“Covid was a wild time,” says Natalya Rodriguez of Baldwin Borough, a nurse at Allegheny General Hospital. She began her nursing career when the covid-19 pandemic struck in 2020. (Shane Dunlap | TribLive)
Story by JULIA BURDELSKI
TribLive
March 23, 2025
When covid-19 struck, Natalya Rodriguez, fresh out of nursing school, watched as a flood of overwhelmed colleagues abandoned the health care field.
Nothing had prepared nurses in the U.S. for a pandemic — or the death and fear it brought.
The National Council of State Boards of Nursing estimated 100,000 nurses quit during the pandemic, creating staffing shortages at hospitals, nursing homes and care facilities.
Rodriguez could have packed it in. But she didn’t. Instead, she embarked on a career at Allegheny General Hospital on Pittsburgh’s North Side.
“I knew that’s where I was needed,” Rodriguez, 35, of Baldwin Borough told TribLive.
Five years later, that’s where Rodriguez remains, a survivor in an industry radically transformed by a virus that killed millions around the world.
“Covid was a wild time,” Rodriguez said.
Health care workers grappled with problems beyond staffing. Nursing homes struggled to abide by infectious disease protocols. There were shortages of personal protective equipment. Debates raged about masking, shutdowns and quarantines.
“The pandemic, it was very rapid, very dramatic,” said Dr. Don Whiting, who served as Allegheny Health Network’s chief medical officer throughout the pandemic and now is chair of Allegheny General Hospital’s Neuroscience Institute. “In the beginning, there were just so many unknowns.”
Although the pandemic exposed gaps in the health care system, it also spurred positive changes with long-lasting effects.
The use of telemedicine soared. Experts learned how best to care for vulnerable residents in hospitals and nursing homes. Administrators figured out optimal ways to adjust staffing levels.
At the cardiac telemetry unit where Rodriguez works, for instance, her union contract stipulates one nurse can be responsible for no more than four patients during the day or five overnight.
Such measures ensure nurses can care for patients properly, even though workforces have shrunk. Unionization has allowed nurses like Rodriguez to get pay bumps and benefit from better staffing ratios to ensure they’re not stretched too thin.
Over time, Rodriguez watched Allegheny General slowly return to something resembling normal. Visitors, once barred from hospitals during the crisis, are once again comforting loved ones.
The uncertainty that reigned in the early days of the pandemic mostly has disappeared.
Kathleen Jae has worked at West Penn Hospital in Pittsburgh’s Bloomfield neighborhood for the past 13 years.
What she’s noticed most since the start of the pandemic is a new reliance on travel nurses to fill the gaps left by nurses who quit.
Travel nurses, she said, rotate to different units and hospitals every few weeks. They’re constantly learning new routines, new systems and new patient populations.
Without them, Jae said, she fears West Penn would face a “critical” problem.
But those nurses aren’t always well versed in the systems in place at different locations or the unique needs of patients in different settings. It’s an imperfect solution, Jae said.
Despite ongoing frustrations and the widespread fear of the virus at the height of the pandemic, Jae, 61, of Franklin Park, said she felt she had to stay on the job. She has worked in various health care jobs since she was 25.
“I felt a responsibility and an obligation to stay and take care of these people who were desperately ill,” she said. “If we all left the bedside, who was going to take care of these people? This is what I signed up for.”
Dr. Carol Fox, chief medical officer at Independence Health, said the pandemic took a toll on caregivers, physically and mentally. Some retired. Some found new jobs.
Filling the gaps they left behind, she said, isn’t easy. And people who were in nursing school as the pandemic struck didn’t get as much experience in their training as normal, making it harder to replace departing nurses.
“People joining the profession needed a longer ramp-up period because they didn’t have as much hands-on training during their education,” Fox said.
Nurses are in high demand in hospitals and care facilities throughout the commonwealth and country.
“Staffing was always a challenge in long-term care, even prior to the pandemic,” said Zach Shamberg, president and CEO of the Pennsylvania Healthcare Association.
The challenge was compounded by workers leaving during the pandemic and more stringent staffing requirements implemented by the state.
Before covid, Pennsylvania required each patient in a care facility to receive at least 2.7 hours of direct care per day.
In 2021, the Pennsylvania Department of Health proposed raising that to 4.1 hours per day — which would have required thousands of new workers and been “one of the largest unfunded mandates the industry has ever seen,” Shamberg said.
Today it stands at 3.2 hours.
Organizations like Shamberg’s have tried to find solutions to bridge the staffing gap.
His group worked with the state to create a new pathway to nursing careers. Pennsylvanians can now take an online course and get hands-on training at nursing homes to become temporary nurse aides, with an option to become permanent health care workers after passing a competency exam.
The pandemic took a steep toll on Pennsylvania’s nursing homes.
By March 2021, about 12,600 deaths were reported in more than 1,500 long-term care homes statewide, according to The Covid Tracking Project at The Atlantic.
Brighton Rehabilitation & Wellness Center — site of one of the biggest covid outbreaks in the nation — accounted at the pandemic’s peak for 65% of Beaver County’s covid-19 cases and 90% of the county’s deaths.
“Covid hit, and we sort of found ourselves in a situation that no one expected or had ever experienced before,” said Chase Cannon, executive director of the Pennsylvania Coalition of Affiliated Healthcare & Living Communities. “How do we control infection? How do we prepare going forward?”
