Masked workers leave Northern Light Eastern Maine Medical Center at the end of the day in December 2020. Credit: Linda Coan O'Kresik / BDN

Erin Oberson has noticed colleagues at Northern Light Eastern Maine Medical Center leaving their jobs at an accelerating clip as the COVID-19 pandemic has dragged on. The labor and delivery nurse said several have left the Bangor hospital to return to school to become nurse practitioners, while others have taken jobs in less stressful primary care offices.

While much of the public’s attention has been focused on health care staff departures due to the state’s coronavirus vaccine mandate, Oberson said she knows far more colleagues who have left due to burnout than due to refusal to get vaccinated.

It’s not unique to EMMC. 

Burnout was common in health care professions before the pandemic, but Maine’s problem has blossomed into a crisis as the pandemic has continued, said Steve Michaud, president of the Maine Hospital Association. Health care staff have been stretched thin as many have had to quarantine due to coronavirus exposure or contracted the virus themselves. Many worked in the nursing homes that were the sites of Maine’s earliest and largest coronavirus outbreaks. Treating coronavirus patients in hospital intensive care units also demands more manpower. 

“All the money in the world doesn’t fix the conditions,” Oberson said. “We need staff.” 

Employment in Maine’s hospitals declined by 5 percent between the second quarter of 2019 and the same period this year, to 34,066 from about 35,839, according to Maine Department of Labor data. Employment in nursing and residential care facilities declined by 9 percent during that same period, to 21,800 from 23,918. 

Nationally, about 1 in 5 health care workers nationally have left their jobs since the beginning of the pandemic. 

What used to be a bad day is now every day, Michaud said a nurse recently told him. In a profession that, generally, has good pay and benefits and gives people the opportunity to help others, Maine’s health care system needs to continue to encourage young residents to enter the field.

“It’s still a very honorable profession,” Michaud said. “We’ve just got to get through this kind of war zone that we are in right now.”

Oberson, who has worked at EMMC since 2008 and as a nurse since 2001, said plenty of colleagues left due to the strenuous nature of the work before the pandemic.

“A lot of the younger nurses are sticking around for less than five years,” Oberson said. “They’re not willing to stay at the bedside.”

But she and others say the pandemic has accelerated the trend, as those in health care have worked longer hours to treat more patients while putting themselves at risk of a deadly virus. More than 3,600 American health care workers had died from the coronavirus through April 2021, a little more than a year into the pandemic, an investigation by the Guardian and the Kaiser Family Foundation found, though not everyone necessarily contracted the virus at work.

While many staffers hoped the COVID-19 vaccine could bring an end to the pandemic, nurses have instead been faced with a new reality: treating patients who wouldn’t have had critical or fatal illnesses had they gotten vaccinated. They say it’s really what defined the difference between care in 2021 versus 2020, when a vaccine was not publicly available.

“It’s always felt a little frustrating to treat someone for something that’s preventable,” Oberson said. “People claiming it’s not real or that it’s not serious when you are seeing it first-hand.” 

Burnout may have also played a role in driving those who didn’t want to get the COVID-19 vaccine out of health care, Michaud said. 

“That was definitely kind of the last straw for some people,” he said. 

The Maine Hospital Association supported the state’s vaccine mandate.

Oberson said a significant reason for the mass departure was simply too much work. She said Maine could help the situation by adopting nurse-to-patient ratios similar to those prescribed in a law first passed by California in 1999. 

That law requires one nurse for every two patients in intensive care, and one for every four in emergency rooms at California hospitals. Though the state has issued waivers from those rules due to the coronavirus, California nurses say the system reduces risk of burnout.

At Maine’s nursing homes, burnout and stress are also the primary drivers of staff departures, said Angela Westhoff, CEO of the Maine Health Care Association, which represents nursing homes. Those most likely to leave are taking direct care of nursing home residents, such as certified nursing assistants.

“They’re taking care of some of the oldest and most vulnerable residents in Maine,” she said. “It’s definitely wearing.”

Nursing home employees have also been at substantial risk of contracting COVID-19, as long-term care facilities with outbreaks dating back to the spring of 2020 have recorded more than 2,000 staff coronavirus cases, according to Maine Center for Disease Control and Prevention data.

While higher pay and new recruiting efforts will bring new staff in, fixing this problem will likely be impossible without COVID-19 cases going down, Michaud said. Only then will it be possible to relieve workers of their larger workloads.

“We’ve got to get this pandemic under control as fast as we can,” Michaud said. “Really repairing some of this pandemic damage is going to be key.”