In December 2020, to the tune of rousing cheers, the first health care workers began getting vaccinated against Covid-19. A year later, the cheers have died down, vaccination rates have plateaued, and the Omicron wave has hit the U.S. with one million daily cases registered during the first week of January 2022. Yet despite the hard work and sacrifices of health care workers, many of them haven’t seen pay raises.
As 2022 begins with another wave of infections, it remains imperative to shine a light on working conditions in health care in general, and in intensive care units in particular.
The Delta wave overstretched ICUs across the country, and ICU workers are now facing the onslaught of the Omicron variant with higher patient care loads, demanding work schedules, sick staff members, and a rapidly shifting set of protocols around testing. Amid this ongoing uncertainty, one thing remains clear: Workers are tired and toiling beyond their limits. Many are leaving the profession and signing travel contracts. Those who stay work in hospitals fractured by staff shortages as their colleagues test positive. In this context, workers need to be paid in wages, not platitudes.
As a medical anthropologist, I study the social dimensions of health care work. Along with several physician researchers, I’ve spent the pandemic studying the lives and labors of workers in intensive care units, including the extraordinary challenges they now face and how they meet them.
When we interview an ICU nurse, doctor, or other medical professional, we begin by asking: “How have things been lately?” The answers vary, but there are common themes of groundlessness, exhaustion, and invisibility. Workers sometimes, but not always, call it burnout, and use this term in different ways. They may echo public accounts of health care workers describing themselves as charred wood.
But just as often they describe the uncertain work environments that lead to these feelings. ICU workers describe both themselves and their workplaces as being in distress. Some believe that burnout narratives let institutions off the hook too easily and, in a cruel twist, render invisible workers’ needs for better compensation.
During the pandemic, health care work has radically changed on many fronts, with new forms of work arrangements and new care protocols. ICUs with a stable cadre of nurses before the pandemic now see their daily rosters filled with travel nurses or workers “repurposed” from different jobs, who often do the same work as the regular staff but for higher pay. Staff members who may have worked together for years now find their workspaces unrecognizable, owing to many new faces. Critical care is team-based medicine, and with the rise of travel nursing, its workers must now constantly relearn each others’ strengths and limitations. With ever more workers sick, teams are being even further stretched and divided.
Early in the pandemic, a primary institutional response was to invest in the superhuman figure of the health care worker and to affirm those workers’ innate resilience. This response summoned individual and collective will amid profound uncertainty. In early 2020, as the pandemic took hold across the U.S., health care labor was heralded for months — free pizza, handmade posters, ribbons on highway overpasses. We called them heroes and championed the workers. But in the process, perhaps there has been a collective failure to adequately grapple with the realities of the work itself.
Nearly two years later, there may be some appeal in shining a light on burned-out ICU workers. This is important because it can reveal the vast mental health challenges health care professionals face, including post-traumatic stress disorder. But there must also be a reckoning with the everyday challenges of ICU work at present and their costs: The distress of caring for unvaccinated patients. The stark inequalities in pay. The fact that ICU workers have been working continuously without breaks, and facing tragic situations repeatedly. The ethical end-of-life dilemmas that must be negotiated with families who may be allowed to see their loved ones only in the moments before death takes hold. Hospital CEOs have raised the alarm in newspaper ads, but the physical and emotional tolls of critical care labor deserve a better spotlight. So do workers’ concerns about working while sick that are intensifying during the Omicron wave. It is one thing for health care leaders to implore the public to get vaccinated in order to avoid strain on hospitals; it is another to listen to workers and meet their needs. Both are necessary to sustain care.
Health care institutions have struggled to manage the mental health and morale of their workers. Banners and mugs affirming resilience do little to address the mass exodus of workers, or the complexities introduced when veteran ICU workers depart. Incremental pay raises and sign-up bonuses are laudable places to start, but they are often applied unevenly to specific categories of workers and not to the entire staff of a unit. This can create friction about workers’ perceived value precisely at a moment when that value feels degraded.
This is, indeed, a matter of burnout and moral distress. But it is distress at a structural scale, with labor at its base. Many workers feel something more than being pushed beyond their limits as individuals. Many feel their profession is on fire and the world is silently watching. Addressing moral distress requires a structural intervention, including first and foremost better compensation and safe working environments.
This calamity demands public discussions about the value of health care work. What sorts of compensation are workers receiving for working beyond their limits? How are they experiencing the constant transformations of their work? What message is being sent when large numbers of professionals leave the medical workforce? What kinds of demands are workers facing as many more of them get sick? How are healthcare institutions meeting the needs of those who sustain their work amid widespread shortages? How can hospitals integrate new care workers under unprecedented conditions of strain and turmoil?
Health care workers in short-staffed ICUs do not need labels of heroism and burnout or free pizza. They need fair wages, policies that sustain safe workplaces, and a public understanding that their work cannot be taken for granted.
Harris Solomon is an associate professor of cultural anthropology and global health at Duke University.
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