Nurses have had a tough year (and then some). How they've stayed resilient

At the beginning of the pandemic, Penny Weismuller, director of Cal State Fullerton's School of Nursing, said everyone in her Southern California neighborhood would come outside at 7 p.m. to make noise in celebration of the health care workers on the front lines.

Her neighborhood still comes out to honor the resiliency of health care workers, especially nurses.

Nurses have always had to be resilient, Weismuller said. The pandemic showcased that resiliency and pushed its limits in some cases.

She said for some nurses, this is their first disease outbreak. Weismuller, who for 30 years worked in disease control and epidemiology, has experienced multiple outbreaks. But this pandemic "has been very difficult for all of us."

With the fourth wave of cases, hospitalizations and deaths, some nurses and other health care professionals are burning out.

In a Mental Health America survey from June to September 2020, 93% of the more than 1,100 health care workers surveyed were experiencing stress. The survey found that 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.

Emotional exhaustion was the most common answer when health care workers were asked what had changed for them recently—followed by trouble sleeping, physical exhaustion and work-related dread.

About 39% of health care workers said that they did not feel like they had adequate support.

We spoke to four nurses on the front lines of the pandemic in Los Angeles County and one in academia to ask what challenges they've faced since March 2020 and how they are coping, personally and professionally. Here's what they said.

Anahiz Correa

Anahiz Correa remembers a strong connection with a patient at South L.A.'s Martin Luther King Jr. Community Hospital, where she is the head of nursing for the intensive care unit.

She and the patient shared a last name, and he happened to be from the same town in Mexico as her grandfather.

Correa had to fill in on night shifts when the hospital was short-staffed, on top of her normal duties. That's how she met and connected with this man.

"We knew that the chances of his survival weren't high," Correa said.

He had been in the intensive care unit for about two weeks, and by the end of his second, the unit's physician, with the patient's consent, made the decision to intubate him.

Correa helped the patient call his wife, knowing it might be the last time he would be able to speak to her. Correa and the other nurses stood by the patient to support him and each other in that moment.

"Witnessing that conversation, it really put me through how many times my staff has witnessed these conversations during this time," Correa said.

Correa's advice:After that phone call, Correa and her team stepped out of the room and talked about what they witnessed and how it made them feel.

Correa said those kinds of conversations occurred often. For some members of her team, that was enough. Others chose to seek professional help—including Correa. She began talking to a therapist about her work in the ICU.

She also relies on meditation and moments of gratitude before and after work to get herself in the right mindset to perform her duties in caring for her community.

When it came to helping her staff, Correa was integral in establishing a post-ICU clinic at Martin Luther King Jr. hospital.

She said nurses worried about whether discharged patients would get the specialty care they needed to completely recover from a bout with severe COVID-19.

"Our nurses were feeling like, 'We're saving these patients, but what was going to happen to them after?'" she said.

Correa collaborated with a physician to create the clinic where ICU nurses can participate in patients' follow-up care.

"It's absolutely healing for a lot of them to know that our patients are being taken care of," she said.

Joyce Leido

Joyce Leido is a support system at work and at home. Leido, chief nurse executive for Kaiser Permanente Los Angeles Medical Center, looked after her team of nurses during the pandemic as well as her husband, who is a registered nurse in an ICU at another Kaiser hospital.

Her husband would come home from work with stories about telling a patient's out-of-town relatives that their loved one was going to die, or of caring for a critically ill patient.

She knew that if her husband was coming home with "this emotional and mental anguish and pain," then every single nurse at her hospital was dealing with the same thing.

"It was a magnifying glass. I just don't get to hear all of the stories from our 1,300 nurses [at Kaiser Los Angeles], but I know they're feeling the same thing," she said.

As a leader, Leido said, she was intentional about providing resources for them.

Leido's advice:Leido said she did a lot of listening—not only about day-to-day experiences, but also fears. Many of the concerns she heard from her staff (and her husband) were about not knowing when the increase in patients would slow down or when the pandemic would end.

She provided a space to talk or cry for anyone who needed it. From that, she learned that many nurses carried a lot of guilt—especially when a patient died.

"He's an excellent nurse, but he would say, 'I wish I could have done something different,'" she said about her husband.

In these scenarios, she could tell a reassuring truth: They did the best they could; the patient knew they were cared for with 120% of you; this is a terrible disease; and there's nothing more that you or anyone else could have done because we all are doing our best.

Another way Leido has helped her team is by certifying her dogs Lani, a soft-coated Wheaten terrier, and Feta, a golden retriever, to be therapy dogs. Lani was a respite for Leido after a long day at work, so she shared her furry support with her staff. Her dogs go to work once a week, and just about every employee at the hospital finds a moment to destress with them.

Penny Weismuller

Typically, students attending Cal State Fullerton's nursing program need to fulfill a certain amount of direct-care hours, earned by working in a hospital setting, to become a nurse. In 2020, students earned their hours by assisting Orange County's emergency pandemic operations.

Penny Weismuller, director of the program, said the county public health department had students plan the conversion of a vacation facility to a hospital setting, conduct contact tracing and administer COVID-19 tests and vaccines.

"The hospitals didn't have the capacity for them to go into critical care because they didn't need the stress of a student at that moment," Weismuller said.

Weismuller's advice: People need to recognize that health care workers are all humans and don't have unlimited capacity to endure stress.

