With a majority of media outlets focusing on the struggles of New York City’s nurses fighting COVID-19, those on the front lines in the Empire State’s capital face similar battles and trauma.

It’s seven o’clock in the morning. Medical surgeon nurse Alicia Lackey arrives at work and puts on her gown, gloves, mask and face shield.

A male patient was medevaced in from New York City two hours ago and is laying on a stretcher in the emergency room of St. Peter’s Hospital in Albany. Lackey doesn’t know if the patient is COVID-positive yet, but she knows it’s best to act like he is.

All of a sudden, something goes wrong. The man needs emergency dialysis. His kidneys are failing, which is an increasingly common complication associated with COVID-19 patients, even without prior kidney issues. Lackey tries to insert a catheter into his neck, but he’s bleeding everywhere and it’s not stopping. Simultaneously, the patient’s blood pressure is dropping and the IV line needed to stabilize him is far from his bed.

The air conditioning in the room is broken and Lackey is standing there with a doctor, covered in blood and overheating in layers of protective gear. She’s overwhelmed, feeling like she’s going to pass out at any moment.

This was a harsh reality for the 36-year old in a hospital receiving overflow from clinics in COVID-19’s global epicenter.

“I've never experienced anything like that,” Lackey said, weeks later.

Nurses at St. Peter’s Hospital in Albany, despite not dealing with nearly the same number of COVID-positive patients as New York City clinics, share similar mentally and physically taxing experiences as their counterparts in America’s biggest city.

St. Peter’s is a large urban hospital with a 482-bed capacity, the largest in the area behind the 748-bed Albany Medical Center. The area they primarily serve, Albany County, has 1,367 confirmed cases of COVID-19 as of May 12. Of those, 61 have died and 210 have been hospitalized.

“I had a patient that was going to pass away and I had to hold up an iPad for the family to say their goodbyes [over video call], because we weren’t allowing anybody in.”

— Sara Tessitore

According to Stat News, the state capital has been underprepared during the outbreak, with an overall “low” preparedness score of 23 out of 100. The website says that the score “takes into account a number of different factors, including residents’ access to care, their risk for severe COVID-19 infections and a county’s overall vulnerability.”

The relatively nearby District of Columbia has a higher preparedness score of 38, with 234 critical staff for every 100,000 residents. They also have the advantage of a young population, with only 12% of residents over the age of 65, who are often considered the most vulnerable people to COVID infection.

Yet Albany only has 94 critical staff for every 100,000 residents and a deficit of over 6,200 intensive care unit (ICU) beds for a theoretical peak of infection.

Close to the current peak of New York’s curve in early spring, St. Peter’s was operating two ICUs: one exclusively for COVID patients and one for standard admittance. As the number of local cases climbed, this arrangement was abandoned as the two ICUs began caring for both types of patients. At one point, the hospital was the host to as many as four ICU floors.

More ICUs meant more nurses were needed to staff them, which presented another unsolved issue.

America’s nursing shortage that has persisted for years has only been worsened by the pandemic.

The World Health Organization reported that in 2018, there was a worldwide shortage of nearly six million nurses. That same year, an RN Network study reported that 91% of nurses surveyed felt their hospitals were understaffed.

This sentiment was echoed at St. Peter’s, with various types of nurses being called upon to assist on the most severe of COVID cases.

Instead of a critical care nurse overseeing just one or two patients, the short staffing now forces them to oversee two medical surgeon nurses in addition to two patients. Often, the “med surg” nurses have little to no experience in treating COVID patients.

“Some of those nurses have been doing this for maybe 10 years or more and adapted a little bit better,” said 31 year-old night shift ICU nurse Molly Tozier at St. Peter’s. Yet Tozier also said that some of those nurses graduated only four months prior.

The increasing demand for nurses also places an increasing demand for personal protective equipment, or PPE. The government’s Strategic National Stockpile of PPE has been almost completely drained of supplies. Prices of N95 masks have increased from $0.38 per unit to $5.75. The scarcity and price of them meant reusing the masks was an acceptable method of protection.

Tessitore graduated from Hartwick College’s nursing program in 2015. (Photo by Sara Tessitore)

“They were saying the masks you could wear five times and then you had to get a new mask,” Lackey said. “You had to put the masks in a paper bag after use, and there were guidelines on how to properly put them in the bag so you contaminate them the least when you’re taking them out.”

The CDC recommends checking the manufacturer guidelines for how many times an N95 can be worn before replacement. They also advise throwing away masks that have any tangible traces of bodily fluids on them and desanitizing masks between uses.

“A few weeks ago, management said you can't use UV light to disinfect N95 masks because it breaks them down,” Tozier said. “Then they retracted that statement. If the UV light really does degrade the mask, then what kind of protection is that for me?”

