Joanna Engman always believed a career in nursing was her calling.
"I loved working in the hospital," said Engman, a nurse in Colorado who entered the health care field a decade ago. "I wanted to be at the bedside of the disadvantaged, the sick, the dying, to be present with them in their most vulnerable times."
But Engman said that when Covid-19 reached the U.S. last year, her love of nursing came under unprecedented strain.
"It's almost like you're in ethical warfare," Engman said of treating critically ill Covid-19 patients. "You're seeing someone who is scared and suffering, and you're not able to be present with them because you're so overworked."
In February, frustrated by the lack of personal protective equipment provided by her hospital and by grueling shifts that left her in tears, Engman made the painful decision to leave bedside nursing, the term for when nurses provide hands-on, physical care to patients.
Joanna Engman.Joanna Engman
"The hardest part for me was feeling like I had no support," Engman said. Speaking of hospital nurses, she said, "There was no one we could speak to, and our mental well-being was beginning to deteriorate."
Engman is one of a growing number of nurses leaving bedside nursing behind.
According to a recent Washington Post/Kaiser Family Foundation poll, 3 in 10 health care workers have weighed leaving the profession, and 6 in 10 say the pandemic burned them out.
In states hardest hit by the pandemic, nurses took steps to find new jobs when Covid-19 rates peaked. In New York, for example, there was a 400 percent increase in nurses searching for new jobs on a recruitment website in March and April of last year.
And in many cases, health care providers are showing signs of post traumatic stress disorder. A recent Yale School of Public Health Survey found that a quarter of health care workers are showing signs of PTSD, and 43 percent of those surveyed reported "probable alcohol disorder."
"This is not sustainable," said Dr. Holly Wei, an associate professor at Eastern Carolina University's college of nursing who is an incoming professor and assistant dean at the University of Louisville's School of Nursing. "We have to think about how to sustain the nursing workforce so that patients can get the best care that they deserve."
Wei said the rising rates of nurse turnover in hospitals are a national "health care workforce crisis," pointing to new figures tabulated by NSI Nursing Solutions, a recruitment agency for registered nurses, that indicate that the turnover rate among registered nurses in U.S. hospitals climbed to 18.7 percent last year, a rise of nearly 3 percentage points since 2019.
The loss of every bedside nurse, Wei said, is costly.
"It costs $30,000 to $50,000 to replace just one nurse," Wei said. "It's a huge loss. This crisis will not only affect health care workers' lives, but also patients."
The role nurse burnout and fatigue can play in patients' health is considerable. According to a 2010 study published by the International Council of Nurses, nurse fatigue has been linked to a number of potentially deadly medical mistakes, including making chart errors, administering incorrect doses of medication and even treating the wrong patient.
To combat growing burnout rates, Nadia Moore and Anthony Berardi, both veteran nurses from the Pittsburgh area, started Nurses Anonymous, a national support group. On alternating Tuesday evenings, Moore and Berardi helm a group Zoom call, in which nurses from all over the country call in to seek and offer one another support, as well as discuss workplace stress.
"What burnout is looking like is acute anxiety when you walk into the hospital and experiencing paralyzing fear, dread, increased heart rate," Berardi said.
Berardi, who previously worked as an intensive care nurse, said he experienced all of those symptoms before he realized the importance of talking to others about his experiences.
Now he and Moore hope to pass on to other nurses the gift of opening up and unburdening.
"No one wants to stop taking care of people," Birardi said. "They just don't want to feel horrible while they're doing it."
The ability to remain anonymous while venting and seeking support is key, Moore said, given the stigma that's often associated with nurses' seeking emotional support.
"A common belief a lot of nurses or caregivers have is that they have to do things on their own," Moore said. "They deserve support."
Nurse burnout is nothing new. But Wei said the pandemic pushed it into overdrive.
Reform, she and Berardi said, is imperative if hospitals hope to retain nurses and properly address burnout rates. Health care advocates say hospitals can decrease burnout by capping the hours nurses work per shift, increasing the time nurses have to rest between shifts and providing adequate staffing at hospitals so nurses can better concentrate on their patients.
But fixes to current flaws in the health care system, Engman said, won't fix the other problem created by the growing exodus of veteran nurses: a dearth of the kind of potentially life-saving nursing knowledge that's attained only through years of experience.
"You don't learn how to be a nurse in nursing school," Engman said. "You learn how to be a nurse through on-the-job experience. That's where you learn your time management, your delegation, your assessment skills. Those take years to master. So our patients are going to be the ones to suffer."
Engman, a mother of three who now works in home health care management, said she misses bedside nursing.
"I miss the camaraderie."
But, she said, she doesn't miss the tears or the grueling shifts.
"You either numb out or you wind up crying," she said of her long days.
Her mission now is to spread the word about the dangers of nurse burnout in the hope that legislators will take notice before it's too late.
"We are in trouble — our communities are in trouble," Engman said. "A burned-out nurse is a dangerous nurse. An exhausted nurse is not a safe nurse. Unless there are tangible changes, we're going to see this get worse."