"In order to continue to provide care to other people, we have to take care of ourselves. ... We cannot burn through our bank of the amount of stress we can endure in our life," she said. "It's so important right now that those of us that are here need to be able to stay here as we get through the end of this pandemic hopefully."

When nurses are reaching their limits, Weismuller said, all public and private medical entities need to help them develop resilience.

She serves on the board of the California Assn. of Colleges of Nursing, which preaches "resilience, reflection and reimagination."

"In order to develop resilience, we need a time to reflect on what we've learned, what we could do differently, and reimagine how we can enhance our care for ourselves and others, for the future," Weismuller said.

Nancy Sumner

Nancy Sumner just celebrated her 45th anniversary at the Dignity Health Glendale Memorial Hospital and Health Center. She's a registered nurse in the emergency room and a retired colonel in the U.S. Air National Guard, where she specialized in aeromedical evacuation.

What has helped Sumner cope through the various phases of the pandemic?

"I always say Air Force core values—which [are] integrity, service before self, and excellence—have been my mantra," she said.

It reminds her, she said, to focus on what she can do for a patient and not allow herself to feel overwhelmed before exhausting other options or asking for help.

"You have to cope, get it done and move on," Sumner said.

Lately, Sumner's team has had to cope with a new challenge: political divisions entering the hospital room.

Sumner said a family recently denied that a young patient who died had been infected with COVID-19. It was frustrating to deal with family members who were not vaccinated, refused to wear masks in the emergency room and yelled at nurses. The family has every right to be angry after the death of a loved one, Sumner said. But other people in the packed emergency room also needed to be kept safe.

"Pre-COVID-19, nurses, front-liners, you were respected a little bit more. Now a lot of nurses don't feel as respected. ... We do feel respected by our hospital and staff," she said.

The other challenge for Sumner is that she doesn't talk about her experiences at work with her family, citing patient confidentiality and not wanting to scare them.

It's not easy for them to understand that she's taking precautions at work and feels safe, because family members are thinking only about her exposure to the virus.

But her adult children can tell when she's especially tired or when Sumner mentions she "dealt with a lot of COVID" that day.

Sumner's advice:Sumner finds solace in the fact that she can remove her scrubs at the end of her shift and change into clean clothes before leaving the hospital.

"It really made a difference for our staff because they felt they can leave everything [from the day] behind," she said.

When she has a difficult day, Sumner will take a longer route home. It gives her time to debrief, think about what she can do differently another day. She also listens to calming music or a meditation app. Or sometimes she just yells in the car, which she finds cathartic.

On her days off, decompressing means playing with her grandchildren, taking them horseback riding, going on a walk or swimming.

Noemi Gomez

Noemi Gomez is a registered nurse, a certified lactation consultant and a perinatal nursing supervisor for East Los Angeles Doctors Hospital. Gomez said she continues to find her work emotionally fulfilling, despite the challenges brought on by the pandemic.

She said East Los Angeles Doctors Hospital cares for an underserved community so the gratitude from patients is visible, especially from expecting or new mothers.

During the pandemic, expecting mothers have worried about possible exposure to the coronavirus when going to the hospital for prenatal care. Gomez said she participated in a lot of community outreach through public forums to educate the community about the safety protocols the hospital implemented.

The other challenge in the prenatal unit was that families couldn't always be physically present.

"We provide a very family-centered approach here, and having to limit the number of visitors that could be at the bedside during that time was a challenge. We had to be able to accommodate the patient with the father of the baby or a designated support person throughout their hospital stay, while simultaneously keeping the other patients and ourselves safe," Gomez said.

For pregnant women who tested positive for COVID-19, a designated support person wasn't able to be in the delivery room, so Gomez and other nurses in the unit were their support system.

"The role of the nurse as being also emotional support, I think, was just so much more enhanced during this pandemic because our pregnant mommies really needed us. It's like we became their second moms because their mom wasn't able to be with them and give them guidance at this moment of becoming a new mommy," she said.

Gomez's advice:Gomez said she always tries to find the positive.

"As hard as that might be sometimes, I try to surround myself with people that are optimistic," she said.

That positivity, for Gomez, can often be found in nature. So she regularly hikes and jogs.

She equates it to finding a little normalcy in the midst of all the chaos.

How can the community care for nurses?

Nurses The Times spoke to were unanimous: Saying a simple "thank you" goes a long way for health care workers.

They also talked about working together as a community to end the pandemic by practicing hand hygiene, wearing a mask and following local safety guidelines.

And Kaiser's Leido emphasized vaccination.

"The best way that you can help and provide support to all of our front-line health care workers, all of our essential workers, is to get vaccinated," Leido said.

Mental health resources for nurses

• Front-line workers, including health care workers, who are concerned about their mental health can visit Mental Health America to be screened and find resources and support.

• The American Nurses Association recommends nurses contact their organization's employee assistance program if stress, anxiety, fear, rumination or depressed moods are interfering with their functioning. Be proactive and do not wait until you're in crisis.

• Healthy Nurse, Healthy Nation Grand Challenge is a program that aims to create a healthy nurse population.

• The American Psychiatric Nurses Association provides self-care strategies.

• Nurse associations collaborated to create the Well-Being Initiative, a nurses' guide to mental health support services.

• The National Alliance on Mental Illness created a guide for health care professionals that covers when to reach out, confidential and professional support, peer support resources, building resilience and other resources.

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