In March 2020, as the pandemic spread across New Jersey, doctors, nurses and staff in hospitals and nursing homes scrambled to care for a growing number of patients infected with COVID-19, while also trying to address their own physical and mental health needs.

Now, five years later, many hospitals have enhanced their mental health supports for caregivers as a result of the pandemic, according to health care experts.

But some experts say there is still a “tremendous amount” of stigma attached to mental health treatment for health care workers in the state. This is, in part, due to workers’ concerns that they may be penalized by an employer or a licensing board for revealing a past mental health issue.

“I think there is still that very common misconception that you shouldn’t be seeking mental health treatment if you need it,” said Tyla Minniear, the chief operating officer at the New Jersey Health Care Quality Institute. “We want to make sure that we’re encouraging health care workers to seek out that treatment,” Minniear added.

A 2021 report from the institute and BioNJ, the life sciences trade association for New Jersey, detailed recommendations to create and support a resilient and diverse health care workforce as it emerged from the COVID-19 pandemic. These recommendations included developing and supporting behavioral health programs to target the “growing need” of providing mental health services to health care workers in the state.

A heavy toll

Staff and medical providers faced the mental health toll of bearing witness to sickness and death during the height of the pandemic. Since the first recorded case of COVID-19 in New Jersey in March 2020, there have been over 193,000 hospitalizations in the state due to the disease, according to a recent NJ Spotlight News analysis of state Department of Health data.

There have been 37,315 deaths in the state due to COVID-19, with 34,196 of those confirmed and 3,113 probable. The novel coronavirus continues to mutate and remains a threat in New Jersey and across the country, particularly for people with limited immune defenses.

‘A lot of health care workers felt forgotten and that was when they could actually take a pause to reflect on what they had just been through. For a lot, that’s when burnout happened.’ — Cedar Wang, Holy Name Medical Center

Dr. James Pruden, an emergency physician at St. Joseph’s University Medical Center in Paterson, became infected with the virus on March 6, 2020, and was the hospital’s first COVID-19 patient. He became so sick that word briefly spread in the hospital that he had died, according to an interview Pruden did with “60 Minutes” in October 2020.

“Ultimately, one of the biggest symptoms I had was a sense that I could not breathe and just could not get enough air,” Pruden said in a recent interview with NJ Spotlight News, “to the point that just doing things like moving from the bed to the bathroom, you take five minutes to recuperate trying to catch your breath.”

His colleagues in the emergency room became “very familiar” with death and they developed rituals to protect their loved ones, Pruden said. These rituals included immediately washing their clothes after finishing their shift, showering before greeting family members or, in some cases, staying in hotels to limit their family’s exposure to the virus.

“It was a very, very tense and imposing time,” Pruden said.

Dealing with burnout

Health workers, including nurses and doctors, already faced overwhelming demands and experienced “crisis levels of burnout” before the COVID-19 pandemic, according to a 2023 report from the Centers for Disease Control and Prevention. The public health crisis presented unique challenges that further impaired their mental health, the report says.

For many health care workers, burnout — the feeling of being mentally, physically and emotionally exhausted — happened after the height of the pandemic, according to Cedar Wang, the vice president of nursing operations at Holy Name Medical Center in Teaneck.“There was this phrase in nursing and health care that happened — ‘from hero to zero’ — because there was all of this attention on health care workers for a time … and then it was just like, ‘OK, everyone’s back to normal,’” Wang said.

“A lot of health care workers felt forgotten and that was when they could actually take a pause to reflect on what they had just been through. For a lot, that’s when burnout happened,” Wang said.

Pandemic bonds

But some health care workers who spoke with NJ Spotlight News, including Ashley Fitzpatrick of Holy Name Medical Center, pointed to “a level of bonding” that took place among health care professionals during the height of the pandemic.

“I still see some people in the hallway, and I just think of them during that period of time and just seeing how they rose to the occasion really was so beautiful,” said Fitzpatrick.

Michael Kirk, the nurse director of the intensive care unit at Virtua Mount Holly Hospital, said that working through the height of the pandemic was also among “some of the best times in our life” for frontline health care workers at the hospital because they were able to “pull together” as a group and tackle the health challenges that confronted them.

“We had a motto, ‘No one was going to die alone,’” Kirk said in a recent interview with NJ Spotlight News. “I often said to them the sacrifice that we’re making is why we became nurses and doctors. We were in it together,” Kirk said.

‘Many institutions now have wellness officers, people who regularly provide surveys, for example, across the organization and ask people anonymously about their mental and physical wellness.’ — Dr. Frank Ghinassi, Rutgers University Behavioral Health Care

The pandemic was also a “catalyst” for Virtua to take a more proactive and comprehensive approach to staff members’ well-being, according to Nicole McNeal, who was hired in 2022 as the organization’s first well-being director.

Over the past several years, Virtua has implemented new programs to support staffers, including a peer support program and “stress first-aid trainings,” according to McNeal. This training aims to teach skills for prioritizing a person’s mental health and is designed to help people manage and recover from emotional distress, McNeal said.

Additionally, Virtua offers Carebridge, an employee assistance program that provides emotional and “work-life” support for staff. The program offers six free sessions with a mental health professional “per occurrence,” which could include grief related to a death, a divorce and work-related stress, among other mental health challenges, according to McNeal.

Renewed focus on wellness

Health care professionals, including Dr. Frank Ghinassi of Rutgers University, said many hospitals with employee assistance programs have delivered those services to people “with far more vigor and energy” than they did before the pandemic because they realized health care workers were under just as much, if not more, stress as other people in their communities. Hospitals also realized that if they wanted a workforce that was going to continue to care for other people, that workforce had to take care of its own mental and physical health care, said Ghinassi, the president and chief executive officer of Rutgers Health University Behavioral Health Care.

gularly provide surveys, for example, across the organization and ask people anonymously about their mental and physical wellness,” said Ghinassi, who also serves as the senior vice president of the behavioral health and addictions service hotline at RWJBarnabas Health.“Keeping those efforts moving and continuing to enhance those to the extent that we can — that’s a good five-year legacy for what we learned during COVID,” said Ghinassi.

Pruden of St. Joseph’s University Medical Center in Paterson also recommended that health care workers today avoid isolation and spend “face-to-face time” with other people. He noted that his own social support system — which included his wife, who is a nurse — helped him to navigate these last five years.

“Most people who died yesterday had plans for today. Death comes at any time. And so, we

should not live in fear of death,” said Pruden. “We should say, ‘Hey, I’m alive today. I have another chance.’ Every day is a gift.”