Nurses in the United States Were Burnt Out Before Omicron. What’s Next?

A nurse practitioner talks about Omicron, nursing shortages, and what to do about seeing loved ones during the holidays.
A nurse rests while treating COVID patients on March 27, 2020, in Rome, Italy.
A nurse rests while treating COVID patients on March 27, 2020, in Rome, Italy. (Photo by Antonio Masiello / Getty Images)

The holidays are here, and so is Omicron. And while the pandemic has deeply affected all of us, nurses and other healthcare providers have confronted it every day for nearly two years—and now they’re preparing for even more. 

Cases have exploded across the United States, particularly in the Northeast. Less than a month after the most transmissible variant thus far was first discovered by South African doctors, Omicron already makes up the majority of new cases in the United States and has caused an enormous spike in the New York City area

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And although there are some encouraging signs that the illness caused by the variant is milder than before, experts fear the worst is yet to come, particularly for the nation’s bruised and battered hospitals and healthcare system. 

Nurses have been dealing with the pandemic since the beginning, and two years in, they’re burnt out. A September survey of nurses by the American Association of Critical-Care Nurses found that up to two-thirds of nurses have considered quitting due to COVID-19, and heading into the Omicron wave, nursing shortages—caused by low pay, low staffing levels, and exhaustion—that were present even before the pandemic are hitting the system even harder. 

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VICE News spoke with Dr. April Kapu, the president of the American Association of Nurse Practitioners and associate chief nursing officer at Vanderbilt University Medical Center, about Omicron and the holidays, the nursing shortage, and how healthcare providers are preparing for yet another surge.

The conversation below has been lightly edited for clarity.   

Nurses were already burnt out prior to this wave of the pandemic, and one survey recently showed that up to two-thirds of critical care nurses have considered quitting. What have you heard from nurses and nurse practitioners about how they’re preparing for this upcoming wave?

Well, it's daunting because it's another one in a series of waves. We know that there are some measures that could have been put into place earlier to help to have mitigated it. But right now, what we're doing is everything we've done every time. We're assessing our staffing, our capacity both in our clinics and our hospitals, along with nurse practitioners, nurses, all the members of the healthcare team, just to make sure that we have all of the resources, the space and the people to be able to care for COVID positive patients, whether it be the home, the emergency room, in the ICU, or ongoing. That’s what we do, is we care for patients, and we provide the very best care we can.

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It’s still pretty early for Omicron in the United States, but so far, what are nurses and other providers seeing in terms of symptoms and severity?

We know that Omicron is transmitting at an alarmingly fast rate, faster than any other variant thus far. What we don't know is how severe it's going to be, what it's going to do in terms of impacting severity of illness, hospitalizations, [and] death. And that's what we can really only follow and study because it's just rolling out now. What we're seeing in the hospital is still largely Delta, and largely with unvaccinated individuals or highly immunocompromised individuals.

What should people know about keeping their friends and families safe?

Well, I would say the number one thing is to get vaccinated. And if you're eligible, get the booster, go ahead and get that going so that your immune system is building up its defense against getting Omicron. And if you did get it, the booster would reduce the severity of illness. That's number one, just get the vaccine. 

And if you are going to be spending time with family, don't feel bad about asking people if they're vaccinated and asking them to test. 

Masking, social distancing, all of those measures that we've been putting in place—we have to do that as individuals. If we're going to go to the store, we need to say, ‘Okay, we know there's a new variant out there, it's highly transmissible, what do I need to put in place in order to go to the store. Do I need to wear masks? Do I use those? Do I need to social distance?’ Just like when we go out into the cold, we see what the weather is, we put on our layers, we have to do that with this virus.

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You mentioned mitigation measures that should’ve already been in place. Should we return to mask mandates?

Well, I work in the hospital and I work in the clinic. So when we're around the respiratory virus, we wear a mask, right? That's what we do. And so the mask mandates and all of those things, from a health care worker perspective, it has been frustrating to see much of that be politicized. Because we know the mask is a very effective tool, and it filters out airborne particles; it definitely decreases your risk. And so that's been tough. 

