Before last year, Victoria resident Jazmin Montalvo, 38, had spent 15 years as a registered nurse in various capacities. She had seen patients with gunshot wounds, children with cancer, in operating rooms and many other in dire circumstances.
When the pandemic started, Montalvo joined Citizens Medical Center out of a sense to serve. However, about a 1½ years later she would fall to nurse burnout like so many others nationally and around the state. It’s an issue expected to become more prevalent in the year to come.
Nurse burnout had already dogged health care providers before the COVID-19 pandemic, according to the 2018 US Department of Health and Human Services’ Health Resources and Service Administration’s National Sample Survey of Registered Nurses. The pandemic made the matter even worse.
It was constant
Montalvo knew since she was in fifth grade she wanted to be a nurse, and first started in the field in one of the largest hospitals in the Rio Grande Valley, McAllen Medical Center.
“We lived close to the border, so there was a lot of cartel crime,” she said. “So I got to see a lot of that high action, high adrenaline stressful situations where I’ve lost patients doing chest compressions while taking a patient to the (operation room) on a gurney.”
She recalled days when a major accident would happen at 2 am and carry into the next day at 3 am, as well as stress of working in children’s oncology. But none of it was comparable to the constant barrage of emergencies during the COVID-19 pandemic.
“I would lose patients… but not all the time, it was once in a while, and, yes, I would see them sick, but I would see their progression and getting better and the families being receptive and being kind,” Montalvo said .
When the pandemic became an issue, Montalvo was in the middle of a yearlong hiatus from working as a nurse, a time when she focused on earning her masters degree in nursing from the University of Texas Rio Grande Valley. But with the pandemic killing scores of people, she felt she was needed and was hired at Citizens Medical Center.
“When I saw the need for nursing with all the news reports, something in me told me I had to go back. That there was no way I could in my conscience knowing I had something to give and to help, especially in our community, “she said.
However, as COVID-19 cases grew in the hospital, the challenges of the pandemic became more apparent. What nurses were asked to do changed daily as researchers learned more about the virus.
Thankfully at Citizens, the circumstances were never as dire as other areas of the country, where nurses would have to reuse masks and wear trash bags as gowns, she said.
However, the staffing challenge remained, and due to the increased number of patients from the pandemic there was no way to maintain normal nurse-to-patient ratios, she said.
Patients who got COVID-19 would get sick fast, she said. Oftentimes, the conditions made it difficult to eat and difficult to go to the bathroom without help because of how weak the disease left people.
Often, patients would get worse and enter the Intensive Care Unit. Because of the way information is share in a hospital, she would be left wondering what will happen to her patients – only to see their obituary published, confirming her worst fear, she said.
While this was challenging it would be the misinformation about COVID-19, how it affected the patients and how the long days in that environment affected how she interacted with her family that would drive her over the burnout edge.
Misinformation and family
“It was hard when patients started not trusting us,” she said. That’s when unfounded blame began to shift to health care workers.
Families started calling and blaming health care workers for them being sick, patients telling them they were fine, making a bigger deal than it was, and patients screaming and yelling at the nurses who were taking care of them, she said.
“At that point, that’s when I just couldn’t do it anymore,” she said.
Montalvo recalled how at the end of her shifts she couldn’t hug her three daughters when she got home, as she would have to first enter their garage, use Lysol on herself, take off all her clothes and shoes, use Lysol further on her hands and then come into the house, where her children would be waiting to greet her, but not touch her, through their laundry room.
She would still have to shower to make sure she didn’t spread it to them, she said. “It hurt,” Montalvo said. “After working 12-13 hours, they were what would make me feel better and I couldn’t even hug them as soon as I walked in.”
The combination of that, plus everything at work from how some patients were treating her – with patients denying they even had COVID-19 despite being on oxygen – she submitted her resignation in October 2021, two months after completing her masters in nursing from UTRGV.
Toward the end, it became particularly hard for her, as those who were hospitalized were the younger population who hadn’t been vaccinated due to misinformation, people around her age, she said.
At this point, toward the end of her time at Citizens, Montalvo’s husband noted her mood had changed; she was depressed and moody, she said.
“It went from ‘I hope we don’t loss any patients,’ to ‘I wonder how many we are going to loss today,’ and I never, in my time as nurse, had to think of it that way,” she said.
