Compassion fatigue, burnout and stress among health care workers

As Minnesota hospitals fill with a fourth wave of COVID-19 driven by the delta variant, health care workers are struggling to stay on top of the work and digging deep for compassion. 

The COVID-19 patients now filling the state’s ICU beds are overwhelmingly unvaccinated and younger, often surprised that they were hit so hard by the virus. Some are demanding untested treatments.  

Exhausted by the prolonged pandemic and increasingly adversarial interactions with some patients, more health care workers are calling in sick, and some are leaving the field.  A looming federal vaccine mandate is expected to add to existing staffing shortages. 

MPR News host Angela Davis talks to two doctors and a critical care nurse about fatigue, burnout and what it’s been like to work on the front lines.

Guests:

• Jacob Lyons is a critical care physician at St. Cloud Hospital, a main health hub in the CentraCare Health System

• Annie Gucinski is an ICU nurse at St. Cloud Hospital

• Sara Spilseth is an internal medicine doctor and chief of staff at Regions Hospital in St. Paul, which is part of HealthPartners

The following is an edited transcript of the discussion. To listen to the full conversation, use the audio player above.

Annie, I want to start with you. Because I know the strain of your work as an ICU nurse really became so bad that you decided to take a break, understandably, you're taking a couple of weeks off from work to care for your own health, describe what was going on when you made that decision.

Annie Gucinski: Well, things have basically gotten so stressful and kind of almost overwhelming at work to the point where it's hard to function, even when you're outside of work, you're in this state of being on high alert every second, and that just starts draining on your body in every way possible.

I mean, I work a job so that, you know, I find that fulfilling and that I can obviously make money for my family. But when it comes to the point that it starts affecting every aspect of your life, and it's hard to enjoy your family and your friends, you don't want to go out and do things just because of how work is that I knew it was time for me to take a break, take care of myself for a little while, get things back together. So I'm ready to go back and be in that environment again, knowing that the environment isn't going to be any better anytime soon. So just kind of working on my own coping to get there.

I want to hear more about the environment. Annie, why has caring for some COVID-19 patients been so difficult now. You know, I've read that lack of trust has been an issue in the interactions between nurses and patients.

Gucinski: That is completely true. It's been difficult for most patients. You know, if I say five years ago, I can walk into a room, educate them about their illness, tell them what's going on. They believe what I say they're thankful for the care that they've been given. And now it's almost the complete opposite of that. You walk into the room and you can just feel people staring daggers at you.

You try to explain what's going on with them, you know how much oxygen they're using, and they don't believe anything I tell them. It's very frustrating in a way and honestly I don't know when Facebook and these other media sources became more important than listening to physicians or people that work in the health care field. So it is incredibly frustrating and just like kind of deeply sad at the same time that people are just so misinformed that this has become a political dilemma. Instead of a health care dilemma, which is what it truly is.

Annie, as an ICU nurse, have you had to put patients on ventilators who were extremely ill from COVID?

Gucinski: We do that almost every day that we're at work actually. And surprisingly, it's almost a fight with some people to get them on the ventilator. They're so hypoxic. And almost in a way, when your oxygen levels get so low, you almost get delirious and people are crawling out of bed, and just so confused. So you literally have to sometimes lay on people to get them to stop moving. And every time they move, their oxygen levels get lower.

And there's also different times before you intubate people, where they have a moment, we let them call their families generally to talk to them to say their goodbyes, because no one ever knows when they go on a ventilator. If they're going to make it through this or not, we don't know, they don't know. So we generally allow people to have time to say goodbye to their family if time allows for that.

It's incredibly sad in those moments, because some people do understand what's going on at that point in time. And they’re real people. You have empathy for them, as they're saying goodbye to their families, and wishing they, you know, would have gotten that vaccine or would have done something different. And realizing the entire significance of what's going on.

One moment I had with a patient — this was during the November wave — actually stopped and thanked me for 10 minutes before we intubated him for the care that he received. It was just so moving to know that someone in their last, you know, few seconds that they would be conscious and alert and alive, they spend that time thanking you for what you did.

That's kind of changed a little bit with this new wave with the types of patients we're getting, you know, the ones that are kind of against vaccination and COVID. But I always think back to that moment, like we're all people. And underneath these various levels of education and understanding of COVID, we all need to, you know, still be compassionate for each other. But that's just getting extremely difficult as time goes on.

Dr. Spilseth, you're there at Regions in St. Paul, you're the chief of staff there but you're also caring for patients. How are you doing?

Sara Spilseth: It's a stressful time. Our critical care nurses, I worry about them. They are in a really tough spot. But it's not just them, right? It is everyone at the hospital. From our nurses, to our doctors, to our respiratory therapists, to our nursing assistants, to our physical therapists, to our transport people across the system, we're feeling this. It is a really stressful time. Our teams are working longer hours, they're picking up extra shifts.

