‘It’s devastating, it’s dangerous’: How it feels to be a nurse on an understaffed floor
When there aren't enough nurses on the floor, patient care can suffer. And nurses, forced to ration care, can suffer acutely, witnessing this inadequate care and being powerless to fix it.
Nursing is all about relationships. The relationship between a nurse’s watchful eye and appropriate, responsive treatment. The relationships nurses form with each other and the other health-care providers at their facilities to ensure fast, effective care. And at the center of everything are the relationships nurses form with their patients, whose moment-by-moment health and well-being they hold in their hands.
Today, nurses are experiencing something we’ve seen in most industries of late: mass staff resignations. But while staff shortages in other fields mostly manifest as inconveniences — longer wait times on helplines, or at the takeout place or bank — in hospitals, staff shortages can be deadly.
As if current shortages weren’t enough, a recent national poll found that one-third of nurses are planning to quit.
» READ MORE: ‘I see someone quit every day’: Nurses, in their own words | Expert Opinion
Nursing organizations in the state are lobbying in favor of a Pennsylvania bill called the Patient Safety Act. The bill, like a similar one in California, would enact a basic minimum nurse-to-patient safety standard in all Pennsylvania hospitals, reducing nurse burnout and making the single biggest difference in improving nurse retention and patient safety in Pennsylvania. The bill would require, for instance, one nurse for every patient in active labor, and one for every two patients in intensive care. The Pennsylvania House Health Committee passed the bill on Tuesday, and it is now up for a vote on the entire House floor.
When there aren’t enough nurses in a particular hospital unit — a situation registered nurses call “short-staffing” — the essential relationships between nurses and patients can suffer. Patient care can suffer. And nurses, forced to ration care, can suffer acutely, witnessing inadequate care and being powerless to fix it.
These are their stories.
Birth plans get thrown ‘in the trash’
The majority of us are born in a hospital. Yet there are fewer hospitals than there were 20 years ago, and far fewer RNs on the floor. Birth is a momentous moment, and in a maternal/fetal medicine unit, the nurses are the support people for families. When we are staffed at bare-bones levels, as we often are now, we are unable to fulfill that incredibly important role, because we have too many mothers and babies to care for at once.
Sometimes I feel like Lucy with the conveyor belt of chocolates. It’s funny when it’s chocolates. But imagine that each of those little nuggets is a newborn baby.
Many birth mothers come in with detailed, well-thought-out, and researched birth plans. Short-staffing basically takes those plans, balls them up, and throws them in the trash. Nurses are really creative and very practiced at making things work. But we can’t create a nurse. We can’t snap our fingers and create the help that we need and our patients deserve.
Nurses want to provide excellent care. We want to do everything we can and more. And when we know we haven’t been able to, it’s devastating. And it’s dangerous. Everyone in that situation deserves better.
– Carla Le’coin, Einstein Medical Center-Philadelphia, member of Einstein Nurses United
‘Two years ago, we had 50 nurses on my floor. Now we have 32.’
My unit treats patients with acute issues. We have patients with opioid use disorder and alcohol abuse coming in in active withdrawal or intoxicated. They are vomiting, agitated, restless, confused, lacking safety awareness, and impulsive. They need high doses of multiple narcotics, administered every three to four hours. We attend to sick patients who have unstable blood pressure, with conditions that affect all body systems. Their heart is failing; they have sepsis. We have patients with untreated mental illness. And we have patients with COVID-19 or other respiratory infections.
Two years ago, we had 50 nurses on my floor. Now we have 32. Given how sick our patients are, we should have a nurse for every four patients, but typically, every nurse has five to six. Some days, we have seven. This is every day. We have to prioritize care, which means we have to make tough decisions in very challenging situations. Medication can be delayed. Vital sign checks can be delayed. Teaching can be limited. We can’t clean incontinent patients right away. This is every day.
– Nancy Wilson, Temple University Hospital, member of Temple University Hospital Nurses Association
‘I’ve googled new jobs’
I work in the emergency room at a pediatric safety-net hospital. It’s a special population. Young kids can appear to be fairly stable when they come in, and just two hours later, their status can change dramatically. Their care is different from adults. A simple procedure or IV insertion in adult patients may require only one nurse, but in pediatrics, it often requires many, since we have to help a child through something incredibly scary to them. Still, there are many shifts where we have four to six nurses when we should have eight to 12. This means that patients and their families have extremely long wait times and experience significant delays in care.
In my lowest moments — and there have been many — I’ve googled new jobs. Yet somehow — so far, anyway — I’ve managed to persevere. I stay for the patients we serve and for the excellent nurses I work alongside.
In some cases, unsafe staffing is about corporate greed. It’s about purposely understaffing nurses to enhance profits way up the food chain. It goes against everything nurses are taught and believe in and is driving us away from the bedside. It’s not a choice we would make otherwise.
– Becky Murphy, St. Christopher’s Hospital for Children, member of St. Christopher’s Hospital for Children Nurses United
‘How can I leave a sobbing mother?’
In labor and delivery, our patients frequently have medical problems that are further compromised by pregnancy. Their babies are tiny patients we can’t see or touch, yet we are just as responsible for them as we are for their mothers. I often have two or more critically ill patients at a time. When that happens, how can I watch both mother’s and baby’s monitors constantly? I can’t. How can I leave a sobbing mother who has just learned that her baby won’t survive to attend to another critically ill mom with dangerously high blood pressure? I can’t, but I must. It’s an awful choice to have to make, and with staffing the way it is, we have to do it every day. Our nurses are leaving at every opportunity. They’ve had enough.
– Waunda Hemmingway, Temple University Hospital, member of Temple University Hospital Nurses Association