In 2021, Marilyn McCluskey, an intensive care unit nurse at a local Madison hospital, felt her anxiety grow so severe she sought grief counseling to help cope with her experience on the front lines during the COVID-19 pandemic.
McCluskey said the counselor told her she was one of many health care workers experiencing symptoms of PTSD in the workplace.
“She described us as having veteran episodes like we were in war,” said McCluskey.
In January, Dane County allocated $621,000 to mental health support for health care providers through a trauma recovery program in response to the mental health crisis among frontline workers exacerbated by the COVID-19 pandemic. The Health Care and Public Health Workforce Mental Health and Trauma Recovery and Workforce Development Program will be funded through Public Health Madison & Dane County.
Nurses hope the program will address the lasting impacts the pandemic had on their mental health and provide support.
Frontline health care workers report high levels of stress, burnout
McCluskey began nursing because of her desire to help those who could not help themselves, which ultimately carried her through the pandemic.
“For me, when people get really, really sick, they get so scared that they could die,” McCluskey said. “Their fear is real, and I just can't imagine not being that person that would just watch and not know what to do or how to help.”
But because of staff shortages and low morale among hospital staff due to COVID-19, McCluskey said she is stressed and overwhelmed by a lack of mental health support in the workplace. McCluskey shared the struggle of her emotions getting in the way of patient care during the pandemic.
“I need to work through some of these feelings because I can't guide [patients],” said McCluskey. “That's what all of us health care staff should be doing, but we do run that risk of our own thoughts, biases and opinions sneaking in if we are not mentally well.”
Ann Russell, a flight nurse of 12 years, works on transporting critically ill or injured patients to trauma centers for treatment. The pandemic made this work increasingly difficult, Russell said.
“Flying in a helicopter is already physically stressful due to the extreme conditions,” Russell said. “During the summer, it gets extremely hot in a flight suit, and then you add on the extra layer of [virus] protective equipment. The exacerbation of already stressful conditions were trying for flight crews and hospital staff alike.”
In addition to the physical strain, Russell observed continued negative impacts of the pandemic on her and her peers' mental health.
“I could tell that [health care professionals] were experiencing compassion fatigue due to the high acuity of the patients, the seemingly endless stream of COVID patients [and] the inability for hospital administration to adequately staff units and limited supplies,” said Russell. “All these factors contributed to a feeling of helplessness and even abandonment towards the end of the pandemic.”
Staffing vacancies exacerbate mental health concerns
In its 2023 annual report, the Wisconsin Hospital Association found vacancy rates among health care workers rose from 5.3% to 9.9% between September 2020 and September 2021. Though vacancy rates rose across all 17 of the documented professions, the rate spiked most sharply in nursing and frontline positions such as lab technologists, respiratory therapists and surgical technicians.
McCluskey said her department struggled with vacancies during the pandemic and losing nurses to other health care professions, like travel nursing, that traditionally offer more pay.
“In our unit before COVID there were almost no turnovers, and it was very rare to have open spots,” said McCluskey. “You had to have a crazy amount of critical care experience, and the ICU is very picky about who they were able to hire. We were desperate to fill up positions, and now we're hiring people right out of college with no experience in the ICU.”
A 2022 study conducted by SEIU Healthcare Wisconsin that interviewed 920 health care workers, including registered nurses, certified nursing assistants and others from hospitals, nursing homes and other settings, reported 90% of health care workers agreed understaffing is having a “major negative impact on patients.”
“Only ICU nurses know how to do ICU nurse jobs, so if I don't come and if I don't show up and if I don't do my best, who's gonna help these patients?” said McCluskey. “Who's gonna help my coworkers? Because they're all struggling too. If I don't show up, I've just made their work day 10 times harder. A lot of people just kept plowing through without taking any time to figure out how they're gonna work through their emotions.”
Dane County takes action to address mental health
According to a 2021 survey from the Kaiser Family Foundation, 62% of frontline health care workers reported the COVID-19 pandemic had a negative impact on their mental health. Similarly, the SEIU study showed one in six Dane County health care workers rated the severity of the pandemic on their mental health and well-being a 10 out of 10.
For Russell, these statistics bore out in her day-to-day work life.
“During COVID, I reached a new level of resilience in my practice, both mental and physical,” said Russell. “I experienced anxiety due to the unknown nature of a pandemic and landscape, but also because I observed burnout in several of my fellow nurses. I saw firsthand the desperation and frustration of these health care professionals.”
The Health Care and Public Health Workforce Mental Health and Trauma Recovery and Workforce Development Program included in the 2023 county budget allotted money for the creation of free telephone hotlines, health care worker support groups and a training program for providers to work with their peers on mental wellness. Russell told The Daily Cardinal she thinks this initiative is a good start in addressing a growing mental health crisis among health care workers.
McCluskey supports the amendment with the hope that the program will normalize the struggle of health care workers and provide adequate support and counseling they need to push forward in their work.
“During COVID, a lot of nurses felt this hopelessness. If we can't help anybody, if we can't cure anybody, those thoughts start creeping in, and you see more and more nurses burn out,” said McCluskey. “Any program that can help normalize these feelings of inadequacy and hopelessness is always gonna be helpful. It's better than nothing, which is what we have right now.”
Looking to the future, health care workers hope for sustained support
While the Health Care and Public Health Workforce Mental Health and Trauma Recovery and Workforce Development Program is a step towards improving the overall well-being of frontline health care workers, Russell said nurses need continued support.
“It needs to be recognized that nursing education must hone in on resiliency and self-care training. Studies have shown that new nurses are trained to care for patients but not necessarily themselves,” said Russell. “This inability leads to early burnout. Additional efforts could be focused on mentoring new nurses, which fosters a sense of well-being and inclusion.”
McCluskey also called for increased support from the county.
“I can't imagine not being that person [to help others], but it's hard to keep going when you feel like you can't help. I think what's kept me going is that I have been able to remind myself of the times that I was able to do something for that patient, when I was able to bring about healing,” said McCluskey.
Russell said frontline health care workers deserve the support the amendment offers, allowing them to continue to serve their community.
“My motivation to continue to practice as a nurse stems from my love for the profession, my specialty and the profession of nursing,” said Russell. “It has been an honor and privilege to care for patients and serve the community. I take strength from knowing that what I do matters.”