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Finding My Joy: Fighting Nurse Burn-out

      Graphical abstract

      At the beginning of April 2020, the COVID-19 pandemic burned me out. I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches.
      I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team.
      The apex of this pandemic that we were preparing for came much too early. Physicians, nurses, and technicians were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, and post-traumatic stress disorder, a real threat.
      We were protected, we assured ourselves, but how could you be confident about how safe you are when the COVID-19 fatalities keep on rising? The whole hospital (and all of New York City) was in a pandemic chokehold.
      It took a few minutes of deep breaths before I could summon the courage to rise from my bed. For the first time in my long nursing career, I was at a crossroads I never thought I would be at. I had considered myself unshakable. “Been there, done that; nothing can ever make me turn away from nursing,” or so I thought.
      That morning, I felt burnt out, but I went to work. I could not abandon my staff. To fortify myself, I looked up onto the heavens and whispered, “My Lord God, take charge of my life.”

      On The Frontline

      New York streets were empty. The “city that never sleeps” had been in total lockdown since March, and only essential workers were allowed to travel. Along the Cross Bronx Expressway on my way to work, what was once a traffic nightmare looked more like an apocalypse with nary a car nor truck in sight for miles on end. Times Square was a ghost town. The silence was both eerie and deafening. I felt as though I was going to war, but I was scared and helpless. I hated being vulnerable.
      I was on the frontline but felt like a spectator. I was not actually at the bedside giving direct care as I wanted to be. The responsibility of being a Director of Nursing in an emergency department amid a health care crisis was overwhelming but not more than what the emergency nurses, technicians, medical providers, and other ancillary personnel had to go through. I can only imagine the enormous impact of the unending crisis on their psychological well-being when their best efforts sometimes failed.
      My nurses forbid me to go into the rooms, even to help prepare the bodies for the morgue. They wanted me safe. I joked that I was not that old, that I could fight alongside them. As with imposter syndrome, I felt inadequate and that I was not quite pulling my own weight on the battlefield. I felt guilty that I was not at the bedside.
      All I could do was make rounds, check on the staff, order supplies, request more staffing help from the Incident Command, coordinate travel nursing coverage, handle family complaints, and act as a cheerleader and emotional support for the staff. I followed up with my quarantined staff members for COVID-19 exposure and illness. It was difficult to hear their anxiety, and I feared that they could hear the quiver in my voice, so I preferred texting to phone calls.
      I saw the patients come through the triage area with no family members to sit by their bedside. They were whisked directly to rooms and supplied with high-flow oxygen masks to aid in their breathing. I saw patients inside the isolation room as they lay with apprehensive eyes looking at their oxygen saturation numbers on the cardiac monitors. I also saw some patients lose the battle and die.
      I remember the eyes of the ED staff beyond their masks and face shields. Eyes that were sad and worried. Eyes haunted by the final goodbyes between the patients and their loved ones on an iPad. Eyes filled with despair because of the unprecedented challenge wrought by the COVID-19 onslaught. These were our darkest times.
      I tried to be transparent in providing information to the staff. But I grappled with what I could share. So, in my emails and our daily huddles, I talked about the nurse travelers coming in, the nonclinical activities, and nonemergent procedures that were put on hold to deploy the staff to the emergency department and other patient units. My news was as upbeat and hopeful as I could possibly communicate it to my already disheartened staff. I informed them of other surge capacity activities that the hospital leadership had initiated to accommodate the influx of patients with COVID-19.
      I did not share my concerns about the grim statistics and the dwindling supplies and equipment (because we compete with other hospitals for resources). I did not share that the morgue was full and that there were medical examiner trailers on our campus. I did not confess that I wanted to quit nursing.
      I did not want to stop and answer questions about my state of mind for fear that the tenuous hold on my fragile emotions would break. I did not want anyone to see me ugly-cry because of the sadness in my heart. So I cried behind the doors.
      My priority was to have my staff feel supported so that they could take care of the patients who needed their expert help. I had to be the leader they deserved. I learned how to appear confident on the outside while I was frazzled on the inside. I learned to hide my fear. I could not afford to be weak.

