When Allan Kinyua arrives for his evening shift at the UW Medical Center near Northgate, the special care unit buzzes with energy. Staffers cart meals and medical equipment in and out of patient rooms, pausing occasionally to check records and doctor notes.
Kinyua, a certified nursing assistant, is in charge of eight of the 17 patients. One has COVID-19. Another is legally blind and coming from the intensive care unit. Some need assistance breathing or help going to the bathroom. Many have heart or lung issues.
The day was already busy, though routine. But in this hospital's hallways, the trauma of the pandemic lurks in haunting memories.
Evening after evening in early 2020, Kinyua would start a shift by taking a COVID patient to the bathroom. By morning, they'd be intubated. When he would return the following night, the patient would be dead, the room already getting prepped for the next one.
Terrified co-workers broke down in tears often, he said. "It was just happening so fast. You couldn't even take time to process what was going on. ... I think to some extent, I became numb to the pain."
Since then, more than 13,000 Washingtonians have died from COVID. Still, Kinyua, who moved from Kenya 3 1/2 years ago, has pushed forward in the health care field, even deciding last year to pursue his nursing degree in an accelerated program.
As thousands of students like him finish their classes this summer, the state's newest crop of registered nurses will start to bolster the strained health care systems throughout the region. Recent legislative action has boosted efforts to patch staffing holes within hospitals and long-term care facilities. But nationwide attrition rates among health care workers reveal a lot has been lost, leading to big questions over the future of an industry at a crossroads.
While omicron's contagious subvariants led to a spring surge of infections and hospitalizations, COVID antivirals became more accessible and deaths stayed low. But it's still a difficult time for health care staffers while patients, now mostly people whose conditions have worsened after delaying care, continue to pour in.
"I think back to when I graduated from nursing school" about 30 years ago, said Darcy Jaffe, senior vice president for safety and quality at the Washington State Hospital Association. "There were staffing shortages back then as well, but we didn't have as much unknown as we have right now about what health care is going to look like in the next few years," she said.
Kinyua, on his recent shift, heads into his first room of the evening. He cheerily greets the patient, sitting upright in bed, before checking his temperature and pulse. Minutes later Kinyua is on to the second room, where a patient sleeps and a CPAP machine hums.
He continues down the hall, popping in and out of rooms.
It's not yet apparent, but it is going to be a long night.
Constant staffing holes and overwhelming patient loads have ranked high as top reasons for health care worker burnout in Washington and throughout the U.S. But other factors also weigh on the industry, like the rising demand for medical services as baby boomers age into retirement.
Meanwhile, the number of students completing undergraduate nursing programs has declined in recent years, despite the growing need, according to a 2020 state Department of Health report.
In 2015, 3,347 undergraduate nursing students completed their programs in the state, the report found, compared to 2,671 graduates in 2020.
Washington doesn't track how many health care workers leave the industry every year, but the U.S. Bureau of Labor Statistics recently reported nearly 1.7 million Americans quit their health care jobs between January and April alone. In addition, the field lost about 20% of its workforce in 2019 and 2020, including 30% of nurses, according to a 2021 American Hospital Association survey.
More new nurses are also asking to start off part-time, said Jaffe, of the state hospital association. She's glad to see new employees ease into the job, but she worries the staffing shortage will only worsen.
"The pandemic has had that impact on a lot of the staff in general about reevaluating their work-life balance," she said. "I do think it's tough for new grads right now because they're entering hospitals that are not quite in recovery."
The shortages are expected to persist, she said.
Despite the long hours and enormous emotional burden, many health care workers, including Kinyua, stick with it. New nurses are filled with hope.
When he moved to Washington state, Kinyua planned to go to graduate school for project management. He landed in health care instead after a friend asked him to temporarily fill a shift at an adult family home.
"I just completely loved it," he said. "I've worked in many industries, but there's a lot of satisfaction in helping people who need it. ... Even though the pandemic was pushing (health care workers) in one direction, leaning on each other helped us push back a bit."
While most health care systems in the state still grapple with day-to-day burnout, some new long-term solutions are in the works.
Chelene Whiteaker, senior vice president of government affairs for the state hospital association, spent much of the past year advocating for new policies to boost health care education and alleviate staffing strains.
Meanwhile, health care labor unions last year pushed for hospitals and other care facilities to do more for their staffers, like ending mandatory overtime policies and offering retention bonuses.
During this year's session, Washington lawmakers made a series of moves to address health care challenges, including adding 220 new nursing education slots at the University of Washington and in community colleges and introducing a new bachelor of nursing degree at Eastern Washington University.
Lawmakers also funded Gov. Jay Inslee's hospital staffing initiative, incentivizing long-term-care facilities to take more patients ready to be discharged from the hospital and establishing more than 200 more nursing home beds.
"It's a good starting point," Whiteaker said.
New education programs are also popping up throughout the region, including one at Providence Mount St. Vincent in West Seattle.
The Mount this year received state approval to create its own four-week certified nursing assistant program.
"It's a great way to get exposure in a way that's safe and supportive," said Kayett Asuquo, director of clinical facilities at Providence. "After that, they're guaranteed a job as Providence employees."
In January, UW's School of Nursing also added a externship program for students interested in long-term care, sending them into nursing homes and other facilities to give them a taste of a non-hospital environment.
Program leaders are hoping the experience will renew interest in long-term care jobs, a particularly difficult corner of health care during COVID because older adults were at a higher risk of getting severely sick.
"There was a mass exodus of long-term care jobs during the pandemic," said Tatiana Sadak, who's leading the UW program. "Those jobs became impossible."
The new programs are finding some early success, though. This year, six students signed up for the pilot version of UW's long-term care externship. Next year's program has already enrolled 14.
Keetra Kartes has worked in health care for years and is now a registered nurse on an acute-care floor at Harborview Medical Center. She loves her co-workers and her job — but she'll never forget the daily feeling of watching patients with COVID get sicker and sicker.
She recently saw a video on social media posing a question: If you had to go back to nursing school knowing where you are now, would you?
"I had to really think about that," Kartes said. "And that was really jarring to me."
But there are signs that new nurse classes are diving into the health care field with a different energy, she's noticed. There's a stronger desire to be advocates for their fellow health workers, push for new legislation and become more involved with labor unions. And graduates know that regardless of how tough the job can be, it likely won't be worse than the past two years.
Julie Trotter, one of Kinyua's nursing classmates at UW, said for her and many of her peers, the passion for the job outweighs their fears.
"We applied for the program knowing that COVID was a thing, knowing the pandemic was ongoing, but a lot of us have worked in health care spaces already so I think we know firsthand the challenges are not something we're going to let stop us," Trotter said.
She, Kinyua and dozens of their peers have one more quarter left at UW this summer before many will apply for their nursing licenses.
Back at UW Medical Center, Kinyua continues to check in on patients in the special care unit. Another certified nursing assistant's shift is almost up, so she walks Kinyua through her patient notes before she leaves.
As his night winds down, he checks on staffing levels elsewhere in the hospital. He's not surprised to see shortages — and quickly volunteers to help in a couple of surgical units. He often takes the hours where he can and when there is need.
Kinyua is scheduled to clock out after eight hours at 11:30 p.m. But it's 7:30 a.m. before he heads home.
He's exhausted, but his goal of becoming a critical care nurse in the ICU remains. He hasn't looked back.