Our Health System Is Stealing A Free Ride On The Broken Backs Of The Nurses


 
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By Rachel Basham, RN, CCRN

Nursing has always been my passion. The idea of spending hours at a patient’s bedside, putting in blood, sweat, and tears to save a life. Now that is living! I was made to be a nurse. I’m not afraid of hard work. I have worked 13 consecutive hours without as much as a bathroom break; more often in my career, this is the case than not. I’m not afraid of conversations about death or quality of life, or any number of heart-wrenching topics.

I would rather have a hard conversation than leave the most important things unsaid. I have grown accustomed to rapid downshifts from an adrenaline-pumped room pulsating with frantic energy to a calm discussion about the plan of care down the hall. I have endured countless ethical dilemmas where there seemed to be no “right” choice, where all the options were grim and gut-wrenching. I have stood at the bedside of a meth-addicted mother who delivered her baby in our parking lot, as the emergency team raced to save her innocent premature baby’s life. Our hands were steady, our minds alert, while our hearts were aching. Tragedy and human suffering is part of my daily diet.

COVID-19 has changed everything. We thought we knew tough. What used to be difficult is so much worse. How is that even possible? For those of us committed to the bedside, it has made us question everything. There are so many dimensions to this that it could keep me awake for weeks if I tried to mentally sort it all out. There is the part where hospital administration bends the truth to fit their model of care and doesn’t want to hear anything that contradicts their version of the truth. First, we are changing out the curtains in each room where a rule-out COVID patient receives care. Then we run out of portable plastic fold-out curtains, as the patients overflow the emergency department. It’s OK, we’re told, COVID doesn’t live on the curtains. First, we are told that COVID is spread through airborne transmission; N95s are required to care for these patients. Then we run out of N95 masks. It’s OK, we’re told. COVID is actually transmitted through droplets, so N-95s aren’t required. When nurses contradicted this announcement with real scientific findings and research, they were dismissed as if they had no idea what they were talking about. Just accept our truth, administration demands.

We were each faced with the decision: Do I continue caring for the patients that need me? Even to my own detriment? Do I walk into that room to take report on the ambulance patient who is having difficulty breathing with only a surgical mask on when I know that my protective equipment is not a match to the transmission capabilities of this virus? These are rapid decisions made in seconds, make them now, and live with them forever. We’re usually good at those – but these feel so much more personal. Should I stand up and say no, leaving that patient without a nurse and very likely leaving myself without a job? The decisions are tough ones, and none of the options are good. If I contract COVID-19, my workplace will tell me that I contracted it outside of my workplace. “We are giving you appropriate PPE” is their mantra. Yet, my N95 many days is self-supplied and has already seen over 24 hours of use. I dread throwing any used N95 away because I’m unsure if there will be any tomorrow when I return to work. They tell us this is “the long-haul,” so how many stashed N95s are enough? I chose to continue caring for my patients, knowing that my PPE was likely to be ineffective. The decision kept me up nights in the beginning. It felt so wrong to be sacrificing so much because of poor preparation by hospital administration and governmental agencies. Why do I take the risk? Why have more than a thousand nurses, physicians, NPs, and PAs died after caring for COVID patients with the hospital-provided-PPE? Is it right that we sacrifice those who choose to provide care in this time of global crisis on the altar of poor preparation? Who is caring for the caregivers? And in a time of a critical nursing and physician shortage – who takes the place of those who die or are taken ill?

I have never felt so alone and so angry about things that are out of my control. I feel alone because I am expected to be on the “frontlines” of this pandemic, and I’m given reused PPE. I’m given poor information and even poorer protection for myself and my family when I do contract this virus. The hospital system does not pay for my test, or even perform it on our campus. I can see my doctor and pay for that out of pocket. That is, unless I am someone important, because then the rules are vastly different. The caste lines are clear. Bedside nurses are of the lowest group, no resources to be wasted on them. Nurses on critically-short units are allowed to have an “exception” to this at the approval of higher management. The reasoning is clear: If the staffing situation is bad enough, they perform the test in hopes that it is negative. Then that nurse can still work their shift tonight even if they are feeling ill. I can hardly believe it even as I write it. Do not be mistaken by the shocking nature of some of this. It is undeniably true.

The lines have been drawn. I know where I stand now if I had any question before. Yet my heart is torn. I am a nurse. A healer. An encourager. A team-player. A self-sacrificer. I never showed up for hospital administration. I always, irrefutably showed up to care for my patients. If I accept the truth behind all this and leave the bedside after 13 years of nursing, who takes my place?

Our broken and ungrateful system is stealing a free ride on the broken backs of the nurses who care too much for their patients to leave.

Rachel Basham is a nurse.


 
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COMMENTS

  • jill silverman

    July 30, 2020 06:17 36

    OMG HE IS SO RIGHT. As a retired E.R./Critical Care Nurse I have been watching and realize that there is a lot of: CLOSING THE CURTAIN. Then you go on to the patients who can be hopefully saved. Anyone who doesn't think this is happening is naïve!! It is so sad but true. You can only go so far w/a patient and then "close the curtain" and go on. You out there know what i'm saying.