      Epiphany: Self-Care

      The staff needed a sort of personal protective equipment for our mental well-being. We corroborated with the mental health liaison psychologists, who offered counseling and other options for the team to de-stress, decompress, and start healing our broken hearts. The psychologists taught us to reach out and seek help.
      My epiphany was that I had to do self-care. How could I help my staff when I was running on empty? In my personal life, through all of life’s ups and downs, I relied on my family and friends, my church, and my writing to endure. I knew I was strong enough to survive my personal travails, but I was unsure if I could remain a nurse amid the challenges that had brought down my colleagues. I resolved to look for my joy triggers at work. I knew I had to heal myself before I could lead others.
      One day, a nurse asked to speak with me. The nurse broke down crying as soon as we got into my office. Words of pain and despair poured out, and repressed emotions from the past months finally tumbled out. The nurse was not suicidal but was profoundly sad and depressed. We talked for a long time, but mostly I just listened. I called one of the mental health counselors and arranged an emergency visit. Then we hugged, and the nurse thanked me for listening and being there. I am glad to report that today that nurse is healthy and thriving.

      Finding My Joy

      I promised myself that COVID-19 would not be my downfall. Having witnessed the heroism and fortitude displayed by all health care personnel during these uncertain times made me realize how much I love the nursing profession. In my little way, I am privileged to have made a difference, and I wanted to continue to be a nurse.
      That moment of indecision in my nursing career, that short period of burn-out, that temporary insanity is no longer. I have recovered my self-worth; I have found my joys and my “why.”
      What turned me around? What prevented me from leaving my profession?
      My healing came as I continued working as a nurse. I poured out my emotions into my daily journal, a catharsis that helped me exorcise my negative feelings. My writing brought everything into perspective. Much as there were so many heartaches, I found comfort in our small triumphs. As a nurse, I was part of the army against this virus.
      There were numerous things to celebrate. Let me recount the reasons I persevered:
      • The clapping and appreciation from the hospital neighborhood and other heroes such as the firefighters and police officers.
      • The outpouring of support from the community with unsolicited food deliveries, which fed both our bodies and our souls.
      • The staff working as a team and caring for one another.
      • The staff coming in extra days so that their peers did not work short-handed.
      • The deployed staff working in unfamiliar places and doing their very best to help.
      • Dancing to the music “Call on Me” each time a patient was discharged.
      • Receiving thank you's from the patients and their families.
      • The staff rising to the challenge, despite the threat of COVID-19.
      • The knowledge that every single hospital employee was doing their best under the most extreme circumstances.
      • The realization that we were doing God’s work.
      I created a Facebook photo album using pictures from the staff to celebrate the resilient group that they are. It was a way to pay tribute to and highlight this particular group on the frontlines of this war. I wanted to preserve in posterity the faces of the brave ones who had come to fight the battle against COVID-19.
      The Facebook photo album grew into a photo journal. It chronicles the moments of levity captured in between the moments of heartbreak, those moments just before the staff rushes back to the unit to save more lives.
      Frozen in time, the pictures capture the ED team taking a much-deserved break, a respite from the hard work–just a little breather. They show the spirit of our camaraderie, of having bonded as we worked together. As time went on, the staff started to “SMIZE” they smiled with their eyes.
      These health care workers, heroes of my time, were simply inspiring.

      Nurses’ Month

      In May 2020, the hospital managed to celebrate the “Year of the Nurse” creatively despite the constraints of social distancing and face masks. We danced in the streets, gave out cookies and cupcakes, published the emergency department’s virtual nursing journal, enjoyed the gifts from numerous sponsors, and were treated to an aerial display from the US Air Force and Navy. The festivities were a harbinger of hope that we would survive. The end of the pandemic would come. And then we prayed for the vaccine, our fighting chance.
      In 2022, the American Nurses Association chose the theme, “You Make A Difference.” Nurses in all specialties and sectors truly matter as we give our patients a chance for a better life. Every day. Our strength is rooted in determination and dedication to serving those who need help, and is fortified by the challenges and disruptions of the past years.
      Every single nurse affected by the pandemic crisis should be proud to be still standing. Bruised maybe, but still standing. Today, I am retired, but, one way or another, through my teaching and my writing, I am still a nurse.

      Biography

      Jocelyn C. Sese is retired, Independent Consultant, Author of “ER Nurse: The Warrior Within”, Queens, New York. Twitter: @Filnurseinameri .