‘It’s So Much Worse Than Before.’ Dread And Despair Haunt Nurses Inside LA’s ICUs

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Hospital workers move a patient into the prone (face down) position, which can help increase the lung capacity of some COVID-19 patients. The medical team was photographed Nov. 19 at Providence Holy Cross Medical Center in Los Angeles.

Jae C. Hong/AP

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Jun Jai during a shift last July in the ICU at Los Angeles County+USC Medical Center. He says now the work load is the worst he’s experienced since the pandemic began: ‘It’s nonstop running from morning to the evening. You can see so many nurses have depression.’

Jun Jai

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Jun Jai

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Jai immigrated to the U.S. from China in 1999, and he continues to follow Chinese media. He says Chinese media outlets frequently show images and footage of patients hooked up to ventilators — but he sees much less of that kind of content in the U.S., and he thinks that is one reason why so many Americans deny or minimize the seriousness of the pandemic. Americans, he says, don’t understand what the coronavirus can do.

«The people didn’t see the suffering, they didn’t see the people who are sick. With a tube in your mouth and connected to the [breathing] machine you can’t do anything,» he explains.

After immigrating to the U.S., Jai worked in restaurants to improve his English skills and make money while also attending nursing school. Jai has now been an ICU nurse for more than ten years, and he’s proud of his work. But for the first time ever in his career, he’s thinking of quitting.

Before the ICU shift: ‘I would pray ’til I cried’

Chanel Rosecrans had just started a new job in February, working the night shift at a hospital in the San Gabriel Valley. She was 27, and while it wasn’t her first nursing job, it was her first job in an ICU. Working in critical care had been a career goal. But when the pandemic hit just a few weeks later, she was shocked by the relentless onslaught of seriously-ill COVID patients.

«There was no way I could, as one person, replace a full staff of ICU nurses,» she says. «We were on a skeleton staff.»

She asked that we not name the facility because she wants to return to work there in the future.

Because the coronavirus is so contagious, each patient is kept isolated in their own room. Rosecrans spent her night shifts rushing between rooms, closely monitoring patients on breathing equipment and keeping track of their multiple medications. The patient rooms would get so hot from all the machines, and she had to wear so much PPE, that she’d end up dripping in sweat.

Since relatives weren’t allowed to visit, Rosecrans spent a lot of time on the phone with family members. Often she had to explain that there were no other medications left to try, and nothing else the medical team could do, to keep their loved one alive. She had always wanted to work in the ICU, and she expected, as part of that, to see patients die, but the sheer number and pace of the coronavirus deaths shocked her.

«It just felt like ticking time bombs,» Rosecrans says. «I didn’t want to have to just sit and wait for all these people to pass away, but it felt like all these people were just doomed. It was just really hard to accept. I don’t think I ever really did accept it.»

Before her shift, she would sit in her parked car, outside the hospital, and wrestle with feelings of dread.

«Before work, I would pray ’til I cried,» she says. «Begging God [to] please not let me lose a patient tonight. I can’t take it.»

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After more than eight months in the ICU, Rosecrans quit in October. It just seemed impossible to balance work and life. She wasn’t eating enough, and on her days off all she had time for was catching up on sleep. Caring for COVID-19 patients had left her physically and emotionally exhausted.

She wonders if she contributed to the staffing problem by leaving.

«I feel horrible that I’m not there fighting that fight with what’s left of my colleagues. But everyone has their limits,» she says.

A call for new ways to support nurses and prevent burnout

In her new job, Rosecrans is a surgical nurse for a plastic surgeon in Beverly Hills. But staffing agencies still contact her, trying to persuade her to come back to intensive-care work, even for short-term gigs. As coronavirus cases have surged, the calls have come more frequently — and they’re not just asking her to travel to understaffed hospitals in other states. Now the demand is local, too, and they want her to fill in at local hospitals.

But Rosecrans continues to say no, even when the money sounds enticing. «I don’t see what the point of going right back would be because I feel like they’re going to be operating in that crisis mode.»

Other ICU nurses have quit, but the strain of the pandemic isn’t just affecting critical care, according to Megan Brunson, the immediate past president of the American Association of Critical Care Nurses.

«There’s not a nurse — no matter what their specialty, whether ICU or not — who is not having COVID in their face every single day,» says Brunson, who works with COVID patients in a Dallas hospital.

Brunson says nurses need more support, and that includes more discussion and acknowledgement of the unique emotional burdens of nursing, particularly for those who are witnessing, first-hand, frequent deaths from a new and unpredictable disease.

«When you have whole families coming into an ICU, [and you see that happen] many times, that’s morally very distressing,» Brunson says. «You’re taking care of the mom, the dad and the adult children all in the same ICU,» Brunson says.

Brunson says paying attention to something as seemingly simple as scheduling can have a big effect on a nurse’s ability to recharge. Supervisors should look at how often each individual nurse is working the usual 12 hour shift, and take into account their sleep routines.

«Working Monday, Wednesday, Friday, on a day shift, that might be completely fine. But on a night shift that could be detrimental to their sleep, working every other day,» she explains. «I think even just having the conversation acknowledges the strain, versus this panic mode of getting the nurses in the door to cover the shifts.»

Brunson says hospitals might try doing longer «debriefs.» It’s an idea borrowed from the military, another institution that grapples with employee burnout and retention because of the dangerous and stressful nature of the work. During debriefs, which could be in person or virtual, nurses would be encouraged to discuss the challenges of their jobs, and share their concerns or suggestions on what could be improved, with a guarantee that the feedback would be shared with managers.

But it’s incumbent on the hospital to make it a priority, Brunson says.

«Nurses have to be given the place and the time to do it, otherwise they go home into this silo with their thoughts and feelings. And I don’t think that it’s offered as much as it should be,» she says.

Shorter huddles — at the beginning and end of shifts with the entire interdisciplinary health team of doctors, nurses and therapists — is another opportunity to insert recognition, Brunson says.

«That’s not necessarily the large hour-long heart-to-heart, but that is a place for nurses to feel valued. And also to bring up concerns in a bigger forum, you know, with respiratory therapy, with physicians, because we’re all in this together, in collaboration,» she says. «That recognition is so powerful.»

This story comes from NPR’s health reporting partnership with KPCC and Kaiser Health News.

• coronavirus patient surge
• nurse burnout
• Los Angeles County
• intensive care