KSL+: State Of Nursing Profession After Yearlong Pandemic
SALT LAKE CITY, Utah – The nursing profession has been in the spotlight over the last year. They’re on the frontlines of this pandemic. But they’ve been on the front lines of treating the sick in Utah and around the country for much, much longer. Today, we sit down with Deseret News reporter Sara Israelson-Hartley, who started reporting on the issue when a nurse reached out to share their experience. She has since talked to dozens of nurses about the profession, what the pandemic has revealed about it, why many nurses are leaving, and what we should take away.
Editor’s note: transcript lightly edited for readability and clarity.
Sara Israelson-Hartley: And so I thought, okay, if one nurse is experiencing this, maybe there are others. And so I just started talking to more nurses and asking, what are you seeing, what are you experiencing? What are you feeling? We’ve all been hearing about nurse shortages. That was a really big issue around the country. So is this what does this mean for Utah? Is this happening here? How is this affecting nurses here?
Matt Rascon: That one nurse, it sounds like turned into several.
Sara Israelson-Hartley: So I talked with, as I said, in the article 35 nurses. I also connected with some that weren’t comfortable even having an anonymous interview. So I talked with a lot of nurses, trying to find them in different ways. Reaching out through social media. Talking with friends of friends of friends, nurses, who would refer other nurses to me. Trying to get a sense for what was going on in as many different locations, in many different hospitals, as many different health care systems. Trying to really understand what’s going on and trying to also understand what was going on for ICU nurses specifically. Because obviously, a labor and delivery nurse is having a very different experience than an emergency room nurse or an ICU nurse. Same thing with pediatric nurses, they’re seeing kind of a different situation right now than the adult ICU nurses. So that’s what we really tried to focus on as I just tried to find ICU nurses that could really talk to what they were seeing with COVID patients specifically,
Matt Rascon: What were you hearing from these nurses about their experience?
Sara Israelson-Hartley: Let’s take this in a couple parts. It seemed like it we don’t think about nurses a lot in general. Hopefully, we’re not visiting the hospital often. And so we kind of forget that they’re there and the work that they do until we need the– until that crisis happens. Right now, the crisis is happening everywhere. COVID is of course, affecting everyone in a variety of ways. They’ve really been brought to the forefront. But at the same time, as you said, the pandemic has revealed that there are things that haven’t really been working for them for a long time. And they were able to kind of get along and make it work because there wasn’t a global pandemic pressing down on them on all sides. And now these things that they were kind of making work, are no longer working. And it’s really getting harder to do their job when the demand is so great. The pressure is so high, the stresses are just almost unimaginable in some cases. And we’re just asking much more of them than we’ve ever asked before. And the systems that have been kind of working in the past are just starting to break down. And they’re just not working.
Matt Rascon: In the article, you get into the idea which we saw a lot at the beginning of the pandemic–nursing shortages.
Sara Israelson-Hartley: That was a really interesting point, because you’re right, we have been hearing that we don’t have enough nurses. But when I really started to look at the numbers, at the data, that’s not entirely true. We kind of have to unpack that sort of claim. The pandemic has created this situation where we definitely need nurses, we need bodies in hospitals, taking care of people. But generally, that’s not the case. We don’t have this overarching global shortage. We have regional shortages. And we have experienced shortages as older, experienced nurses are retiring. They’re being replaced by younger nurses who are excited and energetic, but just don’t have the same years of experience behind them as these older nurses do.
So to just kind of use that as an excuse for everything, “Well, we don’t have enough nurses.” We have to really look at what that means. Because there’s also this situation where maybe healthcare systems and hospitals across the country aren’t doing the best they could to keep the nurses that they already have and to support them, to retain them, to offer them the things that would be really helpful to keep them and a lot of the nurses talked about that. It’s not it’s not just about the money. It’s about feeling supported, so that they can do the job the best way they can. And I heard from a lot of nurses that the hardest thing for them is to go to work and feel like they can’t do their best for every patient because they want to care for their patients the best way possible. They are giving people that are in a very selfless profession. And the hardest thing for them is to go to work and feel like they don’t have enough time or resources or support to be able to care for each patient the way that they believe that patients should be cared for. And that’s really what’s driving them leaving, because of this moral quandary that they’re in that they can’t give the care that they know needs to be given.
Matt Rascon: What did they say, when you reached out to these health care systems in Utah?
Sara Israelson-Hartley: There’s a lot of hesitancy to talk about specifics. I couldn’t get hospital systems to really talk about salaries or things like that. One system told us a number of nurses that were leaving, others wouldn’t really confirm that. We have a lot of nurses that are maybe transferring between health care systems trying to find a better schedule, hopefully better support. There’s also a lot of nurses right now that are leaving to take traveling nurse positions, just because the pay is so much greater right now, the need is very high. And so they can make significantly more as a travel nurse than they could staying in their original healthcare system and their hospital. Some, again, are transferring between systems, some are retiring early, some are going back to school, and but a lot are leaving for these lucrative traveling positions.
