As pandemic wanes, will burnout fuel exodus of Colorado health care workers?

Dr. Amy Olson spent much of 2020 in a state of fight-or-flight. First, she feared working without enough proactive gear. Then, her sick coworkers struggled to get tested for COVID-19. Amid all that, she grieved over losing patients, some she’d treated for years, to an unyielding disease.

Each day brought new challenges and the 49-year-old’s workload grew and grew.

As the pandemic reached its third deadly peak in the late fall, Olson thought that if she could just make it to Christmas, when she had scheduled time off, things would get better. But the holidays came and went, and nothing changed. She was still anxious. She was still burned out.

So, in March, Olson left National Jewish Health, where she’d served as the Denver hospital’s medical director of the Pulmonary Physiology Unit.

“I felt very guilty for leaving my colleagues,” Olson said. “I felt very guilty for leaving my patients.”

But, she said, “Even having time off wasn’t fixing the problem.”

Colorado health care workers are struggling with trauma, burnout, grief and other mental health issues after spending more than a year responding to the worst public health crisis in a century.

The pandemic has reinforced many health care workers’ desire to work in medicine. But medical professionals and industry experts fear that as the crisis abates, doctors, nurses and other staff will leave in increasing numbers because they no longer feel valued, they’re emotionally exhausted and their jobs are no longer what they envisioned.

“It’s hard to predict what that exodus looks like,” said Dr. Jessi Gold, a psychiatrist who treats health care workers and an assistant professor in the Department of Psychiatry at Washington University in St. Louis.

“It’s not an easy decision for people to leave this career,” she said. “This is not some impulsive thing that someone is doing. To make the decision to leave medicine is one of the hardest things that anyone will ever do. It’s brave, honestly.”

“It’s as if we’ve been in a war zone”

In 2020, Colorado saw a higher turnover rate among nurses as more people left the state’s health systems than were hired, said Cara Welch, spokeswoman for the Colorado Hospital Association, in an email. She did not provided specific employment and turnover data.

And a survey released in the spring by The Washington Post and the Kaiser Family Foundation found that almost 3 in 10 medical workers have considered leaving their job and more than half said the pandemic has negatively affected their mental health.

Health care workers have endured an unprecedented amount of death. They have felt fear that they or a loved one will get sick from the coronavirus, especially early in the pandemic when it was difficult to find enough personal protective equipment. They have expressed disillusionment with their jobs and the health care system. They have felt let down by how governments and the public responded to the crisis.

“It’s as if we’ve been in a war zone for the last year,” said Dr. Marc Moss, head of the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado School of Medicine, who has researched burnout among hospital workers. “It’s not anyone’s fault. We have tough jobs and we see tragedy.”

Hospital workers have carried out duties that they have never done before — and likely never expected they would be called on to do — before COVID-19. For example, there were radiologists working in intensive care units during the pandemic, Gold said.

Families often were unable to visit their loved ones in the hospital because of visitor restrictions during the height of the pandemic. So staff on the intensive care units often would conduct video calls with families to discuss care, including when it was time to take a person off of life support, Moss said.

After such conversations, he would suit up in his protective gear, enter a patient’s room and hold the person’s hand while they die.

“After doing that several times… that makes you think,” Moss said. “It’s also the right thing to do. But it takes its toll and has its consequences.”

Staffing the health care system

Nationally, there were already provider and nursing shortages. The health care industry also was preparing for 25% to 30% of its nursing workforce to retire within the next three to five years, said Karen Donelan, a professor at Brandeis University who has researched the health care workforce.

It’s too soon to know how many more people will leave because of the pandemic. Those who don’t leave the profession entirely could also move into new careers. For example, there has been an influx of people turning to travel nursing, especially as such jobs became lucrative, especially in COVID-19 hotspots.

“People will be assessing who they work for and how they work and how they were treated during that time,” Donelan said, adding, “Any state that wants to ensure that its population has good health care should be working to understand how people living and working there are doing in these professions.”

Before the pandemic, Colorado mostly experienced nursing and provider shortages in rural areas where it is more difficult to recruit workers, Welch said.

Staffing at hospitals became a major issue as the state’s COVID-19 infections grew for the third time in the fall. As hospitals filled, more of their staff became sick. Nurses in Denver reported caring for more patients during their shifts, which grew longer.

“It’s definitely better than the height of COVID,” said Olivia Thornton, an associate nurse manager for UCHealth University of Colorado Hospital. “There’s still definitely is a nursing shortage. We’re still working very, very hard to bring in as many people as we can.”

She said that the hospital would like to staff an intensive care unit with 15 nurses a day, but it only has 13 nurses. That means nurses have to care for more patients than normal.

“I can’t do what I was doing”

Olson, the Denver physician, last saw patients in March.

By that time, she was mostly working remotely. When she returned to see patients that day, she thought it wouldn’t be as busy or difficult as it was during the surge in November and December.

But nothing had changed. The patient charts kept coming and coming as she tried to keep up, and they didn’t stop until she left that day.

“You were expected to do much more work than humanly possible,” she said.

Leaving National Jewish wasn’t easy. She had expected to stay there until she retired. Olson, who joined a pharmaceutical company, felt like she was leaving her colleagues in the same situation she was trying to escape.

She told her patients, “I’m not leaving you, but I can’t do what I was doing.”

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