I haven’t posted any stories about what physicians face when working on the front lines during the Covid-19 pandemic. Of course, my Blog is about nursing. In more recent years, the collaboration between nurses and physicians has grown. The professions work together with more mutual respect than when I began my nursing career. And physicians on the front line of the Covid-19 pandemic risk their lives just as nurses do.
I have reblogged a story written by a physician who is working “extra on-call time” to care for the new admissions at a local hospital. I read this essay in the online publication: Pulse: Voices from the Heart of Medicine.
I highly recommend reading Pulse, which publishes each Friday. There you will find stories that show the human aspect behind the practice of medicine.
In Need of a Prayer
Posted By Jo Marie Reilly On December 16, 2020 @ 10:44 pm In Stories
The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.
It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.
“I’ll take him,” I tell my colleague.
“Sure?” he asks, eyebrows arched over his face mask.
Thank you for your openness to representation of nurses on the Biden-Harris coronavirus advisory panel. Nurses deliver most skilled health care and have valuable insight into what patients and the healthcare system need. So plans for national solutions will be more effective with their input. Below we propose nurses for your consideration, in sub-categories that address particular needs, based on recommendations from the many nurses we have consulted as well as my own experience providing ICU care to Covid patients.
As a preliminary note, while I understand that there are many physicians on the task force, they can’t represent nursing because it is a distinct, autonomous profession with a different scope of practice. In general, physicians focus on the disease process, while nurses focus on how humans react to disease, including patient education. And of course, the U.S. has struggled with Covid-19 relative to many other nations not so much because of the disease itself but because of how humans have reacted to it.
I understand that some have described the inclusion of different types of physicians on the panel as taking an interdisciplinary approach. However, we believe a truly effective interdisciplinary approach includes other types of health professionals, such as respiratory therapists, social workers, occupational and physical therapists, pharmacists, and of course nurses.
Below we introduce nurses for your consideration who are from different fields and would provide unique perspectives to the Covid advisory panel.
1. Experts in infection control
Although there is no shortage of infection control professionals on the current advisory panel, infection control nurses could give a more on-the-ground perspective to better address how people can live more safely with Covid.
Jason Farley, RN, PhD, MSN, MPH, is a John Hopkins University (JHU) professor who mobilized resources to help coordinate the response to Covid-19 in the Baltimore community, including JHU schools and hospitals, while continuing to play a leadership role in international scientific endeavors. His work has encompassed testing, addressing the needs of the vulnerable (e.g., getting pulse oximeters into people’s homes), and the stigma of infectious diseases in the community.
Ann Kurth, RN, PhD, CNM, MPH, is Dean of Yale University School of Nursing, an epidemiologist and nurse-midwife. She chairs the National Academy of Medicine Board on Global Health, and her research focuses on HIV, reproductive health, and strengthening the global health system. Dean Kurth’s work has been funded by NIH, Gates Foundation, UNAIDS, CDC, and HRSA. She chaired the 190+ member Consortium of Universities for Global Health and has published over 200 peer-reviewed papers.
George Allen, RN, PhD, is the Director of Infection Prevention at New York Methodist Hospital, and author of Infection Control: A Practical Guide for Health Care Facilities, and Infection Prevention in the Perioperative Setting: Zero Tolerance for Infections, an Issue of Perioperative Nursing Clinics. He is a Clinical Assistant Professor at SUNY and a force for improving policies to address infection control in hospitals.
Sharon Vanairsdale, RN, DNP, is the Program Director for the Serious Communicable Diseases Unit at Emory University Hospital in Atlanta. She manages unit readiness and hospital preparedness for patients with Ebola, Lassa fever, and other special pathogens. She coordinates clinical operations, staff safety, and patient outcomes. She is also the Director for Education within the National Ebola Training and Education Center, a federally funded collaborative between Emory, Nebraska Medicine, and New York Health and Hospital-Bellevue.
2. Experts in health care disparities
Considerable data shows that Covid has had a particularly severe impact on communities of color. Many nurses focus on health disparities, including how to deliver care to underserved populations.
