Anyone working as a nurse in the hospital setting during the pandemic is well aware of the hardships we have endured over the last several years. Before Covid, patients would come to us with illness or injury and we would follow the steps to make them better. Some infections wouldn’t respond, some trauma was too extensive, and some organs were simply too worn to be repaired and patients died. This was a sad but normal part of our job and most of us had effective, healthy coping skills to deal with death. Everything changed when Covid came around.
Suddenly, nurses and doctors didn’t have the knowledge or the tools to make our patients better. Covid was new, unresponsive to early treatments, and was spreading like a California wildfire across the globe. We watched as our patients took their last gasping breaths. We held their hands as they squeezed tightly, one last plea for us to do something to help them. But we couldn’t help. Through our face shields, goggles, and Papr hoods we watched as they said farewell to their family and loved ones through the screen of an iPad. Morgues were overflowing, hospitals were packed, and nurses were being asked to pick up as much overtime as they could bear. Burn out started setting in and many nurses began leaving, some to find work outside of the hospital and others left the profession altogether.
For those nurses who stayed, the issues seemed to snowball. With the suspension of elective procedures and other revenue streams, some hospitals fell into financial hardship. While a few hospital administrators donned their white capes and donated portions of their salaries to relieve their hospitals’ monetary struggles, not all were this generous. Many hospitals didn’t see a dime taken from the administration level. These facilities mitigated the financial strain by cutting employee benefits and freezing salaries. At one South Jersey hospital, the very nurses who were risking their lives to treat Covid patients had their raises frozen, 401k matching stopped, and lost their tuition assistance.
As treatments improved and less patients were dying, administrators with extremely short memories started to loosen safety guidelines in the interest of recuperating their finances. Patients began to share rooms with other patients, nurses began caring for Covid positive and Covid negative patients simultaneously, and rule-out patients were treated as though they were negative until tested positive. The fallout from this recklessness was entire teams of staff members becoming sick and missing work at the same time. Remaining staff became even more burned out from the increased workload and, in the current state of things, hospitals can barely staff their units.
At least the nurses still grinding out their shifts have the help of CNAs and PCTs to get the job done, right? Think again. Many ancillary staff members endured the same cuts in benefits and frozen wages as nurses, but were disproportionately affected due to their lower wages. With the Great Resignation movement and formerly-minimum wage employers like McDonald raising their pay, coupled with higher-than-normal inflation, ancillary staff members can easily find comparable or better wages and benefits working jobs far removed from the risks and bodily fluids associated with hospital work. Of the CNAs and techs from the beginning of the pandemic, most have now either graduated into higher-level positions or have left in pursuit of the aforementioned “better job.” Even bleaker, no one is lining up to take their place. Nurses are frequently working without help and getting burned out even faster.
Even when hospitals got too greedy to be safe and even as they felt unappreciated, underpaid, overworked, and greatly under-supported, nurses could still rely on the protocols put forth by organizations like the CDC and American Heart Association which protect themselves and their patients from the virus. Hospitals aren’t concerned with protecting nurses or patients, yet they will abide by these guidelines as they provide a legal safety net for when people die. Recently these protocols were amended and they no longer protect patients and providers.
In their October 2021 update regarding CPR for Covid patients, the AHA stated “Do not delay chest compressions for provider PPE or to place a face covering on the patient.” This update comes only months after Celia Marcos, RN died for doing exactly what the AHA recommended. Celia was working in a California hospital that had struggled to maintain proper PPE for their staff. She was charge nurse one night when a Covid-positive patient on her unit went into cardiac arrest. Protected only by her paper surgical mask, Celia responded by initiating CPR on the patient. During this incident, the virus was transmitted to Celia who died only 14 days later. She lost her life “not delay[ing] chest compressions for provider PPE.”
Fortunately, the AHA received very vocal opposition to these dangerous guidelines from the nursing community. Nearly every nurse blog and nurse influencer voiced criticism for the guidelines which seemed to completely forego the risk to providers. The latest update from the AHA has redacted the no-PPE-necessary approach, now stating that “initial responders are not already wearing appropriate PPE, they should immediately put on PPE, and then begin CPR.” The American Heart Association cited the reason for their change of heart is due to the contagious nature of new Covid variants.
The reason the AHA would knowingly put nurses and other providers in harm’s way is unclear. It would be unfair to accuse them of submitting to political pressure which would absolve hospital systems with mismanaged supply chain issues liability which would prevent nurses like Celia Marcos from having access to PPE in a moment’s notice…so I won’t.
