Samantha Jex, 22, prides herself on being a hardworking student and caring friend. She values her time with family and loves reality-TV shows. Despite having so many good things in her personal life, she still has a hard time going to work every morning.
Jex is a nurse extern at Riddle Hospital in Media, Pennsylvania, and the past two years have been, well, difficult.
One day, during a 12-hour long shift, Jex was punched in the stomach by a patient, she said. Instead of reporting the incident, or even taking the rest of the day off, she collected herself and carried on. She had been up since 4 a.m., and just wanted to make it to the end of her day.
Like other nurses, Jex had grown used to the long hours, physical strain, and intense workload that comes with nursing. She often ends a shift feeling utterly spent.
“It was a mental and physical exhaustion,” she said. “From being on your feet three days a week for 12 straight hours, it’s not easy work.”
Even before the COVID-19 pandemic, exhaustion ran rampant in the health care industry. As the pandemic has spread, so has nurses’ burnout.
“I have multiple times experienced burnout,” Jex said.
Though nurse externs like Jex are usually students finishing a degree, they work alongside registered nurses, carrying the same workload as their registered counterparts. They do whatever work their nurse or supervisors assign to them.
“I was sleep deprived,” Jex said. “I was only doing the bare minimum of outside work and sleeping for the rest of my time.”
Over time, she has seen other nurses fall into cycles of burnout, with little relief. Hospitals are understaffed and new workers are few and far between.
Burnout, specifically among nurses, is defined by the National Center for Biotechnology Information (NCBI) as, “a widespread phenomenon characterized by a reduction in nurses’ energy that manifests in emotional exhaustion, lack of motivation, and feelings of frustration that may lead to reductions in work efficacy.”
The NCBI does not list an official cause of burnout.
“For me, my burnout was caused by having too much on my plate,” Amelia Caston, a nurse extern at Jefferson Hospital, said. “Since I had to work long night shifts, my nights were spent in the hospital, and it really hurt my sleep schedule.”
On top of being a nurse extern, Caston is also a student at Temple University. Working night shifts has impacted not only her social life and mental state, but her school work as well. Her classes are held during the prime sleeping hours her night shifts demand, so she is often left choosing between her career and her school work.
She often chooses to sleep during the day, missing a few classes but also choosing to prepare to be the best nurse she can be while on the night shift.
However, working a night shift and sleeping throughout the day leaves little time for friends. So, every few days—when Caston had long stretches of time off—she would readjust her sleep schedule back to what it was before, sleeping at night and working during the day. After weeks of bouncing between sleep schedules, Caston found herself exhausted.
“I had to come home, readjust my sleep schedule, and balance my social life,” she said. “I felt very overwhelmed. It was a combination of anxiety, stress and sleep deprivation that made everyday life feel overwhelming.”
Exhaustion, both mental and physical, can vary from nurse to nurse. What is consistent however, is the fact that burnout is among the leading causes of nurses and other health care workers dropping out of the health care system, especially after the rise of COVID-19, according to research from the NCBI.
In a study done in 2011, figures show that nearly 33% of nurses working in U.S. hospitals were experiencing strong symptoms of burnout, such as emotional exhaustion. Now, burnout rates among nurses are at nearly 50% in the U.S., with many leaving to pursue travel nursing outside of hospitals for greater pay and more flexible hours, according to a study published in the journal Clinical Medicine.
“We’re in a toxic situation where we’re short-staffed and either you’re leaving to go travel [travel nursing] to make six figures in six months, or you’re taking these insanely intense overtime shifts,” said Eileen Armani, a registered nurse at ChristianaCare in Newark, Delaware. “You can make overtime pay at my hospital, plus $1,000 for every overtime shift. It’s a toxic cycle of money.”
Though nurses are offered additional pay to take extra shifts, hospitals are still understaffed.
A lack of resources pushes nurses away from hospitals, and leaves those who do stay with little choice but to overwork themselves for the sake of their patients, Armani said.
“Everyone in the hospital, higher ups and even the government, everyone is like ‘Oh I’m sorry, we appreciate you!’ but nothing is done about it,” Armani said. “ People send their sympathy, and no one takes action to make it better.”
Armani asks herself, frequently, how this cycle of burnout and exhaustion might end. She sees COVID-19 patients on a daily basis, which takes an incredible toll on her mental health, and contributes to her burnout.
Armani said one of the most difficult things about her job is the pain she sees in her patients. Watching COVID-19 patients become ill, and watching their families suffer with them, can be a grueling experience, especially when there is nothing she can do.
“We take a bulk of COVID ICU patients,” she said. “A lot of time, when working with COVID patients, I feel like I do nothing for them. They are so sick, and a lot of them ultimately don’t make it.”
On top of the medical care she provides, she has also become a housekeeper for many of her patients. COVID-19 rules mean nurses are now doing the jobs of orderlies, custodians, and other hospital staff so that patients can limit their contact with other people.
“You’re really on your own in a lot of ways,” she said. “You do housekeeping, delivering meals, attending to things nurses shouldn’t be doing. These are the things nurses have to do to decrease exposure.”
While resources at individual hospitals are still scarce, several state-level initiatives promise to relieve some of the strain nurses feel. Gov. Tom Wolf announced in January the implementation of regional support strikes for hospitals and long-term care facilities.
Despite the struggles that these nurses face, several still carry on for the sake of others, even at their own expense.
“I’ve never seriously thought about leaving the profession, honestly,” Caston said. “I love what I do, and I’ve always wanted to be a nurse. I can’t see myself doing anything else.”
Armani holds out hope for the day the pandemic fades and her routine returns to normal.
“A lot of times I leave work, and I don’t know how I’m going back tomorrow,” she said. “But it’s a temporary feeling, and I’ve never considered actually leaving because I love being an ICU nurse.”
Please email any questions, comments, or concerns about this story to: email@example.com.