As the outbreak spread further, the CDC continually changed their guidelines of how to wear N95s. In late March, the devices were only recommended to be used during “aerosolizing events,” including procedures such as intubation. Days later, the CDC recommended that all healthcare workers wear facemasks, including the more basic and common cloth surgery masks.

This forced hospital management to constantly shift their mask policies without much warning, leading to frustration with some of their staff.

“I worry that when we are not protected or have the adequate protection that we will be probably dropping like flies,” Tessitore said.

The combined stresses of inadequate staffing, lack of PPE and number of COVID patients has a negative effect on the mental health of those in the confines of St. Peter’s.

“I’ve been thinking about leaving. You can make a lot more money doing less stressful things.”

— Molly Tozier

A survey conducted by Nursing Times in April revealed that 33% of the 3,500 nurses who answered the poll listed their mental health as “bad” or “very bad.”

“I had a patient that was going to pass away and I had to hold up an iPad for the family to say their goodbyes [over video call], because we weren't allowing anybody in,” Tessitore said.

The stresses of traumatic experiences with patients and quickly adapting to new treatment methods pushes some nurses to the edge.

During a busy weekend shift in the ICU, Tozier’s unit was down one med surgeon nurse after they refused to work with COVID patients. She quickly found a replacement, yet while the experienced ICU nurse was teaching the rookie a new task, the med surgeon nurse suddenly burst into tears.

“She was so overwhelmed and she felt like she was such a burden,” Tozier said. “She felt worthless being there because all she had was questions. I feel so bad for them because they’re just being thrown into this with no idea what’s going on.”

Those surrounded by inexperienced nurses in a rapidly-changing environment during a seemingly endless pandemic leaves many RNs questioning their career choice.

“My husband asks me to quit my job every day,” Tozier said. “I’ve been thinking about leaving. You can make a lot more money doing less stressful things.”

The Daily Mail reports that one in every 30 nurses have left their job over COVID stress and three in five nurses have strongly contemplated unemployment.

“You come home and you're like, ‘I made a difference, I saved a life today,’” Tozier said. “Or should I go work for an insurance company where I'm going to be bored out of my mind, but not be stressed and make better money? That’s definitely an internal dilemma that goes on.”

Yet the stresses of work follow St. Peter’s employees to and from the sanctuary of their home.

“There are days where I come home crying,” Tozier said. “And it’s like, how much of this can you take?”

Before the days of coronavirus, coming home from work was as easy as opening the front door, taking off their shoes and plopping down in a kitchen chair to decompress. Yet that routine has changed.

“I get home and I immediately go into the shower and I keep my [work] clothes in like a plastic garbage bag until I wash them,” Tessitore said.

At home is her husband, a fifth grade teacher doing distant learning with his students.

“You're worried that you're bringing the virus home to your loved ones,” Tessitore said. “I've had really vivid dreams about it, too.”

Avoiding news about the health crisis isn’t easy, either. A Pew Research Center study showed that seven in 10 American adults feel overwhelmed by coronavirus news and need frequent breaks from it.

Lackey (far left), a graduate of Binghamton University and Siena College, was forced to adapt to an ICU nurse role due to their high demand at the peak of the outbreak. (Photo by Alicia Lackey)

“For example, I read two articles about it and it was enough to get me on edge and I was like, ‘Alright, that’s it,’” Tozier said.

Yet others prefer to be well-informed about the situation.

Lackey says she watches up to an hour of news daily and checks updates nightly. “I actually watch way more news now than I ever have,” the med surgeon nurse said.

Regardless of how the nurses handle their mental burden, finding solace is difficult, even with a return to pre-COVID days on the horizon.

This month, the Governor’s office outlined seven metrics all state counties must abide by to begin the reopening process. These include having 30 percent of both a hospital’s standard and ICU beds being vacant, providing readily accessible testing areas and recruiting numerous contact testers.

Their job will be tracking down every person who interacted with a COVID-positive patient in the 14 days prior to their diagnosis and have them self-isolate to contain any potential small outbreaks.

Fortunately, Albany County has met six of the seven requirements to begin reopening. Yet with St. Peter’s still remaining short staffed, keeping enough nurses, beds and even contact testers available to fulfill Cuomo’s reopening requirements could prove difficult to maintain.

Dr. Anthony Fauci, President Donald Trump’s infectious disease advisor, warned on Tuesday that opening states too soon has the potential to turn small spikes of COVID cases into more full-blown outbreaks.

This fine balance between slowly reopening while simultaneously preventing another dramatic rise in hospitalizations leaves many wondering when the light at the end of the tunnel will get brighter.

“We saw a little surge, we're going down, we're going to plateau, and then we're going to surge again,” Lackey said. “I feel like it's just going to go on for a while until they have a vaccine.”

With the Albany hospital running multiple ICUs, relieving the pressure of arriving inpatients is a crucial step towards reopening. (Photo by St. Peter’s Health Partners)