By Naomi Spencer

Christina, a licensed practical nurse in Louisville, Kentucky, spoke out after reading of a young Ohio nurse driven to suicide by the abusive conditions in the for-profit healthcare system. She described worsening conditions over her more than four decades as a nurse: chronic understaffing and burnout, the malignant presence of insurance and profit in healthcare decision-making, and the devastating impact of the COVID-19 pandemic on nurses. Her name has been changed to protect her anonymity.

“Healthcare as a whole has become very hostile for workers,” said Christina. “You have no support from management. The documentation is impossible to maintain while doing your job.”

“I am an agency nurse,” she explained. “I go into many healthcare settings and can see so much that other nurses, who may be limited to one area, cannot see.” She is often hired by nursing homes for short-term contracts, sometimes for only a few hours or a single shift. Christina has been contracted to work in the ICU, surgery, orthopedics, women and children’s care, and more.

Supervisors sometimes have little medical knowledge and are unable to answer nurse questions. “On the weekends or holidays, someone has to be a supervisor. You are supposed to have at least one RN on hand. You rarely see an RN in the building. Most ‘on-call’ people are not in the building. You are supposed to text them if you have a problem, and try to understand each other through text, which may lead to a phone call. And they’ll have someone like the housekeeper supervisor, maintenance supervisor, social worker as the supervisor. It takes the whole team to run a hospital, including housekeeping, maintenance—but the whole point of this team is to provide healthcare to the patient. You just have no support. A maintenance worker cannot give you medical direction.”

Understaffed and overwhelmed

Nurses are overwhelmed by workloads, Christina said, and conflicts are common. “Because they don’t have enough nurses, management pit the staff against each other. It becomes ‘I don’t want to do it and you’re not going to make me do it,’ so it comes down to who has the biggest voice. Who has the backbone, who’s going to say, ‘I’m not doing this,’ and there’s no management to say, ‘No, this is the way it needs to be.’”

This level of conflict has only fueled the exodus of full-time staff nurses to agency work, where nurses are not required to be on-call. Agency workers may walk into a facility and work a four-hour shift with no strings attached—a relationship that undermines continuity of patient care but benefits the hospital industry’s bottom line because it relieves administration of providing insurance and retirement plans for a growing segment of its workforce.

“When I started agency work decades ago, it was to fill in for someone on family leave or when an illness struck a facility,” Christina stated. “You almost needed another full-time job. It was hard to survive off of contract work.

“As a contractor, you don’t get any of the benefits, but you get flexibility and more money. When COVID hit, people started leaving their full-time positions and there was no one to fill those spots. It got to the point where you have hospitals with 50 to 60 percent short-term agency temp nurses. When it comes to critical times, management can’t guarantee they will have enough nurses to come in to work.”

“It used to be that before you could be a contractor, you had to go through all these tests,” she said. “But half the agencies will let you take the test five times before you pass it. The agencies need the workers, they can’t make money if their workers don’t pass the test.” Christina felt this state of affairs could only be addressed by eliminating contractor positions across healthcare. She pointedly supported striking California nurses, noting that she had received calls to travel there to fill in for $100 a day but refused. “There is a reason they went on strike! I don’t want anything to do with that mess. We need a strike here. Part of the reason they are on strike is they don’t have enough help and support. It’s management, it’s insurance, it’s state-level problems. It’s policy.”

Christina described a byzantine and impossible-to-maintain computerized documentation system within Louisville hospitals, which nurses are expected to continually update. “There is a lot of paperwork, and training does not prepare you. School teaches you how to do an assessment on a patient, but not how to document it.

“There is a saying that ‘nurses eat their young,’ because the more experienced nurses resent having to show new nurses how to do their work. It’s not intentional. But if you have a workload that is so heavy and you don’t have support from management to get you through, and you have doctors that are barking at you, throwing charts and hanging up the phone, downright disrespecting you in front of everyone, how are you going to assist the nurse beside you when you’re stressed out trying to do your own job? You’re starting your day with a fight and then expected to go in and treat your patients with a smile.

“You want to sit down and take a break? Nine times out of 10 you’re not going to get it,” Christina stated. “You can say, ‘I’m going to take a break,’ and you’ll hear, ‘Yes, but I need you to do this, this and this right away.’ How can you take a break when you have to hang this IV, start this g-tube feeding, and this man just got out of the shower, and you need to re-dress his wounds? You get in at 6 a.m. and haven’t had a bite to eat.

“They’re telling you to do these things, but you don’t have any equipment.” Nurses are sent scrambling throughout the hospital in search of supplies. “Nurses are not supposed to be responsible for the supplies, but management has made us responsible for them. If you hire someone off the street as an orderly and they know nothing about nursing, how will they know what you need when you ask for four-by-four gauzes or 60cc syringes, how could they possibly get our order right?

“If I need an oxygen canulate for a patient having trouble getting enough air, do you really have time to go running around to find a nasal canulate? But you find yourself doing that day after day after day.

“When I started in nursing, I didn’t have to think about not having what I needed or run around a building for supplies. I’ve had to get in my car and go to another hospital or another nursing home to find equipment that we need—things that we use every day, we’ve had to get in our cars and go look for it. It may take hours to go across town and get it, and we still have to get back there to take care of our patients.”

“COVID is not over”

“The COVID pandemic really broke my spirit,” Christina said. “It took my love for nursing away quite a bit. I can vividly remember the first time we were told about COVID in a healthcare setting. We were told, ‘This is some kind of virus. We don’t know what it does or where it came from.’

“They said, ‘We will provide you with equipment.’ We didn’t have anything that we needed. It doesn’t matter that everyone in the country needed it. We should have had it all along. There were many times we had to don masks and gloves, so we should have had it all along.

“Instead, they said: We’re going to give everyone one gown and one mask. When you’re done with your mask, put it in a paper sack with your name on it and put it on this shelf. And when you come back the next day, you take that same mask and put it on. So, we said, ‘How long do we have to wear this one mask?’ They said, ‘We’ll let you know.’ For at least 13 hours a day, for a week, we were wearing these masks.