Nurse, doctor exhausted and fear staff burnout from grief, trauma in Manitoba ICUs
ICU nurse transitioning to a new career, doctor studying impact of pandemic on grief
An intensive care nurse who has worked countless hours at patients' bedsides during all three waves of the COVID-19 pandemic says facing death on a daily basis has taught her something she didn't know how to do: Take care of herself.
"After the second wave I felt pretty beat up. Now in the third wave, I went off social media just trying to block all the negative in my life to stay afloat," said the nurse, Jane. CBC is not disclosing her identity because she fears reprisal from her employer as she transitions out of working in an intensive care unit (ICU) into a new job outside of the hospital.
"I am tired. Exhausted. Burned out. Wiped. Mentally and physically," she said. While being with dying patients is all part of working in am ICU, seeing so many die from COVID has changed her and her colleagues to the core.
"We still work, hard and tirelessly and endlessly with all hands on deck. But there is a light in a lot of us that has just faded," she said.
Dr. Kendiss Olafson is all too familiar with front-line grief. She's a critical care physician with a masters in public health who co-leads quality improvement in Winnipeg ICUs.
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"Grief is not new to us. What is new with COVID is that the grief we experience by helping people has intensified. COVID is a devastating disease. The volume and number of patients coming through ICU can be overwhelming, especially when our most limited resource is staff," said Olafson.
Olafson is involved in research at the University of Manitoba examining the impact of the pandemic on grief. She's helping to study how COVID has influenced grieving of families and health-care providers, to better understand how to prevent unhealthy grief and promote recovery.
Olafson is an educator for ICU doctors, but also works at ICUs in St. Boniface Hospital and Grace Hospital, where she's felt the impact of the pandemic herself.
"I am tired. I am exhausted, I am bracing myself for the third wave, anticipating the tsunami of patients that will be coming. And scared, as I hear the stories of my colleagues in Ontario," she said.
Beds, ventilators and PPE are stockpiled Olafson says, "but there isn't a stockpile of extra ICU physicians, nurses or respiratory therapists."
'I have been their comfort'
Nurses are helping dying patients do Zoom calls with family because no visitors are allowed under provincial health restrictions. Patients get end-of-life rituals and prayers through an iPad. Jane listened to family members asking her to tell their loved one over and over again how much they are loved and missed.
"I remember every single family member who has told that to me. And to take on that grief, to know you are the last person someone will see before they die, nobody else can know and understand that. To do that time and time again, there isn't a word for it outside of heartbreaking," said Jane.
She recalls two patients, both dying of COVID-19, who decided against being intubated and were able to briefly talk to Jane before they died, thanking her for her warmth and kindness.
"Even though there is lots of death, I know I have been their comfort and they felt safe in their final moments. That has really helped me, and those are the moments I hold onto when I question why I became a nurse."
Sadness and exhaustion aren't the only emotions Jane feels — there is anger too. Anger with people who are going out to parties and socializing and who are now in ICU, and anger at a system that Jane says has left nurses short-staffed.
Then there is anger at herself too.
"When you are working four shifts straight in a row and you don't get a break, you may be able to go to the bathroom at one point and you are running in circles and can't remember the last time you ate, something can be missed. Luckily there was no huge errors," said Jane.
No time to process grief
Olafson says while working overtime and extra shifts just to keep up during three waves, there is limited time for self care, to process grief and stress and to recuperate and mentally recover.
She has experienced multiple situations where many members of the same family have been admitted to the ICU, and are dying a few rooms away from each other.
"There is a huge risk our grief can be delayed or disenfranchised. We bear witness to the trauma and suffering of patients and families. We grieve with them and yet that grief is not ours. We can't own it. We are risk of not fully processing it. We are at a significant risk of burnout in our health-care staff," said Olafson.
Preventative strategies are being implemented, such as team huddles after someone has died, structured debriefing with colleagues, a moment of silence to reflect on the loss and grief counselling.
As for herself, Olafson finds solace in long walks, nature and yoga. Her faith and church community have been an anchor in coping. She hopes that as more people get vaccinated, there will be an end to the pandemic in sight.
Like Olafson, Jane finds hope in her colleagues, and in their resiliency. She does online counselling, dance classes on Zoom and cherishes her time with her partner and her dog.
Both have seen colleagues go on stress and sick leave, break down on the job or make the decision to leave the bedside — even change careers.
Jane will leave ICU for a new career. She wanted to quit a year ago, but won't abandon her co-workers during a pandemic.
"Once things slow down I will be gone. I will really miss them. They are some of the smartest, most amazing, professional caring people I have ever met. It will be hard."