New York nurses endured COVID's darkest days. Now, they spoke to us about lessons learned
- Nurses who first shared their COVID accounts in 2021 have since seen their lives and jobs forever changed.
- Their stories, in many ways, embody America's ongoing struggle to process the mental and physical trauma of the pandemic.
A quiet stairwell inside Unity Hospital near Rochester, New York, embodied the pandemic trauma that gripped Kendall Piccirilli, whose first day as a nurse came just weeks after COVID-19 struck in 2020.
When the job quickly got overwhelming, she would sit alone there and cry. Her feelings of helplessness seeded doubt about becoming a nurse. Imposter syndrome seemed destined to derail her career before it started.
But Piccirilli, like thousands of nurses in New York, endured to keep working despite all the unknowns and death. She has since risen to become a nurse clinical leader, the hard-earned promotion forged in those harrowing early days.
“That made me stronger — those challenges — and I look back and the things that made me cry in that stairwell as a new nurse wouldn’t touch me now,” Piccirilli, now 27, recalled recently.
Her pandemic odyssey, in many ways, was shared by nurses across the country. They persevered through unthinkable barriers that forever changed their jobs and lives — in ways that will reveal themselves for generations to come.
A team of Paste BN Network reporters explored this historic era through interviews with a dozen nurses in New York, following many of their stories from the grim waves of infection in 2020 and 2021 to the precarious transition to a post-pandemic world today.
The years-long investigation revealed how pandemic burnout, trauma and the staffing crisis still plaguing New York's health system led thousands of nurses to quit or retire. These exclusive frontline accounts also underscored why about a third of nurses nationally plan to leave the field due to the pandemic.
Read the initial investigation: How New York nurses viewed COVID fight in 2021
Yet some nurses who kept working in New York also posed a crucial question: When will all the systemic flaws in American medicine laid bare by this global catastrophe get addressed?
"Nurses don’t want to walk away from the job," said Nancy Hagans, a Brooklyn-based nurse and president of the New York State Nurses Association union representing more than 42,000 nurses statewide.
"They are walking away from the profession and from the poor working conditions," she added, "And we can’t just do a little bit to fix it; we have to look at the whole system from the pay parity from upstate to downstate to patient-to-nurse ratios at every hospital."
A nurse committed to the community
Sheila Conley’s 40-year nursing career almost ended in 2021 as she considered joining scores of colleagues leaving their jobs at St. Elizabeth Medical Center in Utica, New York.
Ultimately, she chose to weather the pandemic storm. Nursing still delivered her moments of joy and a livelihood in the place she made home, despite all the frustration and stress plaguing the profession.
But the decision left Conley, now 61, to face another challenge as her hospital — and many others across upstate New York — struggles to replace the thousands of nursing jobs shed since 2020.
About 100 travel nurses have currently plugged staffing holes at St. Elizabeth, Conley said, but the threat of those temporary contracts ending in the coming months and years without permanent workers in place looms large.
“It doesn’t help us in the long-run,” she added,” we need people who are committed to the community.”
Immediate concerns about insufficient nurse-to-patient ratios also remain an issue at St. Elizabeth and other hospitals, despite the travel nurses.
“Sometimes we don’t have the extra time to spend with the patient who might need more education on their diagnosis,” Conley said. “Sometimes we don’t have the time to be able to provide that human element to the job."
Yet that humanity, in some ways, is key to recruiting and retaining new nurses, a realization Conley often shares with new colleagues.
“It’s a people business and you want to care for people and make their lives better in some way, however small that be,” Conley said.
Amid the pandemic, Conley’s connection with the job was rekindled by a thank-you note. It came from a family of a dying patient, after Conley helped them navigate pandemic visitor restrictions to allow their elderly patriarch to say good-bye to his wife at the bedside.
“It was beyond unbelievable and if you hadn’t gone through it, you don’t understand it,” Conley recalled of the real-world toll of measures intended to limit the spread of COVID-19.
But now Conley is cautiously optimistic about the future with the virus in retreat and billions of dollars in state and federal funding flowing to health care workforce stabilization efforts.
“It was frightening for patients and families and for the nurses,” she said, “We didn’t know what was going to happen, and it’s nice to hopefully have some of that behind us.”
'They have stopped fighting' - challenges of understaffing
Amy Purpura Smith raced down a hospital hallway to reach a patient struggling to breathe during the pandemic. Each doorway she passed brought cries for help from other patients in urgent need of a nurse.
"Please change my diaper. Please take me to the bathroom. Please feed me."
But Smith couldn’t help them all immediately, she recalled recently. The lifesaving care came first while the others waited, a heart-wrenching triage all too common during Smith’s nearly three decades working as a nurse in understaffed hospitals in New York.
“The nursing crisis is not just about nurse staffing,” she said, “it’s also a crisis of not enough aides, not enough transporters. It’s everybody who helps nurses.”
Yet for the first time, Smith now knows what having enough staff feels like.
