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At the end of a 12-hour shift and before heading home for some hard-earned shuteye, traveling nurse Caleb Cullen pauses for a photo at daybreak, outside Maine Medical Center in Portland.
For many newly minted college graduates, the pandemic forced a delayed entry into the job market or an unorthodox start — getting to know one’s teammates virtually rather than around the office water cooler.
COVID-19 had a different impact on Caleb Cullen. For the 2015 Mitchell Scholar from Katahdin High School and University of Maine at Fort Kent graduate, the stress level of an already fast-paced job — emergency room nurse — surged off the chart since March 2020.
“About a year ago, amidst the worst wave of COVID in Maine, we were at 130% of patient capacity,” said Cullen of the Maine hospital where he worked.
With a lack of beds available for patients, declining numbers of nurses, and increasingly hostile patients, “I found myself overwhelmed and headed for early burnout,” he said.
But he didn’t want to leave nursing or the ER. Having worked his way through college — first at Northern Maine Community College and later UMFK — as an EMT, Cullen enjoyed the challenges of treating patients requiring urgent medical attention.
“I have always had a passion for emergency medicine,” he said. “I love the fact that when you get an ER patient, nothing has been done. They may be in critical condition or close to death. You have a chance to make a big difference. You can provide a lot of care and activate a lot of protocols even before the patient is seen by a doctor. I don’t think I would like doing anything else.”
Realizing that self-care would be critical for career longevity, Cullen decided to become a traveling nurse, taking on assignments of up to six months at hospitals wherever there was demand. And the demand has been strong.
“The need for nurses is so high, you can name your hospital and then pick up and go,” he said. “It’s a great way to gain a breadth of experience with different equipment, like IV pumps and cardiac monitors. It teaches you to be easily adaptable and flexible.”
After six months at Yale New Haven Hospital in Connecticut, Cullen is now closer to home, working at Maine Medical Center in Portland. As before, the work is still grueling, and the hours are long — 12-hour shifts for six days in a row sometimes — but as a traveler, he finds himself with longer “weekend” breaks in between long stretches of work. And then there is the time he gives himself in between service at different hospitals.
“I might work six nights in a row, but then I might have eight days off and time to travel to New York City or hike the Grand Canyon. Traveling has refreshed my ability to be a nurse. Having that balance is really important,” he said. “Plus, every new hospital is a fresh start. With traveling, you don’t get mired in the politics of the workplace.”
But Cullen said the challenges of delivering healthcare in hospitals are an existential constant, regardless of where he works.
“I know I’m not going to find a hospital that’s perfectly staffed,” he said. “Everywhere I go, if the nurses give 110%, then you can get through the shift and deliver the best possible care.”
With Maine hospitals already warning of strained pediatric inpatient capacity due to Respiratory Syncytial Virus and delayed care during the pandemic causing higher acuity in adult patients seeking care (requiring them to occupy hospital beds for longer periods of time), experts say we could be facing another tough winter. Whatever the causes, Cullen said the ER is often the place where patients experience the larger, systemic problems with healthcare delivery.
“When larger hospitals are facing shortages of beds and staff, that means smaller hospitals are unable to send patients there, and that can mean patients that should be transferred have to stay longer in the ER,” he said. “A lot of people come to the ER for issues that should be managed at urgent care or at a doctor’s office. Some even come for a refill of a medication or to get a routine COVID swab.”
Another issue facing ER’s nationwide is the increase of behavioral health patients, especially children and adolescents whose psychiatric needs would be better served in less stressful, outpatient settings. As is the case in Maine and throughout the nation, these outpatient treatment options are few and far between, causing pediatric behavioral health patients to board — sometimes for months at a time — in hospital ERs, alongside adults being treated for a range of issues.
“Sometimes there’s nothing medical that you can do for these patients in the ER other than stabilize them,” Cullen said. “But because there are no other treatment options, they might stay in the ER for six weeks. This isn’t just a problem at one hospital. It’s a problem everywhere.”
With all the mounting challenges, he said, “you can feel defeated.”
“You enter the field because you want to take care of patients’ physical, psychosocial, and even spiritual needs,” he said. “But the reality is there might only be 10 minutes per hour for each patient assigned to the nurse. That’s not a lot of time to be there for them.”
And then there are the unprecedented threats, both emotional and physical, that have become commonplace.
“Patients are frustrated with the healthcare system, and sometimes they take those frustrations out on the people they see most — nurses,” he said. “I have been assaulted three times in two years, including being punched in the face by a visitor, and I’ve had things thrown at me. It takes a thick skin.”
But Cullen remains undaunted and fully committed to the profession — even if it means working the most physically challenging hours. At Maine Medical Center, for instance, he takes the overnight shift, from 7 p.m. to 7 a.m.
“I don’t mind it. I’ve always been a night owl,” said Cullen, who counts on blackout curtains and a “good sound machine” to catch enough shuteye during the day. “Working nights in the ER, you start your shift at the busiest it’s going to be, just when you’re freshest. Things usually quiet down by 2 or 3 a.m.”
Aside from a love of nursing, what keeps Cullen going are the good moments with patients.
“You take the small wins when you can,” he said. “You hold on to them for the times when you have a really difficult night.”