‘We can’t keep doing this’

“ Staffing has always been challenging in an ER, as anyone will tell you. It’s gotten much worse over the last 18 months. It’s not uncommon for people that I work with to wait over eight hours to take a break, which is only compounded by the fact that we’re not allowed to have basic things like water or coffee at our desk anymore. Take a moment to consider going through your entire workday with nothing to drink because you have no relief, and no one is coming to help you to get some water or get that second cup of coffee you didn’t get before you left in the morning.

When you’re spending your time in triage, people are waiting 3+ hours frequently, sometimes over six. I vividly remember a poor man that waited eight hours because there was no one to take the patients and move the admits out of our ER. We just don’t have the nurses.

We’ve lost over one-third of our nursing staff in the ER as a result of burnout and travel. I remember awkwardly hugging one of my role-model nurses that helped mentor me when I started as she held back tears, saying she just couldn’t do this anymore. She, her leadership, teaching attitude, experience and 15 years are gone forever.

I’m trusted with some of the most intimate and sacred moments as an ER nurse, from cancer diagnosis to miscarriages to new cardiac problems and diagnosis. What I used to be able to do for people is sit in the room after the doctor left and give them the news, hold their hands, answer their questions and comfort them. Now, as I hustle from room to room and peer through the narrow window checking on my way by to keep my other patients alive, I just see someone scared, lying in a gurney with no one to comfort them — which breaks my heart. But I have to go home taking solace in the fact that at least I was able to keep my patients alive.”

— Robin Cully

I’ve been a registered nurse for almost 10 years. For me, short staffing has led to me not being emotionally available to my patients and also to my spouse.

A story that is very typical and a recurring story for me -— and I’m sure many of my colleagues — is several weeks ago I was with a patient actively dying of cancer who had probably just a few weeks left to live. He’s recalling a memory from his childhood; he’s starting to tear up and I’m just standing there not really listening to what he’s saying. I’m hearing my work phone go off; I’m hearing a bed exit alarm ringing down the hall; I’m hearing patients moaning in the room next to his; and I’m thinking I’m five hours into my shift, and I haven’t had a break yet. Not being emotionally available for my patients is, to me, the biggest tragedy of the current status of being a nurse. If you’re not emotionally available for your patients, then what are you doing? It’s been very difficult dealing with that and then coming home recognizing that I wasn’t there for that patient and feeling even worse because I simply wasn’t there.”

— Christopher Irle

I hit my breaking point this last Monday night.

I’ve been a critical care nurse for a little over six years now. I was a travel nurse, and I’ve worked all over the country in places that are incredibly short-staffed — and that was pre-pandemic. Now I work permanently here in Seattle.

Monday night, I was the charge nurse. I started my shift short three nurses. I pulled one nurse from another unit and had one nurse going home at 11 p.m., which would leave me short two nurses. This is just to cover my beds, not even to have someone to help out our incredibly busy unit. I got word I had yet another patient that had to be admitted. I shifted three nurses’ assignments to make even heavier groups and pulled yet another nurse from another unit to help us.

We were scraping by until 3 a.m., when word comes that we need yet another bed for another patient that needs to come to the ICU. This ultimately ended with me taking a patient that had severe lung disease and who was stable for the moment but very ill, on the ventilator and five different drips just to keep her going. I sent one of my floats back to her unit so she could admit the new patient and then I scrambled to keep my unit together for three hours that ended up feeling like 12.

Not only did I need to keep my patient alive, but I also needed to manage a unit of nurses with very sick groups of patients and no extra help. I held back tears for three hours just to keep the spirit of our unit together. Around 6:30, another nurse comes into my patient’s room to tell me we are about to code a patient. He needed to be reintubated within 15 minutes of coming off the ventilator.