She switched from her myriad jobs in emergency rooms and overburdened wards at New York City-area hospitals to a well-staffed ambulatory surgery gig at St. John’s Riverside Hospital in Yonkers in 2021.
“Having enough staff means being able to leave at the end of the day having run the whole time, but knowing we’ve done a good job,” she said.
Despite the newfound glimmer of hope, however, Smith still doubts New York’s hospital system, in general, will live up to the promises of a 2021 state law requiring health care staffing minimums.
Her skepticism is rooted in the disheartened faces of her countless fellow union members still working in understaffed wards.
“Some nurses have just become like they have battered-wife syndrome, and they don’t say anything,” she said. “They have stopped fighting because this has gone on for years.”
Still, a pivotal moment is approaching as regulators and mediators begin enforcing the staffing minimum law, including potential fines for noncompliant hospitals.
But the true test, Smith asserted, will come in the form of accountability for lawmakers, who must consider additional measures to restore the pandemic-battered health workforce.
“This is a public health crisis and nursing has to be a sustainable profession,” she said, noting some nurses must work nearly 40 years without robust pension benefits before considering retirement.
“We run eight miles a day and lift patients that weigh hundreds of pounds ourselves,” Smith added. “We should have the same benefits as police and firefighters.”
Gender differences between nurse and public safety workers, Smith added, potentially contributed to the professional disparity.
“We are generally women, and we haven’t stuck up for ourselves like the guys have,” she said.
The pandemic, however, exposed harrowing working conditions inside many hospitals, contributing to recent union contract wins at some hospitals, as well as legislative reforms focused on improving educational opportunities and wages in health care.
For Smith, though, the pandemic-related progress for nurses and her first nursing job with sufficient staffing levels also seemed long overdue.
“You shouldn’t have to wait 27 years to be able to have that,” she said.
Not ready for 'Sardine City'
It is late May 2023, and Elise Steffens is sitting in a big room in Fishkill with about 120 people whose jobs put them on the front lines of emergency management.
“I was the only one in there with a mask,” she said. “And I'm OK with that.”
It is February 2023. Steffens, who manages the Emergency Department at St. Anthony’s Community Hospital in Warwick, New York, made her first outing to a restaurant. It was just about three years after COVID first arrived in New York. And it was Olive Garden in Middletown.
“We went at like 2 in the afternoon: after lunch, before dinner. Asked for a table in a corner, where there was nobody. I needed … I wanted to try it. But I knew that if there were too many people, I wouldn't be able to do it. So we did it and it was OK.”
She can count on one hand the number of times she’s been out to eat since.
“If the restaurant's very crowded and if there's a long line, I'll be picking a different one,” she said.
It is September 2022, and Steffens is taking her first “vacation” in 30 months, flying to Detroit to see her son and daughter-in-law.
“Yes, I flew with a mask. And yes, I flew with an N95,” she said. “If you think that I was a little nuts, I booked a first class ticket and I sat in the first seat, A-1. I was still really not quite sure of how far I wanted to be in the airplane."
Having come out the other side of the pandemic, Steffens looks at things differently. Crowds unnerve her.
“The thought of going back to sardine city. Not yet,” she said. “I'm working on it.”
There’s a reason for her wariness, she said, a reason that has everything to say about what she and her staff — five nurses and two technicians, working 12-hour shifts — have been through. You don’t just flip a switch. Not if you’re Elise Steffens, a Brooklyn native who was at Ground Zero, and whose husband at the time, an EMT, was missing there for 16 hours.
She has lost staff, worked with travel nurses and is now back to full permanent staff in the St. Anthony's Emergency Department. She works in the same office, with much of the same staff, in the same emergency department where too many lives were lost. It's impossible not to be changed by that.
She is not who she was three Februarys ago.
“Society is a 'me society.' And 'It doesn't matter. I'll do what I want, no matter what the outcome is' kind of thing. I protected myself, I protected my staff, I protected my family throughout COVID and I just incidentally, don't want to wind up in a situation."
New environment, no more flashbacks
Liya Robin has a new job in a new state. She and her husband moved in April and she’s working as a nurse on an acute-care neurology floor at Houston Methodist, part of Texas Medical Center, the largest medical complex in the world.
It’s a huge change from a community hospital in Yonkers and one Robin has fully embraced.
It helps her look forward, not backward.
“I don’t have those flashbacks,” the 35-year-old said. “When I was at St. John’s it was real.”
When the pandemic hit, Robin was working as a respiratory nurse on a 22-bed medical-surgical/respiratory floor at St. John’s Riverside Hospital in Yonkers. The metropolitan area soon became ground zero for COVID cases. Spring 2020, Robin said, felt like a never-ending cycle of calls to intubate patients, transport them to the ICU and then find out that they had succumbed to the virus.
But with the fresh start in Texas, Robin now expresses excitement about her family’s future. Her husband, Robin Mathai, is preparing to take respiratory therapy licensing exams.