Norma Graciela Cuellar, RN, PhD, is editor-in-chief of the Journal of Transcultural Nursing, Professor of Nursing at the University of Alabama and immediate past-president of the National Association of Hispanic Nurses. She has also researched Complementary and Alternative Health Care, which many members of the public embrace and it would be helpful to have these therapies addressed in regard to Covid.
Sheldon D. Fields, RN, PhD, NP, researches health care disparities, focusing on preventing HIV/AIDS in men of color. He also advised Senator Barbara Mikulski during the passage of the Affordable Care Act. He is Associate Dean for Equity and Inclusion at Pennsylvania State University.
Vickie Mays, PhD, MSPH, is a UCLA professor and clinical psychologist with a public health degree (and in fact, she is the one person on our list who is not a nurse). She directs the 60-person NIH-funded BRITE Center for Science, Research & Policy, working to eliminate physical and mental health disparities and reducing vaccine hesitancy in racial/ethnic minority populations. Dr. Mays has been working with members of Congress on a bill that would require better data on the race and ethnicity of people affected by the COVID-19 pandemic. She is also conducting research on creating better models to predict the spread of COVID-19, in order to reduce the number of infections and deaths in Black communities.
3. Experts in managing and improving clinical nursing environments
It is common for nurses to be excluded from decision-making panels, even though they are the ones delivering most of the skilled care. An overwhelming number of people who wrote us urged that the panel include direct care nurses and their advocates so they will have a voice in national policy.
Bonnie Castillo, RN, is Executive Director of National Nurses United, where she is also director of the Registered Nurse Response Network, a disaster relief program that has engaged in recovery efforts after various natural disasters. In 2020, Castillo was named to the TIME 100 Most Influential People of 2020. She would bring the perspective of direct-care nurses
Mary O’Neil Mundinger, RN, DrPH, Dean Emerita, Columbia University School of Nursing, has been a pioneer in the development of nurse practitioner practice and she is one of its strongest representatives.
Hilda Ortiz-Morales, RN, PhD, NP, is a direct care nurse practitioner at an infectious disease clinic at Montefiore Medical Center in the Bronx. Ninety percent of her patients are from diverse backgrounds, and this is a common feature of nurse practitioners’ practice.
Dave Hanson, RN, MSN, is a clinical nurse specialist who works to protect patients by fostering quality care environments where nurses can focus on the care only they can deliver—bringing in ancillary staff to do the rest. He is a dynamic leader with a reputation for team building, a collaborator and an extraordinary role model for nurses who strive to advance the profession and quality of patient care.
4. Expert in occupational health and protecting the workforce
So far roughly 2,000 health workers in the US have died from Covid, including many nurses, and a colleague of mine just last week. We need a strong occupational health focus to protect our health professionals and our healthcare system.
Bonnie Rogers, RN, DrPH, is an occupational health researcher and Chairperson of the NIOSH National Occupational Research Agenda Liaison Committee. She has served on numerous Institute of Medicine (IOM) committees, including Vice Chairperson for the Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A. She is currently a member of the first IOM standing committee on Personal Protective Equipment for Workplace Safety and Health. She completed several terms as an appointed member of the National Advisory Committee on Occupational Safety and Health and was recently elected Vice President of the International Commission on Occupational Health.
5. Experts in rural health
Many of the communities with critically high rates of Covid infection are now rural ones. Many nurses focus on care for underserved rural populations.
Mary Wakefield, RN, PhD, served as Health Resources and Services Administration in the Obama administration, supporting community health clinics. In her final two years she was Acting Deputy Secretary of HHS. She now directs the Center for Rural Health (CRH) at the University of North Dakota, strengthening the healthcare workforce, increasing health equity, and providing care services to patients who are geographically isolated, or economically or medically vulnerable.
6. Expert in mental health support for the public
Mental health care is critical in addressing Covid, not only because of the virus’s significant neurological effects, but also because the public at large has struggled with the challenges of staying home, lack of contact with family and friends, and overseeing children’s education.
