'Where does this end?': Nurses grapple with burnout amid staff shortages
Sherri Dayton left her home in Quaker Hill about 2:30 a.m. Thursday and proceeded to work a 16-hour shift as a registered nurse at the Plainfield Emergency Care Center. She got home around 7:30 p.m., took a shower while heating up food in the microwave, and was asleep by 8:30, but got up at 2 a.m. Friday to work another 12 hours.
Her budgeted hours at the emergency department are three 12-hour shifts, but she and other nurses have found themselves more frequently staying longer to compensate for staff shortages. This exacerbates burnout, which can lead to people calling out or leaving, which creates more need for 16-hour days.
"It's this vicious cycle. Where does this end? Where does this end?" Dayton questioned. She said her department should have a patient-to-nurse ratio of four to one, but she's been seven to one "lots of times in the last couple months, and seven to one is not safe."
She feels lucky to work a day shift, whereas she knows parents who might go straight from working overtime on the second shift to caring for their kids in the morning.
Dayton is president of the Backus Federation of Nurses, AFT Connecticut Local 5149, and she is studying to become a nurse practitioner. She said she wanted to be a nurse educator but opted against it, because she'd accumulate debt to get her master's degree but not earn much more than she does in acute care.
Lisa Sundean, chairperson for the Connecticut Center for Nursing Workforce, said enrollment in nursing education programs across the state has never been higher, but "we cannot accept all of the applicants into our education program, because we do not have enough faculty, and we do not have enough faculty because those folks are in that magic age range."
Also in that "magic age range," meaning retirement age, are a lot of nurses. For this reason, people in the industry forecast a shortage well before the coronavirus pandemic started, and shortages come in cycles anyway, but Sundean and others agree that COVID-19 accelerated retirement for many.
According to the strategic plan of the Governor's Workforce Council released last October, 52% of employed RNs in Connecticut are over age 50, and Connecticut schools rejected 7,000 qualified nursing school candidates the previous year "due to a lack of educational capacity."
Another "quite frightening" national trend Sundean sees is young nurses dropping out after one to two years, feeling like they're "being thrown to the wolves." And she's seeing shortages not only in acute care settings, but also in long-term care, primary care and schools.
The American Health Care Association and National Center for Assisted Living said in June that 94% of nursing home operators surveyed recently said they'd had a shortage of staff members in the last month, with 73% saying the workforce situation has gotten somewhat or much worse compared to 2020. In September, 86% of nursing homes surveyed said their workforce situation has gotten worse since June.
Hospitals struggle to hire
Donna Handley, president of Hartford HealthCare's Backus Hospital in Norwich, said the national trend of nursing shortages "is exactly what we're experiencing." She said she has a heat map of where every licensed registered nurse in Connecticut lives and there's a "smaller pool of candidates in the east region."
She said Backus is trying to supplement employed nurses with travel nurses, but it's hard to find them, because they're in high demand across the country.
Handley also said it's harder to recruit specialty nurses, such as for the operating room, emergency department and critical care. But she said Hartford HealthCare developed a program to identify and train nurses who want to go into specialty care.
She noted that nurse navigators are pulled from their regular jobs to pick up shifts elsewhere, to have fewer instances of nurses being mandated to work overtime and "make sure nurses can get as much rest as they possibly can."
She said full-time staff got a $1,000 bonus, and the hospital is rolling out a well-being questionnaire this month.
What remains to be seen is the impact of hospital staff not getting vaccines: Hartford HealthCare and Yale New Haven Health, which includes Lawrence + Memorial Hospital in New London and Westerly Hospital, mandated in July that employees be fully vaccinated by Sept. 30.
Dr. Ajay Kumar, chief clinical officer for Hartford HealthCare, said Thursday that almost 98% of employees across the health care system are vaccinated, and the penalty for those who don't get vaccinated "is that they may not be part of our organization over time here, so there could be a termination," unless they're exempt.
Donna Epps, vice president of human resources at L+M and Westerly hospitals, said in an email statement that the shortage of employees has been an issue across the nation for a long time, and not just in health care.