Their son, Ryan, now 7, is still staying with her parents in India, as he had done during the pandemic to keep him safe and supported. They are getting settled in Houston and the couple are preparing for his transition to Texas. It’s exciting for them, she said, but will be a bit of a culture shock for Ryan. In their Houston suburban neighborhood, she said, “There’s a horse in every backyard.”
Liya Robin plans more big changes for herself, too. In 2021, amid the chaos of COVID, Robin completed a master’s degree as a family nurse practitioner at Dominican College in Blauvelt. Then, she decided to wait to make the transition to a new career because hospital nurses were so needed.
Now, she said, “I’m looking for an NP position.”
And, Robin said, she’s again found the positive person she had always been, and the “moral distress” she said COVID brought has nearly faded away.
“Overall the move helped me to change,” Robin said. “And it’s been a positive change. I’m loving my job.”
'In marginalized communities there are differences'
Everything changed for Flo Leighton, a psychiatric nurse practitioner and instructor at NYU and Pace University, after her older sister died of COVID in May 2020.
In some ways, the loss of the oldest of her eight close-knit siblings, Maria “Bambi” Roaquin, to the respiratory illness came at the pivot point of the pandemic era for many Americans.
“(Roaquin) died the day before George Floyd was killed,” Leighton recalled recently. It built up, she said, with “Bambi passing away and this awaking that I had around racism and how that plays into healthcare.”
Leighton saw how the killings of Floyd and Breonna Taylor and the Black Lives Matter movement opened people to getting more support. But, Leighton also realized she was part of a system that was inaccessible to so many people who lacked the financial resources and understanding of a complicated healthcare system that can create barriers to care.
“My sister immigrated here from Philippines,” said Leighton, 17 years Roaquin’s junior. “In marginalized communities there are differences.”
Amid the awakening and loss of her sister, Leighton also decided to pack up and move to Maine in spring 2021. She’s still there.
“I love it here,” Leighton said in late May. “I have zero regrets.”
She bought a house in her little city of Biddeford and has been appointed by the mayor to the city council’s diversity equity and inclusion committee. Leighton continues her remote practice but has cut back some. Her son just graduated from SUNY Delhi and she’s finding fewer reasons to run back to New York for errands and visits.
Leighton is excited about her work on her city’s DEI initiatives. And she’s trying other new ways to support people.
Leighton also joined Two Maine Mermaids as an “ocean dipper,” offering support for one’s first coldwater dip into the Atlantic. The 45-year-old enthusiastically offers her services even to the most cold-adverse.
“I was never a cold person either,” Leighton said, recommending a trial dip. “The fight or flight will kick in for one minute. Then everything actually chills out and it feels quite nice.”
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'I know when I'm not feeling good'
Anne Foran remembers it all — “our 9/11” — when she and her medical-surgical team at WMC Health’s Good Samaritan Hospital in Suffern did what COVID-ward teams did around the world: They navigated the never-before.
After each shift, Foran went home and, like so many others, turned her garage into a changing room, popping her scrubs into the washing machine before trying to wash away day after anxious COVID day.
She remembers wiping down packages and leaving them outside for days before bringing them into her home, how nobody knew what to do, not even the Centers for Disease Control and Prevention.
She remembers talking to her husband, Pat, about what they were going through. A retired first-responder, Pat was in a second career on a different front line, as an X-ray supervisor at another hospital.
Foran also remembers when, after the crush of cases had crested, she knew something wasn’t right and she needed help coping. She picked up the phone.
“I know when I'm not feeling good. And I called my doctor (from) back then and I said to him, 'This is what's going on. I know it's situational. This is what I want. This works for me.' Then he said to me, 'Can I ask you the questions I'm supposed to ask you?’”
Foran laughed at her attempt at self-diagnosis.
“I said: 'Go ahead, go ahead.’”
An antidepressant helped her through the rough patch.
“And then I said, 'OK, I'm good. I don't need it.' So that's me. I know people have gone to the employee assistance program for help, to talk to somebody. I had people to talk to. I have my husband.”
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Foran and her coworkers don't often talk about what they’ve been through.
Nurses are stoic, believe they can handle whatever is thrown their way. But Foran said there are those who — having taken everything COVID could dish out — have moved on from Good Sam and from nursing altogether. Those who remain have seemingly turned the page.
“I think people buried a lot of it,” Foran said, adding that it’s in the nature of the job to turn the page.
“Nurses always want to improve. Nurses are looking to the next step. What do we need to learn? What do we need to improve?" she said. "We're already looking at our quality measures, what do we need to do? How do we improve patient satisfaction, patient safety? You just keep going.”
Last month, her husband retired from his second act, but retirement is not on Anne Foran’s radar.
“I'm not retiring,” she says. “I said 'Fix the house. Decide where you want to move someday and we'll figure it out.’”
That is another conversation for another day.