Editor’s note: This story is part of a series looking at Arizona’s essential workers and is funded by the Solutions Journalism Network. Arizona Luminaria was selected as one of the newsrooms to participate in SJN’s Labor Cohort.

January Coventry steps out of her house a few minutes after six on a late-September morning. The Tucson sky, bleeding tangerine and blue, swirls above her. One of her dogs, Frida, a fetchingly-dopy German wirehaired pointer, puts her paws up on the window to watch her off. With their infant girl in his arms, January’s husband calls her back to tell her a quick reminder of their plans for the day.

In blue scrub pants, as January steps back into her house, away from the outside world where she works as a nurse in an understaffed Arizona hospital, the slogan on the backside of her blue T-shirt stands out: “OG COVID Crew.”

Having already pumped her breast milk, fixed last-minute family scheduling issues, she’s ready to leave again, but can’t help saying another quick goodbye to her husband, child, and dog.

It’s an easy drive north up nearby Campbell Avenue to Banner-University Medical Center, but it carries haunting memories. In the early days of COVID-19, January says, “This drive was a warp. I was totally numb. I’d be thinking, ‘What am I going into?’”

January has been working for the past 12 years on the Medical Intensive Care Unit, or MICU, the hospital unit that specializes in pulmonary care. The lungs being the principal target for the COVID virus, the MICU unit became “the epicenter of the epicenter” of the pandemic in Tucson, Dr. Christian Bime, medical director of the MICU, told Arizona Luminaria.

Nurse January Coventry walks into Banner-University Medical Center in Tucson. Credit: Michael McKisson

Over two-and-a-half years after the beginning of the pandemic, the frontline medical workers — nurses, doctors, and other staff — are still reeling, still overworked, and still coming to terms with the ongoing spread of the COVID-19 virus.

January’s experience is her own, and also captures how both the government — local, state and federal — and society in general failed to live up to promises to support frontline essential workers.

To thank them for their sacrifice, the hospital gave the so-called OG COVID Crew commemorative medallions. But a coin didn’t offset what January called “constant moral fatigue,” and she and other hospital workers scoffed at the gesture. She remembers that by August of 2020, a refrain was forming in her head: “Holy hell, this is not ending.”

Besides the never-ending crisis at the hospital, “the political climate was building up like plaque,” she says. 

Even as patient after patient succumbed to COVID, more were coming in who didn’t believe in the virus. “Patients were yelling at us that it wasn’t real, but then soon we had to intubate them. That’s when things got real rough.”

At one point, January saw a coworker staring out the window. The coworker told her she thinks about jumping out that window every day. 

What did January do to address the mounting challenges she faced? “You work with it, you just keep coming back, you know?” She talked to her coworker, “held space for her, listened to that feeling.”

Many quickly recognized several months into the pandemic just how vital our medical staff are to keeping us safe and alive — and responded by gifting them meals, medals, and donuts, along with general gratitude and tributes. 

But how much did that spike of support actually help? How quickly did it wane? Were there any substantive policy changes that helped nurses and other medical staff do their jobs and stay healthy?

More health-care workers are speaking up about what they need to keep working and living, and more employers, government leaders and community members are listening, but the solutions are tough to implement and many aren’t addressing the core problem: burnout and understaffing.

Though the pandemic is not over, it’s also past time to ask, in terms of supporting essential medical workers, what did we learn from the virus’s global spread, what have we failed to learn?

Short-handed, speaking up

A major issue affecting medical care, not only at Banner, but across the country, is staffing. 

One of the hardest parts of getting through COVID was having enough people to care for our sick. With a huge influx of critically-ill patients and staff retiring or resigning, feeling forced to exit a job without a safety net, staff-to-patient ratios plummeted, piling more responsibility, and more work, on the shoulders of the workers who remained.

Nationally, the vacancy rate of registered nurses rose to more than 17% in 2022, according to a report from Nursing Solutions, a private firm that focuses on nursing recruitment and retention. That’s up 7.1 points over last year, with more than 80% of hospitals reporting a vacancy rate of more than 10%.

“The pandemic has further amplified and stressed the labor market and shortage,” according to the report. While the shortage varies depending on geography, Arizona ranks in the top five states with the highest vacancy rates.

Despite ongoing efforts to expand schooling options and attract and train new nurses, including hundreds of millions of dollars in philanthropic pledges to address the nursing shortage, “a major crisis is evident and deteriorating.”

According to a 2021 survey from ShiftMed, 49% of nurses responding to the survey said they were considering quitting the profession within the next two years, which would enormously exacerbate the problem. 

