Will Nurse Exploitation Continue Beyond COVID-19?

**J.Adderton**, BSN, MSN

Exploitation. It is a strong word that might not ring true in your own nursing career. But for many nurses, the word is a looming “elephant in the room” that just will not move. The COVID-19 pandemic removed my rose-colored glasses and I now see things a bit clearer. I don’t want to accept “the normal” treatment of nurses. Read on to learn how exploitation fits into my nursing experience.

A Story of Our Own

As nurses, we each have unique experiences that builds our story and this article is a piece of mine. I graduated nursing school in 1993 and obtained a master’s degree years later. I’ve spent years of my career away from the bedside in leadership and education roles. Four years ago, I returned to bedside nursing at a large hospital in Alabama. In the hospital, amid COVID-19, is when I felt most devalued in my career. Today, my story is wrapped around the uncomfortable feelings of frustration and anger.

This Normal Will Never Change

According to Gallup polling, nurses rank highest in honesty and ethical standards when compared to a list of other professions. Nurses have held the most trusted spot for 18 consecutive years. Why? Because people trust us to put people first and do the right thing. With or without the pandemic, the profession will continue to provide compassionate care while maintaining human dignity and respect. This is the “good stuff” that attracted me to nursing so many years ago.

I Feel Exploited Because…

I know nursing will always be a demanding job that changes rapidly. I also understand healthcare is a business and there will always be financial constraints to deal with in nursing. However, I am drowning in resentment that my desire to make a difference is being devalued by an employer seeking to deepen financial pockets. My employer is placing unsustainable demands on nurses without providing the necessary resources or support to be successful. Hospital leaders depend on nurses to go above and beyond to meet patient needs, even if it comes with personal cost.

Eventually, like many of my co-workers, I will reach the end of my rope and leave. A large group of new hires will start orientation and the cycle will repeat itself. There is something arrogant in the executive philosophy “nurses are expendable because there is a pool of nurses just waiting to sign on”. Management practices that would be outliers in other professions have been normalized for bedside nursing, for example:

Standing policies, based on best practices, are in place to protect staff and patients from COVID-19. Staff are then provided with 1 surgical mask for protection and it is to be used over multiple shifts. Should the 1 mask become soiled, the nurse must track down the house supervisor for a replacement.
Your supervising nurse calls and asks you to come in on your off day because your department is short-staffed. When you arrive, the house supervisor pulls you to another floor. You explain the agreement was that you would come in on your off day to fill a gap on your floor. The house supervisor simply states, “it doesn’t matter, you agreed to come in’.
You float to an unfamiliar unit and you have no experience with the treatment orders. When you voice concern, you're told, “a nurse is a nurse and nursing is nursing”.
Raises are infrequent and never exceed 1% of your hourly pay. Everyone, regardless of performance, dependability, or productivity, receives the same raise.
Exhausted nurses ask management to provide some relief by hiring agency or contract nurses. They are told this was not an option because employees would resign to work for the agency, and it did not fit into the budget.
A group of nurses approaches their manager and voice safety concerns with the current staffing grid. The manager agrees and takes the concern to administration. Later, your manager announces a small change has been made to the nursing assistant grid, but the nursing staffing grid was reduced.
You have accrued a significant number of paid days off and want to take a vacation. However, you are asked by management to hold off plans until staffing is better.
You are a charge nurse and visitor’s behavior is making you and the nurses uncomfortable. You contact the house supervisor and are told: “I’m tied up but...you got this”.
It is rare you actually get to take a full lunch break, if you eat at all. When you submit the paperwork to be paid for missed meals, you are told to better manage your time in the future.
The hospital changed the vendor for wound care in order to reduce costs. Bedside nurses did not have the opportunity to pilot the products or participate on the deciding committee. Bedside nurses did not know of the change until the new supplies just “appeared” in the supply closet. Unfortunately, the bandages are difficult to use and skin prep is no longer provided.

It saddens me that treating nurses unfairly for financial benefit has been normalized. Now, I don’t think administrators gather in a room and diabolically plan to take more from nurses than they are giving in compensation and resources. But, the burden COVID-19 has made some motives and mistreatment more visible.

Values Taken for Granted

I recently read a New York Times opinion article, The Business of Health Care Depends on Exploiting Doctors and Nurses, written by Dr. Danielle Ofri, a physician at Bellevue Hospital and New York University. In the editorial, Dr. Ofri asserts the U.S. healthcare industry profits from the work ethic of physicians and nurses, stating:

Quote
By now, corporate medicine has milked just about all the “efficiency” it can out of the system. With mergers and streamlining, it has pushed the productivity numbers about as far as they can go. But one resource that seems endless — and free — is the professional ethic of medical staff members.

