Nearly three years into the pandemic, businesses are open. Kids are in school. And polls show a growing a number of Americans think life has returned to normal.
But at the nation’s hospitals, the situation remains fraught — especially for nurses, worn out by years of dealing with a virus that is still killing hundreds of people each day. Understaffing, already a problem before covid hit, has intensified as the stress of the pandemic has driven nurses from the bedside. In Minnesota, the situation has reached a breaking point this week, with roughly 15,000 nurses mounting a three-day strike — the largest private-sector nursing strike in history.
Nurses are fed up elsewhere, too. In Wisconsin, nurses at one of the state’s largest hospital systems narrowly avoided a strike after reaching an agreement Monday, and several smaller strikes have popped up in California this summer.
The message is the same: The nurses who remain in U.S. hospitals are saddled with more patients while getting less support. Pleas for help, in the form of increased staff, pay or mental health services, often go unanswered. And the fall and winter flu and covid seasons are just around the corner.
“We are all feeling pretty apathetic, disheartened and way less compassionate than we used to be, as a whole,” said Alyson Alberts, a critical care nurse at Abbott Northwestern Hospital in Minneapolis. “It’s so hard because we love taking care of people … and our patients are sicker than ever. But [in these conditions], you just can’t care as deeply, it’s a self-protective measure.”
At Alberts’ hospital in Minneapolis, staffing problems began before the pandemic. Usually, nurses in her intensive care unit were assigned one patient, she said, since they require so much attention. But the hospital made changes that resulted in nurses often caring for more than one patient at a time. “Not only do you have one patient with a million things going on, but they doubled your workload while cutting support staff from the floor,” she said.
In the early days of the pandemic, staffing was buoyed by help from surgical nurses freed up by the stop to routine care, as well as travel nurses. “But eventually, [that help] dried up and we were back to just kind of drowning,” she said. “We’ve had a mass exodus of people, nurses who are so tired of being asked to do more with less.”
Nationwide, “nurses are exhausted, overworked and really demoralized,” said Amanda Bettencourt, president of the American Association of Critical-Care Nurses.
“A lot of nurses who were hoping that when the pandemic ended things would get better are starting to see that even though we’re not dealing with major covid surges, we’re still dealing with all those other systemic problems,” she said. “Understanding that what’s happening now might be here to stay is something that’s getting nurses to push further for their advocacy for the things we need to take care of our patients.”
Staffing issues not improving
Since 2014, there’s been a 300 percent increase in nurses’ reports of unsafe staffing levels across the state, according to the Minnesota Nurses Association.
“Most hospitals [nationally] have chronically tried to get by on the thinnest margins of staffing,” said Karen Lasater, a nurse researcher at the University of Pennsylvania. Gobs of studies show that understaffing nurses is worse for patients, and it also erodes nurse trust in their employer, she said. “It takes nurses to retain nurses,” she added.
Across the country, the staffing crunch is getting worse. Only 24 percent of nurses said they have appropriate staffing levels more than 75 percent of the time, according to a 2021 survey from the Association of Critical-Care Nurses.
“We’ve had this bolus of nurses retire early,” said Joanne Spetz, director of the University of California, San Francisco’s Institute for Health Policy Studies. “Older nurses pushing the end of their careers were more likely to say, ‘This is the year I’m getting out of here,’” she said. More than 180,000 nurses could retire or quit annually over the next 10 years, according to Spetz’s analysis of BLS data.
“We’ve also had more nurses who’ve left to be travelers,” she said, referring to temporary positions where nurses can make as much as five times more money than they do in permanent employment.
The exodus of staff and experience is piling more responsibility on the nurses who stay.
“Imagine your unit has had five of your most experienced RNs retire, and you now hire five new graduates,” said Spetz. Those new nurses may have much less clinical experience because of covid, Spetz said, and need more help to get up to speed. That takes time many nurses don’t have, she said, leading to potentially dangerous situations for patients.
Even traveling nurses, who might have more experience, need training too. “Simple things happening with a patient are getting missed because they just don’t know,” said one Twin Cities nurse who spoke on the condition of anonymity. “Little tiny mistakes are going to happen and be detrimental; it’s kind of scary.” In Minnesota, adverse events and instances of patient harm, including falls and medication errors, were up 33 percent in 2021, according to a recent report from the Minnesota Department of Health.
All these extra stressors fuel increased burnout, further stoking the conditions driving that burnout in the first place.
“Every week it seems like there’s somebody new who’s leaving,” the nurse said. She’s on maternity leave now, using short-term disability to receive about 60 percent of her pay for six or eight weeks (some hospitals in the region don’t even allow that as an option). As fall and winter approach, the possibility of another covid surge looms large, especially with staffing issues unchanged. “I don’t want to go back to that again,” she said.
Lack of trust
In Minnesota and across the nation, many nurses simply don’t feel as though hospitals have their back.
“Trust is lower than it’s ever been,” said Bettencourt, citing a recent survey finding less than half of nurses think their organization values their health and safety. “We work under extraordinary stress, and when we feel like the places we work for don’t value us, that creates a new layer on top of systemic issues.”
Part of that lack of trust stems from lack of pay increases. Over the last decade, the median wage for registered nurses has risen only about 18 percent, to $77,600. “Traveling nurses coming in are making up to $13,000 for the week, and we can’t even get a cost-of-living increase,” said Alberts. “For the last six years, I believe our raises have been 0 percent, 1 percent, 2, 2, 2, 2.”
Given recent inflation, the Minnesota Nurses Association is asking for a 30 percent raise over three years, while the healthcare organizations have countered with raises of 10 to 12 percent. Other changes, like giving nurses more control over staffing, and expanding parental and short-term disability leave, are also under discussion.
But truly restoring trust between nurses and staff may take more than money, said Lasater. “Wage increases are nice, but you can only endure unfavorable working conditions for so long,” she said. “The best way to improve trust is through improving working conditions by staffing more nurses at the bedside and working to keep them there.”
Thanks to Lillian Barkley for copy editing this article.