Brooklyn Alm remembers the sweat pouring from her face working in the orange zone.

The nurse said it felt like 100 degrees in that portion of the old IU Health Bloomington Hospital, as she and a team of nurses moved from patient to patient all sick with a virus that was spreading across the globe. She was in her usual hospital getup, except this time she was also outfitted with a N95 mask and a surgical mask over the top, along with a gown, a face shield or eye goggles, and a hair cap.

This section of the hospital was dedicated to COVID-19 patients and those showing symptoms of the virus. She remembers the constant change in guidelines for nurses, as confusion spread rapidly throughout not only the hospitals but the country. One day gowns could be kept on during the work day. The next, they had to be switched out as nurses visited each and every room.

“It was like hell being over there,” Alm said.

In December 2021, Alm and her boyfriend Robert Lowry, who is also a nurse, decided to leave their job at the Bloomington hospital after facing burnout and exhaustion from the relentless nature of the pandemic. They now live and work in Texas as travel nurses and used the time off between the job switch to briefly step away from the stressors within the hospital.

As the COVID-19 pandemic has battered America, nurses are desperately seeking a change of scenery. Many of them are even giving up the roles that once brought them so much joy.

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IU Health Bloomington Hospital is one of many hospitals across the country that has seen change among its staff, as nurses lament over the devastation of the coronavirus pandemic which has pushed several of them to the brink. They have dealt with everything from rising case numbers, abuse from patients and fast-paced shifts, all leading to burnout and exhaustion.

Some switched hospital roles, moved to other departments, took significant time off or have even left the profession altogether.

According to a 2021 article from Morning Consult, a company which evaluates data and business trends, nearly one in five healthcare workers have quit their jobs during the pandemic. For those healthcare workers who remain in their positions, 31% of them have considered leaving the profession, according to the article. As more nurses and other healthcare workers leave, staffing shortages in hospitals can worsen.

According to a blog post from the University of St. Augustine for Health Sciences, the U.S. is currently experiencing a nursing shortage which is expected to continue through 2030. As demand for more nurses rises, projections provided in the blog show that by 2030, in California for example, demand will outpace supply by over 40,000 nurses. These numbers wax and wane depending on the state, but they show a bleak future for an already depleted nursing workforce, especially as the country continues navigating new COVID-19 variants and pandemic complications.

Since the pandemic began in 2020, the United States has recorded more than 975,000 deaths and almost 80,000,000 cases, according to the Centers for Disease Control and Prevention. In Monroe County, there have been over 270 deaths and more than 27,000 cases, according to the Indiana COVID-19 dashboard

One of the recent COVID-19 variants, Omicron, recently inundated the Bloomington healthcare workforce with a new record high number of cases and hospitalizations in January of 2022. Even though those numbers have now significantly lowered and Indiana’s public health emergency has expired, the exhaustion and emotionally taxing nature of the pandemic persists.

Alm said her mother will tell people a story where a young Alm was watching television and a St. Jude commercial flashed across the screen. Alm doesn’t remember this moment, but she said her mother recalls her announcing she wanted to be a cancer doctor that day, the first inkling of Alm’s future in the medical field.

Alm personally said she remembers being pulled toward the medical field starting once her father was involved in an accident when she was young. He had broken his back and needed to spend a significant amount of time in the hospital. She remembers the nurses being the ones who really connected with her father, making his time at the hospital a more bearable experience.

“It was the nurses at the bedside that really mattered,” Alm said.

When she was deciding how she would spend her future career, Alm remembered this moment and knew she wanted to be a nurse. She received her bachelor’s degree in nursing from IU and took a capstone her senior year focusing on the Emergency Room department. Spending most of her senior year in the Bloomington ER, she fell in love with the practice and never looked back. She was hired right out of college and worked at the Bloomington ER up until December 2021.

Unbeknownst to her upon entering the nursing industry, the pandemic would consume her career in the hospital’s ER department.

Before her work began each day, she would make her ritualized trip to Starbucks around 7 p.m., grabbing a much-needed iced dirty chai, double shot, with nonfat milk and vanilla. Both she and her Lowry worked the night shift at the Bloomington hospital, and they liked to get to the hospital early. After arriving, she would scan the ER department, mentally preparing for the day by noting the number of patients in the waiting room and the number of nurses she could visibly see just standing.

Once she arrived at the break room, she filled her pockets with necessities, including things like pens, trauma shears and Coban, what she and Lowry call the duct tape of the nursing world. By the end of her shift, she said her pockets are usually full of random items picked up throughout the day.

Once her shift began, she would head to what she called the huddle room where the charge nurse gave an update about the state of the ER department. This includes everything from the number of beds available, number of patients and how many people are on staff.

“Basically, how fucked you are for the shift,” Alm said.

She also would check the staffing grid, where she analyzed what rooms she would be taking care of that night along with what other nurses would be on her team. Day shift nurses would begin to let their patients know they were leaving and introduce Alm as the nurse for the nighttime, updating her about their condition and any other important details.

