The Healthcare Hero Paradox and the Alleged Nursing Shortage

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by AM408 AM408, BSN, RN (New)

Specializes in Med-Surg.

An exploration of the Healthcare Hero paradox as it relates to 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. This is a personal account of burnout in an effort to humanize and illustrate the unfortunate state of nursing and to provide some reasoning as to why nurses are leaving the bedside.

Burnout: Nurses leaving the bedside

The Healthcare Hero Paradox and the Alleged Nursing Shortage

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

AM408

AM408 is a BSN, RN and specializes in Med-Surg.

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9 Comment(s)

Julita, BSN, RN

Specializes in OR,PAR,PainMgmt,GenSurg,Cosmetic,Imaging,Endoscopy. Has 22 years experience. 2 Articles; 7 Posts

Oh what an accurate account of what has been happening all along in the healthcare organization. Nursing shortage has become the norm in many countries. I totally relate to this. Thank you for highlighting this. 

brandy1017

brandy1017, ASN, RN

Specializes in Critical Care. 2,700 Posts

I left bedside and took early retirement for all the reasons you cited.  I am coming up on 18 months of freedom from the stress and disrespect and feel so much better.  One of the last remaining loyal, experienced nurses recently left, quitting under duress while dealing with a true mental health crisis that left her hospitalized and had 200 hours of her PTO stolen from her after working thru covid.  The management there stole thousands from her, got covid bonuses, while nurses were refused hazard pay and totally disrespected and understaffed and now this final insult from a so called "Christian" health system that got over a billion dollars from the government and made over a billion in profit during covid, while denying their workers a pay raise and no compunction at stealing a nurse's PTO on the way out the door!

I'm glad I left when I did and I encourage anyone and everyone to do the same.  Do not put up with the abuse and disrespect!  You are worth more!  Use your PTO do not let them steal it from you!  Know your state laws because unfortunately unless you live in a state that protects your PTO your employer may steal your PTO when you leave so use it up before you go!  Take FMLA for your mental health if needed!  Then come back and give your two weeks notice for a much better job!

Edited by brandy1017

No Stars In My Eyes

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience. 2,945 Posts

Exactly! There is a nursing shortage because facilities chew us up and spit us out. And who wants to apply for a job with "The Dreadful Maw" (mouth) that someone else just left for the same reasons we ourselves might end up leaving that same job. 'Round and 'round and 'round we go, only to end up in the same or a similar spot once again. No one benefits from that.

And I think that 'getting rid of' LPN's was a huge mistake. I remember when I heard that most places would henceforth be run by so-called Primary Nursing: ie," all RN's all the time", who must do everything for each of their patients. Yeah, fine if you had 2 patients. But expecting nurses to take on 5-6-7 patients, or more, for each shift? With the acuity levels straining the whole system?HAH! And the poor techs working by themselves with little assistance from their nurse, because she is already too busy. "Techs are our eyes and ears", I've heard it said. The name was changed from (Certified) Nurses' Aides to Techs. Now, as Techs they can take on even MORE responsibilities.

I do have to remember to smile when someone tells me they are going into nursing, because my real reaction inside my head is: "Oh No! I'm so sorry to hear that. Don't do it! It is a lot worse than you'd ever suspect, these days." [And it never was like those lying "Cherry Ames, RN" books.]

The changes in nursing are what eventually took the stars right out of my eyes, hence my screen name. I loved caring for people, but employers don't care if I do or don't. To them, that's not the point. They want the patients coming into a hospital and going home ASAP, 1-2-3, for $$$,$$$.$$ that goes to all the business folks who think they know what's best. If I didn't feel so sad at the state of things and how it affects everyone caught up in that cycle, I would actually LOL, but I don't have it in me.

And yet, I am so thankful for the GOOD nurses I come across now, who try to stick with nursing in spite of the way things are. 

vintagegal

vintagegal, BSN, RN

Specializes in Geriatrics. Has 3 years experience. 240 Posts

You know why there’s a “shortage”? Three little bitties on the floor control the whole thing. They gossip, they lie, they make you feel like crap. They think they are the wisest of nurses, they’ve seen everything, they’ve done everything, they know everything. And maybe you don’t stick the tape to the back of your glove so they think you’re not like them. The nursing shortage is due to rude, back stabbing, immature, middle aged women with nothing to do all day but congratulate each other on being masters of the universe. 

Silver_Rik

Silver_Rik, ASN, RN

Specializes in Perioperative / RN Circulator. Has 2 years experience. 184 Posts

The legislature in my state is proposing to go down this road to “solve” the problem.  Remove capacity limits for nursing programs and lower the standards for nursing school instructors. Now you need a BSN to teach in an ADN program a masters is required to teach BSN students. They propose to change this so an ADN nurse can teach ADN students etc.

also opening up licensure to anyone with an RN license whether or not we have a compact  / reciprocity agreement with their home state (this one actually makes sense and is probably just reality for smaller / more rural states)

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 11,001 Posts

3 hours ago, Silver_Rik said:

Remove capacity limits for nursing programs and lower the standards for nursing school instructors

In other words, solve the warm body problem but propagate the lack of care

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 20 years experience. 3,597 Posts

I can see why the powers that be decided lowering standards for nursing instructor's was needed. I don't agree with it but I can see it. I recently got a recruitment letter from a local community college for both full time faculty and part time adjunct faculty.  The education requirements for faculty in both positions is MSN required, PhD preferred though they would consider an applicant with a BSN who has made "significant progress" toward their MSN.

The pay? Well, I made more than the $64,500 full time faculty position's posted salary the past few years with my lowly ADN. The part time adjunct faculty position was listed with an hourly wage of $44.00/hr...say what? That's insultingly low when every hospital and most SNF in the area pay around that or more with no BSN required much less an MSN. 

It's got to be hard to attract well qualified applicants when they know the students they are teaching are going to graduate making about what they are at least, and possible more.

cgw5364

cgw5364, ADN

Specializes in Maternal Newborn and Denials Management. Has 38 years experience. 25 Posts

I have been a nurse for 30 years. I left the bedside 10 years ago to work in medical review/denials management. I still liked my bedside nursing job in mother/baby but was tired of being on call and working 12-hour shifts.  I worked on mother/baby for 10 years. The local BSN program rotated on our unit and we had Summer externs. At least half of the students told me and others on our unit that they only planned to work bedside nursing for a year before moving into management or going to NP school. I imagine the last two years of Covid have exacerbated this situation. 

RN WRITER NC, ADN

Specializes in Alzheimer's disease, Dementia. Has 16 years experience. 3 Articles; 16 Posts

Thank you for your article and also for the references.  I am one of the many burned-out nurses in LTC and appreciate your detailed analysis.