Taken from NJ.com
November 18, 2020
Michele Burlington survived the first wave of the coronavirus on the front lines, working in a hospital’s packed COVID-19 unit.
But she wasn’t going to risk the second wave. Even if it meant giving up her career of 42 years.
A respiratory therapist at Palisades Medical Center in North Bergen, Burlington has a wealth of experience helping patients with pulmonary problems, a key field for a disease that attacks the lungs. She was there last spring for the scared men and women who would walk into the hospital on their own, seemingly stable, only to cease breathing hours later and wind up on ventilators.
“Just patient after patient, ‘Code Blue, Code Blue,’” Burlington remembered, using the emergency shorthand for someone in need of immediate resuscitation.
But as coronavirus cases leap again, Burlington is no longer in the medical profession — she retired on July 1, her 64th birthday, fearing she was putting herself and her loved ones in peril if she continued working. Amid a new barrage of COVID-19 patients that is only expected to grow, Burlington says she knows she made the right decision, though she misses her job and its chance to comfort the ailing.
And Burlington is not the only medical worker taking that tough choice. As the stresses and traumas of the job pile up, a worrisome number have left critical jobs, union officials say, an exodus that comes as the Department of Health has warned that hospitals could see concerning staffing shortages as a reinvigorated outbreak again sweeps through New Jersey.
“I did not want to risk my health or my family’s health anymore, so I said, ‘Well, I guess it is time to retire,’” Burlington said. “I just didn’t want to risk my life anymore, or to bring it home.”
Just how widespread those retirements are is unknown, with one partial state survey suggesting the number of nurses planning to pack it in could be on the rise, though not alarmingly. The New Jersey Hospital Association says that hospitals have long struggled to satisfy the demand for nurses and other key professionals, with spokeswoman Kerry McKean Kelly saying that “no doubt, COVID is exacerbating that.”
Several hospital chains said that while they have had pockets of workers leave, there has been no mass flight, and they have recruited to fill openings.
“We have folks that were close to retirement that after the spring surge, sort of made it official, but we haven’t seen a big departure,” said Dr. Daniel Varga, chief physician executive of Hackensack Meridian Health, the state’s largest hospital network. He said that is testament to the dedication health care workers have shown during the country’s worst public health crisis in at least a century.
“These people are heroes. I know that is an overused phrase, but it is in these people’s DNA,” Varga said.
Still, leaders of JNESO and the Health Professionals & Allied Employees unions, which both represent frontline health care workers in New Jersey, say retirements have leaped at many hospitals, driven by burnout and safety concerns and happening at a time when their expertise is vitally needed.
“A lot of nurses will tell you that what they do is a calling, that they came into the industry because they want to care for people and save lives,” said Debbie White, the president of HPAE. “That calling is often tainted by a painful disillusionment, especially when faced with the enormous loss of life experienced in our hospitals due to the COVID-19 pandemic. This dichotomy creates an enormous amount of stress and some have indeed chosen to leave the profession.”
Job boards for nurses are full of open positions, and some hospitals are offering hefty bonuses to attract candidates. Last month, for instance, state-owned University Hospital in Newark advertised sign-on payments of as much as $10,000 for experienced registered nurses.
That comes after the first wave of coronavirus stretched New Jersey’s medical system nearly to the breaking point, with hospitals scrambling to expand their intensive care beds and amass the personal protective equipment required to keep staff safe. Across the nation, an untold number of health care workers have been infected or even died of COVID-19, underscoring the dangers, particularly in the early days of the pandemic.
Gwen Feuerstein, a nurse for over 40 years, retired March 16 from Jersey Shore University Medical Center in Neptune because, she said, she saw what was coming at the emergency department where she worked. Feuerstein, who is 60, said she would have stayed for a couple more years, but felt unsafe as the flow of coronavirus patients began.
“There was a sense of panic at that point, a lot of people coming in wanting to get tested,” recalled Feuerstein, who said she loved her job, but felt it was too dangerous. Feuerstein lives with a man who is high risk, with COPD and asthma, and she has hypertension and is pre-diabetic.
“It’s kind of like, you’ve got to gamble and I don’t want to gamble with my life,” Feuerstein said.
Hospitals say they are better prepared than they were in spring, and have learned many lessons from those difficult days. They say they know how to quickly screen patients who have COVID-19 and to keep them separate from the rest of the hospital’s population. They’ve been stockpiling protective gear and say they have ample supplies stored away, though workers at some hospitals charge they are still being rationed.
But as the second wave of the disease sweeps New Jersey, Health Commissioner Judith Persichilli has said staffing shortages could be “our biggest struggle” in the health care system. Because coronavirus is on the rise across the United States, the national staffing agencies that hospitals tapped in March and April to bolster their ranks may not have nurses to send to New Jersey. Also unlike the spring, plans call for hospitals to continue to offer elective surgeries and their typical fare of services, making it harder to divert workers if COVID-19 patients continue to leap.
“The big question that both we and the state are trying to deal with is how to strike the balance between keeping a full-care hospital and taking patients with COVID-19,” said Varga, of Hackensack Meridian.
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At the virus’ height in April, New Jersey’s 71 hospitals cared for more than 7,800 patients, according to seven-day rolling averages, including nearly 2,000 in intensive care. But with new cases on the rise since late September, the health care system is again beginning to feel the strain.