Ukamaka Oruche, RN, PhD developed six innovative educational products for children with behavioral challenges during the Covid crisis, as well as self-care guides for parents, frontline nurses, and underserved communities. The videos can be seen at Be Well Indiana. Dr. Oruche can help guide public mental health wellness in the time of Covid.
7. Expert in palliative care
It’s not clear what was happening in this pit in El Paso, except that the patients surely needed far less CPR and far more palliative care. Hospitals and patients need more help putting a palliative care plan into action when death from Covid is the only realistic outcome.
Betty Ferrell, RN, PhD is expert in how to provide compassionate care to dying patients and their caregivers. She developed and leads the End-of-Life Nursing Education Consortium, which has trainers in 99 countries and all 50 states. She will be able to offer the Covid advisory panel guidance on how to improve palliative care and make it more widely available.
8. Experts in school nursing
School nurses are among the public health nurses who are most vital to controlling Covid, including through work in infection control and vaccine rollout. Many now work long hours contact tracing for the families at their schools, and there are plans for some to play a key role in Covid testing. Basically, they have taken on the work of the public health department, but without adequate staffing or support. Nursing takes time, resources, education, expertise and perseverance. Nurses who can bring the school nurse perspective to the advisory panel include:
Cathy Riccio, RN, MSN, MS, who had so many enthusiastic letters of recommendation submitted on her behalf. She is a school nurse with a degree in Environment Science who guided principals, teachers and staff in Newburyport, MA, on how to re-open schools safely—from health procedures and building operations to the emotional health of students, parents and faculty. She designed professional development materials in language simple enough for everyone to understand. She does contact tracing, delivers food, and acts as an air quality expert and guidance counselor. So far there has been no traceable spread of Covid within the schools she oversees.
Robin Cogan, RN, MEd, is a New York school nurse and frequent media contributor. She is a strong advocate for school children and will be able to give practical, realistic advice on how the nation’s schools can administer testing and roll out vaccines.
9. Experts in vaccine hesitancy, public education and health literacy
A large part of nursing care is aimed at developing strategies to educate patients about the disease process and paths to wellness. Because nurses are widely considered to be trustworthy, members of the public might be more likely to listen to health advice from them. And some nurses have focused on working to persuade reluctant members of the public to follow public health guidance.
Eileen Fry-Bowers, RN, PhD, MSN excels in health literacy and addressing vaccine hesitancy (countering anti-vaccination disinformation).
Blima Marcus, RN, PhD, is a nurse practitioner and assistant adjunct professor at Hunter College. She is also an excellent advocate and educator on vaccine hesitancy, especially in the Orthodox Jewish community.
10. Expert in pain management
Pain management is critical for Covid patients. Nearly every ICU patient on a ventilator is on a fentanyl (opioid) IV because being that sick and coping with all those tubes and procedures is painful. After patients recover, many continue to have pain because of the myriad long-term problems Covid causes.
Sheria G. Robinson-Lane RN, PhD, Assistant Professor, University of Michigan, focuses on pain management, especially in older people—who are hardest hit by Covid and can guide the way forward.
11. Expert in the ethical issues of how to allocate the nation’s health care resources
The panel would benefit from a nursing perspective in considering how limited resources are allocated, including how to balance support for public health measures and clinical care. In particular, as my own recent work providing ICU care to Covid patients has underlined, the current system is struggling to provide effective care with available resources. Vast sums are devoted to ICU care, but there are still insufficient ICU nurses and equipment to provide effective care to all Covid patients. For example, the survival rates for patients once they go on a ventilator is very low, unless they go on ECMO machines, in which case the survival rate is quite high. But we don’t have many ECMO machines. Should the Defense Production Act be invoked to make more? Would we save more lives if we re-directed some efforts to preventive public health work, such as educating society about protective measures and quarantine practice, contact tracing, coordinating vaccination and promising potential therapies, such as vitamin D supplementation? Nurses think about the lived experience of patients and help them plan how to cope with their new realities.
