As the Delta variant continues to rage in the United States, maxing out many of the nation’s intensive care units, we face a severe deficit in direct care nurses and caregivers in our hospitals. Since 2016, hospitals have turned over an average of 90.8 percent of their staff, including registered nurses (RNs). Some hospitals have annual RN vacancy rates hovering well beyond 20 percent. But the number actually needed to provide safe care is often double or even triple the number of budgeted vacant positions.
While there’s been no shortage of students wishing to study to become nurses, nursing programs across the country are closing, even as demand for nurses continues to rise. In New York State alone, more than 170 nursing programs closed over the past 50 years, with only 65 accredited nursing schools remaining.
What are the conditions driving RN turnover and vacancy rates, and what can we do to bring on and keep more qualified nurses in the field?
Salary and Pay
While salaries and benefits in “union-dense” regions of New York State have improved, they have still remained substandard in other areas. In nonunion and even some unionized hospitals in these areas, the cost of health benefits outweighs salaries, and nurses must resort to the taxpayer-funded state government system for their dependents. Ironically, these hospitals, which receive state subsidies, are relieved of the cost of insuring their employees, while additional state funds are expended for this purpose.
Defined benefit pensions have been discarded by many hospitals and replaced with defined contribution plans that are dependent upon the stock market and offer far less protection to retirees.
Travel nurses, on the other hand, can earn over $5,000 per week plus housing, transportation and food. When hospitals run out of enough nurses to keep patients alive, they resort to paying these costs as well as travel nurses’ lucrative agency fees. Nurses often choose to leave hospital staff and opt for these assignments in various locations in order to make more money, travel and avoid the torments of staff nurse positions in uncaring facilities.
Ultimately, chronic understaffing and unacceptable working conditions are the main reason new nurses leave the bedside, senior nurses retire early and others “shop around” — or leave the profession entirely.
Nurses have been saying for years that we must have a standard of care that includes minimum nurse-to-patient ratios in order to deliver “the kind of care I would want for my mom.” Often, based on our professional judgment, we know that we can safely care for two, three or four patients, depending upon severity and complexity of illness. Yet we are told instead that we are responsible for double, triple and even quadruple that number of human beings, leading us to decompensate.
There is a mantra in the medical community: “Do no harm.” Forcing us to accept an assignment far beyond our capabilities, in volume or in competency (hospitals often demand we treat patients we’re untrained to care for) places us in a dizzying state of cognitive dissonance. We undoubtedly become accomplices in potentially harming the patients in our charge.
Yet, if we refuse to take on such an assignment, we’re threatened with termination. Adding to the stress, employers harass us with nitpicking details related to repetitive documentation via the electronic charting systems (EMR) — thus, making care of the patient secondary to its documentation. Why? The tedious checklists in the EMR generate billing, which enables the hospital to get paid.
This focus on documentation is the final straw in the pain nurses endure as we try to do our jobs. We have far less direct contact with our patients as a result, and are forced to “speed up,” and engage in rote, factory-like activities, rather than being able to develop meaningful relationships with our patients and their families, and utilize the critical thinking skills we cherish. Nurses are key in detecting and preventing complications and in creating a framework that most benefits our patients. That world is disappearing as we are dangerously understaffed and challenged without support and resources.
The SARS CoV-2 pandemic didn’t initiate the nursing shortage, but it did exacerbate the problem and made the public painfully aware of its seriousness. This “shortage” is manufactured by an inflated, top-heavy health care system built on profit-making rather than enhancing care. Dollars in hospitals are spent on consultants, marketers, information technology “streamliners,” and overpaid managers whose job it is to cut staff and work nurses beyond human capacity. That doesn’t even touch the money lining the pockets of insurers, Big Pharma, and other predators of the health care system — money that could otherwise be spent on staff, training and preventative care for our patients.
In addition, the frenzied competition and breakneck efforts of hospitals to make a buck result in overtreating the well-insured and undertreating the underinsured and the uninsured, leading to negative outcomes and complications. Nurses are pressured to reduce “length of stay” and often have to take on hospital and insurance administration to advocate for patients staying an extra day to recuperate.
As the pandemic continues to rage amid the Delta variants spread, patients in already overcrowded, understaffed and poorly prepared environments are still dying by the thousands. However, even in the face of this horrific medical nightmare, there was the potential to save so many more. The death toll and the conditions New York nurses faced in March and April 2020 left nurses numb. Many of us developed an almost collective amnesia about what occurred, just so we could continue on. Post-traumatic stress disorder is rampant among the medical community, and now, with numbers rising in intensive care units once again, it has become almost too much to bear.
What’s worse, the flip-flopping and crass abandonment of caregivers by the Centers for Disease Control and Prevention and our employers at the start of the pandemic resulted in a form of “trauma betrayal,” leaving people in caregiving professions skeptical about believing anything else the government promotes, including vaccines.
Without fundamentally altering the focus of the health care system away from the business model of profiteering and back to the social model of care facilitated by a Medicare for All system, our society will fail again to develop a reliable public health infrastructure. Without mandating standards for patient loads and without affording us respect as competent, thinking professionals, nurses will continue to “burn out” and abandon our beloved profession.
There are many idealistic youth who wish to give from their hearts, hands and minds to our society, but without making nursing school accessible and affordable to all, the nursing shortage will escalate — and there may not be anyone to care for you when you are most in need.