The Healthcare Hero Paradox and the Alleged Nursing Shortage

AM408, BSN, RN

The "nursing shortage" gained notoriety during the pandemic's exacerbation of this incessant age-old struggle. Hospital administrations and city officials tend to advocate for an expansion of nursing school capacities and an increase in prospective students as if pumping more nurses into a broken system will resolve all of the systemic issues that have long resulted in such high turnover rates. Like many medical interventions in the United States, this is only a band-aid solution to a chronic systemic problem.

In this essay, I will paint a picture of the crippling overwhelm, exhaust and disrespect that have resulted in my personal nursing burnout as a means of illustrating the true reason behind the "nursing shortage", which I believe to be a shortage of nurses willing to tolerate the current conditions of overwork, underappreciation, high stress, and abuse.

We must first acknowledge how dangerous and absolutely dire it is that nurses are short-staffed. When nurses are short-staffed, it doesn't just mean that tasks get completed more slowly. It means poor outcomes. Patients will soil themselves and sit in it for hours. Medications will not be given on time. Unsteady patients will fall to the ground. They may hit their head or fracture their hip because no one was around in time to assist. Patients who become septic or have stroke symptoms may not receive timely intervention because their nurse was providing care in too many other patient rooms to notice, to no fault of their own. Short staffing is unconducive to patient safety. Short staffing is unconducive to work satisfaction. Short staffing is unconducive to nurse retention.

The way that nurses have been publicly celebrated compared to the way that we have been mistreated throughout the pandemic is an utter paradox.

Healthcare Hero. That's what they called us on the news while we got coughed on by potentially Covid-positive patients who opted to remain maskless despite their vaccination status and hospital recommendations. That's what they called us when we wore the same N95 for a month — when we were each given a brown paper bag with our names sharpied on — a bag for our single-use N95 to live for the next 30 days "or until visibly soiled".

Healthcare Hero. That's what they called me when I couldn't physically stand up after some 12.5-hour shifts because my feet, my shins, and my back would ache to the point of collapse. When I drowned in an unreasonable workload that only increased when fellow nurses, respiratory therapists and social workers justifiably quit.

Healthcare Hero. That's what they called us when we didn't get a raise amid 6% inflation when we could barely support ourselves, let alone any other family members — when we couldn't reasonably afford therapy to mitigate our trauma without forgoing something like our gym membership, childcare, groceries or rent. It's what they called us on medical-surgical nurse appreciation week when the hospital administration unfathomably expressed their gratitude by gifting each nurse a Hostess Ho Ho wrapped in plastic with a bow. Yes, a Ho Ho.

Healthcare Hero. That's what they called me when I advocated, educated, supported, and listened to people who did not say thank you. When I was verbally and emotionally abused by the people I was bending over backwards and neglecting my own needs to care for. "Get me ice water", "You're not doing it right", "You're a pest", "what are you looking at you ***ing ***”, "You're ruining my life", "stupid ***”, "you're a nasty ***.” Any nurse reading these quotes will be completely unphased. This is our normal — but it's not normal.

There are a lot of things about this job that aren't normal.

It's not normal to watch an elderly woman rip a surgical drain out of her knee and attempt to strangle herself with it — to actively tug of war the tubing from her grasp so that she could not succeed — "Rosa, stop. Please let go.”

It's not normal to administer an intramuscular injection into the deltoid of a person who is being pinned down by 6 staff members against their will while their screams for help echo across the unit.

It's not normal to get charged at by a violent man experiencing psychosis and quite literally run for your life out of his room and down the hallway — watching him aggressively flip over and shatter medical equipment as he approaches you.

It's not normal to watch the same violent patient hurl a metal folding chair at a hardworking coworker and proceed to assault two staff members in the hallway with a portable blood pressure machine — to scurry around this violent brawl in an attempt to close the doors of surrounding patient rooms — to shield sick people from the horror they are experiencing in an alleged healing environment. "Code grey, nine west. Code grey, nine west.” I stood five feet away from my coworkers as they pinned him to the floor with all the strength that they could muster, subconsciously on standby in case they were to need additional help. I stood five feet away, uncontrollably vibrating with adrenaline, as we waited too long for security to show up. "Additional help needed on nine west. Additional help needed on nine west.”

"Are you okay after what happened last week?” I'd say "Yes — It was scary at the moment, but I'm okay now.” I didn't realize at the time that I was lying. It had affected me in more covert ways. I was on edge lately. I was afraid — Afraid of slow passing cars and seemingly destinationless pedestrians during my dark morning walks to work. I used to listen to podcasts during those walks, but lately, I couldn't fathom putting headphones in, occluding my senses and my safety. I was afraid of the way my shadow doubled against the bushes that line the sidewalk, triggering my gaze to scan the eerie space behind me. I have been triple locking my apartment door.

I wasn't hypervigilant like that before.

"Why did you become a nurse? Because you're pretty nasty.”

That's what a patient told me on the most grueling and short-staffed day of the pandemic. Each nurse cared for an extra patient, which means that the workload of every team member increased by 25% (with no additional compensation). I hadn't eaten or sat down in over seven hours and I was probably too short in conversation with her despite my well-meaning intentions. I told her that I was doing my best and she told me "no, you're not.” I proceeded to replace the linens on her bed and take her for a walk around the unit, during which tears of overwhelm spilled from my eyes behind my goggles and surgical mask. I would have preferred to cry in the bathroom or the break room, but I was unable to step off the unit without neglecting sick people with real needs, so the hallway it was.

When I told a friend about recent events, she said "you're so selfless.”

Compassionate, patient, empathetic, hardworking, intelligent — I strive to be all of these things, but never do I want to be selfless. While I understand the positive connotation of the word, the unfortunate reality is that nurses often do feel as though they have lost themselves. In order to care compassionately for others, we must first be absolutely full of self. Our figurative cups must be full to the brim so that we can then give to others without running our energy supply dry. In this system of overwork, underappreciation, high stress, and abuse, we become numb, hopeless and burnt out. Over time we lose our inner light, our creativity, our drive that propelled us into nursing in the first place. Our cups have run dry.

Over 80% of nurses report feeling burnt out¹. Over a third of nurses report that it is very likely they leave their jobs by the end of 2022, primarily citing high stress and burnout as leading causes, followed by pay and benefits². If we pump more nurses into the system, over a third of them will feel the same way. We need to address employee satisfaction and retention so that nurses choose to remain nurses.

We do not need performative displays of gratitude like "healthcare hero" posters and appreciation emails from the hospital CEO. We do not need Ho Hos.

We need action. We need mandated rest breaks with the opportunity to fully disconnect, regulate our nervous systems, and lower our cortisol levels. This means we need break nurses to relieve us of our vital responsibilities so that we can step off the unit to catch our breaths with the reassurance that our patients are being cared for. We need appropriate compensation that increases when the workload and the cost of living do. We can't do this job if we can't live off of it. We need to be paid like the "heroes" that indeed we are. We cannot be told that our "time management" needs work when we acquire overtime after providing thorough care for 12.5 hours. We need some mercy and some grace.

We need these things so that we can continue to fulfill this vital role that is the backbone and the glue of our healthcare system.

References

¹ 2022: This Is The State of Nursing

²Study: 34% of Nurses Plan to Leave their Current Role by the End of 2022

The Healthcare Hero Paradox and the Alleged Nursing Shortage

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