Making the call.
As I got home this morning after a hectic 12-hour shift as charge RN in a 50-bed ER, I sat in my silent car for a moment to ponder how much has changed in the last three weeks.
Three weeks ago, overwhelmed by walk-in patients and ambulance traffic and severely short-staffed, I called the emergency services non-emergent line and asked for help in our crowded lobby. I wasn’t thinking about the repercussions, about the uproar or the giant target I sometimes feel I’ve installed on my back with my outspokenness. I was thinking about my coworkers, spread too thin, exhausted and afraid for their licenses, and the patients that I knew had been sitting in the lobby for hours, sick and in pain and mostly unmonitored. I had no idea of the attention that call would receive.
Did speaking out change anything?
Someone recently asked, “What changes have you seen in the month since you made that call?”
For myself, I’ve been learning to navigate in a more public arena, to not choke when I know I’m being recorded or stress too much about how people might perceive my words and actions. At work, we’ve seen some effort from upper management to connect with us. While it’s imperfect and awkward and feels forced, I have been encouraging people to keep an open mind and give it a chance. It’s too soon to tell if these efforts will pay off.
And finally, on a larger scale, I see more and more news stories about nurses banding together to rise up and protest the conditions we have accepted as the norm for far too long. We’ve been conditioned to be martyrs, that it’s okay to miss breaks and meals and to go for so long without peeing that it’s like a badge of honor. We’re encouraged to work extra shifts, a lot of them. We’re told that due to budget cuts, “ancillary, non-patient-facing roles” will be cut, and that we will pick up the slack.
It’s been drilled into our heads that our worth is tied directly into our feedback from our patients, yet we work in conditions where it’s almost impossible for that feedback to be positive. We are encouraged to meet up with our hospital president—not on the unit, as his “walking tour” headline would suggest, but rather in the hospital boardroom during a busy shift with no one to take our patients. It’s not fair to us or to our patients, who need us to be at our very best, to expect us to deliver that best when we are hungry and dehydrated and emotionally and physically exhausted.
What are you afraid of?
Is outspokenness really so rare anymore that when it does happen it’s a newsworthy oddity? I can’t tell you how many of my coworkers and people on social media have said some version of “You’re saying everything I wish I could say but I’m too afraid.”
I’m not a fan of conflict; I prefer to keep my head down and do my job. But I’ve learned over the years that some things are worth the stress and exhaustion and potential for interpersonal discord. Patient safety and the quality of care we give are examples of those things. I’ve been a patient in my hospital. My best friend’s dad has been treated in my ER. My daughter has spent time on a hospital gurney, and we have received the best, most compassionate, thorough, thoughtful care out there. My coworkers are second to none, and, given the right tools, they will give every patient exactly what they need and more. Unfortunately, short-staffing and a major disconnect between senior executives and the staff working the floor are combining to create an environment where the next parent that brings in their very sick child may very well not receive the care we did.
Flipping the apathy script.
When we are so incredibly busy, we also begin to lose our humanity, the ability to really connect and empathize with our patients. For most of us, that connection is a huge part of why we went into nursing in the first place. For me, the loss of that connection is unacceptable. We learn in nursing school about the ethical dilemmas we might face, the conflicts that naturally occur in high stress emotional situations where life and death decisions and patient priorities might not line up with our personal value system. We learn about the moral distress that can come from constantly trying to juggle our own ethical priorities as well as those of patients and employers, and how that moral distress can lead to apathy and burnout.
Maybe that’s the biggest thing that’s changed in me over the last few years. I do feel apathetic, but not towards my patients or my coworkers. I feel apathetic towards the potential consequences of certain actions, towards the uncertainty I feel when a manager asks to talk with me. Are they looking to ambush me with an HR meeting, or do they just need clarification on something that happened in a shift? I find myself caring less and less about “getting in trouble.” And it’s not because I’m brave. It’s because my fear of becoming so apathetic that I become a health care robot, delivering care without any heart behind it, surpasses my fear of what might happen to me professionally. Instead of pointing my apathy towards my patients, I find myself pointing it at my hospital leaders.
Nurses challenging the norms across the nation.
I feel frustrated and some days very tired, but I see that other nurses are also challenging the norms at the very hospitals that are supposed to be supporting them as they care for their communities, and it rejuvenates and energizes me. I see unions growing stronger as nurses direct their frustration into action instead of apathy. I see communities supporting nurses in ways that are both small and profound, both in my own personal world and across the country, and other nurses speaking out, those whose coworkers might also have said, “You’re saying what we wish we could,” and I feel proud and humbled to be a part of such a group.
We still have many fights in the legislature for safe-staffing ratios, problem solving to do to revamp our educational system to allow more nursing students to move through, and discussion in our own systems on how we can be better supported by our hospitals. It seems like an overwhelming, unachievable goal to even begin to bring about some of the much-needed change.
I hope that more of us find what inspires us to set aside our fear of what “they” might do to us. And, as someone recently pointed out to me, “If you get fired, so what? You’re eminently hirable. In case you haven’t noticed, there’s a nursing shortage going on.”
Kelsay Irby, BSN, RN, CCRN, is an ER charge nurse at St. Michael Medical Center, Silverdale, WA. Writes Kelsay: “I’m about 3/4 of the way through grad school . . . . active in our unit-based council, our local union, and I serve on the hospital-staffing committee. In my personal life I like Olympic-style weightlifting, gardening, paddleboarding, and home projects.“
I retired from hospital nursing many years ago after a catastrophic injury to me related to poor staffing. The staff of our busy, rural, surgical unit had met earlier with administration about staffing and patient safety concerns, but we were only advised that we were all replaceable. Everyone is replaceable, but good luck finding a suitable replacement. At my previous hospital, I was one of the first to be diagnosed with toxic shock, due to never having enough time for personal care. We would routinely stay over, unpaid, to finish our charting (by hand back then!). These abuses have gone on far too long in all fields of nursing and I applaud those willing to seek change. Thank you Kelsay and all those you have inspired!
We need safe patient staffing limits, violence against healthcare worker bills, metal detectors in facilities, increased security, facilities to stop elective cases if they do not have enough nurses. Acuity scales in every unit & required to be used. CPT I codes tied to care RN’S give, mandatory breaks & lunches every state, every state should have a union nursing organization. This is now beyond critical & facilities will shut down due to lack of nurses. We are done tolerating all the abuses as this article so eloquently stated.
As a retired nurse, I empathize with hospital nurses and the patients they care for. After all these years, the disconnect continues?!?
As a 48 year recently retired peds nurse, I would like to thank you for your courage,and empathy. Thank you so much for sharing your story. May you continue to shine in your career.
We need regulatory reform. Nurses are afraid because their bosses have “immunity.” Nurse administrators are not subject to nurse practice acts because any protective action by front line is labeled an employment issue. This immunity can be removed only if individual states make nurse management subject to same Code of Ethics we must practice under. Retaliation, discrimination, wrongful termination, etc. For example, were any nurse managers subject to licensure review for all the misconduct and failure to protect and report during Covid?