Will the Omicron Wave Break Nursing?

After two years under siege from COVID, many are reconsidering the profession.

Nursing continues to suffer significant collateral damage from the ongoing war on COVID-19. Photo: Jeffrey Basinger/Newsday via Getty Images
Nursing continues to suffer significant collateral damage from the ongoing war on COVID-19. Photo: Jeffrey Basinger/Newsday via Getty Images

At Jacobi Medical Center in the Bronx, patients have found there is no nurse to greet them when they enter the pediatric emergency room in the borough’s largest public hospital and are forced instead to pack into a waiting room with two dozen or more people for up to three hours before a nurse checks their vital signs.

“You have no idea how sick any of them are until a nurse triages them,” one Jacobi nurse told Intelligencer. “In the last weeks, the scary thing for me is there could be an hour wait for triage and you get to a patient who is in respiratory distress and they’re in need of immediate attention. That happened to me twice already. There’s just no physical way to get to them and that’s an incredibly upsetting situation.”

Nurses at Jacobi, home to the city’s busiest pediatric trauma center, were used to the intensity of caring for patients in life-threatening situations, but the ordeal they’re facing is different this time: a severe shortage of their coworkers. Jacobi’s pediatric emergency room was supposed to have 27 full-time nurses, but it had dwindled down to 18 before the highly transmissible Omicron variant arrived last month, sickening both patients and hospital staff. At one point, several nurses had called out sick with COVID, dropping the number to 11. The hospital’s adult emergency room is also overwhelmed with hours-long wait times for patients.

It took a month after Omicron first appeared in New York, but hospitals are beginning to fill up at levels not seen since April 2020 when COVID first struck. There are more than 11,000 COVID patients hospitalized in the state, according to health department data. Half of those patients are in the city, where COVID hospitalizations doubled in nine days. The number of children hospitalized from COVID has been increasing since the beginning of December, up more than 1,000 percent among children 12 to 18 years old and 791 percent among infants to children 4 years old, state health commissioner Mary Bassett said Friday.

Hospitals are still struggling to help patients because Omicron has ballooned patient volumes, with many people heading to emergency rooms to search for COVID tests that have been in short supply. “Urgent care centers are full, so patients are utilizing the ER for that purpose and that overstretched the staff. They could be seeing somebody that’s sicker, instead we’re clogged up with patients seeking these tasks.” one nurse at Wyckoff Medical Center said. “But patients figure it’s easier to come to the ER to get it done than to go to their doctor, because they can’t get an appointment. And urgent care is saying they’re at capacity so they direct them to go to the emergency department.”

A lot has changed since the beginning of the pandemic when there were more than 3,000 patients in intensive care units at New York City hospitals and upwards of 750 people were dying a day from COVID. This time, admissions to ICUs have remained comparatively low, with about 600 people were in ICU beds and there have been 33 an average of deaths per day over the past week. What’s also changed since then is a widening shortfall in the city’s nursing corps, part of a nationwide trend. Nurses are also falling sick from COVID, having their isolation times cut short or removed entirely, and their shifts extending past 12 hours. The relentlessness of treating COVID patients over the past two years has led many nurses to question whether a career in the health-care industry, which promised secure jobs with high pay, is worth it anymore.

“Burnout is coming faster because of increased stress we have right now,” one nurse at Maimonides Medical Center said, who has been in the industry for 20 years. “We’ve seen nurses come into work and they’re turning in their notice that day; when you ask ‘What do you plan to do?’ they say they don’t have plans. I’ve never seen so many people willing to leave without a job in place.”

Private hospitals have struggled to fill the slots that nurses with decades of experience have left behind. Instead, administrators are floating nurses from one wing to another, sometimes out of their specialty, to cover for people who are out sick and begging nurses to stay late or come in early for their next shift. Those who do take sick leave or vacation receive calls from their superiors to come back to work regardless of how they are feeling, nurses said.

“Nurses have to take time off but they are being asked to come back. As recently as before Christmas they were calling people who were sick to see how sick they were and could come anyway,” one nurse at NewYork-Presbyterian Hospital said. “I hear people coughing around me and it feels like just a matter of time until I get it. I would be out for a while if I got sick.”

In addition to their roles caring for patients, nurses sometimes have to take on the role of security guards when visitors wander the hallways maskless. Nurses at multiple hospitals recounted telling family members of COVID-positive patients to wear a mask only to be ignored or berated.

“People get mad when you ask them to put their mask up. It’s not just for me and my other nurses, we work with immunocompromised children,” a nurse at Westchester Medical Center said. “Having to police that is another burden to put on nursing staff but once they get past security that job falls on nurses. It’s a whole other role in our job that I’m worn out about.”