January Coventry peeks into an empty hospital room at Banner-University Medical Center in Tucson. Credit: Michael McKisson

At Banner-University Medical Center in Tucson, the pandemic placed an intense stress on health-care workers who were risking their lives to care for patients. Nurses and doctors at Banner hospitals in Tucson and Phoenix complained that they were “treated as expendable,” weren’t given proper access to testing and protective equipment, and that they had to use their own PTO, according to whistleblowers who spoke to the Phoenix New Times. Similarly, if they refused to work in high-risk areas, where they were more likely to be exposed to patients with COVID, they had to use their PTO or take unpaid leave. 

In various press releases and statements to the media, Banner officials said that they were prioritizing the health and safety of workers, as well as patients. Hospital leaders responded to the crisis by creating a webpage dedicated to supporting medical workers, including options for on-site counseling, listening tours so employees could air concerns and how community members could get involved by making financial contributions to workers enduring hardships and by donating meals. Banner officials did not reply to Arizona Luminaria with specifics about what additional solutions they established since the pandemic to retain nurses and health-care workers.

However, they also called for mandatory vaccinations, which an estimated 97% of workers complied with, and implemented COVID screenings and visitor restrictions that were updated as recently as November amid a spike in seasonal flu and RSV cases. That same month, officials announced the opening of “recharge rooms” for health-care workers at Banner-UMC and several other Banner hospitals in Arizona and Colorado. The rooms include music and other neuroscientifically-based sensory tools designed to address trauma, anxiety, stress and cognitive performance.

“Recharge Rooms are a restorative space for team members to relax, refocus and recharge during their breaks, lunch, and before and after shifts,” officials said. 

January Coventry stands in the recharge room at Banner-University Medical Center in Tucson while it displays the Northern Lights. Credit: Michael McKisson

But many health-care workers, January says, are so overwhelmed amid staff shortages and treating patients that it is tough to take a break to do anything but eat. For some nurses, the recharge rooms feel like a publicity stunt, like placing a band-aid on a chronic and gaping wound.

A wave of nurses and doctors at Banner-UMC — owned by Banner Health headquartered in Phoenix and one of the largest hospital chains in the U.S, with dozens of hospitals and health centers in six states — are among the growing number of health-care workers who saw the pandemic as a turning point, risking their jobs to speak publicly and advocate for better health and worker rights. Banner’s Tucson hospital is one of two Level 1 Trauma Centers in Southern Arizona, so health-care workers see the worst of the worst in an expansive region. 

The shift in Arizona — a so-called right-to-work state historically focused on policies and laws that favor employers not employees — for workers’ rights started spreading in 2018, pre-pandemic, when thousands of teachers organized a strike demanding better pay and benefits. Similarly, journalists at The Arizona Republic, the state’s largest newspaper, surprised even longtime media and political analysts in 2019 when they voted overwhelmingly in favor of unionizing the Gannet-owned newsroom.

While it remains difficult for workers to risk their jobs and speak up, and especially difficult for those in essential worker roles that lack leadership positions and are not empowered to make systemic changes, a 2020 MIT Sloan study of 6,000 Microsoft employees found that “speaking up about a multitude of topics is associated with positive employee behaviors.” Indeed, the study found that the majority of workers, 47.1%,  spoke up about five or fewer workplace issues. However, workers who spoke up about all 15 study topics — from their immediate job assignments, the culture of their teams, how employees are treated across the organization, the strategy of the company and work-life balance alternatives — were 92% more likely to want to stay with the company. 

As more companies seek solutions to retain workers seeking a better balance between their work demands and life needs, the value of new policies and programs that empower workers is key “because employee voice is not a voice of complaint or protest per se. It encompasses the willingness of employees to speak up about opportunities for improvement,” say Ethan Burris, Elizabeth McCune and Dawn Klinghoffer, workplace experts involved in the study.

“These efforts are not a prescribed part of employees’ jobs; they are a voluntary communication of constructive ideas to leaders that enable learning and effective change in work groups of all sizes, from teams to entire organizations. Yet these efforts to tell the truth can involve confronting leaders, who can feel challenged or even threatened, especially when the proposed changes involve things that leaders have helped create or for which they are responsible.”

Workplace cultures where employees are empowered to speak up and influence systemic changes that benefit people and the companies they work for can lead to higher employee retention, which is vital in industries like healthcare where lives are at stake and resignations are increasingly common. But empowering workers is only a half-step, and takes time. Once those workers have a seat at the table, it then requires trust, collaboration and shifting traditional top-down business-decision dynamics to pave the way for affecting lasting, positive changes.

