What's driving the pandemic's health care exodus
1 in 5 American health care workers have left the profession since the pandemic hit.
The pandemic has pushed what was already a tough situation into crisis mode. And as psychiatrist Wendy Dean sees it, this is more than just burnout.
She says health care workers are suffering a moral injury.
“It’s that essence of: I knew what I was getting into. I know I’d work long hours. I knew I’d see some horrible, horribly hard things,” Dean says. “What I didn’t know was how hard it was going to be for me to get my patients the care they needed.”
Today, On Point: Why health care workers are hurting — and leaving.
Cassandra Alexander, ICU nurse. Author of “Year of the Nurse: A 2020 Covid-19 Pandemic Memoir.” (@CassieY4)
Wendy Dean, co-founder of Moral Injury of Healthcare, a non-profit organization that provides training and consultation to organizations focused on alleviating distress in the workforce. Dr. Dean practiced for 15 years as an emergency room physician and psychiatrist. (@WDeanMD)
Justin Meschler, former anesthesiologist.
Show Highlights: ICU nurse Cassandra Alexander reflects on her COVID experience
What was your toughest moment so far during the pandemic?
Cassandra Alexander: The one I needed the most therapy for, and that’s kind of like a trauma laugh there, because if you don’t laugh about things, you realize that you’ve kind of lost a piece of your soul sometimes. Came last winter when I was taking care of a member of a family who had not wanted to participate in the holidays, and they were overruled. And unfortunately, at their holiday gathering, they and many other members of their family got sick with COVID. So I took care of them on and off for six weeks I think.
“All the while, their condition deteriorating and all of us, at least on the hospital side, knowing that they weren’t going to make it. You would tell family members that recovery is unlikely, but everybody keeps hoping and hoping and hoping for a miracle. And we inside the hospital know that miracles are few and far between. And at the end, the day that they were going to pass, they were my patient. And so I called the family and told them that they needed to get in if they wanted to see them while they were alive.
“And so in my efforts to keep them alive, for that to be able to happen, their lungs had deteriorated. So much so that our ventilators weren’t able to actually provide enough force to kind of press the air into the lung tissue and then hopefully have it circulate to some degree. I mean, honestly, at that point, they were kind of alive in name, only. They were actively dying, as we call it, which sounds technical. But it’s true. There was nothing that I or anyone else could have done to change the course of events at that time.
“Not that we still didn’t want to, and not that we still weren’t giving it our all, but there was just nothing that we could do. And so I was bagging the patient with one of those bags. People have probably seen on TV because again, I needed to provide more force than the ventilator could attempt to oxygenate them, just long enough for their family to visit. And then their family got there and they were obviously so distressed and so dismayed. And praying for a miracle that I knew would never happen. I mean, it was impossible.”
You were physically with your own hand squeezing the bag to try to ventilate this person. That was the only thing keeping them technically alive?
Cassandra Alexander: “Yeah, yeah. And alive should be in air quotes there, unfortunately. And the second I stopped, they were going to die. And that’s what happened.”
On the trauma nurses across America faced during COVID
Cassandra Alexander: There’s so many and I’m not alone. I always try to impress upon people, every nurse in America who went through COVID last year has experiences like that that haunt them. Whether or not they realize that those hauntings are the side product of the PTSD that I am absolutely sure that all of us carry with us right now. We all were in the same boiling pot, slowly getting boiled together.
There was a point where you sent a message to some of your friends one day. What did that message say?
Cassandra Alexander: “On April 25th in the morning, I sent my girls chat a note. I was at work and I was like, basically it’s pretty ironic that I’m here trying to keep people alive when all I want to do is die. And they kind of alerted my squad and got ahold of my husband. And I talked to my charge nurse and I got to leave work early that day because I had started crying and I didn’t stop crying, probably for three to four weeks.
“Like I just had reached the maximum of emotional strain that I could even begin to cope with. And luckily, I was able to get in with my therapist and start treatment immediately, and I did get to take some time off for psych reasons. But yeah, I had never had PTSD before my job. And while I did suffer occasionally from anxiety and depression, I had never had such vibrant suicidal ideation as being a COVID nurse.”
You’re back at work now. Are you one of those 30% who are thinking about leaving the profession?
Cassandra Alexander: “If you offered every health care worker in America a job that paid equivalently well as their job that they currently have, they would leave. Like, there’s nobody who’s super interested in sticking around and being a nurse anymore. And I say that with some sense of shame because that’s like, you know, we all became nurses and other health care professionals so that we could help people.
“But now we’re just so grown down by the system that that doesn’t have any real meaning for us anymore. But one of the things, though … that’s also why you see so many people leaving to take traveler positions because they think if I’m just going to get injured, no matter where I go, I might as well cash out. But what I found from talking to friends who’ve changed hospitals recently is that right now, if I can impress upon your people, it’s that there are no life rafts. Each hospital is just its own different, like sinking ship.”
Transcript: A former anesthesiologist on why he left his health care job
Nearly 1 in 5 health care workers have left the profession for good. Justin Meschler lives in Colorado, and practiced anesthesiology for about 15 years at the beginning of his career. Everything was great, he says. Until …
MEGHNA CHAKRABARTI: Meschler noticed how multimillion dollar corporations kept buying up the private practice groups he worked at. And this was before the pandemic. And after those purchases, he says things did not run as smoothly as before.
JUSTIN MESCHLER: So at first I thought, Oh, you know, I’ll give it a try. I’ll see how it goes. But ran into so many weird ways in which the group was being managed by somebody. Honestly, the manager was oftentimes living in another state. You’d see them once a year, and they would do silly things like tell us we had to schedule our shifts this way or that way. And then, you know, you tell them, Well, if you schedule us that way, people are going to start leaving. And they do it anyway, and people start leaving the group.
CHAKRABARTI: Before the pandemic, Meschler had already been thinking of jumping from anesthesiology to pain management or psychiatry. But then COVID arrived, and he found himself in situations that he felt wholly unprepared for and unsupported. At the hospital where he worked last year, for example, there were no protocols for how to safely intubate a suspected COVID patient. So he and his colleagues wrote their own protocol. Now, I will say that that might not be so unusual in the first days of a once-in-a-century pandemic. However, Meschler also told us the hospital was unprepared in other more fundamental ways. For example, they provided spacesuit-style protective gear. But when Meschler asked for instructions on how to use that gear, no one responded.
MESCHLER: So Sunday rolled around that week, and I happened to be on call. And I got a call that there was a patient with a high fever with suspected COVID, and they needed to go to the operating room. I really freaked out because I had no idea how to use the protective equipment. I was the first person to actually do this protocol that we wrote on how to most safely put a breathing tube in the patient. And do the surgery, and then take the breathing tube out as soon as possible. And I think I told you before, that was my last day as a doctor. I became so scared and frustrated that not only my safety, but the safety of the people all around me who I worked with was not being taken as seriously as I thought it should have been.
CHAKRABARTI: Justin Meschler left working as an anesthesiologist in early April 2020, and he says he may not have left his hospital system had it been more prepared and concerned about the health and safety of its employees. Dr. Meschler says he now feels a mixture of guilt and relief. But as time goes on, he says the relief is winning out.
From The Reading List
The Denver Post: “Guest commentary: Why I quit being a doctor in the middle of a pandemic” — “As a physician anesthesiologist, I am well-trained in managing airways and placing breathing tubes in patients. Therefore it is no surprise that my colleagues and I were summoned as the first line of providers to intubate Covid patients who require a ventilator. This is one of the most dangerous procedures a physician can do for a Covid patient.”
This article was originally published on WBUR.org.
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