Matt Rascon: Yeah, I have a I have a relative in Texas, actually, that did just that. They were working, I think for the first six months, and they thought, “What am I doing? I could be making so much more, you know, doing this doing this other job?” I think the example you gave in your story was a nurse making something like four times as much as they were making. Why is that these traveling nurses are making so much more?
Sara Israelson-Hartley: The traveling agencies that are hiring these nurses are hiring trained ICU nurses. So they already know basically what they’re going to get, they’re going to get a very experienced nurse who can come into a situation and just immediately start working. So unlike a hiring a brand new nurse that would need some training and onboarding and walking through the process, these ICU nurses that are hired as travelers know exactly what they’re doing, and many of them have traveled before. So they’re used to going into a new hospital, learning the charting system, figuring out on the fly how things work. And so that’s the appeal. You’re pulling in someone who’s already very experienced, and because of that, they can command a higher wage. And so as we see, in places like California, and Arizona and New York, places that were hit really hard initially, they’re just there weren’t enough bodies to care for people. And so hospitals, health care systems needed to bring in these experts as soon as they could, to just get the care to patients that they needed. So as the pandemic has continued, we saw the entire country really struggling with this–there just weren’t enough, even traveling nurses to go around. And so in a scarcity, they could command a much higher wage, and people were receiving wages that they even acknowledged were larger than I’d ever seen, and just kind of insanely high, because the need was so great.
Matt Rascon: You throw out some interesting numbers in there–different studies that were showing that higher nursing, nurse staffing levels reduce the risk of patient deaths in hospitals, and why it’s so critical that there is enough. As opposed to during the pandemic, according to your reporting, they had more patients that they were caring for and like you said, not able to give each patient the support the nurses believe they need.
Sara Israelson-Hartley: Yeah, and what’s interesting that they told me with these COVID patients is that they were hooked up to so many machines, a lot of them were prone, meaning they were laying on their stomach, which is not very common to have an ICU patient do that. And so it just, it took a lot more care per patient. And so when you’re an ICU nurse, and if you generally would have one, maybe two patients, now all of a sudden, you have two or three, and they each have higher needs and are much sicker than you’ve seen before. There’s just you. You physically can’t be in three rooms at a time. There’s also the issue of needing to get the proper gear on to keep the nurses safe, and changing that from room to room so you’re not cross contaminating. There’s just a lot of a lot of things that had to be done that were maybe not common in just winter flu seasons or things. And so nurses just did not have the time and they were just running ragged and trying to get to everyone they could.
They would also have colleagues that would get sick and then they’re out and then they’re down people and so it’s this cycle that feeds on each other and the you know, the feeds on itself as it as it gets worse and worse. And not to mention, the emotional, psychological impact of this. These nurses can’t really go home and sort of debrief and forget and go out with their friends or their family, they’re trying to quarantine and stay safe. And so it’s just, it’s a really sort of tough, tough mix for them to be dealing with.
Matt Rascon: Yeah, I think he called it frontline fatigue. And we’ve on this show talked about how many nurses are really experiencing what they called burnout. And mental health struggles during the pandemic, and how it’s taken its toll, leading to people leaving for other careers, also in the medical field, just less intense. Is that something you heard about at all?
Sara Israelson-Hartley: Yeah, a lot of nurses told me that they were going to be leaving bedside nursing–it had just kind of broken them. Some were newer nurses, and this was maybe more than they’d signed up. Others were very experienced nurses, and just thought like this is too much right now, it’s just sort of taken this mental toll on me, and I need time to recover. Maybe some will come back, maybe some will take a break and return. Others have stayed in the medical field, working in different parts of the hospital, getting out of the immediate bedside care. A lot of them feel like, this is what they want to do forever and this is just a really big challenge. And they work through it. And they hope things get better, they hope the pandemic opens people’s eyes to what nurses deal with and have been dealing with. So there’s a range for sure of opinions and decisions to be made. But all of the nurses that I talked with were tired, they were they were burned out to some degree. They were just sort of emotionally and psychologically really, really tired.
A part that didn’t necessarily come out in the story too strongly is that in the initial phases of the pandemic, when there was so much concern and discussion about how masks were to be used, or whether they should be worn or not, nurses, often felt like they were battling a pandemic, and the public. It was sort of these two different fronts–you had people arguing over whether this was real, whether the pandemic was a hoax. And here they are–going to work every day, dealing with patients that are sicker than they’ve ever seen, not being able to see their loved ones or friends, they’re mentally exhausted. Then to have the public call into question what they’re doing, if this is even real. So especially toward the front end of the pandemic, a lot of nurses said that was really hard–feeling like they were fighting with the public too.