If the AHA is sinister for their attempt to put nurses and other providers in harm’s way, then what do we call the CDC for their most recent updates to the quarantine protocols? The latest CDC guidelines for healthcare providers with a Covid infection and “mild or improving symptoms” is only 5 days, regardless of vaccine status, “when staffing shortages are anticipated.” Sounds bad, right?
It gets worse. The guidelines state “When staffing shortages occur, healthcare facilities and employers (in collaboration with human resources and occupational health services) may need to implement crisis capacity strategies to continue to provide patient care.” This “crisis” strategy means there IS NO WORK RESTRICTION for healthcare providers with Covid. One more time for clarification, the Center for Disease Control has decided that if hospitals have a staffing shortage (which, as we’ve discussed, is most likely a result of the poor treatment of their staff during the pandemic, so…their fault), Covid-positive CONTAGIOUS nurses and doctors will be caring for sick patients.
How can it be fixed?
Nurses are exhausted. Hurt. Depressed. We are sleeping more, crying more, drinking more and pursuing fewer advanced degrees and certifications. Omicron and other variants have just ripped their way through households celebrating the holidays and are on their way back to offices, schools, college campuses, and nursing homes. With such a bleak future, what can be done to mend the profession of nursing? What can we as nurses do in the meantime to keep ourselves at the bedside caring for the patients that inspired us to enter the profession in the first place?
There are 3.8 million nurses in the United States. We as nurses must acknowledge our power as voters within the political system that drives so many of the unsafe changes to Covid guidelines. If we stick together and put pressure on our legislators, I believe we can push safer practices up the ladder to the CDC. If we all use our voices and social media presences to speak out against the AHA’s guidelines, we will be heard (by both the AHA and their donors). Remembering the hospital admins will usually follow the guidelines (for legal CYA purposes at least), this would be a great first step toward repairing our profession.
Next would be focusing on our individual hospitals. How do nurses earn more gratitude from administrators than the occasional pizza? That is a tougher question for sure, but one I have a theory about. Administrators in nearly all cases are motivated by money, therefore the only way to incentivize the administration to offer better treatment, pay, and benefits to nurses is to show the financial benefit of doing so. What has the turnover cost our hospitals? One anonymous nurse educator estimates the total cost to on-board a new RN is close to $125,000, therefore losing nurses adds up very quickly. Every 8 nurses that leave can cost nearly one million dollars!
So how do we keep our nurses? We could throw money at everyone; who doesn’t love a raise! But is this the best solution? Or is there something we could do to ensure our nurses are properly supported, can provide the care they were born to provide, and remain safe while doing so? The consensus amongst my coworkers was unanimous: we would take happiness over a few extra dollars.
Happiness comes in many forms, but for nurses we are looking for support and the opportunity to do the job we were born to do. First, I ask hospitals to take strides in attracting and retaining ancillary staff. Fair pay, increased benefits, tuition assistance, and acknowledgement would all go a long way to ensure our CNAs, techs, and coordinators know how much they mean to our healthcare system and would prevent so much migration away from these professions. These changes would cost less than if we attempted to provide nurses with meaningful raises and would easily pay for themselves through the retention of just a few nurses.
Second, I would ask hospitals to take a close look at the way they communicate and provide support for their staff. Does the staff have a voice? Are concerns taken seriously and are reasonable actions taken to constantly improve systems? Do nurses feel comfortable and safe when they are working or walking around parking areas? A supportive and happy nursing environment is one with resources, amenities, and advancement opportunities which make it much easier to attract nurses rather than repelling them. Until the establishment of such an environment, I’m afraid hospitals will continue losing staff as nurses and other professionals seek out careers where they are valued.
As a nurse, here is your to-do list:
Write your local representatives and use the weight of your voting power to push for change.
Write to the CDC and express your feelings toward their guidelines and how they put our patients at risk.
Thank your support staff. The gratitude must start with us. Ensure your aids and techs know they are an integral part of the team.
Protect yourself and each other, regardless of the dangerous new guidelines in place. We cannot serve our patients if we become patients ourselves.
Communicate with your chain of command and offer yourself and your willing colleagues as a think tank to improve staff retention and happiness. Many managers will stonewall you. May I suggest a taller ladder?
Remain united. We are valuable, educated, caring, instinctual, multi talented professionals in the most important profession in the world. Don’t forget it, and don’t let anyone hurting our profession forget it either.