Nurses wear N95 masks and other protective equipment at work but the lingering presence of coronavirus in the air means that few areas within the hospital are truly safe. Common areas and cafeterias where staff congregate are now fraught with risk for exposure. Some nurses keep their mask on for their entire 12-hour shift, foregoing lunch. “For the last couple of shifts at work I have had no break. There’s nobody to relieve me. You’re asking the patient, ‘Just call the resident or a patient care manager’ so you can go to the bathroom for five minutes. And that is my break,” one Wyckoff Heights Medical Center nurse said. “I have not gotten sick and I hope to stay this way. I’m wearing an N95 every single shift. It’s gotten so bad when I’m in the bathroom I keep it on.”

Omicron spread quickly through the city health care corps over the past four weeks, forcing nurses and support staff to isolate at home. Their absences have prompted hospital executives and the CDC to trim COVID isolation guidelines for the sick, allowing health care workers to return to work after five days at home following a positive test. Some administrators pressured workers to come back as soon as their symptoms recede, remaining in isolation as short as 72 hours.

New York hospital leaders acknowledge the pandemic’s current wave has put a greater strain on their staff than previous surges but insist Omicron cases will begin leveling off soon. “We’re now seeing more people return to work than are leaving because they’ve been tested positive,” Kenneth Raske, President of Greater New York Hospital Association, said. “They met the quarantine requirement, have tested negative, and can go back to work. We think hospitals are achieving equilibrium.”

Health care workers aren’t so sure. “When I hear spokespeople from hospitals say things are stable I don’t know what they’re talking about. I don’t know what reality they’re living in,” the Jacobi nurse said. “People come into this profession because they are invested in human health, but when they’re put in this situation where they can’t care for people, and they have to be the ones denying care and seeing the consequences, there’s only so much a human being can experience before they reach their breaking point.”

Nursing was once seen as a recession-proof occupation that would grow steadily as the nation’s population aged. The country added nearly 700,000 nurses between 2002 and 2015, a growth rate of 31 percent — well above the nation’s job growth rate of 8 percent, according to the U.S. Bureau of Labor Statistics. During the Great Recession, the industry added 187,000 jobs while the national economy lost 7.3 million jobs. In New York, where 2 percent of the workforce are registered nurses, salaries are among the highest in the country. In 2020, the average annual salary was $89,760, up $10,000 from a decade ago.

Still, high pay wasn’t enough to retain nurses once the pandemic arrived. One in five health care workers have left the industry over the past two years and roughly two in five nurses said they would leave their practice within the following two years, an American Medical Association-led study said. Some of the nurses who left had decades of experience. The demand to enroll in nursing schools and enter the nursing profession is still high. But fewer nurses at the beginning of their careers are joining hospitals in favor of less stressful positions as nurse practitioners in private practice, nursing homes, or clinics and outpatient settings. And hospitals have been slow to fill vacancies even as the state passed safe staffing laws to mandate a minimum number of nurses and support staff to run a medical facility.

In the meantime, nurses at all levels of their profession are taking lucrative positions in travel-nursing agencies where the salaries can be two to five times as high as their hospital-bound counterparts. Others are simply quitting without lining up another job. “People working frontline jobs feel exhausted and betrayed and this is not the job that they thought they went in to do,” said Kristi Barnes, a spokeswoman for the New York State Nurses Association. “Early retirement is one thing but mid-career people are re-evaluating. Witnessing the death of their patients and colleagues is life changing and it is something that hospitals need to be aware of.”

More money to convince health care workers to stay on the job appears to be one strategy. The Federal Emergency Management Agency is sending $924 million in COVID relief funds to the city’s public hospitals and five nursing facilities for the staffing and equipment costs they incurred during the early waves of the pandemic. Mayor Eric Adams announced Thursday that public hospitals would receive $111 million to hire temporary staff, including nurses for ICUs, emergency rooms, and medical surgical units, and send a $33 million loan to safety-net hospitals for COVID-related costs. And Governor Kathy Hochul proposed Wednesday investing $10 billion in wage increases and bonuses for health care workers over the next five years with the goal of expanding New York’s health care workforce by 20 percent. Hospital leaders want the state to invest another $300 million for tuition for nurses, respiratory therapists, and home health aides, repay loans and cover additional costs to ensure people can join the health care industry quickly.

“This is something commanding the attention of all boardrooms of health care institutions these days and we are working with nursing staff to try to figure out how to better handle the recuperation period post pandemic,” Raske said.

But more funding and more nurses won’t necessarily reduce burnout in the long run. Nurses are tired of making sacrifices like working 60 hours a week and refusing to see family members and friends’ newborns while a portion of the public refuses to wear masks and get vaccinated even after contracting COVID-19.

“We don’t have the same morale we did two years ago, and that affects the way you work too,” the Westchester Medical Center nurse said. “Two years ago people were screaming for health care heroes through their windows and now it means nothing to be a nurse. I’m not sure what changed. That health care hero-mentality has dissipated. I don’t know when we became the enemy, but we’re really not.”

Will the Omicron Wave Break Nursing?