National Nurses United

As a charge nurse, Macasieb-Paat also struggles with how to best help her nurses as their patients are crashing. "When [the nurses] are all four or five knocking on the window, needing my help, there's the stress of, 'Who do I go to first?'. . . It's overwhelming," she said. There's never enough staff. It can require up to seven people, including a respiratory therapist, to flip Covid-19 patients from their stomach to their back. Meanwhile, other patients may be going downhill, and the families of those patients want to say their final words. It's tough, nurses said, to do all of the physical, cognitive, and emo- tional labor required of them, but they want families to have closure. "A patient is not just one person," Nieto emphasized, noting that even in nursing school, RNs are taught to work with families. That's why it was second nature for her to help when she heard that the wife of her colleague's dying patient wanted to say goodbye. The medical team was too busy trying to save the man's life. "My patient or not, I ran and grabbed the iPad," she said. "I told her, 'You are going to have five minutes,' and I hope I made a difference." Guiding patients and families through this new kind of death has been just one stressor during the pandemic, said nurses, combined with worries about suboptimal PPE, working short staffed, and infecting their loved ones. A family member of Sio's contracted the virus and was hospitalized for four months. She wonders whether she carried it home. To cope with it all, nurses may have work-based options, such as an employee assistance program (EAP), but when their employers haven't earned their trust over the course of the pandemic, some wonder why they should trust EAP with their private thoughts and feelings. "I don't know if anyone has used it because of confidentiality," said Macasieb-Paat. Ugarte wishes there were just more time to debrief on these difficult deaths, and finds it too hard to attend EAP sessions anyway, given the understaffing that fuels nurses' frantic schedules. Instead, she and her col- leagues have started their own monthly gathering called "tea for the soul," where hospital staff can meet for a hot drink, a snack, and a creative project. Sio vents in a group text with her coworkers, who are "like sisters and brothers." If the hospital had shown some real appreciation, that would have gone a long way toward healing, she said, pointing out that her facility made nurses feel especially disrespected by having them write an essay on why they deserved pandemic pay. She kept her mind off work by starting a business making fashionable PPE, @MaskLA on Instagram. "That's how I cope: staying occupied," said Sio. For months, Nieto did puzzles, journaled, and meditated to deal with what she was going through. For a while, that helped. Until it didn't. "I think it's all come to a head," said Nieto, who eventually began attending therapy sessions, and recently got on medication for anx- iety. She is open with her colleagues about her process because she wants other nurses to understand it's okay to get help. "I think this is something we need to talk about," said Nieto, who acknowledges nurses can feel pressure to just tough it out. Macasieb- Paat remembers a time years ago when one of her colleagues was crying, and an intensivist joked with the nurse that "ICU nurses don't cry!" "At some point, a nurse is going to break, in some way; it's just a matter of when. Part of me is waiting for that," said Macasieb-Paat, who has only cried "a handful of times" in her 23 years with Kaiser, but it's been harder to leave work at work lately—especially with no end to the pandemic in sight. "I definitely feel very proud of all of us for how we are hanging in there because there's a feeling we are in this for the long haul," said Nieto, who encourages her colleagues to show themselves the same compassion they have shown to Covid-19 patients and their families. "You don't have to suffer in silence," she said. "I was really disap- pointed in myself that I needed to get help. I heard myself saying I needed to be better at coping. I would never say that to someone else … It's not a badge of honor to suffer in silence." Kari Jones is a communications specialist for National Nurses United. Nurses anywhere in the country who are struggling can contact the Disaster Distress Helpline, 1-800-985-5990, a confidential, toll-free, multilingual, 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. For nurses in California, the Alameda County Crisis Counsel- ling Services are offering a free, confidential and non-judgmental support line for California workers in health care settings responding to Covid-19. If you would like to use these services, please call 1-510-420-3222. The Group Psycho- therapy Association of Los Angeles is also conducting free support group meetings for all California frontline healthcare staff. Visit: gpala.org/covid19 N A T I O N A L N U R S E 23 Life Support "I tear up just thinking about it because you are their only lifeline."

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