Year of the Nurse

In 2019, it was announced that the World Health Organization was designating 2020 as the International Year of the Nurse and Midwife. Dr. Tedros Adhanom Ghebreyesus, director general of WHO, stated in the official announcement that the year would be "dedicated to highlighting the enormous sacrifices and contributions of nurses and midwives, and to ensuring that we address the shortage of these vital professions."

Little did he know what 2020 had in store for the world. Dr. Jenna A. LoGiudice and Dr. Susan Bartos recently wrote for AACN Advanced Critical Care that WHO's yearlong honor was quickly "overshadowed by the international invasion of the novel coronavirus disease 2019." 

Over the past year, nursing shortages have been at the forefront of the conversation as SARS-CoV-2 spread rapidly throughout the United States, but it is hardly a new conversation. Dan Schank wrote about the nursing shortage for the Erie Reader in 2016 and a local chief nursing officer in his story stated that "we have a perfect storm brewing across the country." At her hospital in Erie, she said, over one-fifth of her nurses were over the age of 56 and nearing retirement. The American Nurses Association more recently noted that with 500,000 registered nurses retiring by 2022, there will be a need for 1.1 million new RNs in order to avoid an even worse nursing shortage.

In April 2020, this predicted perfect storm manifested in New York City. It was only in 2019 that 13,000 city nurses voted to authorize a strike over a lack of safe staffing ratios. Now, New York City was the world epicenter of the pandemic and the city's Health Department estimated a then-unfathomable 10,000 residents had died due to COVID-19. The virus overwhelmed the hospital system. Nurses, who were overworked and understaffed before the pandemic, worked even more tirelessly to save lives, risking their own safety and health in the process. Selfless nurses from all over the United States traveled to the city to assist with an influx of as many as 3,000 new admissions per day. 

"I have never seen patients so sick before," Tamara Williams, a nurse from Dallas, told the New York Times on April 28, 2020. "And dying, despite everything that we're doing."

Sara Marks-Sammons, a graduate of Union City Area High School, now resides in Florida where she works as a registered nurse. When she heard reports of what was happening in New York City, she felt a sense of obligation to help.

"It was just so heart-wrenching and saddening to hear how bad things really were [in New York City]," she says. She, along with nurses throughout the country, arrived in the city to help in the midst of that deadly April, feeling a duty to her fellow nurses as well as the community. "I just knew in my heart it was what I needed to do no matter how hard or scary it was with all the unknown."

Nurses were at the forefront in a way that many in the field had never anticipated. Already thinly-stretched staffs were reduced even more from their own infections. On a single day in April, the NYC Health and Hospitals Corporation confirmed that 924 staff members in city hospitals had tested positive for the virus and over 3,000 had called out sick the day prior. 

"I don't think there was any part of being there that was easy. From the beginning until the end of my entire 31 days there, it was a struggle mentally, emotionally, and physically," explains Marks-Sammons. "Every day was a new challenge … [and] the days were long and hard. Flexibility became who I was when I was there."

The Journal of Clinical Health noted that same month how nurses were "literally working until they drop" and many were "dealing with a lack of essential items."

"I think a lot of what was happening was known, but maybe not necessarily believed. We didn't all have PPE. We were reusing it and putting ourselves in danger. It was real and it was hard," says Marks-Sammons. The uncertainty did not help. "It was also new and a learning process for everyone. We weren't ready for a pandemic of this degree and that became clear." 

She says that they all simply did everything that they could, based on what they knew at the time, and hoped, if nothing else, they were making some kind of difference by being there. The signs and support from the residents of New York City as well as the hospital staff helped and were encouraging.

"The clapping during shift changes and all the healthcare signs on buildings were noticed," she says. "There was a genuine thankfulness from the majority of staff that we were there to help. They needed us and we were there. We stepped in and did everything we could, with very little, to make a difference." Still, she adds, "It was a lot of feeling helpless."

