Alessandra is in her 40s and grew up between Seattle and San Diego in the USA. She recently moved to France to recover from a burnout caused by working as a nurse throughout the pandemic. I was introduced to Alessandra through mutual friends in France, and after meeting in person to discuss whether or not she wanted to participate, we did the initial interview on Zoom.

Alessandra had done her undergraduate degree in Communications with Spanish but told me that she had come from a family of nurses, so nursing had always been in the background of her life. After studying to become a nurse she worked for the first 6 months (during what is called the “new graduate program”) in the oncology department, and then she moved to a department for 6 months called “step down,” where the patients are more unwell and often need what she described as a “rapid response” as they are declining in some way. She would regularly need to call all healthcare professionals working with the patient to come in and make important decisions about the type of care and interventions that may be needed.

She moved onto a transition program in post-partum care, where she worked for 9 months looking after the babies before they were discharged from the hospital, but eventually got bored. She did another transition program for 9 months in Telemetry Nursing, monitoring cardiac patients before eventually being accepted on a transition program in ER nursing in February 2015. She worked for 7 years as an ER nurse but told me that after 5 years she was already burnt out—which unfortunately coincided with the start of the pandemic. Around the 6.5-year mark of her time at ER, she began working temporary contracts in the Post Anaesthetic Care (PAC) department and for 6 months she alternated between ER and PAC.

At PAC, she was told that as she had been an emergency nurse, there was no need to have recovery experience, as in ER she would have covered so much already. There she found the work-life balance healthier, and she began to have better sleep and “nicer patients” who were able to thank her for her work. Overall she felt less stressed. Not seeing such traumatic things every day helped her stress levels and she had much more control over her schedule—she chose her shifts to match her capacity; they were not assigned to her. She began to realise that she could let go of working in ER—she described it as “addictive, like a drug,” and she restored a bit of calm to her life.

Alessandra was happy to contribute to my PhD research as she had a good grasp of the concept of moral injury and thought it might be similar, describing herself as “one of many who had suffered a lot.” She felt like nurses had been acknowledged as “the unsung heroes of Covid-19,” but actually, the stress of the job had been an issue for some time before 2020 and she warned: “we are losing nurses.” She believed that the more education and awareness of moral injury and burnout the better, especially if it could lead to better resources and better outlets. She told me that she is interested in learning more about photography but was always too tired and busy to make a start; she would go to the store to look at cameras but never took it any further.

The first memory that came back to her was of an elderly Vietnamese patient who had died and as a result, her body had swollen up, which meant that it was hard to remove some of her jewellery. The family had requested that both of the thick jade bracelets that she wore should be removed so she was buried with them, she remembered that they would be placed near the body in a specific way, in keeping with the practices of the woman’s culture and background. She described in vivid detail the memory of her and her colleague trying everything they could to remove the second bracelet, pulling at the deceased patient’s wrist. It was a disturbing incident as it felt like she was being disrespectful to the dead lady. This was in her first 6 months of nursing after graduating, but she obviously already knew that in front of the family members she should treat the dead person’s body with respect. Eventually, after several awkward attempts, they told the family that they would wait for the swelling in the body to calm down before trying again, and the family were very understanding. Alessandra said that a photograph of the jade bracelet would communicate this moment well.

Another memory that involved conflict between staff and a deceased patient’s family member arose, one where the patient’s brother was accusing the staff of not properly taking care of his sister, something that Alessandra found hard to hear, the patient was not easy to care for as she was morbidly obese, and she felt that the staff had done their best.

She spoke then about the rhythms and pace of the ER after showing me a photograph that she had taken when the ER was empty and calm. She described the drastic shifts in atmosphere that occurred there regularly when a patient was admitted who needed urgent care. One incident she remembered was when they were notified that there was a five-year-old girl on the way who had been shot in the head. The girl arrived sitting up, and clearly not as seriously injured as people were expecting. It turned out that during a celebration, people in the local community were shooting guns in the air and one a bullet had lodged between her skin and her skull. The process of preparing to witness and care for this patient caused her to mentally prepare for a traumatic event that never happened, which initiated a physical state of hyper-vigilance and stress. Being in this state was a frequent occurrence which eventually led to her decision to stop working in the ER.