Care facilities have spent the past five years figuring out the best answers to those questions.
They’re now focused on keeping enough personal protective equipment on hand. Staff undergo additional training to ensure they know best practices for curbing the spread of infectious disease and disinfecting surfaces.
Emergency preparedness is now top of mind, with some nursing homes hiring designated infectious disease specialists. Stricter protocols are in place for sanitization, testing sick residents, and communicating with patients and families during crises.
“That’s one of the silver linings,” Shamberg said. “We recognized the importance during the pandemic of having comprehensive emergency preparedness plans for future outbreaks.”
Covid protocols at care homes have evolved, he said. No longer are patients quarantined by themselves if they test positive. In most facilities, they’re now put into groups that separate the ill from the healthy. In many nursing homes, Shamberg said, there may be a separate wing or floor where covid-positive patients stay.
Even five years after the first wave of covid-19 infections, the virus still rears its head. But long-term care advocates said the virus isn’t circulating with the same virulence, leaving it more akin to seasonal influenza or RSV infections.
“While the pandemic may be over, covid is still very much a part of our daily operations,” Shamberg said.
Facilities continue to test patients and employees who may have contracted the virus, keeping affected patients and workers away from healthy ones. Masks remain commonplace, Shamberg said, though other measures like goggles and gloves largely have been phased out.
Also lingering are uncertainty and stigma around care facilities, said Susan Saxinger, executive director of the Pennsylvania Assisted Living Association.
“Personal care providers and assisted living providers did their absolute best to preserve life,” she said. “It’s something that will be an ongoing tactic to ensure that families and consumers know that they will always receive the highest quality of care.”
Nationally, she said, assisted living facilities have soaring satisfaction rates. More than 90% of residents in senior living facilities report high satisfaction, and more than 80% of their families think the model provides good value, according to a 2023 report from Argentum, a national trade association for companies managing senior living communities.
In the early days of the pandemic, officials conducted contact tracing, a process of tracking down people recently exposed to the virus, monitoring whether they become infected and trying to prevent further transmission by measures such as isolation.
Dr. Kristen Mertz, a medical epidemiologist at Allegheny County Health Department, said it’s unclear whether that worked.
“The impact of contact tracing was less clear, given the short incubation period and thus an inability to reach contacts before they started to spread the virus,” she said in a written statement. “To reach more cases and contacts, new texting platforms and online forms were developed, which are now more widely used for other diseases.”
Technology also has revolutionized how patients connect with doctors. People who once drove to an office for routine care now often have virtual options.
Whiting, the Allegheny Health Network physician, said telemedicine had been available for years, but the pandemic accelerated its availability and popularity.
“Without the urgency of the pandemic, that would’ve been a thing that would’ve taken years and years,” he said.
Telemedicine is particularly useful for people with disabilities who may struggle to get to a doctor’s office or people who find doctors’ offices anxiety-inducing.
About 55% of AHN’s behavioral health visits now are conducted via telehealth, Whiting said.
“I don’t foresee that telemedicine would ever take the place of traditional in-person appointments altogether, but I think there’s a role for it and a value in it,” Independence Health’s Fox said. “I think it creates access in many ways because that patient’s not having to spend time traveling. They’re not having to spend time in the waiting room.”
UPMC has embraced virtual options as a way to link skilled specialists with patients in rural hospitals, allowing doctors to help patients hundreds of miles away, the health care giant said in a written statement.
As health care workers are navigating their industry post-pandemic, they’re facing a new political climate, one in which health care workers are sometimes vilified and scientific breakthroughs politicized.
In 2021, the Associated Press described how anger over covid safety rules, vaccines and masks became so bad that some health care workers were given panic buttons and others removed their scrubs before going out in public.
Fox said a perfect storm of factors contributed to increased animosity toward health care workers.
Some people were skeptical of the science behind vaccines and covid-19 research. Others listened to politicians peddling false claims about the pandemic. Anxiety and fear abounded, particularly among those who couldn’t afford or access the care they needed. And misinformation proliferated through social media.
“I think that leads to some skepticism and animosity toward health care workers,” Fox said.
But not all health care workers feel that negativity.
Jean Caruso, 30, of Regent Square, said the attention paid to health care workers seems to have faded since the height of the pandemic, but she remembers fondly the pandemic-era trend of extending extra appreciation to nurses and others on the front lines.
Some shops or restaurants offered them discounts. Hospitals and nursing homes displayed signs saying thanks.
“It was awesome when people were looking to us as these health care heroes,” Caruso said. “But we’ve always been there, and we’ll always be there for our patients. That’s our job.”
Caruso has been a nurse at UPMC Magee-Womens Hospital since 2017.
Some things there still haven’t returned to normal. Staffing shortages linger. Interactions with patients are more limited — partly because staffing pressures pull nurses to fill more roles and partly because health care workers want to get patients out of the hospital quickly to reduce the risk of catching another illness during their stay.
And burnout persists.
“We were all in survival mode for a long time,” Caruso said. “I’m not sure if we ever left that.”
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Julia Burdelski is a TribLive reporter covering Pittsburgh City Hall and other news in and around Pittsburgh. A La Roche University graduate, she joined the Trib in 2020. She can be reached at jburdelski@triblive.com.
