Inside the ICU in 2021: from hope to burnout

Editor’s note: This Women of the Year award goes to all of the hardworking frontline nurses who have been relentlessly treating patients with coronavirus for more than 18 months. The Spokesman-Review interviewed three nurses who work in intensive care units in the Inland Northwest for this story.

The year began with hope, a vaccine had finally arrived after a year of incredible loss and death. With a light at the end of a tunnel, 2021 held promise.

Health care workers had early access to the vaccine that would ease anxiety, especially for frontline nurses, and helped contain cases and prevent deaths among the most vulnerable.

A brief spring surge gave way to a mostly improved summer. Vaccines were widespread, people could ditch the masks. And then delta hit – an undeniable blow to health care workers, particularly those in intensive care units.

To be an ICU nurse requires a deep knowledge of advanced life-saving treatments and machines, from dialysis to ventilators. Keeping patients who are at their worst physical state alive is no easy feat, but it’s a challenge that many nurses have embraced and enjoy.

“What can we do to help get you better and get you moving and better, so you can get to where you want to go?” Christi Tolman, ICU nurse at Deaconess Hospital says of her role with patients.

The ICU is the last place most people want to be, and nurses understand that. Their day-to-day work shifts are once-in-a-lifetime nightmares for most patients and families.

“You know even if you can’t change the outcome always, you can be a supportive, kind, caring and compassionate person,” said Sonja Massie, an ICU nurse at Sacred Heart Medical Center.

Crystal Cronoble hadn’t been in the Kootenai Health critical care unit for long before the pandemic hit. She graduated with her nursing degree from Washington State University in 2019 and started in the critical care unit that summer.

There are rewarding experiences every nurse has, from patient success stories to the bonds built with coworkers. Cronoble told the story of a very sick patient who got better in the ICU and recently reached out to her and a colleague.

“I want to thank you two in person for saving my life,” the patient told Cronoble and her coworker. And while she thinks the doctors also contributed to helping this very sick patient recover, the recognition is meaningful.

‘Salt in an open wound’

The year 2021 brought initial improvement, but hope soon sank into despair amid the worst of the pandemic.

North Idaho entered crisis standards of care, stretching nurses beyond their typical caseload. Kootenai Health opened an alternate care site for the overwhelming number of COVID patients.

As Cronoble describes it, “2020 was difficult and surprising, but this (delta surge) felt like we hadn’t fully recovered, and we put salt in an open wound.”

Thousands of elective procedures and surgeries, for things as serious as cancer, were delayed months as younger patients, those who had not been vaccinated, filled hospitals, sick with the delta variant in late summer and early fall.

The pandemic has made life in the ICU much more challenging for nurses.

Patients typically can be visited by family members, who can hold their hand, comfort them and understand the true condition of their loved one. But the pandemic took that away, except for virtual video call visits.

This leaves a lot of communication to nurses, which has grown increasingly hostile with some families as the pandemic rages.

“I understand that people never want to accept that (their) loved one is going to die and I get that and have compassion for them because obviously that’s very understandable,” Massie said. “But sometimes they are questioning of what we’re doing, requesting us to do things not supported by medical evidence.”

The trust in health care workers has deteriorated as the pandemic continues on.

“I feel like it’s shocking,” Cronoble said. “Nursing, it’s been known for a while, was the most trusted profession for years and years and now we’re definitely not.”

The delta surge meant younger and younger people were hospitalized with the virus. Previously, many COVID patients were older, but this fall nurses were seeing patients who could be their peers, very close in age.

“When they’re 40 to 60 years old, it is some of our age group, and I think that’s what hits home,” Tolman said. “This is not just a vulnerable population virus; this is not selective in that way.”

And now as fall fades into winter, with many health care workers burned out and leaving their jobs, those who stay are feeling the strain of what has been a different kind of difficult year.

Combating burnout

The nursing shortage and burnout existed long before the pandemic became a part of ICU nurses’ daily routine.

Massie, who has been a nurse for 22 years, was working on a research project for the American Association of Critical-Care Nurses with a few coworkers, about improving the quality of care by reducing burnout, when the pandemic hit.

“How can we do more to be aware of and focus on burnout? That’s a really hard question, and there’s really not a great answer to it,” Massie said. “This job is hard. It’s tough and by its nature alone is traumatizing, just at baseline it is.”

And while she doesn’t have the answers, Massie said it needs to be evaluated as the pandemic has continued to add to the burnout, with nurses retiring early or moving on to other nursing roles not at bedside.

Tolman agrees.

“There is no magic wand or magic bullet that’s going to fix staffing or fix the pandemic,” Tolman said.

Instead, she said taking the time to show up for her coworkers or giving someone just 10 minutes to step away is vital.

“I find it’s those small, simple things that as they add up will make a great impact on what we do,” she said.

Being an ICU nurse comes with a fair amount of trauma and stress normally, but the pandemic added even more on top of already demanding positions.

“I have always been an Energizer bunny, so I’ve never felt like I’ve needed to recluse and recover until now,” Cronoble said.

Typically she would keep busy on her days off, but now she feels like she has to intentionally slow down and rest. Cronoble recently got back into her morning weight-lifting routine, which can mean an early morning alarm clock on days when she’s picking up extra shifts. Working out is a way for her to care about her own body, which in turn helps her release stress.

Tolman got through tough days calling her dad after her shifts. He inspired her to get into nursing originally, and his inclination that his daughter had a knack for the profession turned out to be correct. Tolman has been a nurse for nearly 25 years.

Her father died this year (not from COVID-19), which has been extra difficult for the veteran ICU nurse. She now calls her sister after tough shifts; they have taken on that role for one another.

“I need that outlet so I don’t walk in the door with it,” Tolman said.

Typically Massie would unwind playing piano, going on hikes or spending time with her kids and husband. The pandemic led to an increasing amount of anxiety, however, to the point where it felt like she almost had post-traumatic stress disorder even after she left the hospital. She decided to get help.

Now she sees a counselor every other week to talk about her work stress and work on managing her anxiety levels.

Therapy has helped, and Massie wanted to share her experiences with the hope of encouraging other health care workers who need it to do the same.

“As health care workers, we always think that we’re the healers. We’re tough and think that we’re not supposed to need help,” Massie said. “… But I have seen the toll in myself and in my coworkers as we’ve gone through this pandemic.”

‘One day at a time’

For nurses who have stayed in ICU units, the future is taken in day by day.

On top of COVID cases, hospitals are working through thousands of backlogged procedures, including some that might require a hospital stay.

“It feels like you’re on a roller coaster and you can’t get off, and I’m like, ‘I’m sick now and need to get off,’ but I can’t, and it adds to that numb feeling,” Cronoble said.

The pandemic has made the small things matter more: caring for coworkers both on and off the clock; a glass of wine on a same day off; watching over another nurse’s patients so they can take a much-needed break and step away.

Teamwork sustains the teams on the frontlines.

At the Deaconess ICU, Tolman said it’s those little things that can make the biggest difference, especially after a rough day on the floor or after losing a patient. Sometimes it’s teamwork or something small that reminds her why she first became a nurse.

“I think one of the big things we can learn is giving grace to each other.

“Nobody’s perfect,” Tolman said. “We’re all going through different things at different stages in our lives.”

Massie calls COVID the “comeback king” and as a result is taking things day by day. Cronoble agrees, taking each shift as it comes is what’s working for the moment.

“If there was some sort of magic solution, we’d all be doing it, but the truth is we’re just in an extremely challenging time,” Massie said. “And I think you can just go one day at a time and do the best you can.”