've had patients that have been critically ill recover from it and then refuse to acknowledge that COVID-19 is why they got ill. They try to attribute it to other things, and it is a disconnect like I've never had with other conditions and patient care that it is truly perplexing.”

Nebbe: “You talked about fatigue as opposed to burnout. How are you personally coping?”

Arnold: “I've got a great team that I work with and a loving family, and I lean on them. Throw your faith on top of that, and you just make it through each day, and know that you're making a difference and you're supporting your team members. That's what gets me through the day, the people I work with.”

Nebbe: “Do you find that you're talking to members of your team about their fatigue, about how they're feeling, about their frustrations?”

Arnold: “Yeah, I think it's important to talk about it. I think it's important to recognize it and express those frustrations and fatigue with each other. It's helpful to know that you're not alone. The last thing that you want is isolation. You know, I don't talk about retention. I talk about re-recruitment, make people feel special when you first hire them, make them feel like that every day. And if we can do that, that helps. But recognizing that it's there and talking amongst each other and it's okay to be frustrated, it's okay to be tired and fatigued. It keeps you on the right path.”

Nebbe: “Being a doctor, being in health care, has always been a profession that takes an emotional toll. You become invested in your patients, sometimes you lose patients. And, lately, with COVID-19, with these severe cases, you're losing a lot of patients. Is it worse now, do you think that this is harder than being a physician has been in the past?”

"Normally an ICU will have one or two young people die a year. Now we have two or three a month."
Dustin Arnold

Arnold: “I always say ‘beware of the tyranny of the anecdote,’ but it does seem like the patients are younger, and it's always so sad when you lose someone early in their life or a young person. And we're having more of that. It did, or it does, seem that the delta variant in the patients that are unvaccinated causes a greater degree of illness in the lungs than the alpha variant, and that's just based on observation. You know, normally an ICU will have one or two young people die a year. Now we have two or three a month. I know it doesn't sound like a lot, but it's a lot. Especially nurses, they're emotionally attached to those patients. They get to know the patients. They become almost family because they're in the ICU 20 days, if not longer. And it's very sad and it's trying when you when you lose a young patient.”

Nebbe: “We've been talking a lot about urban versus rural Iowa and really talking a lot that over the last 18 months the pandemic experience has been very different in urban and rural Iowa, in a lot of different ways. You're probably getting a lot of patients sent to you from rural hospitals. Is that true?”

Arnold: “We are, yes. And we're trying to make room for them every day. We collaborated with our rural partners prior to the pandemic, and they were there when we had our surge. They were willing to help out and take maybe non-COVID-19 patients. And so now we're returning that. But it's difficult to find beds some days, and that's really disheartening. I know Dr. Van Gundy stated that he was boarding patients for an extended period of time. That's just not optimal care, and we try to do our best to avoid that.”

Nebbe: “So you've actually been sending patients from Cedar Rapids, from Unity Point, to rural hospitals?”

Arnold: “Previously in the pandemic we did. We diverted some of our non-COVID-19 patients to a rural hospital and then took their COVID-19 patients.”

Nebbe: “We've mentioned already that this pandemic has become political. It has been politicized in many ways. The virus, the vaccine. Politics, again, is not something that you're supposed to deal with as a doctor, when you're caring for a patient. What do you want people to know? If you were going to create a Facebook video, what would you tell people? What do you just wish people knew right now?”

Arnold: “There's so much disinformation. I mean, I think the pandemic started in an election year, and during election year, everything's political. Okay, I get it. But I really thought after the election that that would go away, and it hasn't. And disinformation has continued to be circulated, and a consistent message from health care leadership in the country has been lacking at times. If I could stress one thing, just please get vaccinated. The vaccines work, they're safe and they prevent disease and death. And if one message could come from this interview today, it would be that.”

Nebbe: “Are you concerned about people losing faith in their physicians? It's a position where there used to be so much trust.”

"If I could stress one thing, just please get vaccinated."
Dustin Arnold

Arnold: “I think it's probably for the medical industry in general, more so than the one-on-one physician, which is still a concern. It's obviously true that big pharma has made a lot of money on these vaccines, and I think people look at that and wonder about their motivation. But at the end of the day, the vaccines are safe and they work, and I can't stress that enough. I think the one-on-one relationship with physicians, with their patient, I think that's preserved for the most part.”

Nebbe: “When you look at your staff right now and you see the fatigue that they're feeling, what do you see in the future?”

Arnold: “Well, I'd like to see some light at the end of a tunnel, know there's a peak in recovery. And I take every opportunity to re-recruit them and make sure that they know how much we appreciate how hard they work. If you see someone that's being stressed, give them a break and get them out of the front line for a while.”

Nebbe: “Is it possible right now to give people time off? If you see that they're struggling?”

Arnold: “We would make it happen because mental health and physical health are so intertwined, and we certainly want our team to feel appreciated both emotionally and physically.”

Nebbe: “Now we're going to focus on the people who spend the most time with patients. Cheryl Bombei is a registered nurse who recently retired after a 46-year career. She was a nurse manager at the University of Iowa Hospitals and Clinics when she retired.