In Erie by this point, two deaths were known to be from COVID-19. Yet, while some in the Erie area were arguing over the constitutionality of mask-mandates, for many, especially those in healthcare who were reading about and seeing reports out of New York City, it seemed like the calm before the storm.

The deadliest wave began here as winter arrived. By the end of December, there were over 270 confirmed COVID-19 related deaths in Erie County (with nearly 200 more deaths added since). According to data from the CDC and Pennsylvania Department of Health though, 725 more people died in 2020 than in 2019 across the county. Since 2000, an average of 2,774 people have died each year countywide. In 2020, a total of 3,650 people died throughout Erie County. By the side of each person who died of COVID-19 were the local nurses who were caring for them. 

One of these nurses was Brandon Adams, who was a nurse in the critical care COVID units at St. Vincent Hospital. When the virus first hit Erie, he and his colleague's entire work routine was "flipped upside down." The six-day turnaround for the initial testing results made it even more of a challenge. They soon dealt with a shortage of supplies, as they worked to combine ICUs and convert them to negative airflow units, allowing air to be pulled in but not let out. Despite this and other constant challenges and changes, they adapted.

"[A]ll of my co-workers were able to pull together and function as a well-oiled machine," Adams says. "We went through the craziest times that I could have ever imagined and I felt that my staff was the rock that kept it all together."

Their support for one another was crucial. As winter approached and cases increased in the Erie region though, the situation became dire.

"I will never forget ... all of the trauma that we saw," says Adams. "I have never seen so many people who were that sick in my entire career. These patients could be up talking and eating breakfast with minimal oxygen requirements and by dinner time they were deceased or on the brink of death." 

As the death toll increased in Erie County, nurses assisted families with their goodbyes.  

"The family phone calls and FaceTimes that we had to listen to as families were saying their last goodbyes over the phone because they were not allowed into the hospital and all of the hands that we held while the patients were passing will also be something I will never forget."

Adams adds that he could write an entire book of all of the individual stories and experiences over the past year. 

"I wish that the general public could have actually seen these patients struggling to breathe," he says. "I wish they could have seen how hard we worked to try and keep these people alive."

For those who are frustrated with the mask-mandates, Adams explains that wearing a mask isn't "taking away your freedom" but "only helping to save another human's life."

"Yes, most people can get this virus and survive, but when they pass it to someone who has underlying conditions or someone who is frail, it is usually a death sentence for them. I believe that if the general public could have seen some of the struggles that we saw and dealt with they might have had different opinions."

Since then, Adams has passed his boards to become a nurse practitioner and moved to a family practice. His office does weekly COVID vaccination clinics and have vaccinated over 1,000 people so far. 

Adams says of his new position, "I feel that I have come full circle with caring for those who had COVID to now preventing it."

National Nurses United has conservatively estimated that 1,700 healthcare workers have died from COVID-19. The toll this pandemic has had on nurses cannot be overstated. JAMA Psychiatry, a peer-reviewed journal published by the American Medical Association, published its findings last month that female nurses are twice as likely to die by suicide than women in the general population. Perhaps the more alarming part of these findings is that these conclusions came from analyzing pre-pandemic data. Other recent studies have assessed post-traumatic stress symptoms in healthcare workers and have underscored the importance of preventative and management strategies.

"I wish people realized that over the past year everyone who makes up our healthcare system is still struggling," says Marks-Sammons. "Some have coped and others have not. Some have left the field from such overwhelming feelings of being helpless. Many are still trying to find their way back to what real life consists of after being on the frontlines. Some of us are still there fighting. We literally battled a war that's not over and are still experiencing the mental fatigues that come with such devastation."

Nurses have been taking care of us and our loved ones since before the days of Florence Nightingale. It is imperative then that we as a society and as communities, make sure that we help take care of and listen to them now more than ever.

Jonathan Burdick runs the historical blog Rust & Dirt. He can be reached at jburdick@eriereader.com. Find him on Twitter @rustdirt