Connie Ulrich, RN, PhD, Professor of Bioethics, University of Pennsylvania, provided testimony to the Presidential Bioethics Commission on the importance of ethics education for nursing and how ethics education influences the moral action of nurses with their patients.
12. After the Inauguration—please consider current government employees
Rear Admiral Aisha K. Mix, RN, DNP, MPH is the Chief Nursing Officer of the US Public Health Service. There is no one more fitting to be on the panel than she is.
Cori Bush, from Missouri’s 1st Congressional District was just elected.
Final Note – Please consider using the Defense Production Act to protect health workers and the public
Nurses and other health workers cannot get enough N95s to work safely. In addition, if every member of the public had an N95, we could better prevent community transmission. An N95 protects the wearer, not just those around them. At my last hospital, I wore one N95 for 8 weeks straight. Other nurses have cared for patients with only a surgical mask—offering themselves up to the disease. Nobody should be sacrificed to Covid. If we invoked the Defense Production Act to fully address these shortages, we could better protect health workers and the community, and get the virus under control. On the other hand, I urge you not to encourage the manufacture of masks with valves. They only protect the wearer and we have to count on each other to protect us. Any mask mandate should make it clear that valve masks do not meet the requirements.
Thank you for considering our recommendations for how the Biden-Harris coronavirus advisory panel can better address the needs of the US healthcare system and the residents of our country. Please let me know if I can assist you in any way.
Sandy Summers, RN, MSN, MPH Founder and Executive Director The Truth About Nursing Co-author: Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk 203 Churchwardens Rd. Baltimore, Maryland 21212-2937 USA phone 1-410-323-1100cell 1-443-253-3738 firstname.lastname@example.org www.truthaboutnursing.org
The Truth About Nursing is an international 501(c)(3) non-profit organization working to challenge stereotypes. We show that nurses are autonomous, college-educated science professionals who save and improve lives. Each year, the undervaluation and underfunding of nursing leads to millions of needless deaths across the globe. Better understanding of the profession will allow nurses to save all the lives they are capable of saving.
The last day of Nurses Week ends today on Florence Nightingale’s Birthday: May 12.
Would Flo be surprised that a special day, May 6, had been dedicated to nurses in 1982, and in 1990, that day grew into a full week that ended on her birthday? Would she be pleased that the World Health Organization (WHO) has designated 2020 as “The Year of the Nurse and Midwife” in honor of her 200th birth anniversary? Would she be happy to learn that this 2020 designation is significant because WHO is promoting nursing education that will increase the numbers of nurses and midwives in order to strengthen Universal Health Coverage?
What would Flo think of the modern nurses’ role in this Pandemic? Would she be reminded how she, during the Crimean War, campaigned for better care of the sick and wounded soldiers and for a higher standard of hygiene, which saved countless lives? I bet she would be proud to see that nurses are still campaigning for better conditions for their patients. And that they are speaking out for safe working conditions for all health care workers.
Anthony Langley contacted me to ask if he could send me a copy of his book to review and possibly discuss on my Blog. I am always happy to support a fellow nurse who takes the plunge and writes a book about nursing, so I said sure.
About the Author
Anthony Langley has been a registered nurse for twenty-nine years. He also has a bachelor’s degree in criminal justice. His interest in nursing started after getting a job as a security officer in the emergency room of a hospital. A male nurse who worked in the emergency room showed him the things that nurses did, which got him interested in nursing.
He got his bachelor’s degree in nursing in 1990. At his first job, he started on a medical-surgical unit. He has worked in many areas of the hospital, which include surgical stepdown unit, surgical intensive care, same-day surgery, and the post-anesthesia care unit (PACU) recovery room.
Betsy, a writer friend, emailed me the story she had read in our workshop since I had to miss the class. She knows I hang on every episode of her life in Ireland where her second child was born and she negotiated the daily vicissitudes of a different culture. In this episode she had left the hospital with her new baby girl. She happily accepted the offer to have a nurse visit her and the baby at home.