I feel devalued when hospital executives take the work ethic of nurses for granted. Nurses will continue to experience limited resources, low compensation, and high patient to nurse ratios because... despite all these barriers, the business of healthcare knows most nurses will:

Absorb new tasks, even when additional resources are not made available.
Do everything possible to maintain quality of care, including working when burned out, sick or facing demanding outside responsibilities.
Be loyal employees, even when inadequately compensated
Will be resourceful when supplies are few or not available at all

Nursing Beyond COVID-19

As I write this article, I recognize my own learned helplessness. I don’t want to be the complacent and passive nurse that accepts “it is what it is”. And I admit, sometimes the norm seems impossible to change. But it is empowering when I take small steps to stand up, voice my opinion, ask for what is needed, and make suggestions for change. I may need the courage to walk away from my job and find something better. Can you imagine what post-COVID-19 would look like if all nurses expected to find something better? I imagine it would not be long before the work ethic of nurses would no longer be taken for granted.

Yes, nursing exploitation will remain long after COVID-19, just as it did long before. But, the profession’s invaluable role in fighting the pandemic has been noticed. The voice of nursing has become louder, more organized, and larger in number. Exploitation at some level may be part of the future, but there are many reasons to hope working conditions beyond the coronavirus will improve for all nurses.

What is your story?

Workitinurfava, BSN, RN · Aug 31, 2020

Your article made me think of a time that a doctor was yelling at me over the phone and questioning my ability of being a nurse. I made him aware of what he was doing. From that point on he changed his way of speaking to me, he acted professional. Well I said something to one of the charge nurses about it and she said, O your upset about that?, he is usually worse than that. She totally dismissed how wrong it was and seemed to embrace it as the norm. This is why as a profession nurses can't get very far. I love my patients and caring for them, it's the just one more thing, just one more thing, and shame on you for trying to defend yourself that I don't like. I hope the hospital will not continue some of the practices that you spoke of way beyond this covid crisis but I would not be shocked if it does. Right now staff are testing positive for the virus and not required to test negative before returning to work. Staff were told that unless patients show symptoms for the virus they won't be tested for it anymore (admission process). A cotton gown with two points of closure via strings is an acceptable PPE gown. The gowns are washed and reused by all staff. IDK. I have played with the idea of putting in my notice because my husband works and we would be fine, but the uncertainty of finding something later makes me nervous. When you are out of work to long, some places are hesitant to hire you. I don't want to go through the whole new hire process again, same song different dance at another place.

subee, MSN, CRNA · Aug 31, 2020

Until we control our numbers, you betcha it will continue.

BSN-to-MSN, ADN, BSN, RN · Sep 1, 2020

Sadly, nurses are hailed as pandemic heros and are taken advantage of at the same time. The author is right, corporate is making money out of our compassion and professionalism.

Due to my strict nature, they don't dare to call me on my day off. Vacation not approved? I will call in. I have to go on my vacation, life is too short to care about where staffing is too short. Not involved in a committee? Nope, that's too stressful. When I work, I'm a team player, when I'm home leave me the heck alone. Charge nurse? No, not for me, most are the manager's pawns.

Friends, please, try to separate work from life, the managers will never give up stressing you out. Don't let them.

Workitinurfava, BSN, RN · Sep 1, 2020

1 hour ago, RN-to- BSN said:

Sadly, nurses are hailed as pandemic heros and are taken advantage of at the same time. The author is right, corporate is making money out of our compassion and professionalism.

Due to my strict nature, they don't dare to call me on my day off. Vacation not approved? I will call in. I have to go on my vacation, life is too short to care about where staffing is too short. Not involved in a committee? Nope, that's too stressful. When I work, I'm a team player, when I'm home leave me the heck alone. Charge nurse? No, not for me, most are the manager's pawns.

Friends, please, try to separate work from life, the managers will never give up stressing you out. Don't let them.

This is my thing. The place I work can hire enough help and staff appropriately. The only thing I will be rescuing if I show up is a headache.

OUxPhys, BSN, RN · Sep 1, 2020

Yes. This will continue until nurses can form a strong union. I gotta say though they have asked me if I want to come in for OT on my days off. 99% of the time I say no and that's where it ends. As for physicians I don't put up with that nonsense. You start to yell or talk down to me and you're going to get your feelings hurt. I feel that not enough nurses stand up for themselves because of some fear they will be reprimanded. I also don't understand why some nurses hold physicians on this untouchable pedestal.

Nurses will always be exploited until we change the way we provide healthcare in this country.

JVBT, ASN · Sep 1, 2020

23 hours ago, J.Adderton said:

but there are many reasons to hope working conditions beyond the coronavirus will improve for all nurses.

I'd be very interested in hearing more about that.

JKL33 · Sep 1, 2020

41 minutes ago, OUxPhys said:

I also don't understand why some nurses hold physicians on this untouchable pedestal.

I've had my rounds with a few of them but overall I feel they are so far down the list of nurses' actual problems that I end up being surprised how often they are still mentioned. I'm way more annoyed by the business plans of multi-billion dollar corporations that involve disparaging everyone who takes care of patients (including physicians) and constantly meddling in their/our work.