“You have been at University of Iowa Hospitals and Clinics, one of the premier hospitals in the state of Iowa, a place where a lot of people send their patients with the most critical needs. Tell me a little bit about what it's been like over the last 18 months.”

Bombei: “It's been very difficult. I don't think anyone understands how difficult it is to take care of these COVID-19 patients. They are so sick, and they take so many resources. ICU is where I worked, and we are a 26-bed unit. We ended up having to expand and add another 10 beds, so we were actually a 36-bed unit taking care of COVID-19 patients. All the ICU patients were COVID-19 patients.”

Nebbe: “Wow. 36 beds full of COVID-19 patients at the peak of this, all people who really need critical care. Tell me just a little bit about what makes these patients so resource intensive.”

Bombei: “They're all in isolation. They all have to be in negative airflow. You have to gown up, you have to wear masks, face shields, all kinds of PPE.

"They're so sick we were ‘proning’ them, which means turning them onto their stomachs. A lot of them were ventilated. They're on all kinds of medications to let the ventilator breathe for them. They're on blood pressure medication to keep their blood pressure up. They're on all kinds of antibiotics. It wasn't unusual to see 10 different I.V. pumps going into them. To prone a patient, it takes six personnel. It takes about 15 minutes to prepare the patient to just prone them. You have to pull them up. You have to turn the head. You have to have RT (Respiratory Therapy) in there to make sure the ventilator stays in, and then you put them on their stomach. Then every two hours you have to go in and reposition them.”

Nebbe: “I can imagine it's an incredible feeling of victory when one of those patients gets to go home.”

Bombei: “Yes. But this particular population of patients end up staying in the unit for an extended period of time. For some patients it was three, four, five, six weeks. Some patients, if they had to go on ECMO, which is a bypass of the lungs, you need two nurses to take care of that patient. And they could stay on ECMO for 45, 50 days.”

Nebbe: “So a really intensive period of time. And of course, they leave the intensive care unit, they still need care in another part of the hospital, right?”

Bombei: “Yes. Yes.”

Nebbe: “And I'm sure you lost a lot of patients.”

Bombei: “Yes. So when I was a manager, I used to keep track of the mortality of our unit, and we were one of the premier ICUs in the country. We had maybe 10 percent or less that passed away. For example, once COVID-19 hit, the weekend after Thanksgiving (2020), in three days 10 people died. The following weekend, 10 people died. I don't know how many happened during the week, but I know for sure in just eight days, 20 people died, which was so much more than even — we didn't have that many people die in a month.”

Nebbe: “And that takes a toll on you as a nurse, doesn't it?”

Bombei: “Yes. A lot of the patients that came in, because we were so full, sometimes there's a delay getting them in. They would come in, and they were crashing. You would spend hours trying to stabilize them. And what happened was they would pass away in a few hours. And so it was just constant intensive, intensive care that these patients required.”

Nebbe: “I want to bring Bailey Schleisman into the conversation now, too. She's a nurse at St. Anthony Regional Hospital in Carroll, Iowa. She has been a nurse for 12 years.

“Throughout the hour, we've been contrasting the urban and rural experience. You're in Carroll County, which is much, much less populated than Johnson County. Tell me a little bit about what your pandemic experience has been like.”

Schleisman: “In Carroll, it's been a little bit different. I actually serve as the hospital's infection preventionist. So the pandemic for me has really been kind of learning new things, adapting to taking care of sicker patients than maybe we're used to taking care of here. Helping train our nursing staff to care for those critically ill patients. It's been kind of a moving target for us.”

Nebbe: “So the pandemic has been incredibly busy for you, if you are sort of organizing that response.”

Schleisman: “Absolutely. Yeah, it's been a new challenge every single day.”

Nebbe: “We were just talking about patients from rural hospitals getting transferred to urban hospitals when they're critically ill. Can you tell me what you've seen recently with this delta surge in Carroll?”

Schleisman: “Yeah, it's been a little bit more difficult for us. We've had to board some patients in our emergency department from time to time, getting them transferred to the tertiary care centers and our normal referral facilities.”

Nebbe: “All right. So patients are staying there longer, regardless of what they might have. You probably have people with many different conditions.”

Schleisman: “That's correct.”

"Sometimes, previous to COVID, you would have a break, you might have less severe patients and you could take a mental recess from it. This you could not."
Cheryl Bombei

Nebbe: “Fatigue is something that nurses often deal with, this is a difficult job. That kind of burnout is something that nurses have always had to deal with. How has it been different during the pandemic?”

Bombei: “During the pandemic, I think the difference is how sick the patients are, how constant the stress is. The intensity of taking care of these patients is so great, 24/7. There's never a break. You know, sometimes, previous to COVID-19, you would have a break, you might have less severe patients and you could take a mental recess from it. This you could not. You're constantly, soon as a bed opened, you get another patient in. And it's just a revolving door, constant. And so there's just never any kind of a let up.