Banner nurses and doctors who spoke out for strengthening their labor rights in 2020 have continued to do so, knowing that they are taking on the state’s largest private employer. Banner employs more than 52,000 people and has more than $12.4 billion dollars in revenue in Arizona, according to its website.

Many nurses and doctors at Banner and other U.S. hospitals have fought for greater leadership and say in their own workplace, while seeking better benefits, including hazard pay, sick time, paid-time off, as well as greater financial investments to ensure the safety of health-care workers treating patients with contagious ailments and training programs that help educate more staff and strengthen work culture.

January is among those who has chosen to share the stories of what she and her colleagues experienced and continue to experience at work. Many other health-care workers have spoken to media outlets as whistleblowers, but chose to do so anonymously to protect their jobs at hospitals that warned employees against speaking to news outlets without permission. For January, advocating for real solutions in hospitals for nurses could be the difference between living and dying. She’s among the thousands of nurses in short-staffed hospitals across the U.S. who are bearing the burden of speaking up, appealing for change that will deliver health-care workers a better quality of life. The alternative, which many nurses have done and continue to do, is leaving work that is often a lifelong calling to care for sick people at a time in history when health-care workers are essential.

When January first contemplated sharing her story this year with Arizona Luminaria, she was in a rough spot, struggling to synthesize “all that I had witnessed and endured.” 

“It seems like the world has just moved on as is so expected with our culture today,” she says.

Despite advocating for changes on her particular hospital unit, she questioned the possibility of a larger structural change. And yet, “To be heard? Maybe that matters?” she says.

She’s not alone in wanting to speak out, even if she and others wonder how much real change is within reach. In Utah, three whistleblowing nurses spoke out about the perils of staffing shortages. Even long before the pandemic pushes shortages to or beyond critical levels, nurses have long been highlighting the dangers and the toll of being understaffed

The real solutions that nurses are calling for at a pivotal moment in Arizona and across the U.S. are reflected in the 2021 ShiftMed study.

  • Fifty-nine percent of the nurses said that better pay would convince them to stay in their field.
  • Better shifts and more flexible schedules were also major concerns. 
  • A summary of the survey stressed that: “Ultimately, nurses want their administrators to recognize their need to be taken care of during this time, with 41% of nurses wanting more time off and 28% wanting mental health support and counseling to prevent burnout.”

The urgency of the dilemma, and the sacrifices nurses are willing to make for strengthening their working conditions and pay, has come to a head in Europe.

Thousands of nurses recently walked off their jobs on strike in the U.K. to demand more money, asking for a pay rise at 5% above inflation. Chronic staffing shortages in the U.K. have also pushed nurses there to speak out about the emotional and physical tolls. The strike is the biggest labor action since the U.K.’s National Health Service was established in 1948, according to an AP report. 

This is what January wants Arizonans to know about nursing, from what works, to what isn’t working, and why residents and policymakers should be listening to nurses who are still working to save lives in a lingering health crisis.

Nurse January Coventry walks into Banner-University Medical Center in Tucson. Credit: Michael McKisson

First minute of the day 

Nursing shifts at the MICU begin at 6:53 a.m. As the clock turns, a stream of scrubs files out of the nearby break room where nursing staff have been “huddling”: preparing who is taking which patient and downing final bites of breakfast or another slurp of coffee. 

The nurses swipe their ID cards on a small wall-mounted kiosk to clock in, tapping the screen to acknowledge and document that they don’t have COVID symptoms.

That — affirming they are symptom free — is the least of the myriad changes that have taken effect since COVID upturned hospitals and nursing homes, as well as much of daily life across the globe. In Arizona, this exact unit, specializing in pulmonary intensive care, was one of the key units for treating critically-ill COVID patients in the state. The trauma January and her colleagues witnessed, absorbed, and suffered are still being born out, as is trauma for people whose loved ones died in overwhelmed hospitals.

To keep people alive and healthy since the virus began its spread, nurses, other medical staff, as well as hospital administrators, policy makers, patients, and family members all had to adapt, transforming policies, donning masks, picking up shifts, and gritting through the fear and the stress.

But it is nurses who spend the most time with patients, are more hands-on than doctors and build more intimate relationships with patients than any other medical practitioner. In response, nurses have been doing all they can to stay strong, stay healthy, and keep offering the care they’ve been trained to provide. 

That hasn’t been easy, and they’ve needed help.

