From the hospital to the classroom nurses are being asked to do more. When I say asked I actually mean ordered. It really is not a choice for a nurse to care for more patients than can be done safely. It is not a choice for many to decline over time. It is not even a choice to demand proper safety equipment. As more states implement Crisis Standards of Care where does it leave the bedside nurse?

Recently, I visited a couple of emergency rooms. I had the opportunity to talk to a travel nurse. She told me she did not leave her job to be a travel nurse for the money, but rather because she was tired of being taken out of the emergency room to work on COVID units. She had only wanted to be an ER nurse from the time she was in college and that was all she had done until the pandemic. The travel agency promised her she would only be assigned to emergency rooms and they had been true to their word – hospitals take note.

The surprising thing I noticed in both hospitals was that most of the personnel were only wearing surgical masks. No one was wearing either a KN95 or an N95 even though we routinely hear from the experts that even when we are out in public we should be wearing higher quality masks. How could it possibly be that I can now order KN95 and N95 masks online, but the nurses are still not all wearing the ideal personal protective equipment in hospitals? Is it any wonder nurses are fed up and burned out?

According to a 2021 survey of nurses by the American Association of Critical-Care Nurses:

• 92 percent of respondents said they believe the pandemic has depleted nurses at their hospitals, and because of this, their careers will be shorter than they planned
• 66 percent of respondents said they feel their pandemic experiences have led them to consider leaving nursing
• 76 percent of respondents said unvaccinated people threaten nurses’ physical and mental well-being
• 67 percent of respondents said they believe taking care of COVID-19 patients puts their own families’ health at risk

Gualano et al. (2021) looked at the research on burnout in those working in emergency departments and intensive care. They found high levels of stress, anxiety and depression. Globally the rate of burnout in the emergency room and intensive care ranges from 49 to 58 percent. Sadly, this is not new. A study from 2016 showed that burnout was high in nurses due to short staffing, excessive workload, and overtime. As Lasater et al. (2021) put it, “chronic hospital nurse understaffing meets COVID-19” and the result is that half of the nurses give their hospital an unfavorable grade on patient safety and 70% would not recommend their hospital. Part of the reason is a chronic shortage of not only staff, but supplies and properly functioning equipment.

Many people want to cite a preexisting shortage of nurses for the current situation, but the truth is colleges and universities are producing record numbers of nurses that should be able to meet the need if they all stayed in nursing. The shortage that has existed for decades is not because of an inadequate number of nurses. It is due to nurses leaving the hospital and voting with their feet as their voices are not only not being heard but actively silenced.

It has been a common practice to fire or discipline nurses that spoke publicly but nurses are starting to stand their ground and take such cases to court. The federal appellate court recently ruled that firing one nurse for speaking out about safety issues violated the law. If your hospital has a policy that bars you from speaking they are going to lose in court and it is past time. Media policies are an effort to hide safety issues forced on nurses by the administration and are part of the reason hospitals have gotten by with unsafe nurse staffing and overtime requirements for years. COVID brought this to a boiling point as already overworked nurses were fired for speaking out about safety concerns.

1st Circuit panel made clear that an employer cannot bar an employee from engaging in “concerted actions” — such as outreach to the news media — “in furtherance of a group concern.” That’s true even if the employee acted on her own, as Young did in writing her letter. The key in her case was that she “acted in support of what had already been established as a group concern,” the court said.

Meyer – Kaiser Health News

Who of us will ever forget the nurse yelled at by a supervisor to take off her mask during the early days of the pandemic because it would scare the patients with absolutely no concern for the safety of the nurse or the nurse’s family. We should all be grateful that nurses went public as did so many others. It should not be the case that we are expected to advocate for the patients and ourselves only in private. We have years of evidence that does not work.

Many administrators and government officials put Crisis Standards of Care in place to help address the issues of too many patients and too little staffing and supplies. Crisis standards of care are peer-reviewed guidelines that help health care providers and health care systems decide how to deliver the best care possible under the extraordinary circumstances of a disaster or public health emergency when there are not enough resources. Indeed, they provide some limited protection in most states. However, what they continue to fail to address is the moral injury to the healthcare workers that are making decisions about life and death, quality of care, and even saying “I can’t work another shift without rest.” It makes sense to implement crisis standards of care, but two years into this pandemic someone should have addressed the long-term psychological, behavioral, social, and spiritual harm to healthcare workers when such policies are implemented.

I’m not sure how we get hospitals to move away from their profit-making business model and to a model of high-quality compassionate care, but what I do know is that what you are doing right now is not good for patients or nurses. We must all stand together and support nurses at the beside. I am curious if any nurses working in the emergency room or intensive care have had any tasks reassigned during this pandemic.