Since the coronavirus pandemic hit the U.S. in full force in March, Krista Perry, who's been an intensive care nurse for eight years, has "seen more horrible things" this year than she had in her entire career.
Reflecting on those early weeks, she told TODAY, "It's like somebody flipped a switch, and we entered into this kind of alternative reality." Perry's new workflow at her Arizona hospital includes extensive infection control protocols, comforting end-of-life patients whose families aren't around and battling almost-constant short staffing, to name a few changes.
She's one of hundreds of thousands of nurses who treat cases of the coronavirus every day — and whose mental health is suffering as a result.
A recent survey from the American Nurses Foundation — the philanthropic arm of the American Nurses Association, a leading professional organization for nurses — found that more than half of nurses feel overwhelmed amid the pandemic, and 29% are depressed. Of the 10,000 nurses included in the research, almost three-quarters reported challenges with sleeping.
There have also been dozens of reports of health care workers dying by suicide since March, seemingly due to the stress of fighting on the front lines of an outbreak that's claimed more than 100,000 Americans' lives.
This phenomenon has shined a light on something Perry and her colleagues already knew: Nurses die by suicide more often than the general population. A recent study estimates female nurses are 58% more likely and male nurses are 41% more like to take their own lives.
"I have a very robust happy life, and to have every day feel like a struggle now I know is directly related to everything going on in the world," Perry said.
At work, she cares for a greater number of patients with more severe illness than she ever has.
"I use the analogy of watching somebody drown and doing everything you can to help them, and they still drown in front of you," Perry described. "And you're the one who communicates with their family about it, and then imagine if that happens to you every day you go to work and ... four or five times a day. That's what nurses and doctors are facing right now."
At home, she said she's "terrified" of infecting her husband, 5-year-old son and mother, who lives with her and is almost 70. As the only health care worker in her family, Perry also plans their activities and errands, which now has the added "burden" of keeping everyone safe, she said.
"I have nightmares all the time. That's now a normal occurrence," she added.
Another registered nurse, Candice Cordero in Bradenton, Florida, is currently living through many health care workers' biggest fear. In late June, about 10 days after treating two patients in isolation because they'd been exposed to COVID-19, Cordero, whose son has asthma, tested positive.
She told TODAY that she wasn't provided with an N95 mask, and when she spoke up, her hospital threatened her with disciplinary action.
"To feel like you're not protected and then to be threatened on top of that is really demeaning," she recalled. "I kind of felt betrayed."
Cordero added that a primary source of stress has been her hospital's lack of transparency about personal protective equipment, changing policies and staff's coronavirus exposure.
"Most nurses would never have anticipated working during a pandemic," she said. "It's a lot of stress that I never thought I would have to go through."
Cordero said her hospital has had at least 33 employees test positive for the coronavirus, and almost 100 nurses have left since the beginning of the year.
Josh Deal, a nurse manager in North Carolina, told TODAY that he doesn't believe his own mental health has suffered as a result of the pandemic. But he worries about the at-home support systems of his emergency room staff, many of whom are voluntarily working overtime.
"As a supervisor, seeing the stress that goes on in your unit is very taxing," he said.
In Deal's personal life, which includes caring for a new baby and managing his type 1 diabetes, he struggles because of his line of work. His children can't go to daycare because of their father's risk of exposure to the coronavirus, and friends avoid seeing him for the same reason.
He understands why this is the case, but that doesn't always make it easier.
"People in the medical field don't like taking care of themselves because they're always taking care of others," he said. "We're getting to a point where we have to take care of ourselves."
For those who are running out of energy to do just that, he said he doesn't "know what the solution is."
When asked how she'll move forward when the pandemic is over, Perry said, "Whenever that is, I'll have some serious healing to do."