Her daughter is in college now but Betsy still remembers how helpful the nurse was—and knowledgeable and reassuring, which, in turn, made me remember the article I read not too long ago by David Bornstein, The Power of Nursing (NYT, May 16, 2012) about nurses who made regular home visits to at-risk pregnant women and continued these visits until their children reached the age of two. The program, Nurse-Family Partnership (NFP), conducted studies that demonstrated the visits improved both child and maternal health and financial self-sufficiency and provided a five to seven point boost to the I.Q of these children. Plus many more positive results.
NFP, which has been around since the ‘70s is implemented in forty states, empirically proves what many of us already know: nurses REALLY make a difference. Training paraprofessionals to do the nurses’ job didn’t yield the same outcomes.
We nurses do make a unique contribution. No one else can fill our shoes.
A nurse has called attention to our dysfunctional health care system in the OP-ED section of the New York Times. (Our Jury-Rigged Health Care System by Teresa Brown, New York Times, September 6, 2019)
Brown has hit a nerve as evidenced by the 969 comments to date supporting her stance.
Her article discusses how nurses (and physicians) use “workarounds,” that is, they circumvent onerous rules to make sure patients get even basic care.
I found the piece a frightening expose.
May more nurses speak out about our ineffective and unsafe health care system in order to educate consumers and institute functional policy changes.
Our Jury-Rigged Health Care
By Theresa Brown
New York Times, OP-ED Friday, September 5, 2019
The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.
Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”
Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.
I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.
But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.
Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.
However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.
Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.
Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.
Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.
I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.
As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.
The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.
The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.
As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.
Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.”
I came upon this post on KevinMD.com, written by a nurse. I am pleased that a physician has provided a vehicle for nurses to tell their stories and, in this case, share the heavy toll that working in a hospital setting can have on nurses.
Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.
Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time. As a living organism, we know that the body can only sustain so much stress before it starts to break down. These ailments can be physical and/or mental. Sometimes they happen over a period of time, however often times we do not even realize the symptoms until they have forced us to take notice. As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest.
Bedside nursing is hard and very stressful. The bedside nurse is responsible for caring for multiple people every minute of every shift. That is, multiple sick and potentially dying people. The nurse is responsible for monitoring the patient’s response to treatment, the patient’s condition, the patient’s mental health, the doctor’s orders, assisting the patient with activities of daily living, and being there for the family.
Bedside nurses are the coordinators of care. We are the ones who make sure that all parts of the care plan are being carried out and that the system is working the best it can. We are the ones who comfort the patients when they need us the most.
We do not mind doing all of this. In fact, this is what we signed up for when we graduated from nursing school. We can handle these tasks if we have a partnership with the hospitals that we work for. This partnership all starts with the nursing grid. Each unit in a hospital has one. It is basically a chart that states how many patients each nurse should have. It is a chart that is supposed to indicate the safe number of patients that each nurse should be assigned every shift. It is a topic of heated discussion in the nursing world.
Normal patient-to-nurse ratios depend on the unit and the acuity of the patients. For instance, most nurses agree that in the intensive care unit (ICU) nurses should not be assigned more than two patients each. If a patient needs continuous dialysis or another procedure that needs to be monitored, then this ratio goes to 1:1. This is a common theme. If a nurse is assigned to a critical care unit or cardiac unit, then the patient to nurse ratio is acceptable and safe at 3:1. This means that each nurse on the unit should only have three patients. Acceptable medical-surgical unit ratios are usually either 4:1. This means that for every four patients, there should be a nurse. Another rule of safety is that there should never be only one nurse on a unit. Too many things can change quickly, and safety comes in numbers. Remember we are talking about human life.
When these basic rules are followed, then nurses and patients have better outcomes. Nurses stay at the bedside longer and patients do better overall. The problem that nurses are having is these basic safety numbers are not being followed, and we are burning out as a result. This has to change if we are going to keep our valuable nurses at the bedside. It has to change if people are going to receive the care they deserve when they are in the hospital.
