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Rachel Fratzke led her Mercy Iowa City nursing staff in a meditation session to start the work day on a recent morning. A nurse manager, she had the nurses do deep breathing exercises and think about when they first wanted to be a nurse, or how they felt about passing their certifying board exams.
The session was necessary, Fratzke said, to deal with the facts of COVID-19 and the rippling effects the coronavirus is sending through the nurses’ work day but also home life.
“Burnout is not going to go away any time soon. The pandemic is not going to go away any time soon,” Fratzke said.
That reality has made healthcare workers and administrators weary, thinking that the two years they’ve spent warning people about the highly contagious COVID-19 and its effect on hospital resources have yielded little to help relieve the pressure.
Numbers at Iowa’s hospitals remain high when compared with what they were in summer 2021. In all, 998 patients with COVID-19 as a primary or secondary diagnosis, including 215 admitted in the past 24 hours and 174 in intensive care, were in Iowa hospital beds on Thursday, Jan. 13, the Iowa Department of Public Health reported. The number was 57 on June 20, 2021, before the Delta and Omicron variants spread.
“Overall, the situation is not great,” Jennifer Nutt, vice president for nursing and clinical services at the Iowa Hospital Association, said. “Nurses are tired and they’re needing the public to do anything they can to keep themselves healthy.”
The public likely is weary of the warnings, too, Nutt said in an IowaWatch interview. “I know they’ve been hearing it a long time,” she said.
Iowa’s hospital demand peak was in November 2020, when more than 1,500 people were hospitalized. More than 1,100 were there with primary diagnoses, the state data show.
A second diagnosis means the patients were hospitalized with a problem other than COVID-19, although the coronavirus could affect how the patient deals with the primary medical problem, or how the patient can be treated.
“Having to watch this, having to work extra, having to pick up extra shifts, having to be away from your own family in order to manage this pandemic has become very, very difficult for health care workers,” Suresh Gunasekaran, chief executive officer of University of Iowa Hospitals & Clinics, said at a news conference.
The Genesis Health Group in eastern Iowa and western Illinois, reported that demand for beds has been moving upward at the five hospitals it owns or runs. December 2021, with 356 patients, was the second-highest month for COVID-19 hospital admissions since the pandemic’s start. The worst month has been November 2020, with 501 admissions, the system reported.
“I feel that each time we think we’ve seen the worst of it, another more powerful surge comes along. With each surge the stress and discouragement also skyrockets,” Dr. Robert Mixsell, Genesis’ convenient care medical director, said. “I do not see an end in sight with variant after variant emerging.”
Craig Cooper, Genesis’ senior communications officer, reported 67 COVID-positive patients on Thursday, Jan. 13 in the five hospitals. The number had been 73 earlier in the week, on Monday. Most were in the Davenport hospital.
Cooper said about 138 Genesis employees were not at work Thursday because they are ill. The daily average, counting those sick with COVID-19 but also other illnesses, is 100, he said, although 162 called in sick on Friday, Jan. 7. Meantime, the system has 200 openings for nurses, he said.
At least the line was shorter and waits for testing were shorter by the beginning of this week at Genesis’ testing site, Cooper said. People need an order from their health care provider to get tested at the site. Since the pandemic started, more than 3,060 patients have been hospitalized with COVID-19 at Genesis medical centers and several hundred more have been treated as outpatients, he said.
At Broadlawns Medical Center in Des Moines, healthcare workers feel the stress as well.
The burnout has led some nurses and doctors to take other positions in healthcare, while a few have left the field for another, said Dr. Jason Kruse, an internal medicine physician at the hospital for seven years.
“We talk a lot about maintaining your self-care but it gets really hard when there are shifts to fill and your options are to take care of what you need to take are of … or to take that extra shift, knowing that if you don’t take that shift someone else is making that tradeoff instead or you are going to be more thinly staffed over that shift,” Kruse said.
“There’s a lot of sacrifices being made.”
Fighting burnout amid Iowa nurses
An April 2021 professional journal article, “A Nurse Leader’s Guide to Reducing Burnout,” states that three phases of nurse burnout exist. First is exhaustion, leading to depersonalization and, eventually, failing to accept that work efforts have accomplished anything, the article, by Lesly A. Kelly, Marla Weston and Perry Gee in Nurse Leader, states.
A follow-up article in November, by nursing researcher Timon Kaple, identified ways to overcome burnout: developing strong relationships at work and home, setting boundaries between work and home life, getting enough sleep, regular exercise and tending to mental health matters, and seeking therapy and mental assistance.
Fratzke, who is studying nurse burnout as she works toward earning a master’s degree with Walden University, said she tries to help her Mercy Iowa City staff to focus on giving health care to those who cannot do it on their own. “That’s why we entered health care,” she said.
Fratzke said nurses dealing with COVID-19 patients are weary and frustrated from seeing people die on a regular basis but also a lack of public understanding about the pandemic. She is not a political person, she said. Rather, she talks about practical things the public can do to help overworked healthcare workers.
