"I could not understand how this highly educated, powerful trauma nurse is now the patient."

A registered nurse who asks that we call her "Gi" is talking about herself. While working in the emergency room of her community hospital at the height of the COVID-19 pandemic, Gi started crying unconsolably, unable to speak or function. She was having a panic attack and was later hospitalized in an in-patient psychiatric facility, diagnosed with PTSD. Gi is back at a hospital bedside now - as a hospice nurse.

A pandemic of nurses suffering

Gi is not alone. The number of nurses with mental health issues has grown substantially during the COVID-19 pandemic. A survey by the International Council of Nurses (ICN) shows that the number of nurses reporting mental health issues since the pandemic started has risen from 60% to 80% in many countries.

"Nurses are suffering," says ICN CEO Howard Catton. He cites violent attacks, "along with the exhaustion, grief and fear faced by nurses who are caring for patients."

The American Nurses Foundation says 1 of 3 nurses indicate they are "emotionally unhealthy."

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'Normal systems breaking down'

Nurses say the mental health strain arises from a variety of issues.The industry was already facing a staffing shortage prior to COVID-19, and many nurses juggled multiple jobs caring for increasing numbers of patients.Now the recommended ratio of 1 nurse for 2 patients is stretched to a ratio of 1 to 3, to the detriment of patients and nurses alike.

"Clara," who has spent her career as a nurse, says she's up against "tremendous workloads, tremendous volumes, with not enough resources."One misstep can make the difference between life and death - and potentially ruin a career.

"It's a constant pressure on your shoulders, a constant downward pressure, you have to move faster, you have to do better, you have to work harder," she said.

Alex Kaspin left her emergency room job for a less stressful nursing position on a pediatric floor. Her stress led to a panic disorder. (Carolyn Presutti/VOA)

Alex Kaspin was suffering from a panic disorder from being overworked, overtired and overwhelmed. She recently stepped away from a Philadelphia emergency room when the COVID-19 numbers were matched by the city's rising homicide rate.

"At that point," says Kaspin, "all normal systems were breaking down." Kaspin says her hospital was operating in a "triage situation." It did not have enough nurses to attend to patients in regular rooms.So the emergency room was filled with in-patients, and the waiting room became the emergency room.

Philadelphia Police Officer Shawn Wills investigates a double shooting. The city homicide rate has exacerbated Covid-19 stress for emergency room nurses. (Carolyn Presutti/VOA)

'Please give me the vaccine now'

Between rising violence in the United States and the increase in COVID-19 patients, Kaspin felt she could not deliver health care at the standards she set for herself.Adding to the stress were patients unvaccinated against COVID-19.

She is haunted by her memories of several COVID-19 patients in their 20s. "Right before we put the breathing tube down, the last thing they say is. 'I want the vaccine now. Please give me the vaccine now.' "

Pennsylvanian Jen Partyka calls vaccine hesitancy a willful ignorance she's never seen in her 27 years of nursing.

"You are willfully creating a situation that I can't keep up with as a nurse manager," says Partyka. She will always do her best for her patients, she says, but she feels differently when she learns they are unvaccinated."You are willfully harming others."

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Experts say getting more people vaccinated will tremendously lower patient numbers.

Chip Kahn is the president and CEO of the Federation of American Hospitals. He says there is no "short term, magic bullet," but what is needed is "less COVID."

No more banging pots of support

Abigail Donley worked in a Manhattan ICU during the early phases of the pandemic.She left her job to co-found IMPACT in Healthcare to work to change policies to benefit workers and patients.IMPACT's December campaign promotes safe staffing levels.

Donley says nurses were once viewed as COVID-19 heroes."People were banging the pots for them at seven o'clock, but now they can't get a raise," Donley said on Skype. "They can't get a bonus. They can't get child care. They don't have maternal health care."

A growing number of nurses are leaving the hospital bedside for a less daunting work schedule and better pay.Travel nursing agencies send nurses where they are needed to stem the dwindling staffing numbers, offering as much as triple the salary that other nurses receive.

"Michelle" helped set up the COVID-19 unit at the hospital where she had worked for 10 years.This month she left her $30-an-hour registered nursing job to be a travel nurse in an intensive care unit in another city. She calls her new salary "crazy."

"I'm leaving that system and going to a travel nursing position, and I'll be making $120 an hour," she told VOA.

Kahn says agencies are "gouging" hospitals when they offer travel nurses such high salaries. He agrees it is much better to have a strong, in-house team rather than temporary staffing.

When asked why hospitals don't retain veteran nurses by offering higher salaries and other benefits, Kahn says, "There's no way that that any institution could afford to pay the broad base of their nurses anywhere near what they're paying for the travel nurses."