"We have an aging population and many baby boomers are retiring," Epps said. "As the pandemic has unfolded, people are reevaluating their priorities and putting greater importance on work/life balance, which often leads them to leave employment altogether."
She said Yale New Haven Health recently advertised for a position — an administrative assistant — and found only one qualified applicant.
Alexa Mills said while she has loved working in the intensive care unit at L+M, burnout and staffing issues led her to put in her notice last month to transfer. Her last day is Friday, and then she is starting work at an outpatient endoscopy clinic in Guilford — where she'll have patients choosing to be there, for planned procedures.
Mills, 33, said for her sanity, and for her relationship with her spouse and family, she had to take a break from the ICU.
"There's some days I can't talk. There's some days I cry in the shower," she said. "I feel like that meme when someone pulls up at a light next to you, and you're crying at the stoplight."
Mills said the community is very supportive and bonuses are nice, but money only goes so far.
"When we swipe out, we don't forget about the patients and the hands we've held and the FaceTime conversations we've had," she said.
Dale Cunningham, president of AFT Connecticut Local 5049, the registered nurses' union at L+M, said she doesn't feel as valued as she did when she entered nursing 45 years ago — and there's more work, more pressure and more technology to learn. Cunningham, 66, works in the neonatal intensive care unit.
Cunningham said nurses also have been impacted by a decrease in other staff, such as respiratory therapists, personal care assistants, aides and secretaries.
This is something the Eastern Connecticut Workforce Investment Board is working to address: Modeled off the successful Manufacturing Pipeline Initiative, which has had 100 classes since its inception in 2016, EWIB launched the Eastern CT Healthcare Pipeline Initiative this year.
EWIB President Mark Hill said there has so far been one class to train sterile processing technicians and one for personal care aides, with more to come. Pipeline classes run five days a week for five to 10 weeks, and these two were held at Three Rivers Community College.
With state and private funding, the intensive training is free to participants.
'There's no relief in sight'
When Sarah Sparen was diagnosed with cervical cancer earlier this year, her initial reaction, she said, was "fear and tears." But when she realized it meant she would be out of work from her job with the Visiting Nurse Association for six weeks, the feeling turned to relief.
"I was more scared of what was happening to me mentally than what was happening to me physically, and this was going to offer me respite," said Sparen, 43. She added that when "you're grateful you have cancer so you can just have a break, there's something not right."
She said as a home care nurse, she was asked to see five or six patients on a regular day but started getting plugged into overtime more and more, meaning she'd get an email partway through the day telling her to see five more.
"Nurses left, and then there was nobody to replace them with, and so then we were getting mandated overtime, and then nurses left, and then we were getting more overtime," she said.
Sparen said after her diagnosis, she put in her notice without having a job lined up, and she considered going back to waitressing. She ended up taking more than three months off, but she recently started work as a hospice nurse for Hartford HealthCare. She speaks highly of her new job, saying she feels supported and there isn't a high staff turnover.
Through it all, Sparen stressed that nurses love being nurses, and she tells people, "I am the luckiest person in the world because I get paid to love people." She said through the pandemic, she never felt like, "Oh, I didn't sign up for this."
Annie Ryan is president of AFT Local 5119, which represents nurses with the VNA of Southeastern Connecticut. She does home care during the summer and school nursing during the school year. Her school hours are fewer and more regular, but she said her job is more stressful than ever.
"We have not had a moment to sit down," she said. Last week, she sent home 17 kids in two days, and she said some parents understand while others "are screaming in your face, like, 'Why did you send my kid home, because they just have a cold?'"
Ryan explained that per rules from public health officials, if a child has two or more symptoms, they are sent home. To get back to school, they have to either isolate for 10 days, get a doctor's note with an alternative diagnosis or get a negative PCR test.
Ryan said her family doesn't want to hear about COVID-19 or stress at her job anymore, and the effects of her work have put a strain on her marriage.
"We've never had vacancies for school nurses before, and we started the year with vacancies that aren't filled," said Ryan, 60. "There's just no one coming. The stress that we're feeling now, there's no relief in sight, because it's not like you put an ad in the paper and somebody will respond."