Last month, at the start of a fourth Covid-19 wave in the US, a nurse in a Seattle-area intensive-care unit announced her resignation on Twitter. “No amount of money could convince me to stay on as a bedside ICU nurse right now,” she wrote. “I can’t continue to live with the toll on my body and mind. Even weekly therapy has not been enough to dilute the horrors I carry with me from this past year and a half.”

The nurse, Sara, who asked to be identified by her first name so she could speak freely about her experiences at work, told Vox that she’s been offered incredible bonuses in exchange for extra hours. She said she could make an entire month’s mortgage payment just by working one extra shift, but has declined. “We’re not soldiers,” Sara said. “We’re not the saviors of humanity. We’re humans who have families and the need to take care of ourselves.”

In June, Julia Belluz wrote for Vox about the many structural barriers that prevent physicians from getting mental health treatment. It led to an outpouring of support, and a question: What about the nurses?

The roughly 3 million registered nurses (RNs) currently employed in the United States are, in Sara’s words, “the eyes and the ears and hands and feet of providing health care.” But nurses are leaving the profession at a staggering rate. According to a 2021 report from Nursing Solutions, the turnover rate for registered nurses last year was close to 20 percent. This leaves hospitals understaffed: About 10 percent of hospital RN positions were vacant last year, the same report found, perpetuating a cycle of burnout and likely worsening the quality of care for patients.

As an ICU nurse, Sara said the pressure and strain have felt unbearable. When Covid-19 arrived, she was often the only health care provider in the room with a critically ill patient, “feeling like this person’s life was completely in my hands, and it was up to me,” she told Vox. She said her own symptoms now mirror some of those of post-traumatic stress disorder: traumatic flashbacks, nightmares, uncontrolled moods, and crying.

Sara was able to carve out time to find a therapist and join a virtual support group, but she worries that many nurses don’t have the capacity to seek support on their own. “It feels like everybody’s running on fumes,” she said. “We need to make the barriers to accessing [mental health support] quite a bit lower because people are just so exhausted.”

The mental health of nurses was taxed even before the Covid-19 pandemic. Female nurses in particular were at twice the risk of dying by suicide as women in the general population, according to research published earlier this year. And that’s only “the tip of the iceberg,” said Christopher Friese, a professor of nursing at the University of Michigan and a co-author of the study. “What I worry about is the large number of nurses that we can’t even quantify, that are suffering in silence.”

Friese, who has practiced as a registered nurse for 27 years, spoke with Vox about the toll nursing can take on mental health, and what has to change for nurses to get the support they need. Our conversation has been edited for length and clarity.