Nursing salaries also need to be increased. Most nurses have their bachelors in nursing degree (BSN). Many hospitals require it as a condition of employment. A bachelor of nursing degree takes about five years, and the cost of the education starts at $50,000. Many nurses have to take out loans to pay for school. If we look at a 10-year repayment plan that does not include interest — a $50,000 loan means a monthly payment of $417.00.
I work in the Midwest. Our new nurses start at $22.00/hour. Some nurses earn a differential for working nights and weekends, too, although those shifts come with health and family costs. If we multiply $22.00/hour by the average 160 hours that most full-time people work each month, we end up with a gross monthly salary of $3,520. Most accountants say that taxes and benefits equal at least 30% of our pay. This means that on average, a new nurse can expect to bring home $2,464 a month. If we subtract the student loan payment, this means a new nurse will need to live off of a little over $2,000 a month. Trying to pay for housing, food, transportation, and utilities each month, forces many nurses to choose to work overtime.
Working 12-hour shifts are rough. In fact, 12-hour shifts often are 13-hour shifts, and many times, nurses do not get breaks. We want breaks, we do! They just become impossible with the increased patient loads and the increase in patient illness that we see. If a nurse somehow gets to leave to go on break, the relieving nurse needs to assume the responsibility for double the patients for the period of time. If that nurse is already having a hard time staying afloat of the assigned tasks at hand, then giving this nurse more responsibility doesn’t make sense. Bedside nurses are tired.
We also are often asked to float to other areas of the hospital — without training. Yes, I learned about basic orthopedics in nursing school; however as a neurology nurse, my knowledge of repairing bones is limited. Nurses should never be asked to float to another unit of a hospital unless they receive adequate training. This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. A salesperson would never be asked to work as an architect. A cardiologist would not be asked to fill in for a neurologist. It just isn’t done. Why do nurses have to risk their licenses to do this? It is not safe patient practice.
We get scared.
When nurses have all of these stressors constantly, they may not even realize that they are having symptoms of chronic stress that can lead to PTSD. It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as “another part of the job.” We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again.
Nurses need support from our hospitals, our government officials and our communities. We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves, and we need to take advantage of employee-assistance programs that offer free, confidential counseling. We need hospital-provided exercise rooms. We need to learn coping skills. We need to be able to process all of the emotions that we feel that have always been discarded as, “part of the job.” We need to talk about our issues, and we need to feel like we are being heard. We need to heal.
I had finally decided to clean out my office closet. I started with the stuffed cardboard file box. The first thing I reached for was a frayed manila envelope. The stack of typed pages spilled out onto the floor. After I read the first two sheets—an early attempt at documenting my nursing life—I knew I was doomed to sit on that floor by the open closet door until I had scrutinized every page. One story especially held a surprise.
In the early 70s, after my husband completed his degree at the University of Chicago, we moved to the far south suburbs where housing costs fit our tight budget. My first job was at a community hospital. Soon after I started, I found out that my salary was the same as a new graduate nurse who had never even done a simple urinary catherization. I, on the other hand, was an experienced ICU nurse. I wrote a letter of complaint and while the Director of Nursing of the hospital commiserated with me, I wasn’t offered a raise. I quit.
I decided to apply for a job at a close-by nursing home in spite of the fact that I thought I was overqualified and working at a nursing home felt demeaning to my young arrogant self. I eventually learned differently.
I wrote about this experience in my memoir:
. . .I had worked in a nursing home—a well-run home
with low staff turnover—for a short period of time, but long enough
to savor the slow pace after being an intensive-care nurse for years
before. The residents bestowed many hugs and an occasional slobbery
kiss as I passed out medications on the evening shift.
I had forgotten that experience the day my academic advisor and
I talked about a master’s thesis. In 1979, like most of my classmates, I
wanted to study women—women of child-bearing age. Why did she
think she had to ask me again: “What group do you REALLY enjoy
caring for?” That’s when I remembered the hugs in the nursing home.
At the end of the version of the story about working in a nursing home that had sat in the manila envelope for over 15 years, there was an added comment about Eva Harrison that I hadn’t remembered writing.