On Wednesday, 2,089 hospitalizations for COVID-19 were reported, including 402 in intensive care, also using seven-day rolling averages. And with new infections reaching record levels, those numbers are almost certain to continue to jump, especially with the weather cooling and the holiday season approaching.
“We have asked a lot of our health care personnel in this year,” said Stephanie Silvera, an epidemiologist at Montclair State University. “But we have now asked them not only to go through it again, but also now potentially worse.”
Hospitals have pursued a number of efforts to retain workers, said Kelly, of the New Jersey Hospital Association. Some have expanded access to child care for employees whose children may be learning virtually. Some are continuing to provide hazard pay for frontline workers. Hospitals are also trying to address the mental toll employees have been under, by bolstering emotional support programs.
To be sure, concerns about shortages in New Jersey’s medical workforce predate COVID-19. Health care is a graying profession, with the average age of registered nurses 51 years old, and one in eight over the age of 65, according to the New Jersey Collaborating Center for Nursing.
Every two years, nurses must renew their licenses, and as part of that process, they are asked whether they intend to retire before their next renewal. This year’s crop of answers showed a 5% increase in retirement plans, a figure that Edna Cadmus, the executive director of the collaborating center and a Rutgers School of Nursing professor, said she did not find alarming.
Cadmus underscored that the stresses of a job are just one factor for someone weighing retirement. There’s also the question of finances, at a time when spouses may have lost their jobs in the economic downturn, she said.
Cadmus had yet to break down the statistics further, to see whether nurses in hard-hit fields like emergency departments, intensive-care units or nursing homes are disproportionally among those planning to retire.
The broad number, she said, “It doesn’t seem outrageous to me at his time.” She called nurses “very resilient people” but noted the unique strains they are now under.
“No one was prepared for this large of pandemic, so I do obviously think this plays into your thoughts of what you are doing,” Cadmus said.
For some nurses, those thoughts weigh very heavily in a state in which more than 16,500 people and counting are believed to have died of COVID-19.
Sheryl Mount, a nurse at Virtua Memorial Hospital in Mount Holly, reflects back to the early days of the pandemic, when New Jersey issued a call for retired medical professionals to come forward to help battle the new disease as it ripped through the state.
Mount, the president of the local HPAE union, said she knows of no one who stepped forward. But she said she knows plenty of nurses who have left the profession, burned out and afraid for their safety. She knows others who wish they could.
“You hear a lot of, ‘I didn’t sign up for this,’” said Mount, who is 58.
“Would I retire if I could?” Mount asked. “Probably.”
Virtua Health, which includes five hospitals in South Jersey, says it has seen some nurses near the end of their careers push up their retirement plans, though Catherine Hughes, the system’s chief nursing officer, called it “not a huge number.” Virtua is making efforts to retain staff, Hughes said, for instance by offering flexible schedules to accommodate nurses whose children are at home for virtual learning.
Like others, Hughes said the pandemic has shown her colleagues at their best, despite seemingly overwhelming pressures.
“It’s what we do. It’s our calling,” Hughes said. “It’s our profession to take care of people and heal them when they need it.”
Few would question the emotional toll the past eight months has taken.
But for all the difficulties the medical field faces, it can also draw strength by remembering the vital role it has played in saving lives, said Susan Salmond, the co-director of the New Jersey Nursing Initiative.
“Being able to see that and feel that keeps one engaged and believing in the value of what they do,” said Salmond, whose organization is developing programming to help nurses cope with the past eight months.
The initiative is putting together virtual forums to allow nurses across the state to discuss their experiences with each other. The group will also be offering training in stress-coping techniques used by such high-intensity occupations as the military and law enforcement.
Still, even some of the most dedicated professionals are asking whether it is worth the risk to their or their family’s health.
Barbara Boyler, a nurse of 19 years, went part-time in September and is considering whether to retire altogether from her job at Jersey Shore University Hospital. She worked on the COVID-19 floor at the pandemic’s height, and said the experience made her rethink a lot of things.
At 64 and with a lung ailment, she is in a higher risk group for coronavirus, though nursing has defined who is she for the past two decades.
“I’m toying with my own limitations. My own health, my own aging,” said Boyler, whose voice caught as she recounted the heartbreak she has seen with COVID-19, with patients dying alone without their families in the room.
“Our role was hooking people up to FaceTime just so they could say hello to their husband or their wife,” Boyler said. “And sometimes, to say goodbye.”
So far, the second wave hasn’t brought the same levels of death. At the pandemic’s peak in April, the state announced hundreds of deaths each day, and while they have been growing recently, they are still now generally in the teens and 20s. So far, those getting infected are younger and less vulnerable, and medicine has gotten better at treating the disease with drugs like remdesivir, steroids and blood-thinner medications.
Burlington, the respiratory therapist who retired in July, said she was so busy at the outbreak’s height that she didn’t have time to reflect on her life and her final months in the profession. She’d get through difficult, heart-wrenching day, after difficult, heart-wrenching day, collapse at home for the night and then wake up to do it all over again.
“Being in the field for so long, I just did what I had to do,” Burlington said.
But as the first wave of the virus receded, Burlington said, she got to thinking. About her husband, who has health problems. Her sister, who also has health problems. Her niece’s upcoming baby, who was due to be born in weeks.
As she spoke with NJ Advance Media recently, she was driving to Mississippi to meet that newborn — a trip she could have never taken if she was still on the frontlines.