I can’t help but wonder... had I not been tied up with my own patient and making assignments for the day shift, would I have been able to help the nurse taking care of this patient see the signs to prevent this? Because I wasn’t just the charge nurse and the primary nurse to my own patient that night, I was also the nurse with the most critical care experience. Most of my nurses that night were new to the unit within the last year. It takes time to see the signs of decompensation in critical care — that’s why we staff a charge nurse with no patients, so that the charge nurse can help the rest of the nurses to see the signs.

I’m exhausted. I can’t sleep, and I cry at the smallest things that never would have broken me before. Every day, I wonder how long I can keep going like this, running on fumes with no relief in sight. I’ve gone through periods of burnout before in my career, but when I moved to the West Coast — where staffing ratios have generally been safer — I was able to actually remember why I wanted to be a nurse in the first place. That feeling is long gone because we don’t have safe staffing ratios anymore. We are piecing it together one hour at a time, missing the signs we would normally catch because our workload is higher than ever, and our patients are sicker than ever.

Ask yourself: Would you want your loved one’s life to be held in the hands of someone stretched so thin? Ask yourself: Would you want your health to be determined by someone who can’t even eat something for 12 hours because they are so busy? By someone who can barely take two minutes to go to the bathroom?

We can’t take care of you if we can’t take care of our own basic needs while doing a highly physical and technical job. You can’t replace us with just anyone, either. This is a job where experience matters immensely. I’m asking anyone who can hear me to please consider what it would mean if any more nurses left the field. Who would hold you up when you are having the worst day of your life in that hospital bed? We need safe staffing ratios now so we can breathe. We need compensation for our trauma now so that more of us can at least get the financial relief we need to keep returning to work. And we need someone to advocate for us so we can keep advocating for you.”

— Mariah Wilson

“ I have a million stories about short staffing. I could tell you about all the times I haven’t peed; I haven’t gotten to eat; I haven’t had time to drink. The breaks that I was supposed to have that I never took because I cared so much about my patients.

The truth is this isn’t new. This isn’t something that’s happening because of COVID. This has been happening since before COVID. The unfortunate truth is it’s gotten worse with COVID.

Nurses are leaving the bedside. I’m burnt out. We’re all burnt out. This is so hard, and it’s because we care so much. We want to be able to take care of your family members and you as well as we can. We want to keep you all safe, and we want to help and promote your healing as best we know how to. The hospitals and hospital executives are not interested in helping us do that.

Those slogans you see in commercials and on buses and outside of buildings — they feel like complete and utter lies. We want to keep you safe, and we need your help doing that. We can’t keep doing this. You will lose us. We’re all leaving. And we want to be there for you — so please, please, please help us. Help us keep you safe.”

— Julie S.

“ I have worked in a COVID telemetry unit since the beginning of the pandemic when we first saw COVID hit our city. I want to emphasize that our staffing crisis isn’t entirely new — we have been short-staffed as long as I can remember, ebbing and flowing. We’ll go through periods where we just can’t hire enough people to fill the demand — and as our city has grown, our acuities and chronic illness have started to, I feel, exceed our bed capacity. COVID has only made it 10 times worse.

Our night shifts have been just slammed with patients. There will be a full floor, and they’ll be taking six patients at a time, with the charge nurse taking a full assignment, as well — which is really difficult on a fully COVID unit when you have 29 beds that are all in air drop isolation. You have to don and doff your PPE and keep yourself safe. When a bed alarm is going off or when a patient is critically hypoxic, we need to respond immediately, and it takes 40 to 50 seconds to a minute to get into each room — that’s critical time. When we’re under-staffed — and in particular night shift is understaffed — and you’re already in that hypoxic patient’s room and another patient is hypoxic, now you have two patients that you potentially have to deal with. So, it’s a scary time sometimes on nights especially. I see the aftermath of it as I come on day shift — tired faces, emotional exhaustion — and that bleeds right over to the next shift, which is again short-staffed.

It’s just really difficult sometimes emotionally to go home and feel like you haven’t provided excellent care the way that you dreamed you’d be able to provide.”

— Alyssa Boldt