From that point on, she focuses on the patient’s ABC’s: airway, breathing and circulation, prioritizing patients by who needs the most care at the moment. Alm then locks in for the long haul.

Once she had her assignments, she became entrenched in a cycle of meeting new patients, checking on ones already admitted and holding down the hospital ER with her co-workers during a pandemic. These 12 hours came with little to no down time due to the fast-paced nature of the work. Alm and Lowry said their co-workers and they were lucky if they got five minutes to scarf down pizza from Aver’s or Domino’s.

Alm repeated this process three times a week, for a combined total of 36 hours. Due to staffing shortages, the last 15 weeks of 2021 turned into 48-hour weeks with four shifts, she said. Alm said sometimes the shift would turn from 12 hours into possibly 16 hours depending on the state of the hospital.

“On day four of the week, you get a triple shot,” Alm joked about her coffee order.

Alm and Lowry sometimes went to Runcible Spoon with some of their co-workers after shift, relaxing with a nice breakfast after a long and exhausting day at work.

“I genuinely think talking about your shift instead of just going home alone,” she paused. “Like, you sleep better.”

Alm has been a nurse for about three years now working in the ER, and she said the morale in the hospital has been very low during the pandemic.

“We have staff members that are out sick,” she said. “We're working extra. We're just at our wits' ends. It doesn't seem like this is ever going to end which is really difficult.”

When hospitals overflowed with patients, nurses who had already reached their limits had also been attacked and criticized due to a political battle over a vaccine many have chosen not to take. According to the CDC and health experts across the country, the COVID-19 vaccine is a safe and effective way of protecting oneself from the coronavirus. Regardless of what doctors have repeatedly recommended, political divisions over this shot have heightened tensions in the hospital.

Alm has personally struggled with handling unvaccinated patients, who have yelled, attacked and emotionally drained her throughout her work.

Alm said she did not become a nurse to judge people, and she will care for anyone regardless of who they are, but the abuse from patients has taken a toll. Patients, usually those who are unvaccinated, have been particularly abusive during the pandemic as they refuse to wear masks, to acknowledge the severity of COVID-19 or to be conscientious of the health and safety of those in the hospital, she said.

When Alm worked at the former Bloomington hospital, she recalls a patient arriving at the hospital for a non-COVID-19 related issue. Since the hospital had a policy that everyone must be tested for the coronavirus, the patient was tested and the result came back positive. The patient then proceeded to purposely cough directly on Alm once she told them the results.

Nurses have also faced complaints about wait times, which skyrocketed during the pandemic as hospitals work with fewer nurses and more patients.

Alm said people don’t always recognize that nurses are humans too, just trying to do their best and get people through the hospital as quickly as possible. People don’t understand when they enter the ER, patients are not seen on a first-come, first-served basis, she said. Nurses are trained to evaluate everyone in the ER as a whole, and they sometimes have to move those who are in need of more immediate care to the front of the waiting list.

“We're trained as nurses to take your vital signs and look at you as a whole and recognize when you were actually dying,” Alm said.

Lowry said he recognizes it can be difficult to sit there and wait, especially if you are in pain, but everyone needs to receive treatment, some quicker than others.

“If I am not in your room, that’s a good thing,” Lowry said. “It means you’re not dying.”

During the winter months in 2020, Lowry estimated that he would see between one and five COVID-19 cases during his shifts. He said with the Omicron variant and the large uptick in cases and hospitalizations around December 2021, he was surprised if someone came to the hospital and their COVID-19 test would return negative.

Lowry said nurses are struggling with shortages in the hospitals when these waves of variant cases hit and the hospital receives a higher influx of patients, which has become a consistent pattern. Lowry said a fully staffed ER at the old Bloomington hospital was around nine nurses. Due to COVID-19 and a shrinking workforce, he remembers nights where there would be only six nurses working.

Lowry said the typical number is four patients to a nurse, but numbers sometimes rose to around six patients for him some nights.

Margie Clouse has navigated the pandemic in multiple positions, working as a flight nurse, ground paramedic and an ER nurse.

Like Alm and Lowry, Clouse has been in the thick of the pandemic. She has seen it from varying angles and shares many of the feelings Alm and Lowry experienced. It is difficult for her to speak about her job without shedding tears.

“We have seen the worst,” Clouse said.

Clouse said in the beginning of the pandemic it was difficult as patients had little to no contact with their families while trying to fight off COVID-19. She remembers speaking with her mom, who she limited contact with because Clouse spent most of her work day surrounded by sick patients.

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Her mom didn’t understand at first why Clouse wouldn’t come to visit her, even as Clouse explained to her mother if she gave her COVID-19 there was a likelihood she would be put on a ventilator due to her respiratory issues.

Clouse called her mother one night and told her a story about one of her patients. The patient was brought into the hospital, not articulating full sentences because they were struggling to breathe. The patient was alone with no family by their side due to hospital precautions. Clouse said she took care of the patient, but they died within just a few hours after leaving her care.

Clouse sat on the phone pleading with her mother.

