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

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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