Brownelfin, ADN · Sep 1, 2020

I work in one of four inpatient rehabilitation hospitals in a large healthcare system. When I was hired, we had a “closed unit” arrangement with the nearest of the other rehab hospitals such that we could only be pulled to work in either of these locations. The nurses in these two hospitals had fought hard for this arrangement. After the pandemic began, the System enacted an ‘emergency staffing policy’ eliminating the closed unit arrangement and forcing us to float to either of the other two hospitals as needed. At first I was on board, willing to do my part in this unprecedented situation. However, as the pandemic has dragged on in this country, the nurses of our location are increasingly being sent to the other two hospitals - farther away, with unfamiliar care orders, supplies and processes - at the last minute. It is extremely stressful to work in an unfamiliar unit without an orientation, especially when you arrive late because it’s an hour away and you weren’t notified of the assignment until you were leaving home for your regular shift. All of the nurses in my home unit are daily living in dread of being sent for an exhausting day in an unfamiliar and understaffed unit. We are not offered incentive or resource pay for these shifts, and we recently learned that the decision was made during this time of crisis to stop employing travel nurses, whom are paid more because they willingly agreed to the added stress of going where they’re needed most. We are most definitely being exploited, but there is no union to organize a response. In fact, both state laws and local traditional beliefs highly discourage collective bargaining. I feel powerless to do anything about it.

OUxPhys, BSN, RN · Sep 1, 2020

6 minutes ago, Brownelfin said:

I work in one of four inpatient rehabilitation hospitals in a large healthcare system. When I was hired, we had a “closed unit” arrangement with the nearest of the other rehab hospitals such that we could only be pulled to work in either of these locations. The nurses in these two hospitals had fought hard for this arrangement. After the pandemic began, the System enacted an ‘emergency staffing policy’ eliminating the closed unit arrangement and forcing us to float to either of the other two hospitals as needed. At first I was on board, willing to do my part in this unprecedented situation. However, as the pandemic has dragged on in this country, the nurses of our location are increasingly being sent to the other two hospitals - farther away, with unfamiliar care orders, supplies and processes - at the last minute. It is extremely stressful to work in an unfamiliar unit without an orientation, especially when you arrive late because it’s an hour away and you weren’t notified of the assignment until you were leaving home for your regular shift. All of the nurses in my home unit are daily living in dread of being sent for an exhausting day in an unfamiliar and understaffed unit. We are not offered incentive or resource pay for these shifts, and we recently learned that the decision was made during this time of crisis to stop employing travel nurses, whom are paid more because they willingly agreed to the added stress of going where they’re needed most. We are most definitely being exploited, but there is no union to organize a response. In fact, both state laws and local traditional beliefs highly discourage collective bargaining. I feel powerless to do anything about it.

This is happening at a large healthcare system I used to work for. Before the pandemic we only floated to other cardiac floors. I have friends who still for for this healthcare system and they are being floated to other floors of the hospital and sometimes to other hospitals in the system. Morale is so low now that nurses are calling off left and right and leaving the system in droves. Of course during all this they were not given any extra pay (typical since they are the lowest payers in the region despite pulling in billions annually). Unfortunately this is going to be the new norm for them. This pandemic gave the higher ups an excuse to enact all this and it likely won't change since they have career fairs every 6 months.

14 minutes ago, JKL33 said:

I've had my rounds with a few of them but overall I feel they are so far down the list of nurses' actual problems that I end up being surprised how often they are still mentioned. I'm way more annoyed by the business plans of multi-billion dollar corporations that involve disparaging everyone who takes care of patients (including physicians) and constantly meddling in their/our work.

No I agree. I've rarely had a problem with any of the physicians at my current job. It applied more to my previous job. Im with you though. I cannot stand the way administrators put money first. I understand it's a business but there is still a fine line.

**J.Adderton, BSN, MSN** · Sep 1, 2020

20 minutes ago, Brownelfin said:

After the pandemic began, the System enacted an ‘emergency staffing policy’ eliminating the closed unit arrangement and forcing us to float to either of the other two hospitals as needed.

I also work on inpatient rehabilitation unit and we are being floated to cardiac, ortho, medsurg and oncology. It is stressful and before pandemic, I floated about once every 3 months. Now it is weekly.

Jedrnurse, BSN, RN · Sep 1, 2020

8 hours ago, JVBT said:

I'd be very interested in hearing more about that.

So true! Minus any concrete examples of these "many reasons to hope", the words seem more like bumper sticker cheerleading.

Will Nurse Exploitation Continue Beyond COVID-19?

A Story of Our Own

This Normal Will Never Change

I Feel Exploited Because…

Values Taken for Granted

Nursing Beyond COVID-19

What is your story?

About J.Adderton, BSN, MSN

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