And it is — Annie, you brought this up — it's hard to turn it off at the end of the day. It's really hard after you have been literally managing life and death all day to then go home to your family, and try to leave this ”normal” life. It's hard to shut it off. And the thing is, you know, when you come back tomorrow morning, it's going to be more of the same. In the fourth wave, You know, we used to call it peaks, I call it a plateau. This fourth plateau here, it's tough. And the thing that is harder now than ever before, is that it's preventable. A lot of these COVID cases are absolutely preventable.

What do you mean by that? Because the vaccine is now available, and many of these patients are unvaccinated?

Spilseth: Exactly. The vast majority of patients we're seeing here in the hospital, and certainly those who are in the ICU, those who are on the ventilator are mostly unvaccinated patients. You know, you see that they're gambling with their lives. And we know that had they made a different decision six weeks earlier, we may not be in this situation.

Dr. Spilseth, I know that some of the patients who have died are relatively young adults who were not vaccinated. And that has to be especially difficult to deal with.

Spilseth: That is where I think this next wave has been even more difficult. Earlier on, it was a lot of older people, people from long-term care facilities, people from transitional care units. Now, there are people my own age, I can relate to these people.

It wasn't too long ago, we had a patient. She was a 30 something-year-old female, who chose not to get vaccinated because she thought she was low risk. But unfortunately for her, it didn't work out that way. Right before she got intubated, and right before they inserted the breathing tube, you know, she said, “I wish I had a do over, I wish I would have made a different decision.” Unfortunately, she didn't make it.

She had a daughter at home. And what made it even harder is her daughter is the same age as my own. This 8-year-old girl is now going to grow up motherless, all because she made a bad decision. The mix of emotions that goes with that. There's this anger that, you know, it didn't have to be this way.

But in the end, it's profound sadness. This woman in the prime of her life, died leaving behind now a daughter who will never get to have those moments that you cherish as a mother and a daughter. And I just can't even imagine it's a little bit too relatable as my own daughter turns eight next week, just to imagine, this poor little girl at home, when she turns 9, mom's not going to be there with her. She's not going to see or blow out the candles on our cake.

On Monday, we had almost 200 health care workers who work at hospitals here in Minnesota file a lawsuit to stop their employers from putting [a federal vaccination for healthcare worker] mandate into effect. Your hospital, Regions Hospital is included in that. What are your thoughts about that? health care workers who do not want to be vaccinated?

Spilseth: As health care workers, we take an oath to do what is best for our patients. And that absolutely does mean preventing any diseases that we can from transmitting to our own patients. And for that reason, it is on us as health care providers to serve as leaders within our community, but also to make sure that we are providing the safest environment possible. How can we do that if our if we are not vaccinated?

At Health Partners, 98 percent of our doctors are vaccinated. Honestly, you cannot get 98 percent of physicians to agree on anything. But the fact that you get 98 percent of physicians to agree that vaccination is the right thing to do. That's telling.

It is absolutely what we need to be doing as a community and as a health care system to protect our patients and the population that we serve.

Bethany from St. Paul, what do you want to share with us?

Bethany: I'm a medical interpreter, I freelance throughout the Twin Cities. And what I've seen is what you were talking about, but the receptionist and the individuals who are at the stations to ask the COVID questions have just been getting so much abuse.

It was very poignant one day when I was in line behind somebody who was giving the poor woman difficulty, she was very polite. I came up next. And I said, “I know we have to ask the questions. Thank you for doing her work,” and she burst into tears.

As an interpreter that goes around the Twin Cities, I get kind of a bird's eye view of what's happening at the frontline of just the receptionist and service people. And it's just overwhelming to them as well. And I know I can't even imagine the medical staff and the nurses. Everything you're talking about is so profound and I wish that people would stop worrying about losing their personal freedom and remembering that we're Americans and part of what we do as patriots is take care of one another. But I just had to mention that too, that I see the frontline receptionist that they are just getting abused all day long.

Steve, an emergency physician at Hennepin County Medical Center, what do you want to share?

Steve: We are all very distressed. Not so much because we are stressed, which we are. But because so many patients don't have access to care because patients who are unvaccinated are occupying hospitals and emergency departments and ICU is all over the state. So that hospital, for instance, yesterday, a small hospital in northern Minnesota had a patient who had acute spinal cord compression, it didn't have anything to do with COVID. But this doctor called many hospitals all over the state to try to get a transfer for this patient because his little hospital can't take care of this major problem. He couldn't find anyone to take the patient. The patient had to wait in the emergency department for 12 hours.

Every hospital in the Twin Cities has six-hour waits in the emergency department because hospitals were overcrowded. But we didn't accept this patient. But there are patients all over the state with severe problems, severe illnesses not related to COVID, who can't get care, because all of these unvaccinated people are occupying hospitals.

They have not done their duty as citizens to stay vaccinated and stay healthy. And they are the cause of all this trouble in the state. And I don't think people know how much trouble there is in the state. How I see us are full everywhere. How patients can't get the care they need. And we are distressed because there's so many innocent patients who can't get the care they need in every hospital in the state.

Nate in Ely, what do you want to share?

Nate: I am also an emergency room physician or I was until July, I made a decision during the low in the springtime to quit because of everything they've been talking about. But what's really disheartening is for 25 years, I worked evenings and nights. And then during all of this, you'd be going into work, and thinking, at least let's get rid of this so that we can all get our lives back. But there's no compassion on the streets.