Her first COVID patient

Intubating a patient, a procedure in which a tube is snaked down a person’s throat so a machine can take over their breathing, requires a team of specially-trained humans. The procedure typically requires a nurse pushing meds, a respiratory therapist working the ventilator, someone monitoring vitals, someone else actually guiding the tube through the throat, and others directing the operation or standing by to help.

So you either have eight hands or, typically — especially in an intensive care unit — you have a team of four to six medical professionals.

You also have the patient, flat on their back, held tilted up and mouth agape, breathing for life directly into the faces of the people getting the tube set right. That extremely close exposure to the airway is particularly dangerous when it comes to COVID-transmission — especially in the early months of the pandemic when the world was still figuring out how contagious the virus is.

“I remember my first intubation of a COVID patient,” January recalls quietly, almost clinically. She’s used to hard conversations. “I remember the room. I remember the patient.” 

The respiratory therapist trained to manage breathing for the patient refused to go in the room. He said, ‘I have a baby at home. I can’t do it.’”

January, another therapist, the doctor, and another nurse were all standing outside the patient’s room. The doctor looked at January and told her that she didn’t have to go in either.

“I’m already suited up and I see my patient in need,” she says, pausing to return to the moment of decision, “and I was just kind of like, no, it can’t be done single handedly.”

So she went in — gloved and scrubbed, double-masked, a welder’s helmet on her head — to help intubate the patient. She, along with a number of other staff on her floor, bought welder’s masks to better protect them from airborne contagion.

She doesn’t know what happened to that patient afterward. “That’s the thing about COVID,” especially in the early months, “patients became faceless.”

Everyone masked, double-masked. Workers overworked. Patients struggling to breathe or unable to breathe on their own. The numbers of infections and deaths spiking, with cases spilling across the map in red alarm.

Some of the patients in January’s unit were kept prone, meaning that they were laid on their stomachs, a technique that makes breathing easier but also makes it harder for healthcare workers to either attend to their basic needs or even to recognize them. Nurses resorted to talking to the backs of patients’ heads.

The floor was beyond busy in those months, with sometimes multiple members of the same family in critical states at the same time. 

“Someone would ask me about a Smith,” January says, “and I would be like, which one?”

At one point, she had a husband and wife dying at the same time. 

“I arranged for them to be in a room together so that the daughter didn’t have to choose whose bedside she was going to be at when her mom or dad died.”

Those kinds of gutting decisions — whether or not to help with an intubation, how to accommodate grieving family members with increasingly restricted visitor access — didn’t end when January left her job at the hospital.

She had her own family to think about, her husband, her young daughter, and, soon, another baby on the way.

Banner Hospital nurse January Coventry drives to Banner-University Medical Center in Tucson. Credit: Michael McKisson

“I just didn’t want anyone to suffer”

Despite peeling off layer upon layer of protective gear as she left the hospital at the end of her shift, it wasn’t easy to shuck the stress. One of the precautions against contagion, however, did offer some mental reprieve. When her shifts finally ended — and they often dragged past 12, sometimes past 13 hours, first January would change out of her scrubs and then, when she got home, she would strip again, often before a brief soak in her small backyard pool. 

She would float for a few minutes, staring up at the moon or the blank sky, trying to let the worry, and potentially any last vectors of disease, drain off of her body. Then she would dry off, put on new clothes, and go inside to breastfeed her daughter.

When she felt too stressed to even get into the pool, she would head straight to the shower, scrub herself, and only then go to her daughter. 

“You can imagine, having a screaming child, you’re just hustling to meet her needs,” she says.

Her own children weren’t the only kids on her mind. Despite best efforts to shield herself from the vicarious pain, she knew what so many dying patients — some of them still young — meant: “Lots, lots, and lots of orphans. I’ve watched lots of orphans be created. Lots of emergency C-sections.” 

Speaking from a swiveling easy chair in her home, with her baby asleep in her lap, she steels her face against the memories, thinks for a beat, and says: “Awful. Real awful.”

Not only did we not know exactly how the virus spread in the early months, we also didn’t know what the best treatments were.

She wanted her patients to see her as confident, as willing and able to help them. But she was scared, both for her family and for herself.

“I was terrified for my daughter’s safety and for my household. I just didn’t want anyone to suffer,” she says

Being infected in those early months “felt like an immediate death sentence.” What she had to do, for herself and her patients: “show no fear.” But, in the medical field, there’s a fine line between expressing confidence and taking the necessary precautions.

Her boss frequently told her, “Jan, your family comes first,” telling her to do what she needed to do to protect her family. “And I love her for that,” January says. “I really, really do. It’s also just not how the job works.” 

That is, the job comes with inevitable hazards and with inflexible demands. With staffing shortages, part of what January called a “huge resignation,” and an unprecedented influx of patients, work became not only more dangerous, but more frenzied.

And the coping mechanisms January rigged into her life — soaks in the pool, extra exercise — just weren’t doing enough to ease the stress and anxiety. 

The work came home with her. She was just hoping that the virus wouldn’t come home as well. To keep healthy, both mentally and physically, she couldn’t just rely on herself.

“We had one patient who was pregnant and we got her through with just Herculean effort on the doctor’s behalf,” January says, explaining how a team took over the work, via prolonged CPR, of the patient’s lungs and heart. She says that she would have pronounced the patient dead. “But the doctors were just like, ‘No, we can’t quit. She has this child.’”

January had been pumping the patient’s breast milk. “And I’m only pumping her because I’m a mom. And I know that it needed to happen. Other nurses wouldn’t have caught onto that. So I’m pumping her. But I’m also arguing, like, first of all, we’re pumping and dumping because the meds can’t be given to the baby. Second of all, I’m worried about her getting mastitis because we’re putting her on her belly. And so we’re not pumping consistently. And we’re not pumping effectively because people who don’t know how to pump don’t know how to pump. And then I said, and I remember it sounding so callous, as I’m standing there pregnant, I was like, ‘She’s never going to hold this baby anyway.’”

Doctors had artificially paralyzed the patient to be able to focus, and have her body focus, on breathing and staying alive. The muscular degradation that results from extended paralysis is incredibly difficult to get over, and, January explains, the patient was likely never to move on her own again.

“When a nurse says to you, you should stop” — providing life-saving care — “I feel like it really should mean so much more than it does coming from other people. I know what this looks like. I know what this quality of life is going to look like after this treatment. We may save the life, but the life has been lost as you know it. So in regards to this one, this woman that they just fought for, fought for for so long, and she didn’t get her vaccine. We saved her, but her husband got infected and he died. And we were like, ‘Are you kidding me?’ We tried to preserve the whole family, and the husband saw it all through and still didn’t get the vaccine. And he died.”

In the end, so did the patient: leaving another COVID orphan. When asked about the child, if the child got sick as well, January says, “I never ask about the children. I just don’t want to know.”

Soaking in trauma, hoping for help

How to recover from such experiences — watching babies become orphans? How to go home and be home? 

“I actually got post-traumatic stress responses to breaking people’s ribs,” January says, describing efforts to save patients’ lives by administering CPR. “For the rest of the day, you feel and hear the ribs cracking. You remember it.”

Though completely avoiding the difficulties was impossible — for everyone at that stage of the pandemic — there were a few things that January thinks could have helped her and her fellow workers.

The first is simply more support, part of which, January believes, should include more basic benefits to help people get through their days and months and years.

Better and cheaper food in the cafeteria, more incentives and time to exercise, more paid time off — they may not be holistic fixes, but can be make-it or break-it on the individual level. With stress-levels mounting, sleeplessness and anxiety setting in, January couldn’t even get an affordable healthy meal at the hospital. While Banner’s meal donation program, “Feeding Our Frontlines,” allowed people to contribute food, it offered no nutritional guidance.

In the cafeteria on the bottom floor, the “Deluxe Fruit Bowl,” a plastic clam shell of unripe looking cantaloupe, apple and pineapple slices and a few wet red grapes, with a “use by” sticker set for two days later, cost $5.81.

“You’re hungry, you know? And just taking care of your body. Oh my God, it could be so hard. I’m a vegetarian. And there are times when the only thing that I could find to eat was pizza and french fries. My choices are following the ethics of being a vegetarian or huge fat intake for the day, you know? And I’m a nurse!” January says.

The Physicians Committee for Responsible Medicine has a campaign to get fast food out of hospital settings and healthy food in, even shaming hospitals that host establishments of greasy convenience. They also run a tool and resource kit for hospital administrators to educate themselves and their staff about healthier options.

It wasn’t just what she could find to eat, it was if she could even find the time to eat. Nurses get 30 minutes for lunch during a 12-hour shift. And then you come home and it’s all sitting in you, January says.

“You rely heavily on the nurse to tech relationship and ratio,” January says. 

In the middle of the pandemic, to cite one telling example, the person who answers the phones — a reliable and much-loved administrator who kept the work flowing — retired. The result was that techs had to carry around and answer phones in the middle of patient care. That was on top of a huge influx of patients and fewer staff. “The position that got chewed up the most was the techs,” January says.

And so, eight-months pregnant, January made an Excel spreadsheet to track how many techs were on what shifts and what they were able to do. Specifically, how often they were rounding on her shifts, going patient-to-patient taking care of the basics and supporting nurses working overtime to save sick people.

“I went to my boss and I was like, ‘I hope that this is not perceived as me being a total dick, but my job depends on them and they are supposed to round on me.’”

To prevent bed sores, staff — typically techs — are supposed to turn “a total care patient” every other hour. “At that stage of my pregnancy I couldn’t even squat down to empty catheters,” she says.

She used the spreadsheet, marking the times a tech rounded on her shifts, and found that it could be as low as once in 12 hours. She attributed that to a combination of plummeting work ethic, exhaustion, and burn out — a lot of it due to tanking staff-to-patient ratio.

Her manager was candid, agreeing that it was a problem: ‘No. 1, this is not okay. And No. 2, we’re doing the best we can do.’”

Ideally, on a MICU floor, you have two nurses to one patient. But during COVID, sometimes you would have one nurse to three patients, providing what January called “minimum care.”

“Patients weren’t getting turned and weren’t getting baths,” she says. “And when you don’t have baths, infection rates increase.” 

Short on trained and experienced nurses and other medical staff, those months from late spring 2020 into the winter of 2021, were the hardest months. 

Besides the never-ending crisis at the hospital, “the political climate was building up like plaque,” she says. Even as patient after patient succumbed to COVID, more were coming in who didn’t believe in the virus. “Patients were yelling at us that it wasn’t real, but then soon we had to intubate them. That’s when things got real rough.”

Asked what she did to address the mounting challenges she faced, she says, “You work with it, you just keep coming back, you know?” She talked to her coworker, “held space for her, listened to that feeling.”

Mixed and wrong messaging

The other crucial help medical workers needed was accurate information. From the very beginning, the pandemic was politicized, with attitudes towards preventing contagion and even believing in the reality of the virus falling along political divides. It’s hard to treat a virus when some of your patients don’t even believe in it. 

One of the primary challenges January faced was not the virus — fears for herself and her family, or even employment issues like need for time off or the desire for hazard pay — but simply confusion and disbelief on behalf of her patients and their families.

The mis- and disinformation coming from some officials, including the White House, had real effects on the ground level, seriously complicating the job of healthcare professionals.

“You had people saying, I want ivermectin for my family,” January says. Ivermectin is an anti-worm or parasite medication typically used for horses, and occasionally used for humans. Despite being wrongly celebrated by some public figures and politicians, it is not recommended as a COVID treatment. “And we’re like,” January says, explaining the conversations she would have with some of her patient’s family members, “‘Listen, the research is not indicating this is appropriate.’ And you’re trying to explain to these people and they’re just like, ‘No, you don’t know what you’re talking about.’”

“Time off is good”

Bime, the MICU’s medical director, was not only running the unit and working as a doctor, but was also conducting research on COVID. As the director, he struggled to push his staff to make sure they were delivering the best care possible, but also, as he told Arizona Luminaria, to “keep the morale high and maintain that and make sure that we did not run into issues of burnout.”

Dr. Bime, January, and all the staff on the floor recognized they were on the front lines, so they didn’t exactly feel they needed an official proclamation to tell them so, but, still, that’s what they got.

Arizona’s definition of “essential worker” comes from an April 3, 2020 memo from Gov. Doug Ducey, along with an executive order that outlined an array of essential work, from laundry services and hardware supply services to media and educational institutions. At the top of the list of “essential functions” was “hospitals.”

No surprise: healthcare workers were rightly recognized as crucial in helping society respond to a wave of severely ill patients infected with COVID-19.

“When they woke up in the morning, they did not worry about whether they’re essential workers or not. They thought about what’s going to happen to the 20 patients that they have to care for today and the five, 10, or 15 more that are coming in,” Dr Bime said.

“We sacrificed our families, our personal lives, to do this work,” Dr. Bime continued. “And in the heat of the moment, I did not appreciate how much of a burden it was. At the end when we had vaccines available and things were beginning to get better, that’s when I really appreciated how much my colleagues and I had to sacrifice.”

Recently, January was also able to take some stock of what she lived through. “We as America, we don’t tolerate sickness,” she says. Reflecting back on her own needs, she says, “We don’t really give people sick days.” She explains the complicated system of managing time off at the hospital, where their sick days and paid time off come from the same bank. “So we don’t really get validated for being sick.” Allowing more sick days, and parceling them out from other paid time off would be a help.

What she wants and needs is a vacation.

“I don’t get how professors get their time, all summer. And we’re kind of like, ‘Yeah, we’d love to have one week mandatory time off. I mean, that’s never going to happen, but I think that it needs to be a norm that like. Time off is good.”

January Coventry stands in the recharge room at Banner-University Medical Center in Tucson while it displays the Northern Lights. Credit: Michael McKisson

Comfort measures only

One effort that the hospital took to offer respite to its stressed staff was the “recharge room,” a sterile space with hard-cushioned chairs, dim lights, and a fishbowl full of lipstick-shaped scent-tubes. You can twist open the tubes to take a whiff of vaguely fruity/flowery chemicals meant to trigger thoughts or memories from outside the hospital. The methods are backed by neuroscience studies but there’s no clear evidence on whether it actually helps medical workers.

Later on that same September morning, January steps into the room to stand in front of a giant screen covering almost an entire wall of the recharge room. “Elsewhere,” January speaks aloud, “take me to the Northern Lights.”

The wall-size screen blinks and then shows an image of a night sky with amoebic greenish and turquoise lights fizzling across the heavens.

The room is designed by Studio Elsewhere, with the intent to help staff “Relax, reset and revitalize.” A sign on the door outside reads: “Open Everyday. No food. No Drink. No phone use. Mask required.”

“You walk in,” January describes, “and it’s a dimly lit room that has some fake plants and some fake candles because of OSHA regulations. So there’s no life form. Totally sterile. So you can’t eat in there. That’s an important fact. And you go in and you say, ‘Elsewhere, take me on a walk through the redwood forests.’ And it’s beautiful imagery. And you go through the redwood forest and it’s really nice, right? But, more often than not, you don’t even get a break. So how the hell am I supposed to leave my unit to go enjoy this beautiful technology that you’ve provided for us?” She says very few staff ever enjoy the possibilities offered by Elsewhere. “So it’s like, what am I supposed to stay there after I get off of work?”

Just down the hall from the Recharge Room is the Quiet Lounge, another still and sterile haven that January describes as “where we take people to tell them that their family member is dying. Or that we need you to let them die.” The room wasn’t an innovation for the pandemic, but its import changed after the spring of 2020.  

The view from the Quiet Room is stunning: the distant Catalina mountains, the brown-and-green desert sprawl of Tucson climbing up into the faraway foothills. January remembers that a nearby house spelled out HOPE on its roof in Christmas lights in the first months of the pandemic. “It was a little beacon,” she says. “It gives me goosebumps to think about it.”

January Coventry looks out from the Quiet Room in Banner-University Medical Center. Credit: Michael McKisson

Hope was certainly helpful, and still is, but January and her patients need more than just desire and expectation. “People just don’t respect medicine,” she says. “They don’t respect it or understand it.”

“A lot of times medicine comes down to a single body part,” January says. Doctors with narrow specialties or medical staff can zoom in on a single body part or function. But that’s not the way medicine should work.” It needs to be more holistic, January argues. “You need to look at the gestalt of the patient.”

This is something January is currently studying, as she trudges through the final semester of her program to become a nurse practitioner. In one paper she shared with Arizona Luminaria, she writes of end-of-life patients who decide they don’t want any further medical interventions besides “comfort measures only,” or CMO.

Doctors often take family members to the Quiet Room to have conversations with family members about what CMO implies — that their loved one is imminently dying. But the doctor will typically only have that conversation once. It is the nurse who stays by the patient’s bedside, who watches, counsels, and grieves with other incoming family members, as well as with the patients themselves. “For this reason,” January writes, “CMO patients are uniquely sacred to nurses.”

January also warns that end of life care can often be strained. Sometimes patients and family aren’t on the same page or a doctor’s orders don’t comply with the patient’s wishes, and the nurse “must witness and care amidst the shockwave of grief and processing.” 

Regardless of how that disharmony comes about, “nurses wish to ameliorate suffering,” January writes. That’s their job. But that doesn’t mean they don’t suffer themselves. Despite all of the hospital’s focus on the patients, and the intention to care for its staff, “it comes down to us and our fortitude,” January says.

Part of the gestalt of modern medicine, January argues, is also looking beyond the patient to the medical providers, and to people, communities and society as a whole.