I think that's been part of the pressure, the stress placed on health care workers is seeing things like this that are simple measures put into place to mitigate, that are being politicized. And so that's just added to the mental stress that has happened with healthcare workers over these past couple of years.

We’ve seen extremely high waiting times in emergency rooms. What does that look like from the perspective of nurses in terms of the workloads they’re handling right now? 

Regular health care needs or what you see in the emergency rooms, those things are further stressed and further delayed because we have more and more COVID positive patients. So we are seeing longer lines in the emergency room, we are seeing hospitals filling up with more and more COVID positive cases, which means we have to cut back on electives and routine health care needs. So that's frustrating. We want to be able to move along and continue to provide healthcare to everyone. 

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It's tough, but we have to prioritize the patients that are sick. And if they are COVID positive patients, then we do that. Here in Nashville, Tennessee, where I work, it's a day by day decision whether or not we look at how many beds we have available, how many surgeries can go forward, and how many beds we have to reserve for our COVID positive patients coming in?

We are assessing our capacity and our hospitals and our clinics, what that means is that we have to move some of our scheduled surgeries or our scheduled healthcare appointments. It's the end of the year, people are trying to get in their annual appointments, and their insurance may only cover through the end of the year. They’re trying to get those scheduled surgeries in. And these are big surgeries. These aren't minor surgeries. These could be hip replacements, knee replacements, big surgeries, that may have to go on delay, because we might not have the capacity to care for them. 

Is the nation’s shortage of testing affecting the care that nurses and other professionals are able to provide right now?

Frequent testing when you have symptoms is very important, and we need to make it as available as possible. That's one of the many things that nurse practitioners have been doing alongside other health care workers: making sure testing is available in the community. 

I know we’re increasing access to at-home tests, which is wonderful. But we also need to make sure that the PCR tests are just as available in the community. Drive-thru testing, community centers, churches, tests need to be right there. If you feel that you have symptoms, you should be able to test right away because the quicker you know that you're COVID positive, the quicker you can put into place your mitigation strategy to mitigate others getting COVID around you, and so that you can get the treatment you need.

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Do you think President Joe Biden’s new plan goes far enough towards mitigation?

As a health care worker, let's get the testing out there and make it available for everybody. However that's going to happen, let's just make sure that it's available. And so making sure that we have enough tests and that they're getting to everyone, it needs to be accessible to everyone everywhere. Not just in certain areas, everywhere across the spectrum, whether you're in an urban area or a rural area, we need to make sure that anyone that needs a test can get it right away.

We’re uneasily heading into the Christmas and New Year holiday right now. Do you have any expectations of what this situation is going to look like later this month and in January?

It's too early to tell. What we're seeing now is that we're having higher case counts with Omicron, we are seeing in parts of the country that hospitals are hitting their capacity. And so they're experiencing a significant impact of the wave that's coming on. It's really too early to see if that's going to be across the country, that we start to see once again hospitals reaching capacity and the increase in hospitalizations and death. We don't know that yet.

There was a nursing shortage even prior to the pandemic, and issues of low pay have come up as well as burnout. How can hospitals alleviate this shortage during the pandemic and beyond?

It's a combination of factors. I think that the toughest thing related to healthcare burnout has just been the physical exhaustion. It has been the extra overtime, pulling extra shifts all the time, and then putting themselves on the back burner. So not taking time off, not eating regularly, hydrating, exercising, not sleeping enough. That's physical exhaustion. And then you've got the emotional exhaustion of so many patients being so sick. I mean, the COVID positive patients in the ICU are just so sick. And the death rate has been extremely high, and that's tough. So that all adds to the burnout. 

We really see that there are major gaps that were there before that have been highlighted that we need to address. And that is supporting our health care workers, making sure our healthcare environment is healthy, that we have policies around how many days and nights in a row you can work, policies around making sure that they're paid fairly, and that we have policies around taking time off, that we have counseling in place, and we're debriefing regularly. It's just really spotlighted or highlighted so many challenges that we had even before we were in a nursing shortage.