“She had nobody with her to hold her hand other than a nurse she had never met before,” Clouse said. “So that's whenever I call my mom and I'm like, ‘This is what I've been trying to tell you. I don't want to be the reason that you're on a ventilator. I don't want to be the reason that you don't go home.’”

Hospitals have begun letting people see their loved ones now while receiving treatment, but new challenges have arisen with each new wave.

“We’re tired. We’re really, really tired,” she said. “It’s almost like we don’t know if there is ever going to be an end to this COVID.”

She said she feels much of the nursing workforce has become hardened in some respects, having spent the last few years watching patients suffer from this virus.

Clouse often hears nurses around her questioning why they chose this field amidst the chaos in the hospitals, even though they are making a significant difference in people’s lives.

Clouse said she knows other healthcare workers who have reached breaking points, and she has seen doctors step outside and take time to cry during difficult shifts.

She said everyone in the hospital has been put on edge, and amazing nurses she has known are leaving the healthcare industry because of the emotional toll of the pandemic.

Clouse, like other nurses during the pandemic, has seen and faced abuse from patients, once having a catheter thrown at her face because she was discharging someone who didn’t want to leave.

Clouse once saw a patient who was furious he had not received his medication, even though other nurses were scrambling to help someone who was going into cardiac arrest. The nurse had apologized for the wait time and told the patient they were attending to someone in need of all the nurses.

“I don’t care,” Clouse remembers the patient saying. “My pain medication is more important.”

Clouse recently dropped down to part-time for on-floor work in the ER department, as the hateful words and actions she has seen while working shifts have been emotionally damaging. Stepping away from working on the floor has allowed her to pursue a leadership role and given her time to focus on other health programs within the hospital she is passionate about.

Becca Tucker, an intensive care unit shift coordinator at the IU Health Bloomington Hospital, has watched patients move in and out of her floor of the hospital, fighting for their lives against a virus the country continues to battle to this day.

She remembers the death counts being especially high during the spring and the summer of 2021.

She said ICU nurses are used to dealing with death in the hospitals, but especially for those who are new nurses, the death totals have been a lot to deal with. One of the most difficult aspects of the pandemic though she said was when families would choose to keep loved ones alive, even though it was clear they were suffering. She said it felt like nurses were torturing these patients.

“These are the sickest patients that any of us have ever cared for,” Tucker said.

To give nurses a space to relax and share their thoughts and feelings, IU Health Bloomington has a hospital support group called Compassion Circles. Tucker said nurses can show up and talk about how the pandemic is impacting them or anything else in their life. The meetings are led by a social worker as well as a chaplain much of the time. Nurses learn coping strategies there to deal with the emotional tolls of the pandemic and also have a chance to speak with fellow healthcare workers who are all sharing the same experience.

Tucker said she is grateful for this time, as she has rarely had time for more informal conversations with other nurses during her shifts in the pandemic.

She said once COVID-19 numbers would drop, surgery numbers would then pick back up because of how many had to be put on hold. Patients who had the virus would still have to be in the hospital too as many faced post-COVID-19 issues.

“For so long, we just had no relief at all,” Tucker said.

Recent Monroe County numbers show a much brighter future for the country and for healthcare workers, with COVID-19 cases dropping to under 100 a week after reaching 2,000 in January. These numbers have given healthcare workers a much needed breath of fresh air.

Although cases have dropped, there is always concern of the next variant, which can unleash a whole new whirlwind of complications and unpredictable outcomes.

As she and Lowry begin their nursing contracts in Texas, Alm said she has accepted that COVID-19, similar to the flu, will most likely be a part of the rest of her nursing career.

She said some of the most difficult moments throughout this pandemic amount to feeling helpless against the coronavirus. Patients would keep coming through the doors, and she began to question if she was even making a difference.

She understands the urge to leave the profession behind, especially when mental health takes a toll.

Alm and Lowry’s switch to travel nursing gave them a chance to take a break and recharge after two years spent battling the coronavirus. The couple used the down time as an opportunity to explore nature, having recently visited Hocking Hills in Ohio.

“It's been a huge blessing to have this time off between jobs and enjoy nature and kind of heal from a lot of the burnout, recharge before we dive headfirst again,” Alm said.

Margie Clouse thinks the lasting impact will be the fear that the next variant or next virus is just around the corner. She thinks it will permanently remain in the back of the minds of nurses for a long time to come.

“There is going to be that constant fear as to whether or not it is going to come back,” Clouse said. “I think we’re all going to be living on edge for a really long time.”

Clouse and Tucker both find solace in being with family and in the little moments amid the stress of the hospital. Whether it's walking their dogs, listening to music in the car before shifts or going for a swim, these nurses find ways to relieve stress outside of their shifts.

Before Clouse’s shift each morning, she remembers to kiss her husband and her son on the forehead. She texts her daughter too, reminding her each day that she loves her. As she gets ready to leave, she remembers the risks her job brings as she walks out the door.

The devastation and unrelenting exhaustion won’t leave nurses for a long time, even after the world starts to forget about the coronavirus. Cases may have dropped, mandates may have dissipated and people may throw away the masks, but the emotional and physical impact will always remain.