For example, she said, people can go to pharmacies or their doctor’s office for COVID-19 tests, or use home test kits, instead of tying up a hospital’s emergency room. People who seek an ER test take time and resources away from emergency room patients, she said. “Their actions really do have an impact on health care,” Fratzke said.
Mercy Iowa City had 17 COVID-positive patients the morning of Thursday, Jan. 13, up from 14 the previous Monday; near the 16 the previous Friday, Jan. 7, and a couple fewer than the 19 on Jan. 6, Aaron Scheinblum, Mercy’s communication strategist, said.
Vaccine mandates in Iowa hospitals after Supreme Court ruling
While Fratzke spoke with IowaWatch on Monday, Jan. 10, more than 100 people were rallying at the Statehouse in Des Moines in opposition to mask and vaccine mandates. Those at the rally, hosted by the anti-mandate conservative political group, Iowans4Freedom, called on the state Legislature to prohibit by law any mandate for masks or vaccines as a work requirement in Iowa.
Stacy Crockett-Person of Altoona said forcing nurses, doctors and other healthcare workers to get a COVID-19 vaccine to work is causing nursing shortages and accompanying stress for those still working. She said she knows overworked health care workers and sympathizes with their situation.
“They want to do their job,” Crockett-Person said. “We’re adding to the problem when we’re telling them to go home if they don’t vax up.”
Crockett-Person asks people wearing a mask to remove it when speaking to her because she wears a hearing aid. She says she needs to see the person talking to fully know what the person is saying.
The U.S. Supreme Court ruled on Thursday that the federal government could impose a vaccine mandate on healthcare facility workers if the facility gets Medicare or Medicaid funding. The court ruled against vaccine mandates for large employers.
Chris Mitchell, president and CEO of the Iowa Hospital Association, said he expects the vaccine requirement to add to staffing problems already seen at Iowa hospitals but that member hospitals will work to be in compliance.
“The Iowa Hospital Association maintains that vaccines are an important tool to combat COVID-19, but we have always believed that Iowa’s hospitals and health systems are best positioned to implement policies or appropriate clinical responses in their communities and should be allowed to do so,” Mitchell said in a prepared statement.
Nutt, at the Iowa Hospital Association, said burnout and stress are the most common reasons she hears for nurses leaving the job. “With the duration of this pandemic, it is a long road for the hospitals,” Nutt said. “And, hospitals have been sending the same message from the beginning, of keeping yourself healthy, of doing what you can to stay out of the hospital.”
Difference in pay for nurses leads to some quitting for travel jobs
Some nurses have left hospitals during the pandemic to join travel nurse companies. Such companies often offer higher wages than hospital staff jobs because they respond to high demand situations.
Iowa Capital Dispatch reported last month that the state is paying a Kansas company $200 an hour for 100 out-of-state nurses Iowa has brought in to help with the Omicron surge at 17 hospitals throughout the state. Overtime would run at $330 an hour under the contract, the news outlet reported. The company pays its travel nurse from money collected with those charges. The contract has been extended to Feb. 11, said Sarah Ekstrand, the Iowa Department of Public Health’s public information officer, in an email.
Registered nurses working in Iowa hospitals earn $25.23 to $38.50 an hour, Nutt told IowaWatch. “If I’m a bedside nurse at a hospital and I’m making so many dollars an hour, and there’s a travel nurse working right next to me doing that same work, making two to three times the amount of money I am, that causes some emotional distress,” she said.
Hospital system overload amid omicron
Hospitals do not operate with much slack, Kruse said, so even a short-term spike with a variant adds stress. “The big concern is that the baseline was way up already, and any bump is hard to sustain for even a short time. “
“Omicron Overwhelms Hospitals,” a National Institute for Health Care Management Foundation newsletter stated on Thursday. The story was based on reports about COVID-19 hospitalizations hitting records that go beyond last winter’s peak and Centers for Disease Control estimates that Omicron infection is responsible for 95% of the country’s new cases, the foundation’s newsletter reported.
“The system isn’t overwhelmed as much as it is under strain,” the U of I’s Gunasekaran said.
“People are still getting their emergency needs met. They’re still getting the treatment that they need. But it’s not the same as it was before. There are more delays today for the average Iowan than there were at any other time in the pandemic, though I think this is a pivotal moment,” he said.
“We are used to personal decisions having an effect on health care needs. But I think what makes this one different is it’s been going on for so long, and there is so much evidence that making different decisions around vaccination, making different decisions around safety standards really could prevent a lot of this illness, and prevent a lot of death.”
Lyle Muller is a longtime Iowa journalist who was IowaWatch’s executive director-editor until retiring in 2019. He is a board member for the Iowa Center for Public Affairs Journalism and continues to report and write while advising student journalists at Grinnell College and the University of Iowa.
This story was produced by the Iowa Center for Public Affairs Journalism-IowaWatch, a non-profit, online news website that collaborates with news organizations to produce explanatory and investigative reporting. Read more at www.IowaWatch.org. Editor Suzanne Behnke contributed to this story.