Matt Rascon: There was a compelling image in your story that caught my eye. It was the thank you sign that, from what I understand, and correct me if I’m wrong, but it was the healthcare provider, the hospital, who put in the break room, saying thank you for all you’re doing. But what was interesting was all of the notes that anonymous nurses and others had written on that.
Sara Israelson-Hartley: It was a nurse said that this had happened in their hospital and the sign had been hung up as a goodwill attempt to say thank, like signs, the billboards that you mentioned, and or lawn signs that were put in nurses lawns to say thank you healthcare heroes. And on some level, you know, nurses appreciated that. But on the other level, that isn’t really what they wanted. They wanted the support, they wanted to have more staff, they want to not be working overtime and continually called in for shifts. And so it’s just this sense of, you know, you can say thank you, but we’d really like more–not really what we need right now. You know, we need we need people we need bodies, we need more help, we need to not be working 16 hour days, day after day after day.
Matt Rascon: What were you hearing from these nurses about the solution to this? Utah has a pretty good number of nurses who are graduating in the state, people are still getting into the field. But is this going to change people who thought they might become a nurse? What is the solution here?
Sara Israelson-Hartley: Yeah. And that’s a good question. I’m sure there are lots of different ways to approach it. And I don’t pretend to have all of those answers. I think a lot of nurses talked about the importance of training these new nurses, making sure that they get the training and the mentorship that they need, so that they feel confident going forward and working in bedside care, and that they are able to learn from these experienced nurses, and not just be kind of thrown into situations. Obviously, the pandemic is a unique situation that hopefully won’t happen every year. But just to make sure that they get the training they need, so they feel confident and supported. So you’re not down the road, and they’re thinking I made the wrong choice.
Then the other side of that coin is to make sure that the nurses the hospitals and healthcare systems already have employed feel like their voices matter, feel like their voices can be heard. I mentioned in the article that there are credentialing organizations that work with hospitals, who are working toward making nurses a really valuable part of the of the organization and making sure that they are involved in decisions, that their voices are heard. And so that could be a solution for some healthcare systems is to work toward that, just to make sure that there’s an acknowledgement that the people on the front line, really feel like they are being listened to, and that their concerns are validated. You know, even if it’s something where the salaries can’t immediately be boosted for everyone, small indications that there’s a desire to listen to them; maybe it’s a small raise for everyone. Or maybe it’s just more sort of communication, just a willingness to listen and have it be not just a token conversation, not we’re going to hear you once and then we’re never going to talk to you again. But I think just sort of creating channels where nurses feel like their concerns can be heard and validated and, and really dealt with, I think might be a good step forward.
Matt Rascon: From the reporter perspective, what did you take away from talking to all of these nurses? What impact to the covering the story have on you?
Sara Israelson-Hartley: I think initially, I felt like I should never complain about anything during quarantine again, I’ve been hunkered down at home, making phone calls from my couch for the last year. I haven’t been out and needed to be out and work in a situation like that. So just sort of an extreme level of gratitude for their willingness to be there and to stick it out, even when it’s really tough. And then also, just sort of a sense of trying to be aware of people. I think on a personal level, people that I maybe don’t see a lot, you know, to think of the people that are doing the hard work behind the scenes that I might take for granted–the mail carriers and the people that stocked the shelves at grocery stores, and the people that are driving across the country with FedEx packages. The people that are that kept the country going that are maybe kind of out of the limelight, and that pandemic brought more attention to because they were still needing to do their jobs, and they did them really valiantly. So I think just on a personal level that that I increase my gratitude for those people and opened my eyes as to ways that maybe I could support them. And I was trying to do that by staying home, wearing my mask, trying to be supportive of the public health mandates that were issued. But just a deeper sense of gratitude, really, for nurses and those in the medical field.
Matt Rascon: Did the vaccine offer any sort of hope for these nurses? Now there is there an end in sight to a lot of these issues they felt like they had been dealing with for some time, but the pandemic had exacerbated.
Sara Israelson-Hartley: Yeah, yeah, absolutely. Numbers are going down. And you know, as numbers go down, and there’s fewer people needing intensive care at the hospital that does lighten their load, it makes their job a little bit easier. At the same time, there are still people that need ICU care and their job isn’t over. They still have to go to work every day. You know, it may be slightly less intense but it’s still very intense. You know, the people that are sick are still very sick. So that is still a challenge. There’s also the darker side of that–some nurses expressed concern that maybe, because of the thought “well, the vaccine is here, everything’s going to go back to normal,” that people would be less vigilant with social distance, masking, staying home, and that that could create more problems. It could even lessen the pressure on the hospital system enough so that people think, “oh, nurses are fine, everything’s fine again now the hospital system isn’t at capacity. Nurses are fine. It’s kind of back to normal.” And I think there was that potential fear that this could now that the major sort of crisis has passed, as some might see it, that everything is fine again, and we don’t have to worry about nurses because now that we’ve got the vaccine, we’re good.
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