ICU Nurses Reflect on Pandemic Challenges and Triumphs

Traveling nurses expect a learning curve—they are always stepping into new hospitals, with different protocols, and coworkers to get to know. Change is the norm, but they adapt—even thrive.

Then, COVID-19 happened. As the pandemic descended, healthcare providers around the world were faced with vast numbers of intensive care unit (ICU) patients, a shortage of qualified staff, and inadequate personal protective equipment (PPE).

Verywell spoke to two nurses from the NurseFly (a healthcare staffing marketplace) community about their experiences during the pandemic: Rachel Norton, RN, currently in Colorado, and Krysten Riley, BSN, RN, currently in California.

Increased Patient Loads and Staffing Shortages

Norton has been an ICU nurse since 2007 and is used to caring for one or two patients at a time. With staffing levels at a low as more people become burnt out (on top of the chronic nursing shortages that most hospitals face), nurses are being forced to take on more patients. This means rationing their time and the care that they provide, as each patient needs their undivided attention.

Norton says that while the ICU always has the potential to be an emotional roller coaster in terms of success rates, the vast number of ICU patients with high acuity cases has increased exponentially during the pandemic.

"The bottom line is there are not enough nurses in the U.S. right now to care for all of these patients. All of the nurses are tripled. . . we're supposed to have two patients [each] in the ICU, ideally," Norton says. "Usually, when we have to triple somebody, we say, 'Okay, we'll give you these two lower acuity patients and this one sicker patient.' That's not an option right now."

She says that the feedback has generally been that during a pandemic, everyone is going through the same challenges. "I understand that, but it doesn't mean it's okay. What can we do in the future to prevent this?"

Producing more nurses is the only answer. The additional workload is yet another stressor on nurses who are already caring for patients that stay in ICU significantly longer than normal—often with no real hope of improvement.

Norton says that it produces constant anxiety. "It's the additional stress of not having enough staff and feeling constantly like I feel like I'm on fire—all of the time," she says. "I feel like I literally I am just running around hitting the flames of the fire and constantly trying to put out other fires, especially when I'm in charge. Because I know that all of my nurses are stressed as well."

Standing in for Family

In the ICU, patients are seldom allowed visitors—even when death is imminent. ICU nurses have stepped into a hospice role for many patients.

For several months, Riley worked in a hospital on Long Island at the height of the New York City surge. She recalls that at one hospital, family members were allowed to visit when they knew that there was no hope the patient would recover. However, that did not mean that loved ones were always able to reach the hospital in time.

In one such instance, Riley was able to offer some comfort to a family. "I had five patients that day. We knew one of them would not make it, so we called the family," Riley says. "And I had four other patients, but I really didn't want this man to die alone. So as much as I could, I was checking in on him. I saw his heart rate had been super tachy [tachycardia], which is really, really high, around 150 [beats per minute]. And I walked past, and it was just at 40."

Riley says that she immediately went to the patient's room and held his hand as he died so that he wouldn't be alone.

"His daughter came not 10 minutes later," Riley says. "Obviously, she was devastated. But I did say to her, 'He wasn't alone. I was with him'—and she just collapsed when I said it. She was just so grateful."

Success Stories Provide Hope

There are tales of hope and survival from within the unremitting trauma. Most patients that recover from COVID-19 in the ICU do need rehabilitation because of the stress and damage that mechanical ventilation and stasis puts on the body. Still, every person that is taken off a ventilator is a victory.

Norton says that every "clap out" (where a patient leaves the hospital to the sound of staff and administration applause) has brought her to tears. Some cases have brought nursing staff together like never before.

"We had two patients that were on ECMO [extracorporeal membrane oxygenation, where blood is circulated out of the body for oxygenation to bypass the lungs and allow healing] for over 30 days, which is not normal in healthcare," she says. "And both of them got better and left the hospital. That was a moment for everybody because almost all the nurses on the unit were involved in their care."

Norton says that it's important for nurses to see, because oftentimes, it "feels like we're just failing over and over again."

Riley also had special patients. Even with increased patient loads, certain cases have stood out to her. She recalls a patient she had during her first week in New York.

"He had hair as long as mine," Riley says. "In the beginning, we just threw it up in a bun that was a huge knot on the top of his head because that was all we could do."

Riley says that when patient ratios stabilized, she could devote more time to not just his medical care, but his hair care. "I would spend so much time working on getting the knots out," she says. "And eventually, I got his hair unknotted, and I would braid it and twist it up into a little bun on his head. And everyone loved it."

Riley recalls he only spoke Spanish, and she spoke some. "We just bonded," she says. "He wouldn't eat for anyone else for a while, but I told him, 'No, you have to eat because you're going to get stronger, and you're going to get out of here.'"

The language barrier didn't mean a connection couldn't happen. "He might not be able to speak the same language very well, but I'm sure he can feel my touch," Riley says. "He's a person, and I'm the only one who's caring for him. He knows how much he is cared for. And he's one of the ones who made it."

Inadequate Access to PPE

Personal protective equipment (PPE) has been in short supply around the nation since the pandemic began. Hospital systems that normally only stocked enough N95 masks for surgeries found themselves scrambling to protect staff.

"In the beginning, we were given one N95, and it was supposed to last a week," Riley says. "It was a relief once Governor Cuomo came out and said we had to have a new N95 each day, especially since some of the N95s would stretch out and you wouldn't get as tight of a seal."

After completing her contracts in New York, Riley has since started a new contract in southern California, where the virus is once again surging. She says that nurses are using hospital-supplied powered air-purifying respirators (PAPRs), which are highly effective against viral transmission. Unfortunately, breakage can be an issue over time. Riley says that she's always been willing to work with just an N95 because of her experience during the New York surge.

Norton has also gone to a half-face respirator, purchasing two herself. She says that while normal PPE levels have stabilized, certain types of N95s are still hard to come by. Surgical caps are also in short supply. She has bouffant caps in bulk and has made them available for other nurses to use in her locker.

Nurses' Value Finally Acknowledged

Although both staff and traveling nurses are feeling the strain of burnout, Norton thinks that the public and hospital administrations are finally seeing the value that nurses bring to the table.

"I feel like this is the first time in my career that nurses are being compensated for what they are being put through," Norton says. "Of course, it's never been this bad before, but it's always been a struggle. It's never been easy."

Norton also says that the nurses' strain has created a stronger team mentality than she's ever seen before. "It's been amazing to watch even some of these newer nurses just jump right in and become part of the team and feel supported by their senior nurses."

It's a matter of survival not just for patients, but the healthcare professionals who are caring for them. Coming together is the only way to make it through. "There's no choice," Norton says. "We're not a one-man ship here. There's no way to do it by yourself. So that's been really bright for me."

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