COVID-19: How the Pandemic Changed Nursing

Megan Champion, FNP, worked the pandemic from two sides at once: as a family nurse practitioner in a community health clinic and as a bedside nurse in the intensive care unit (ICU). In the clinic she watched the disease hit underserved communities hardest. In the ICU she faced death and disease directly, made worse by staffing shortages and burnout.

Even with 10 years of ICU experience, she says, "nothing could have prepared me, or anyone, for a global pandemic."

Champion is one of three nurses whose experiences shape this account, along with a veteran charge nurse near the end of her career and a new graduate who has known nothing but nursing in a pandemic. These are their stories.

An Inside Look at the Work

By the second year of the pandemic, the public had a clearer picture of what nurses do. Eve Hinds, RN, MBA, a charge nurse with 20 years in inpatient and outpatient settings, says the recognition made her feel respected in a way she had not before.

"Back in 2003 or 2004, no one really cared if I was a nurse. It was just a job. I was just a nurse," she says. "But after the pandemic, you state your profession, and a lot of eyes open wide."

The media showed gowns, masks, and emergencies. Champion saw a quieter and equally painful side in the clinic. Once lockdowns began, her working-class patients could not stay home, and many got sick or worse.

"Our patients truly suffered not just the loss of life," she says, "but also loss of housing, loss of financial security, food insecurity, domestic violence, increased substance use, and all the ripple effects this pandemic has put in motion."

She also watched immigration enforcement compound the damage. Families in the communities she served lost parents and breadwinners to detention and removal, layering separation and instability on top of disease and financial loss. "Add heartbreak, desperation, and loss of financial stability to a pandemic," she says, "and you can see it has been a nightmare for our patients."

How the Pandemic Reshaped the Job

Maggie Ortiz, RN, started her first nursing job on a medical-surgical nephrology floor in February 2020 and later earned a DAISY Award. Working in a pandemic is her baseline. She cannot recall a time before COVID-19 flowsheets were built into Epic, the hospital's records system. It is all she knows.

For Champion, the intrusion of politics into clinical care was the shock. "It is unnerving to see the effects different presidential administrations have had on something that should be based on science and fact," she says. Her role as a patient advocate grew well past bedside care. Through her clinic's call center she screened and supported patients for depression, anxiety, domestic violence, and food insecurity, and connected them with help for childcare, housing, and hunger.

More Than 'Healthcare Heroes'

Public support meant a lot, but the language of heroism carried a cost. Calling nurses heroes implies they can stretch past human limits, an assumption the pandemic tested hard. As shortages grew, nurses took on more patients, most of them high acuity and needing close monitoring. When a patient died, another arrived immediately, with no time to process the loss.

"There is a stigma that nurses and healthcare providers are heroes, underdogs, and great sympathizers with endless sources of compassion," Champion says. "We are not heroes; we are human. We are not robots; we are tired. We are capable of being frustrated, angry, and outraged."

Workplace violence rose as patients took out their frustration on staff. "Many people have shown huge amounts of gratitude," Champion says. "However, just as many have shown disregard and tremendous disrespect through their actions and choices. It hurts every time."

Ortiz wants the public to understand the stakes of protecting nurses' health. It is hard to take a day off when the unit is already short, but the pressure drives burnout. "Nurses need to protect themselves so they can protect you," she says.

Hinds admits the early days frightened her. "I did not want to deal with it or be around it," she says. "But I realized I was needed, and I needed to do what I do best. I pulled up my bootstraps, and I got to work." Staffing shortages, she and Champion agree, have forced nurses into care they are not proud of. "Patients waiting to be cleaned up, call lights going unanswered, these are all routine now where they never were before," Champion says. "All our energy goes toward putting out emergencies and making sure people don't die."

Preparing the Next Nurses

Many nursing schools moved to virtual learning during the pandemic, and some nurses worry students lost valuable hands-on time. Ortiz says educators should prioritize in-person clinical learning. Students need to practice how to don and doff personal protective equipment, learn the current medications, and recognize the signs and symptoms of COVID-19. Hospital policies change constantly, and seeing those changes firsthand is part of the education.

The work itself has shifted too. "There is more to this job than simply medicine," Hinds tells students. "We have to be able to care for our patients' and their families' emotional needs as well."

Remembering Why

Nursing has changed, and healthcare will keep facing hard years. One thing holds: it is a profession built on care for the human experience. Nurses can support each other by protecting their mental health, staying educated, getting vaccinated, and recognizing that the pandemic touched everyone differently.

The hardest moments were also the most human. With visitors restricted, Hinds sat with dying patients whose families could not be in the room. Champion was struck by clinic patients who returned wearing masks and shirts bearing the names and faces of relatives lost to COVID-19. "Seeing families with the names and images of their loved ones brandished on their faces and chests was a humble and powerful reminder that this pandemic is real, and the loss is personal," she says.

Ortiz finds her footing in connection. She once cared for a patient whose family could not visit, so she called them with updates every day. Months later they called back to say their mother had died, and to thank her for the comfort she gave when they could not be there. "It makes me happy to know I made an impact," she says, "because in my eyes, I was just doing what I was called to do, and that is nursing."