  • Ernest J Bennett, RN, CCRN-K,CCM

    July 26, 2020 15:15 14

    Your article is well thought out and rings true on so many levels. Without bedside nurses hospitals would cease to exist. Administrators should be asking your opinion on how to care for the critically ill in this era of health care crisis. Unfortunately, all they care about is the bottom line and they tell their professional nurses to do the best they can with what’s given them to provide safe patient care. It’s a joke to any seasoned nurse. Thank you fo your service and saving the lives of our nation’s best. And please consider collective bargaining as part of your solution to continue caring for us and about us.

  • Sharon Hauser

    July 25, 2020 09:34 49

    I am an inpatient hospice RN and I want to share the article "Our Health System Is Stealing A Free Ride On The Broken Backs Of The Nurses" on my Facebook page, but fear the risk of being fired if I do post it. It is exactly what my co-workers and I feel about nursing during this pandemic. Well said.

  • Finally, someone has said it! I have been a nurse for 25 years. I left bedside (acute care) nursing (PCU/tele) because I felt morally distressed in that I wasn’t truly giving the care I was trained to give and that the patients deserved. We as nurses were expected to care for 5/6 patients with numerous meds and critical issues while being responsible for an extraordinary/excessive amount of documentation. Pushing a medication cart and putting out fires is not nursing/caring for someone. We are responsible for their lives! We are ran in to the ground. The system has done nothing but continue to load more and more responsibility on to us without taking into consideration patient safety and the impact it has on nurses both mentally and physically. I left floor nursing approximately 10 years ago to work in a cardiopulmonary rehab. Stark contrast to working the floors, but noticed more of the same, “must keep the volume up” without regard to the acuity your dealing with! During the pandemic I returned to floor nursing to help out, I missed bedside nursing, but was quickly reminded why I left. I experienced morale distress again and felt powerless when I realized I couldn’t give each patient the time they deserved. I was forced right back in to rushing to get assessments done, documentation, and giving meds, while putting out fires! I actually considered leaving nursing, if this was to be my future. It saddens me to see the lack of care, basic needs, such as bathing, mouth care, and patient teaching being difficult to accomplish in a shift. We need to come together to put an end to this and decrease patient loads while also increasing the amount of aides to help with some of these very basic needs. Showing up to take care of people should never leave an individual feeling drained or traumatized, and that is exactly what we have been allowing for a very long time. Thank you for your article, Sincerely, Joanne

  • Adianez Garcia

    July 24, 2020 20:50 06

    Great post, I can’t agree more with everything said here! We are missing a very important topic: patients are being brought to the floors without prior testing. When nursing homes request a COVID 19 test in order to DC the patients they test positive. Those providers that took care of these patients for days were completely exposed with a simple surgical mask that is thinner than paper toilet. Those providers are not even informed by Administrators. I personally feel that my rights as a human being and a caring nurse are being violated. But again we have no control. I also choose to stay and care for my patients to the cost of my health and my loved ones. What a tough decision to make, we have no right now days.

  • Brenda O\'Leary RN

    July 24, 2020 13:02 13

    Hello Rachael, I am a 70 year old RN who spent her whole life nursing. I was a staff nurse, a charge nurse, a head nurse and then became a nursing supervisor in a small hospital in Pembroke Pines, Florida. It wasn't long in to my nursing career that I realized that a corporately run hospital was all about the bottom line/bottom dollar. That is a bitter realization for good nurses who want to give, to properly care for their patients, to bond, and to always be helpful, caring, and sometimes loving. The truth is that people will take advantage of nurses like us. We say yes to a double shift, low pay, increased work load, missed breaks and days off, and will put ourselves in danger to save others. The truth is that some of the people at the top do not see you. Maybe one day you could get recognized and promoted to nursing supervisor or DON. Even that is a disappointment because they will put you on a salary which is not always fair because you are then expected to work many more hours and to come in for all shifts. In those positions, you are at fault for everything. I left the hospital for good after two things occurred. One was that they gave me a budget. That was big. I had to stand there and charge for a bandaid before I could take it out of the closet. My patient was bleeding. Everything became about the money. We were the "deplorables." so to speak. Without us nurses, there would be no hospital. Secondly, they put me on a floor with fifty patients by myself on the 11-7 shift. By myself! They could not find staff and I was not allowed to refuse. I did not leave until I finished my notes by 5 PM the next day. The good news is that I found home health. I have two agencies now. The more I give away, the more comes back to me. I can be a nurse and be blessed at the same time. The lesson learned for me is to forget about the bottom line. Your bottom line will always come back to you. When you take care of your employees and patients and give them more than they need to do their jobs money will never be an issue. Acknowledge and bonus them when they go beyond what is expected and be there with them as part of the team. APPRECIATION is key. Believe me when I say that you are blessed! You are also a hero! You are wonderful! You have put in your time and have worked very hard. My heart goes out to you, especially now. My thought is that things have not changed; working in the hospital environment. The reality is that most nurses would work some time in your environment but then there comes a time to move on. You have done a great job and should be proud of yourself...forever. Nurses have a hard time putting themselves first. Then there comes a time when you need to put yourself and your family first. I had to learn that lesson the hard way. Good Luck and THANK YOU for you! Brenda O'Leary RN

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