Nurse, doctor exhausted and fear staff burnout from grief, trauma in Manitoba ICUs

An intensive care nurse who has worked countless hours atpatients' bedsides during all three waves of the COVID-19 pandemicsays facing deathon a daily basis has taught hersomething 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.CBCis not disclosing her identity because she fears reprisal from her employer as she transitions out of workingin 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. KendissOlafsonisall too familiar with front-line grief. She'sacritical care physician with a masters in public health who co-leadsquality improvement in WinnipegICUs.

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COVID-19 takes emotional toll on health-care workers

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Those working on the healthcare front lines say they are holding onto the grief of everyone who they have seen die. They are exhausted, tired and fear they are burning out.

"Grief is not new to us. What is new with COVID is that the grief we experience by helping people has intensified. COVIDis 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.

Olafsonis involved in researchat the University of Manitoba examining the impact of the pandemic on grief.She's helping to study how COVID has influencedgrieving of familiesand health-care providers, to better understand how to prevent unhealthy grief and promote recovery.

Olafsonis an educator for ICU doctors, but alsoworks at ICUs inSt. Boniface Hospital andGrace 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 PPEare stockpiled Olafsonsays, "butthere 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 getend-of-life rituals and prayers throughan iPad. Jane listened tofamily 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, thereisn't a word for it outside of heartbreaking," said Jane.

She recalls two patients, both dying of COVID-19, whodecided against being intubated and were able to brieflytalk to Janebefore they died, thanking herfor her warmth and kindness.

"Even though there is lots of death, I know I have been their comfortand they felt safe in their final moments. That has really helped me, and those are the moments I hold onto when I questionwhy Ibecame a nurse."

Sadness and exhaustionaren't the only emotions Jane feelsthere is anger too.Angerwithpeople who are going out to parties andsocializing and who are now in ICU, and anger at asystem that Jane says has left nurses short-staffed.

Then there is anger at herself too.

"When you areworking four shifts straight in a row and you don't get a break, you may be able to go to the bathroomat one point and you are running in circlesand 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 limitedtime for self care, to process grief and stressand torecuperateand mentally recover.

She has experienced multiplesituations 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 ordisenfranchised. 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. Weare risk of not fully processing it. We are at a significant risk ofburnout in our health-care staff," said Olafson.

Preventative strategies are being implemented, such asteam huddles after someone has died, structured debriefing with colleagues,a moment of silence to reflect on the loss andgrief counselling.

As for herself, Olafsonfinds solace in long walks, nature and yoga. Her faith and church community have been an anchor in coping. She hopes thatas more peopleget vaccinated, there will be an end to the pandemic in sight.

Like Olafson, Jane finds hope in her colleagues, andin their resiliency. She does online counselling, dance classes on Zoom andcherishes her time with her partnerand her dog.

Both have seen colleagues go on stress andsick leave, break down on the jobor make the decision to leave the bedsideeven change careers.

Jane will leaveICU for a new career.She wanted to quit a year ago, but won'tabandon her co-workersduring a pandemic.

"Once things slow down I will be gone.Iwill really miss them. They are some of the smartest,most amazing, professional caring people I have ever met. It will be hard."