It’s no secret that U.S. nurses are under enormous stress. The Delta variant is driving a resurgence of Covid-19 cases, and the new Omicron variant is spreading fast. Some states are maxed out on their ICU beds and rationing care. In states like New Hampshire and Maine, authorities have called in the National Guard for additional help at hospitals.
What running out of ICU beds actually means is that we have run out of ICU nurses. Without nurses, an ICU bed is just a bed. So even if you arrive at the hospital suffocating from Covid, you may have to wait, or even die, because there are only so many people nurses can care for at once.
When nurses have more patients than they can safely care for, it costs patients their lives and drives nurses away from the bedside. Two-thirds of nurses are so exhausted they are considering leaving the profession. This disproportionately affects women, as 89 percent of registered nurses identify as female.
Ideally, hospitals would increase their nurse staffing levels. But nurses are a finite resource. Desperate hospitals are now paying travel nurses four or more times the average nurse salary to replace staff nurses who have fled the profession - or who have become travel nurses themselves. The U.S. Bureau of Labor Statistics projects that there will be about 195,000 RN job openings every year during this decade. One travel nurse agency, Aya Healthcare, is seeking to fill 53,000 travel nurse job openings right now.
Making sure patients don’t die from insufficient nursing care going forward means hospitals should rethink the demands they make of nurses today.
We could ease the shortage, improve patient care, and save money by providing support staff for nurses. That would enable nurses to focus on caring for patients, rather than burdensome tasks that do not require advanced health skills.
I know some hospital managers might say: “You want me to hire assistants for nurses? Nurses are the assistants." It’s not surprising that this unfounded attitude persists: nine out of 10 nurses are still female, and TV shows like “Grey’s Anatomy” fuel damaging stereotypes by portraying nurses as unskilled serfs who merely help brilliant physicians.
So many have yet to realize that nurses are autonomous, college-educated science professionals whose life-saving talents should be maximized. Nurses serve the patient, not physicians or anyone else. And extensive research shows that less care by nurses equals more death.
I returned to ICU nursing last year to help with the pandemic, after years away advocating for better understanding of the profession. So far I have worked at hospitals in Texas, Florida, California, Pennsylvania, and Maryland. I am among the nurses who provide the vast majority of skilled care that Covid-19 patients get.
We meet your loved ones on their worst days and then work, often without breaks, to care for them as we would our own family members. But many patients die no matter how hard we try to prevent it. We suffer one heartbreaking death after another. My social media feeds are full of posts from nurses at their breaking point.
What is the way out?
Let nurses do what only they can do. And hire support staff for everything else. This will allow nurses to provide critical care, save the lives that can be saved, and return for another day.
Here are some ways we could give nurses more time for patients.
Most importantly: hire scribes. The charting most hospitals now require takes at least as much time as nurses spend on direct patient care, because the software seems to have been created with zero nurse input. Nurses are forced to chart so much care we can’t possibly deliver because charting wastes so much of our time. We can either chart it or do it, but not both.
In recent years, many physicians have been provided with scribes to enter information into the charts for them. Physicians speak their thoughts out loud, and scribes enter them into the chart. Nurses need the same thing.
Have support staff gather and fetch supplies. In each shift caring for Covid patients, nurses repeatedly dress in personal protective equipment (PPE), go into a patient’s room, and discover they need some IV tubing, a pump, or dressing. So we have to take off our PPE, wash our hands, go to the supply room, and search. If what we need is not there, we often must begin a contorted time-wasting encounter with hospital bureaucracy to get it.
Help nurses more easily prone Covid patients (flip onto their stomachs). Many Covid-19 ICU patients are obese, and flipping a 250-pound patient is a Herculean task that exhausts and often injures nurses. A simple pair of proning slings makes it easy.
Have lab staff do bloodwork, and buy vein finders to help nurses start IVs. These tasks can take 25 percent of a nurse’s 12-hour shift, depending on patient load and whether patients have easily accessible veins. Covid-19 patients rarely do.
Finally, have support staff answer phones, empty trash bags and soiled linen, which, no kidding, nurses must do in many places.
Taking these steps would allow nurses more time to provide skilled monitoring and therapies, to advocate for patients and give psychosocial support. It is essential that nurses be available to give the enormous amount of support Covid-19 patients need, especially when they can’t be with family.
We must treat nurses as a vital resource - just like beds.
After all, lives depend on it.
Sandy Summers, RN, MSN, MPH is an ICU nurse, and the founder and executive director of The Truth About Nursing, a non-profit working to improve public understanding of nursing, based in Baltimore, Maryland. She is co-author of "Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk."