Editor’s note: This is the fourth story in a series from the Idaho Capital Sun on what the Gem State’s health care workers are experiencing as they battle the latest surge of coronavirus in Idaho. Visit bitly.com/COVID-dispatch-1 or bitly.com/COVID-dispatch-2 or bitly.com/COVID-dispatch-3 for previous installments.
Carol Clark finished nursing school and began her career in the midst of a pandemic.
Elizabeth Steger took a top position at Idaho’s largest health system, just as its hospitals — and the entire state — reached a crisis tipping point.
Trish Heath worked in nursing administration for years. When COVID-19 pushed Idaho beyond that tipping point and into a full-blown crisis, she returned to the ICU.
More people have been hospitalized in Idaho with COVID-19, admitted to intensive care units and placed on ventilators during the past three months than at any other time in the past year and a half.
The Idaho Capital Sun interviewed dozens of Idaho health care workers about what they’ve seen during this fourth surge of the coronavirus, on the front lines of the war with COVID-19.
Nurses have worked through exhaustion, threats, protests and distrust from patients and families.
Idaho is now on Day 41 of “crisis standards of care” — a framework for mass-casualty style care rationing, when the need for medical care overtakes the resources available.
For most of Idaho’s roughly 23,000 nurses, this is Day 593 of a statewide public health emergency that changed everything.
“I gotta tell you, these health care workers, they’ve had a heck of a run,” said Idaho Gov. Brad Little during an AARP Idaho town hall Tuesday.
Idaho’s nursing workforce has been changed by the pandemic.
Even as Idaho’s population grew faster than any other state’s, it lost more than 600 registered nurses from its workforce between 2018 and 2020. And another 1,000 registered nurses in Idaho were neither working nor looking for work, according to the 2020 Idaho Nursing Workforce report by the Idaho Center for Nursing.
That was in spite of increased pay over the two-year period, the report said. Statewide, hospital staff nurses made between $26.90 and $42.30 an hour in 2020, or about $56,000 to $88,000 a year at full time, according to the report. Hospitals in the Southwest and North Idaho regions offered higher pay than those in Southeast Idaho, the report showed.
Becoming a nurse in the middle of a pandemic
Carol Clark graduated in May 2021 from Northwest Nazarene University. She already had a job lined up as a float nurse for St. Luke’s Health System — a position where the hospital could “float” her from department to department as staffing needs arose.
Clark’s first float assignment was on the neurology floor in the Boise hospital, “and since then, I haven’t moved,” she said in an interview Oct. 6.
Her first day was in July, just as the coronavirus delta variant was gaining momentum in Idaho.
Clark works the night shift, starting at 7 p.m. She usually has three to five patients under her care. Some are bed-bound, some are recovering from strokes, spine surgeries or brain surgeries.
The unit isn’t a designated COVID-19 unit, but it is one of many “overflow” areas that local hospitals have turned to when their COVID-19 beds are filled. For Clark’s first month on the job, there wasn’t a single COVID-19 patient on her floor, she said.
As the surge worsened, that changed.
“I remember the first COVID patient I had,” she said. “I was always worried, do they have enough oxygen?”
The neurology floor wasn’t originally set up to monitor patients from a distance — at least, not in the way nurses have to monitor COVID-19 patients, who can go from stable to near death in a matter of minutes.
“We just have to become set up to do it,” Clark said.
The medical team takes each challenge with an attitude of, “Let’s adjust and make it work, and we come up with clever ways to fix problems,” she said. “It’s been cool to see people come together and support (each other, but at the same time) it’s tiring, because it’s just a lot more brain power.”
While this was her first job out of nursing school, it wasn’t the first time she cared for a patient. Nurses receive hands-on training and work with patients as part of their education. In school, and in her clinical training, Clark learned how certain diseases work — and their treatment and recovery process. But COVID-19 keeps throwing curve balls, she said.
Patients with COVID-19 who seem to be recovering can suddenly crash. They can throw life-threatening blood clots or lose organ function. Their blood oxygen can plummet to suffocating levels with no clear explanation.
“You’re always managing something, and it’s like, what’s going to happen? How’s this going to go?” she said. “If it’s hard for me, it’s a lot harder for my patients” to have little idea what the next day will hold.
As a night-shift nurse, she bears more responsibility for her patients, because it’s up to her to reach out to hospital physicians with questions or suggestions, Clark said.
She is learning on the job in a pandemic, during a hospital crisis, when even the most seasoned medical workers are on unfamiliar ground.
Clark said her coworkers include veteran nurses, and she relies on them to answer questions or be a second set of eyes when she feels unsure.
And she finds herself leaning more on other health care professionals outside of work, too. They understand what she sees in every 12-hour shift.
When she has COVID-19 patients who get worse and must be sent to the ICU, it is jarring to leave work and meet up with friends whose jobs aren’t as life-or-death, she said.
“It’s a difficult place to be, right in the middle,” she said.
Her advice to nursing students, or people considering the profession right now: “If you’re not passionate about it, it will not be fun. … I go to work sometimes, and I’m like, ‘Wow, if I didn’t love this, I would not want to be here right now.’”
Her advice to everyone else: “Be careful, be considerate, think about your loved ones,” she said. “I would love it if people would just ask more questions and be more aware. … Yeah, our hospital is full.”
She is a nurse, leading nurses through the unthinkable
Around the time Clark started her first nursing job, Elizabeth Steger was taking the next step in a long nursing career. She joined St. Luke’s Health System as chief nursing executive last summer.
Steger talked with the Sun on Sept. 17, the day after Idaho officially moved into a statewide crisis.
She worried that day about her nurses — about their physical, mental, emotional and spiritual health, as they confronted the very real possibility they could be forced to ration life-saving medical care.
At one point in the interview, Steger fought back tears.
“This has impacted every aspect of their life,” she said. “I talk to nurses, and they’re working 10 and 11 days of 12-hour shifts in a row.”
They’re putting in those hours because they don’t want to let down their patients and their coworkers, she said.
St. Luke’s had nearly 4,800 nurses in its workforce as of the end of 2020, according to its annual report on nursing.
“A lot of times our nurses are really put in the position of having to make some of those difficult decisions,” Steger said.
One recent example: At a St. Luke’s hospital, more than one patient needed to go to the ICU, but there was only one ICU bed left. Nurses had to decide which patient went first, Steger said. They made the right call, but it caused them “emotional turmoil,” she said.
Steger said the health system offered mental health resources to staff early on, but the pandemic took a greater toll as Idaho entered crisis standards.
“We are really ramping up our support even more right now, with chaplains (making rounds) on the units and being able to have some real-time, in-the-moment discussions,” she said. “We’re starting a peer-to-peer training, so that all of us can learn a little bit more about how to best listen, and really facilitate those conversations … (to) overcome the devastation, truly, of the pandemic.”
Nurses are so focused on their patients, the people right in front of them, and they tend to “stuff a lot down” and just try to keep going and push through, Steger said. “But it does catch up with us.”
Some nurses have retired early, she said. Some left the hospital to work in less stressful, or just different, areas. Some left to take jobs in travel nursing. Steger understands those choices, and she’s working hard to make sure St. Luke’s nurses feel valued, she said.
“I’ve been a nurse for over 30 years, and I don’t think I ever expected that I would find myself in this situation,” she said. “Thinking about not being able to really truly provide best practice to individual patients, we really are now having to shift to thinking, what’s best for our community and how do we really do the most good for the most people.”
Steger said the trauma that nurses endure is worse now. The hope brought by vaccines gave way to discouragement, as so many people didn’t take them.
“I think that that has been one of the hardest experiences of the pandemic is there’s an answer, and we’re not using it. I just, I don’t know how to be more effective in winning people over. It feels like we are at a stalemate,” she said.
Back to the bedside at St. Luke’s
Trish Heath has been a nurse for decades. But for the past 20 years, she didn’t take care of patients. She worked in administration at St. Luke’s Magic Valley.
Heath is an accreditation specialist, helping the Twin Falls hospital to navigate the process of inspections by regulatory agencies and other organizations — a process that can take anywhere from a couple of hours to four days.
But this summer and fall, COVID-19 once again engulfed the hospital that serves several counties in South Central Idaho.
St. Luke’s and other hospitals pulled doctors and nurses from their administrative jobs and outpatient clinics, to help out in the hospitals.
When the Sun interviewed Heath in mid-September — the day before Idaho moved into statewide crisis standards of care — she’d been working in the ICU for almost a month.
