Nurses on pandemic front lines look to refill their 'empty cup'
Nurses gained attention during the pandemic for their work on the front lines of health care, taking on extra duties and patients and shouldering a lot more grief.
The unprecedented load shook morale and diminished their numbers—one in four nurse positions in Maryland hospitals is now vacant.
The nurses, as well as their administrators and educators, however, are not letting the moment pass without making some changes to better equip nurses physically and emotionally for the job. Some are seeking help from legislators and officials in Washington and Annapolis, but more are working within their own hospitals and schools.
"Nurses can't keep pouring from an empty cup," said Dawn Mueller-Burke, an assistant professor in the University of Maryland School of Nursing who also works in the University of Maryland Medical Center's neonatal intensive care unit.
"We need to close the academic and practice gaps," she said. "And that calls for doing a better job in a variety of areas."
The nursing school has been changing the way it prepares nurses so students have a better understanding of the work and the tools they need, by focusing more on real-world scenarios, Mueller-Burke said.
Undergraduate students will adopt a new curriculum this fall that was developed by the American Association of Colleges of Nursing that expands use of technology to simulate current experiences. Instead of technical proficiency, the emphasis will be on "competencies" to ensure nursing students understand how jobs are actually done.
"We want our students more immersed in the experiences," Mueller-Burke said. "They can't just be good at taking blood pressure. They need to be a good team member. They need to be taking care of themselves, too."
Hospitals across the country have struggled with COVID-19 surges that have tested their limits. Cases are rising again, though hospitalizations remain relatively low in Maryland at about 200, compared with more than 3,400 at the January peak.
Officials say they expect more waves, adding to the normal caseload from heart attacks, injuries, and other emergencies and surgeries.
Besides adopting new processes and managing staffing shortfalls to address the demand on nurses, just about every health care facility has added or revamped health, wellness and mentoring programs.
More than 90 facilities nationwide and 24 in Maryland now use an online peer counseling program called Caring for the Caregiver: Implementing RISE, which stands for "resilience in stressful events." It was designed by the Johns Hopkins Armstrong Institute for Patient Safety and Quality and backed by the nonprofit Maryland Patient Safety Center, which reports that requests from local hospital staffs seeking support have jumped.
LifeBridge Health's Sinai Hospital in North Baltimore turned to another online peer mentoring program during the pandemic called Cabana. It was created by Even Health, an Annapolis company selected last year by CareFirst BlueCross BlueShield and LifeBridge for an incubator for health care startups.
Debra Morton, chief nursing officer at Sinai and Grace hospitals in Baltimore, said she joined a Cabana session so she could better pitch the service to her staff of up to 1,800 nurses. A nurse for nearly 35 years, she said she was surprised at how much she enjoyed the service, which lets users participate anonymously, and now looks for sessions that fit her schedule.
Morton said she and her nursing staff were thrown by the recent story of a nurse in California who died by suicide in her own emergency department.
They already have endured two years of an intense workload, co-workers leaving and hostile social media directed at health care workers by those opposed to vaccines and mask mandates.
"We are in a very vulnerable stage right now. It's been tough," she said. "In the sessions, you can see a therapist, but no one can see you. … When you're talking to strangers, you really feel like you can talk about it all."
She said there are sessions about purpose that "remind us why we got into the profession," as well as on balancing work and family, and managing your emotions. She's also been recommending that her nurses use the app's 15-minute meditation sessions during their breaks. Her aim is to ensure such programs are "normalized" after the pandemic ends.
The workloads are unlikely to ease anytime soon—even with fewer COVID infections—because of ongoing staff shortages, which vary by department and hospital. Shortages of nurses, doctors and support staff have existed for years but were exacerbated by the pandemic.
The shortages at hospitals around the state are stark: 25% of nurse positions are vacant, according to the Maryland Hospital Association.
State leaders have instituted a number of efforts in Maryland to boost the workforce during the pandemic, including allowing out-of-state and retired nurses to practice. Temp and travel nurse agencies also have filled open shifts. Schools have sought to boost enrollment, though they have faced instructor shortages.
In Maryland, there are about a dozen community colleges and universities with nursing programs, including at the University of Maryland and the Johns Hopkins University.
Nurses have supported legislation to address shortfalls. A bill that passed the recently ended General Assembly session will provide tax breaks for nurse preceptors, who supervise student nurses during their clinical rotations. It also establishes panels to study expanding the state apprenticeship programs to the health care workforce and incentivizing nurses to practice in underserved areas through a loan repayment program and other means.
On Thursday, thousands of nurses from around the country are expected to march in Washington to call attention to the needs and push for legislation. That includes bills to stop corporations from excessively charging for travel nurses to fill workforce gaps. There also is a push for some protections for health care workers from harassment or assault, which jumped during the pandemic.
Another push is to limit how many patients nurses have to care for at once, said Veronica Marshall, an Alabama nurse organizing the march.
"There is a physical and emotional toll this pandemic has taken on the nursing profession," she said. "We want the public to understand we need support if health care is to be there when they need it."
The University of Maryland's Mueller-Burke said her pandemic experiences changed how she thought about preparing new nurses for what they will witness and experience.
Even with her years of experience and training, she said was less prepared for COVID-related deaths than some colleagues in the emergency department. She cited a day in the neonatal intensive care unit when she was talking via Zoom to a new mother who was isolating with the virus. The mom suddenly labored to breathe, and Mueller-Burke watched as medical staff tried, ultimately unsuccessfully, to save her.
"It resonated with me; we really didn't have competence or readiness even for the Zoom calls," she said. "I was totally unprepared for that."
The Maryland nursing school has adjusted for that. And it has taken another step to give students specific, hands-on experience through a program called Practicum to Practice. It places students in hospital departments where they eventually will be hired to give them the most real-world experience possible.
Nursing student John Vincent Adofina said he "got to test the waters" before he graduates this spring and starts work at the University of Maryland Shock Trauma Center.
After spending time in virtual class due to the pandemic, he was glad for the on-the-ground training in an emergency department that gets many of the region's worst traumas. He got to know patients "on one of the lowest points of their lives" and the rhythm of the place. Not only will he feel more confident and ready on his first day, but he said he'll be a better teammate.
"My work ethic is strong and I'm very motivated and willing to learn, and in Shock Trauma I learn something new every day and that will prevent me from experiencing burnout," he said. "Whatever they ask of me, I'll give them."
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