Nationally and at the state level, nurse burn out isn’t anything new, but the pandemic compounded the problem further as the Texas Department of State Health Services was already projecting an inability to meet nursing levels, said Megan Rogers, University of Texas at Arlington clinical assistant professor who previously worked on the topic of nurse burnout.
Montalvo isn’t alone in this, as many nurses, including those just entering the work forces, are leaving the field entirely, Rogers said. And it looks like it will get worse, as by the end of the year nearly a third of nurses plan to quit their jobs, with 44% of that group citing burnout as the cause, according to a survey done by Incredible Health, a health jobs platform.
“A lot of individuals in hospitals are referring to it as the new pandemic because it is crisis level,” Rogers said. “We were understaffed as a profession before all this started and so this is just worsening what was already a difficult from a workforce perspective.”
Texas in particular was one the states with the highest rates of burnout before the pandemic, according to HRSA’s 2018 national nurse survey.
Many hospital administrators have taken steps to address burnout, but it’s difficult to catch up at this point, with many nurses suffering from symptoms of post-traumatic stress disorder, she said.
Some other symptoms include depression, anxiety and disconnection, she said.
Like Montalvo, many nurses face the results of misinformation spreading through the public because they are not able to get in front of it and feel the patients end up taking that confusion out on nurses, Rogers said.
“Stress that our nurses are under is really devastating,” she said. “We’ve had more students than I’ve ever seen in my career change professions after a year of being in the workforce and turning around and saying, ‘Not for me, this is not what I signed up for,’ when they were in nursing school before the pandemic. “
Many health care providers in Texas are trying to fight the nursing shortage by offering sign-on bonuses and some engaging in apprenticeship-like programs with nursing students while they are in school, she said. Which is unique as it has been 15-plus years since the industry has recruited new graduate nurses.
Which offers it’s own financial risk for hospitals, which could lose out on time and effort put into training nurses on the job. This can cost as much as $ 50,000, she said. However it is a risk that is necessary, as there aren’t many experienced nurses available.
UTA is the largest nursing program in Texas and has partnered with rural areas such as the Crossroads to place students in clinical situations, Rogers said. The university has about 10 students placed in area hospitals. Even these placements come with challenges.
“It kind of has a domino effect where these nurses are being challenged to do more and different things,” Rogers said.
A lot of these students have been really inspiring, because they feel called now more than ever as they did their learning during the pandemic.
As for Montalvo, she found peace following a similar path to one of her idols, Mexican artist Frida Kahlo, who went from being a medical student to an artist.
During the pandemic, Montalvo took up craft making as a way of channeling her emotions after her shifts, she said. Over time, her husband and family helped facilitate that growing passion so she could find her peace after having gone through burnout over the pandemic. She now makes and sells her crafts through social media and brick and mortar stores under the name Frida Bae Co.
Now she gets to work in her shed with portraits of Frida Kahlo on the wall, while watching her daughters play in the backyard, she said.
Montalvo said she realized she was privileged to be able to transition the way she did, as there are many nurses who can’t quit that are experiencing the same things she did.
There are lobbying efforts by the Texas Nursing Association and the American Nursing Association to address nursing staff shortages, which is a contributing cause to burnout, but there are things that can be done to help address this crisis, Rogers said.
Rogers encouraged health care administrators to normalize seeking mental health and investing in it without gaslighting nurses with toxic positivity with mixed message statements such as “You are so resilient, look how good you are.”
Having discussion with nurses and providing resources beyond general employee assistance would be areas that could prevent burnout, she said.
On the legislative side efforts to establish standards like other health care areas, such as Neonatal Intensive Care Units, for safe staffing would go a long way as there is currently a standard set for safe staffing for ratios of nurses to patients as the need can vary by the area the nurse is working in, Rogers said.
“The real problem with this is that nurse-patient ratio isn’t always reported, because there is research that links nurse to patient ratios to patient safety and poor patient outcomes,” she said.
There is national data to glean from, but on the state side, that information is lacking as to what is needed. It can vary from national data.
“We’re very far off at the moment, but we also don’t have the data for what it’s going to take, that’s the challenge,” she said.
As for those dealing with burnout right now, Rogers encourages them to remember what got them into nursing.
“It is OK to not be OK,” Rogers said. “We see you, we are trying to advocate for you and I encourage our nursing workforce to stay very close to their purpose and remember why they are called to serve. There will be tough days, but we all in our hearts came to take care of people. “