“The machines are different, the medications are different, and there’s so much” that has changed since Heath worked in the ICU in the 1990s, she said. “But the basic cares are still there. So I’m able to help with our COVID patients. We turn them on their bellies for a part of the day, and then turn them back up on their backs.”
Heath would go into the ICU twice a day to help with that “proning” routine that is vital to COVID-19 critical care. She would fill up medical carts. She would help bathe patients or take care of catheters.
When she worked in the ICU years ago, it was rare to see a patient hooked up to more than a few different intravenous tubes, she said.
That’s not what she sees with COVID-19 patients.
“These patients, every opening in their body has some kind of tube,” Heath said. “(Before COVID-19) that was kind of a rarity. Now, the ICU is full of these people.”
With the ICU beds full, Heath’s hospital was forced to place patients in “step-down” units “that really probably should be an ICU, but we’re not able to do that, we just don’t have the room for that.”
Other nurses in Idaho hospitals have described the same.
“The complexity of the assignment for these nurses is huge,” Heath said. “And the multiple avenues that they have to monitor for this, is just extreme sensory overload. You know, they do such a fantastic job, and I just think about how that would have stressed us out in normal times, back when I was in the ICU … and these nurses have just stepped up.”
While she continued to juggle her job in accreditation, she tried to take some of the weight that her colleagues in the ICU were carrying, she said.
“Sometimes I feel kind of guilty that I’m not able to take an assignment,” she said. “I don’t have those skills, updated to help them in that way. But at least I can take a little bit of the stress off of them. That’s my goal.”
The first week she went back into the ICU, she had to build up a tolerance for the pain she witnessed, Heath said. She toughened up her emotions, as her nursing colleagues have done, she said.
“I just never really thought I’d ever see this,” Heath said.
“I remember the days when we saw 174 patients, a census of 174. And that was like, ‘Oh, wow, we are busy.’ And now it’s well over 200,” Heath said. “And people are just still trudging along. And there’s nurses that are going into departments they’ve never worked. … I heard one (nurse) say, ‘I’m a surgery nurse. And here I am in the ICU, working away.’”
Because of her role in infection prevention at the hospital, Heath would go to conferences and hear warnings that a pandemic would eventually hit the world. For years, she heard that. And she thought, sure, “we’ll have a pandemic, I get that,” she said. “But the level of what we’re experiencing … you really couldn’t imagine it.”
As a parent and grandparent, when Heath goes to the ICU and sees “these young people” struggling to stay alive, or not surviving the disease, “it’s the hardest part,” she said.
Even those who survive and leave the hospital are “going to have lifelong issues, because the lungs take a huge hit, and they’re going to be dealing with this for a long time, if not the rest of their life,” she said.
Heath is one of many health care administrators who wonder how long Idaho nurses can keep witnessing the mass death of their patients — especially when those deaths could have been prevented by a vaccine.
The COVID-19 vaccinations seemed to be a light at the end of a long, dark tunnel, she said.
But so many Idahoans chose not to get a vaccine, and that light at the end of the tunnel? “It wasn’t even that it faded,” she said. “It just went out.”
What can you do to help?
Every health care worker the Sun interviewed said getting a COVID-19 vaccine is key. (And don’t forget a flu shot.)
For people already vaccinated, there are other ways to help, they said:
- If you’re already vaccinated, share your story with people close to you who aren’t. Explain why you chose to get the vaccine, and what your experience has been.
- Continue to wear masks indoors and in crowded outdoor areas.
- Thank a health care worker. “It is extremely encouraging to know that there are a lot of people rooting for us,” said Boise nurse Carol Clark. “Gifts or treats from a patient’s family or an organization, that’s pretty cool.”
- Get tested frequently for COVID-19, especially if you have symptoms and before spending time with people at risk of severe disease.
- If you have a medical emergency, go to the emergency room. Hospitals will not turn you away. Don’t be surprised if there is a long wait, though. Try to be patient and cooperative.
- If you get COVID-19, ask about monoclonal antibodies. Those drugs can help people at risk of hospitalization, if administered early. “If you’re even a tad bit short of breath, you need to (seek health care) early. You know, people wait until they can hardly breathe, and they come in to see us, and they go right on the ventilator,” said Trish Heath, a nurse at St. Luke’s Magic Valley. “Be proactive and contact your doctor (to see) if you need to be taken care of earlier, to keep you off the vent and out of our ICU.”