People almost act like we're not paying attention. Or that COVID is not paying attention outside the hospital. And they're not wearing masks. They're acting like it's all over. They're going to Sturgis and the fair. And I want to do those things too, but we can't. And now we're locked down again, because nobody really cared enough and thought, “Well, I don't have to get my vaccine, and I don't have to wear a mask. And they'll take care of me when I get there.” And (…) there's just no beds. And that's such a complex issue. But it's really disheartening to not be able to get the care that you want to and that you did for so many years.

And that's why you decided to quit, Nate?

It was the lack of beds and the lack of function in the hospital. And it's burnout in the larger sense.

We have Dr. Jacob Lyons with us, a critical care physician. Dr. Lyons, we've heard so much already in just the first few minutes of the show. How are you doing?

Jacob Lyons: Collectively we are burned out. I think that's a good word to use by Nate up in Ely. Every day at work is a grind. We see folks who are by and large unvaccinated. And … The heartbreak that comes from knowing it didn't have to be this way, knowing that these folks didn't have to die or didn't have to be critically ill, is really, it is wearing on our team.

That is the big difference from where we were a year ago, right? Because a year ago the vaccine was not an option.

Lyons: Right, a year ago, we had this both within the hospital and as a society, this collective desire to roll up our sleeves and get through this. That is, as many folks have pointed out, that has largely gone away.

I want to hear about your interactions with some of the unvaccinated patients who are now seriously ill and in the hospital. What are those conversations like?

Lyons: We see a range. There are folks who are defiant to the very end that either COVID is not real or not the cause of their critical illness. But there's a significant percentage of folks who show real remorse. Who will say that had they known it would be this bad, they obviously would have gotten vaccinated, they would do anything to avoid this happening.

And those are the folks I feel for the most. Those are the folks who either, they got bad advice from a friend or a politician or a talk show host and decided that they didn't need to be vaccinated or shouldn't be vaccinated. And now, some of them died. And many will have lifelong physical impairment largely to their lungs. Many have expressed remorse at infecting their family members, their children in some cases. And those are the folks I feel the worst for. They show true remorse, but there's nothing that can be done once you're sick enough to be in the ICU.

We're hearing about the overcrowding. That just gives me chills. You have people who are injured in accidents or who need emergency surgery and there are no beds. There’s no room. There's not enough staff.

Lyons: Exactly. The state has what's called a critical care coordination center, or the C4, and it's an entity that exists to help patients like that find an ICU bed, patients in a small emergency department that need to get to a bigger hospital with specific types of care. [Tuesday], for example, there were 26 asks, 26 patients that needed to get to a higher level of care. And we were unable to place any.

What typically happens? People just wait in the ER? Or the ambulance takes you to the next place?

Lyons: We refer to it as shelter in place. And so the folks in that emergency department do the best they can with whatever limited resources they have until a bed becomes available, or the patient expires. Or there's some other way to provide the care that they need without transferring them to a bigger hospital.

Let's talk right now with Sam in St. Paul, who works as a receptionist in a small clinic. Sam what do you want to tell us?

This one lady called, she was bringing her son. And she said she is not vaccinated, neither is her son. And she said she cannot have him exposed to anybody in the clinic who may have symptoms. She wants to get rescheduled. She said her son can die. My question to her is: If he is that critical, why won’t you get vaccinated? She wants everybody else in the whole world to revolve around her. But she [doesn't] want to get vaccinated. She doesn't want her son to get vaccinated. I mean, you know, it's just ridiculous. I mean, you know, it's just beyond stupidity, if you ask me.

Then there are other people who come in, some want to put the mask on, some don't want to put the mask on. Then they're making each other uncomfortable, and I get to be in the middle of it. And I have to be the one who has to bear the brunt of all this negativity. I mean, you know, it just raises my blood pressure, my anxiety, and everything else, trying to tell the people, “Please mask up, you're making other people uncomfortable.” Those who are masking up, they are telling me [they] don't want to come here and be sitting with the people who are not masking and there are those who don't want to mask up and we have to tell them. I mean, you know, it's just not a good situation.

Malia, an epidemiologist in Minneapolis, what did you want to share with us?

I run research studies actually in a hospital down in Tampa, Florida. And it's so interesting to have governors like Ron DeSantis, he comes into Tampa general all the time, he knows what's going on. But he still has this rhetoric of no masking, “don't Fauci my Florida.” But the hypocrisy of it all. And the fact that this has turned so political, you know, you kind of have to feel bad for the people who have bought into the rhetoric because they truly, truly believe it.

I remember the first patient we had to switch over to high flow nasal cannula. He’s like “Oh, I guess I should have gotten the vaccine.” It’s like, “yeah, you think?”

All I can say for the health care workers, you have to take that self-care. We have to practice radical acceptance around the fact that people truly have been duped and, you know, even though you went to school for eight years, you know, they're still coming in, and they still think they know more than you do.

To listen to the full conversation, use the audio player above.