“The other issue is no one could take vacation because of the shortage. There's a decrease in the flexibility of the schedules. There were some different things that happened, so there was no downtime. And so it's just very difficult.”

Nebbe: “Yeah. And flexibility of schedules, as hard as nurses work, I have a lot of nurses who are in my family, and I know that the flexibility of the schedule is something that they really value. That has to take a toll, too, just to have that tighten up.”

Bickel: “Yes, I think flexibility of scheduling is one of the most important things to keep nurses at the bedside.”

Nebbe: “Tell me what you've been observing, Bailey, during the pandemic. Again, nursing, no matter where you do it and how you do, is always a really intense job. What kind of fatigue and burnout have you been witnessing?”

Schleisman: “Yeah, I mean, health care workers, we're used to adapting and facing challenges on a daily basis. I think the biggest strain has really come with the length of time, the length of the pandemic. We're a year and a half into it. We saw a lot of light at the end of the tunnel with the vaccine, and we still believe in that. We still think that that's the best way that we can move forward. But it's just a prolonged period of time that has been the biggest strain.”

Nebbe: “Yeah. And everybody got that kind of whiplash. We all thought at the beginning of the summer, 'finally, where we're going to be getting back to normal.' As the delta cases have started to rise, Bailey, what kinds of things have you heard from your colleagues?”

Schleisman: “They need support. That's the biggest thing that I try to provide and that I know our nurse leadership here tries to provide, even our providers, our physicians, try to provide them the support. They need the check-in phone calls. 'How are you doing? Is everything going okay?' If we can stop and help give breaks, take in snacks to the unit or deliver lunch from time to time. Those things are all appreciated and are all helpful in supporting them.”

Nebbe: “At the beginning of the pandemic, there was a lot of talk about how our nurses and doctors and other health care workers are heroes, and they are heroes. We saw people putting up signs and chalking the sidewalk and sending food to hospitals. We don't see so much of that anymore. How does that feel?”

Schleisman: “I think it takes even more mental power for our health care team to really cut through the distractions and remember why we go to work every day: that we go to work to take care of people. At the heart of it, those health care providers, you know, they're there for the right reason. They're there to make sure that our community is safe. They're there to make sure that our friends and our neighbors are well taken care of. And I do think we still have that.”

Nebbe: “As we were talking about earlier, we have seen this virus politicized in a way that really is unprecedented, both the virus and the vaccines. Has that intruded into the work that you're able to do as a nurse, Bailey?”

Schleisman: “I think we have to be good examples and we have to continue to call on our family and our friends and promote the right message of 'get vaccinated.' It does provide you with that level of protection. It does help keep you out of the hospital and do the right thing. You know, wear masks when you're in indoor public spaces where you have high levels of transmission. We can be examples to the community.”

Nebbe: “Does that also take an emotional toll, though, to see people not taking precautions that you know could save their lives?”

Schleisman: “Yeah, it can be disheartening. It certainly can be disheartening. But again, it takes that internal call to just go back to why we're doing it.”

Nebbe: "Cheryl, if you could say one thing to hospital administrators right now about what they could do to help their nurses cope with what they're going through and also retain their nurses, what advice would you give them? What would you tell them they need to do?”

Bombei: “Well, patients come to hospitals for nursing care, and so it is so important that they understand what the front line nurses have to go through and to be supportive, to come around and talk with them. Nurses do end up supporting each other greatly. But it's nice when others recognize you for what you're doing. I know that the physicians spent a lot of time bringing lunches for the nurses during their peak COVID-19 time, because we couldn't even hardly take a break to eat, and we work 12 hour shifts. That was very helpful. Making sure we get time off mentally, and the flexibility in schedule, making sure you can take your vacation and get your time off, because you need a breather, you need to be away from the work environment for a little bit to reset.”

Nebbe: “What would you tell hospital administrators, Bailey?”

Schleisman: “I think continuing to empower our bedside staff, continuing to promote an innovative spirit moving forward to encourage them, bringing ideas forward, things that we can make better, giving everybody that voice. Every single person's feedback is supported and considered. You know, are there things that we can be doing better? What do you need from us? Just hearing that from them, I think is very important.”

Nebbe: “We know that there is a fear that young people will look at what's been going on and think, 'I don't want to be a nurse. I don't want to go into medicine.' What would you tell a young person now about becoming a nurse, Bailey?”

Schleisman: “It's rewarding. It is still rewarding. Even after the last year and a half, it's still a very rewarding profession. Knowing that we can take care of our community, our friends, our neighbors. In rural settings, like where I'm at, even your relatives that come into the hospital. It's still a very rewarding profession.”

Nebbe: “Cheryl, what would you say to a young person who might be considering the career?”

Bombei: “I do think people love their job. Nurses actually love taking care of people, they love being critical thinkers, compassionate, kind, and we're in it to help others. But every day is a challenge, and it's just learning to meet that challenge. You're making a difference in people's lives.”

Bickel, Arnold, Bombei and Schleisman made their comments on Talk of Iowa.