How to keep nurses nursing: Responding with real solutions that serve medical workers, patients and communities

  • According to an article in American Nurse Journal about lessons learned from the pandemic, giving nurses a “seat at the leadership table” can be helpful. “It’s important to not separate operational and clinical activities from each other,” the author writes, which can only happen if nurses play a role in decision making at healthcare facilities. The concept may be promising, but will also take time. Various studies, however, point to the fact that hospitals where nurses have unionized — and thus have greater negotiating power over management — lead to better patient outcomes. Other studies show that in unionized hospitals, patients have lower heart-attack mortality rates than non-unionized hospitals. While these outcomes focus on patients, improved care also improves workplace morale.
  • Ensuring all nurses and medical staff on the front lines of the pandemic, and thus at risk for infection, get substantial hazard pay. While hazard pay should be extended to all essential workers, as Molly Kinder of the Brookings Institution argues, frontline healthcare workers are consistently exposed to the virus and should be duly compensated. Hazard pay certainly has its benefits, but as an article in New Solutions: A Journal of Environmental and Occupational Health Policy argues, extra pay for extra risk is not a sufficient substitute for fair base wages and ensuring workplace safety protocols. Another study suggests that, to ensure equity and implementation, hazard pay should be at least partially funded by the government. Both studies, however, see hazard pay as one of a series of much-needed fixes to fully supporting and compensating essential workers.
  • Frontline healthcare workers need emotional support. “Although the culture of service is a positive attribute of health care professionals, it can obscure the human needs for support,” according to an article in the Journal of American Medical Association. That support can come in the form of “stress management and resilience training, recharge rooms, peer support champion (wellness) rounds, and easy-to-access mental health resources.” One recent survey found nearly half of all nurses felt they did not have adequate emotional support. Mental Health America offers a helpline to stressed essential workers. The magnitude of the problem itself poses obstacles. The same survey found that at least 93% of essential healthcare workers cite increases in stress levels since the pandemic began.
  • Workplaces should provide mental health support and allow healthcare workers the time to access it. A report from Johnson & Johnson, the American Nurses Association and the American Organization for Nursing Leadership suggests the need for a “concerted, structured effort to support nurses’ mental health as a non-negotiable element of sustaining the workforce.” But career advancement, the report notes, should not depend solely on further education, “since it lacks inclusivity and implies patient care is not enough.” And while tracks like traveling nursing — temporary placement in high-need settings — can be lucrative and appealing, it also leads to less stable work environments.
  • The same report from Johnson & Johnson and others calls for providing “flexible career pathways that adapt to an increasing range of care needs, especially for mid- and senior-level nurses.” The idea is that career paths provide room for growth and be flexible enough to “keep nurses in nursing.” Even before the pandemic gripped the globe, nurses — facing consistent trauma and death — struggled with burnout.
  • The general public should follow basic health protocols such as staying home, if possible, when sick, wearing a mask when appropriate, and getting both flu and COVID shots. We should also continue to recognize the importance of nurses’ work, as well as the emotional and physical toll it takes on them. With the ongoing politicization of the pandemic, and many of the social-distancing protocols and mask mandates having been lifted, many people seem keen to move on, even as the pandemic continues and infection rates rise once again. There are a number of studies that explore how to effectively convince people to wear a mask in public, such as by emphasizing that masks are a choice not an obligation, offering analogies to other accepted public safety protocols (such as seatbelts and speed limits) and trying to normalize it, but few public officials seem intent on continuing the fight for COVID safety.
  • Hiring enough nurses quickly enough to fill shortages won’t be possible if there aren’t enough nursing teachers. According to the American Association of Colleges of Nursing, “U.S. nursing schools turned away 91,938 qualified applications from baccalaureate and graduate nursing programs in 2021 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.” Arizona and other states are working to address this problem, by providing grant money for nursing schools. Another partial solution is a federal program from the Health Resources and Services Administration (HRSA) that offers 85% cancellation of student loans for nurses who are in programs to become nursing teachers. There are myriad websites offering suggestions as to how employers can attract and hire more nurses. Until the shortages are minimized and the profession is not a probable pathway to stress and burnout, attracting, training and keeping nurses will be a challenge.
  • Higher education in general is crucial, according to a 2022 Center for American Progress study. Bachelor of Science in Nursing (BSN) programs, frequently offered by community colleges, funnel people into programs to become registered nurses. People who complete both programs not only typically earn more money, they have more bedside skills, which lead to better patient outcomes. BSN programs also, according to the study, help attract nurses from more diverse backgrounds. As of 2020, according to a survey from the Journal of Nursing Regulation, the U.S. nursing workforce was 90% female and over 80% caucasian. Lack of diversity may be one of the factors that contribute to up to 45% of registered nurses leaving the profession within two years. The HRSA has specific grants for increasing diversity in nursing.

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John Washington is an investigative journalist based in Tucson with a focus on immigration and borders, as well as criminal justice and literature. His first book, "The Dispossessed: A Story of Asylum...