Travel nurses deal with stress, loneliness and mistrust while serving as a Covid-19 rapid deployment system
After another workday marked by unimaginable death, Veronica O'Kane would return to a hotel room -- empty except for the dumbbell she brought from home.
The travel nurse from Ontario, Canada, took a contract in Maryland to provide support to a hospital struggling under the demands of the coronavirus pandemic. Isolated, to keep herself and her patients safe, O'Kane spent the time she wasn't tending to critical care coronavirus patients working out alone in her hotel room or calling her loved ones to cry.
"I did have moments where I didn't want to talk to anybody because I felt like no one could really understand what I was going through, and that made me feel more alone," O'Kane said.
Travel nursing used to be an exciting opportunity to see new sights, but since the pandemic it has become a rapid deployment system for people who are looking to help those in need, said Sophia Morris, vice president of account management of the travel nurse agency Aya Healthcare.
Tens of thousands of nurses have met the increasing demand caused by the pandemic by traveling and accepting short contracts at hospitals that need them most.
Before the pandemic, there were about 10,000 travel nurse jobs available at any given time, Morris said. After the third spike, that need grew as high as 40,000 nurses requested to help serve hospitals around the US -- and they were needed more urgently than ever before.
CNN spoke to nurses who have traveled to some of the most vulnerable areas in the country. They reflected on their struggles, their hope in vaccines and their knowledge that just because they are inoculated does not mean the devastation is over yet.
Grappling with a history of distrust
Despite her eight months treating Covid-19 patients, Nylah Hamilton was not in a rush to get the vaccine.
The travel nurse from Miami said she was raised to initially approach her own health with naturopathic solutions first -- and she has relied on diet, exercise and a vitamin regimen to see her through the early months of the pandemic.
Hamilton, who is Afro-Caribbean, said she understands the lack of trust that many Black Americans have in the medical system.
Part of the distrust comes from a history of mistreatment Black Americans have faced in the US medical system. A particularly scarring incident came in the Tuskegee Syphilis study, when researchers told Black Americans they were being treated for syphilis when instead they were just being observed for how the disease impacted their bodies.
Many people of color are concerned the vaccine developers haven't taken into account the needs of their ethnic group, according to a study from the Kaiser Family Foundation in December.
But as the pandemic continued, she spent more of her 12-hour shifts reviving patients every 30 minutes as well as cleaning patients and putting them in body bags for funeral homes -- or when the homes couldn't accept anyone else, mobile morgues. And after six days a week of it, she found herself with less energy to relieve her stress with a run.
"It is going to be your job to step through those doors and piece them back together, and in some cases, there is absolutely no more fight left," she said of treating Covid-19 patients in a New York City hospital for months. "Honestly you lose a little piece of yourself in that moment as well."
Though initially not rushing to get vaccinated, she spent time talking to other healthcare professionals and doing research that has lead her to trust the science behind the doses.
"It has opened me up to say that I would like to fight against this virus in this way additionally: being a frontliner, but also being a vaccinated citizen," said Hamilton, who took another contract at a hospital in Texas and has yet to receive her first dose.
Rural doctors had never seen anything like it
O'Kane has spent much of her nearly six-year career as a medical surgical ICU nurse, but never has she seen anything like the coronavirus pandemic, she said.
"My day-to-day was always critical, and I did see a lot of death in my first five years. But going into pandemic, I remember feeling like I had seen as much death as I had in the last five years in a month," she said.
The small rural hospital in Maryland had only four ICU beds. But when the pandemic hit, the need for medical care increased enough that the hospital had to hire 20 traveling nurses.
The doctors had never seen anything like it, and patients were dying every shift, she said.
One man, 56, had to be resuscitated three times. When someone's heart stops once it becomes so weak they are unlikely to survive much longer, she said, but the doctor wouldn't give up hope and kept working to bring him back. He is now on machines to keep him breathing.
Watching the pain in his wife, who still tells him every day that she loves him and wants him to come home, is something that is hard to grapple with, O'Kane said.
'Nobody at the prison knows what happens to me on the weekend'
For the first time in nearly a month, Maria Poloai flew from her assignment working at a prison in Delano, California, to her home in Seattle. The travel nurse had two days off and wasn't going to miss the birthdays of her children who were turning 6 and 13, two days apart.
Their joint celebration was a highlight, but what came next was devastating.
A friend hadn't been heard from in days and wasn't returning anyone's calls, Poloai said. So, she went with police to her home to check on her. When her friend didn't answer, they broke in and found her dead on the floor from suicide.
As a traveling nurse, it isn't the loneliness or the pressure that gets to her, Poloai said. It is wondering if her loved ones need more from her at home than she can give them.
That Wednesday, she was back at work in North Kern State Prison and found herself crying as she charted her patients.
"As a nurse we are faced with people dying all the time," she said. "When I go home and I'm faced with it in my own family, my go-to response is I have to keep working and help people."
And Poloai's help is needed. A small staff treats the large prison population that is at a high risk for infection, especially when inmates are sent from jail to North Kern to quarantine before being transferred to the facility where they will serve out their sentence.
Unlike most nurses, Poloai's work doesn't allow her to have that personal relationship with her patients. When she's treating them, they are usually in handcuffs and accompanied by a guard, she said. She may share a quick hello when taking their vitals or passing them in the yard, but that's about it.
"Nobody at the prison knows what happens to me on the weekend," Poloai said.
'I felt like I was part of history'
Evan Carroscia has spent half of his two years in the field of nursing working during the pandemic.
As a cardiovascular ICU nurse from Cleveland, Carroscia had experience he could lend to other coronavirus hotspots and had been thinking about traveling for a while. So, in December he took his first contract in San Diego.
He was motivated to help where needed, but also to build his skills, he said.
The experience treating Covid-19 patients has been unlike anything he could have expected: patients take longer to recover, more of them end up in the ICU and for the first time in his career patients can't have their family around them.
"I always think about the analogy of soldiers deployed. They see violence. They see death," he said. "We see death regularly and that has to be having an effect on us."
But having now been vaccinated for the virus, he said he feels more confident in his abilities to go into the chaos and treat patients, knowing his health is safer.
"It was honestly kind of a surreal moment," Carroscia said of his first dose. "I remember sitting there just kind of thinking about everything that lead up to that moment and I felt like I was part of history almost."