Nurses are Pushed to the Brink

Nurse Beth, MSN

Greetings from California ? The situation is dire here, and nurses are spent. I hope it's better in your area. I have an idea of how to make things a little better that I just can't shake.

It's a simple idea. Tell me what you think.

Short of Beds

Patients are lying on hard gurneys inside tents hastily assembled on concrete hospital parking lots. Meanwhile, inside, hospital beds are pulled up from basement storage in and pushed to the end of MedSurg hallways with a privacy screen, a commode, and a handbell. There’s no TV, no call light and of course no bathroom.

GI labs and surgery waiting areas are being converted to ICU overflow beds. Patients are even being held in lobbies and gift shops of hospitals that have run out of beds.

Short of Nurses

Nurses are calling out in droves. Nurses who aren’t sick drag themselves in to work but are physically and emotionally fatigued. Suffering moral distress, some have seen more deaths in the last few months than in their entire career. Holding an ipad so their dying patient can face-time their loved ones to say goodbye is heartbreaking, but there’s no time to recover, even after their patient dies. Arrangements have to be made and the room turned over. An ED patient is waiting in queue for that bed.

Nurses talk quietly among themselves about who is the latest one of them to come down with COVID. Even though coworkers are getting sick, vigilance occasionally wanes because it’s exhausting to be on guard for months and months. On guard through Spring, Summer, Fall and now Winter. Most times in break rooms there’s only 2 people eating lunch at opposite ends of the table. But not always.

In illogical denial, on one level some healthcare workers believe they won’t get COVID from their bff at work, but at the same time, worry constantly. “How’s my taste? Can I still smell OK? I have a headache. Is this it?” And in the back of every nurse’s mind is the very real fear of infecting their own family.

Inside hospitals, everything except for staffing has fallen by the wayside. Education classes are not attended, staff meetings are canceled. Nurses are called to work every day, sometimes twice a day, and offered varying amounts of crisis pay.

But $50.00/hr extra is no longer an incentive for nurses who are exhausted as never before.

Short of Travel Nurses

Hospitals are desperately trying to hire crisis travelers. Federal, state and county government agencies are trying to get healthcare workers to hospitals. The National Guard sent crisis workers. The state sent crisis nurses to work for 48 hrs but some of these nurses had been retired for years (read about crisis nurses Hippy Harry and Geriatric Barbie in Day in the Life of an Educator).

Even with lucrative contracts of $180.00 per hour base pay, there are not enough travelers to meet the need.

California Ratios

In California, nurse-patient ratios were waived by the California Department of Public Health (CDPH). Here are the changes:

ICU ratios went from 1:2 to 1:3

Step Down units went from 1:3 to 1:4

MedSurg went from 1:5 to 1:7

Tele went from 1:4 to 1:6

ED went from 1:4 to 1:6

In reality, it’s a moment by moment staffing. Two nurses may take a team of 13 patients, with 1 nurse giving meds and the other doing assessments. If lucky, they may get a “helper nurse” from the OR because surgeries are canceled, but OR nurses aren’t familiar with the meds, have never barcode scanned medications, and have limited experience with computer documentation.

Why Not Hire A LOT of Nursing Assistants?

If RNs have to double their patient loads, work 16 hr shifts, come in on their days off, and be exposed to COVID, then they should be given all the help possible.

Today, in the midst of a national emergency where nurses are central, RNs need to focus on RN tasks. Not clerical tasks. Not housekeeping tasks.

Over the years, hospitals have cut nursing assistants and PCTs to the bare minimum, and RNs have picked up the slack. RNs spend a lot of valuable time chasing down supplies, answering phone calls, answering call lights, wheeling patients out for discharge, helping patients and families, sometimes even cleaning beds and turning rooms over.

But what if RNs didn’t have to answer call lights? What if all patients were toileted and bathed, ambulated, turned and proned, with water pitchers full and vitals taken? What if? If the RN could focus on RN tasks, she/he could safely handle a higher workload.

This isn’t about RNs being too good to perform non-RN tasks. It’s about patient safety and maximizing RNs when they’re overburdened. Would it be helpful if a surgeon on his way to perform an emergency surgery stopped to answer a call light, make and serve coffee?

How about turning the buzzword “working to the top of your license” into a reality?

I’m talking about hiring a lot of nursing assistants and PCTs. Flood the units with them. Is there really no money to hire unlicensed personnel? Paying RNs $180.00 per hour while having 1 nursing assistant per 15 patients is stepping over a dollar to pick up a dime.

If a massive number of nursing assistants had been recruited and hired just a month or two ago, there would be some relief today for nurses and more help for patients.

Hopefully, it can still happen. What other ideas might help? Having clinical pharmacists pass meds? Have lab techs perform all draws, or as many as able?

GI techs and OR techs can go to the floors and help patients call their families, or run to Distribution to pick up supplies.

Just my thoughts, thanks for reading.

What do you think?

Be well and stay safe.

Best wishes,

Nurse Beth