Eva Harrison, the nursing home DON, had offered me a salary higher than the one I received from the hospital. She ran a warm and caring facility, valuing her staff and residents alike. I know she felt sad when I left after only six months but a new clinic opened. At the time, I believed that this new job was more prestigious than that of pill pusher in a nursing home.
What I had written was that I wished I had gone back to tell Eva Harrison that my time at her nursing home had so influenced me that when I graduated as a nurse practitioner a few years later, I had declared geriatrics my specialty. Working in a nursing home, Eva Harrison’s nursing home, set me on a career path that would both challenge and reward me.
In the April 2019 AARP Bulletin there is an article discussing the restrictive laws in North Carolina that control Advanced Practice Registered Nurses.*
North Carolina is where I now live. While I no longer practice as a nurse practitioner, I’m always on the lookout for the latest restrictions or advances in APRN practice. And I am saddened with this particular write-up. Why? Because the story shows that the years of research proving that APRN’s give the same level of safe, quality care as physicians in similar settings is totally disregarded. Therefore, limiting the use of APRN’s has caused the following:
Many rural North Carolina counties face severe provider shortages. Three have no primary care doctors, 26 counties have no OB-GYN, and 32 are without a psychiatrist, . . . .
Ranked 35th for overall health care
Ranked 41st for infant mortality
56% of low-income children don’t have a doctor
(Michelle Crouch, Bridging the Health Care Gap, AARP Bulletin/Real Possibilities, April 2019. p 44.
In 2017, a bill to expand APRNs practice was defeated. Both the NC Medical Society and the NC Academy of Family Physicians opposed this bill, in spite of the fact that “moving restrictions on APRNs could save the state $400 million to $4.3 billion in health care costs annually” and, could increase the number of APRNs to correct the health care shortage.
I have almost 40 years’ experience in watching the struggle to limit APRNs practice. I know many physicians who work alongside nurse practitioners, nurse midwives, and mental health nurses who promote their role in keeping our communities healthy. From my viewpoint, it’s the efforts of organized medicine that disregards putting patients first and values only its own economic growth.
A new bill to remove barriers to APRN practices is expected to be introduced this year. I will be following this closely. It is my dream that in the near future, all states will give APRN’s full practice authority.
I flew into cold, snowy Chicago last week to discuss my book at the main facility of Erie Family Health Centers. This felt like a dream as I stood behind the lectern gazing at the audience that, believe it or not, included a few familiar faces from some thirty years ago. I had been invited to read from my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.I was discussing EFHC’s humble beginnings to this group of employees seated in the conference room on the third floor of an impressively designed modern building.
The main clinic that I remember was housed in a community center. Children’s laughter in the after-school program and the sound of the ball dribbling on an indoor basketball court easily penetrated the partitioned walls of the exam rooms. The dedicated staff experienced delayed pay days when revenue came up short. The clinic where I worked, a short walk from the main center, had mismatched chairs in the waiting area, second hand medical equipment, and roaches in the cabinets. In spite of the physical shortcomings, EFHC cared about the patients, the community, and its staff.
EFHC not only survived its humble roots but thrived and expanded. The non-profit organization now has 14 health centers, and more Advanced Practice Nurses (nurse practitioners and midwives) than doctors and is recognized as providing the highest quality of care by the US Department of Health and Human Services. The Chicago Tribune named EFHC as one of the top workplaces in 2018.
I am honored to be part of EFHC’s history.
Retired Nurse Practitioner & Author Marianna Crane presents her memoir,
Stories from the Tenth-Floor Clinic
On February 20, Marianna Crane, retired Erie nurse and author, met with our nursing staff to discuss her memoir, “Stories from the Tenth-Floor Clinic,” which movingly recounts her experiences as a nurse caring for the underserved elderly at Erie in the 1980’s.
We had a full room, a great discussion about the nursing profession, and over $300 were raised for Erie’s patients through the sale of her book!
Please join us in continuing to support Crane’s work! Keep up with her on her blog and website, Nursing Stories.
Buy the Book!
Proceeds from the sale of Crane’s memoir go towards providing quality care for Erie’s patients.