- New York nurses are celebrating after a strike resulted in an agreement to improve staffing ratios.
- Staffing ratios help nurses provide patients with proper nursing care as they need it.
New York nurses are heading back to the hospital after three days on strike, but nurses nationwide are still facing the combined challenge of burnout and staffing shortages.
Last week, more than 7,000 nurses walked out of hospitals in New York over demands for better pay and safer staffing. The two hospitals involved in the strike — Montefiore Bronx and Mount Sinai Hospital — reached an agreement with the New York State Nurses Association on Thursday, with a plan to implement new staffing ratios immediately.
But around the country, the same problems still persist — nurses are being asked to do more with less and it's putting patient safety at risk, nurses told Insider.
At the core of the nurses' demands in New York was the push to reach sustainable nurse-to-patient ratios, which help patients receive proper nursing care as they need it.
A staffing ratio will vary depending on the hospital unit or medical specialization. The ICU, for example, might have a different nurse-to-patient staffing ratio than general care.
It's normal for ICU nurses to have one or two patients assigned at any given time. But "it's not safe to ask an ICU nurse to care for three to four patients instead of the typical one to two," said attorney Hahnah Williams, a former nurse who now offers legal representation to healthcare practitioners. At that point, patient care can become compromised because nurses may not be able to respond to the needs quickly enough.
'The beginning of another kind of pandemic'
Three nurses told Insider that unbalanced staffing ratios have caused burnout, stress, and frustration at their hospitals in Delaware, Minnesota, and Michigan.
"This is the beginning of another kind of pandemic, of just an outright, you can't get into the hospital because there's not a nurse there to take care of you," said Minneapolis nurse Kelley Anaas.
For hospitals in Delaware, the staffing problem has been persistent for years — and heavily exacerbated by the COVID-19 pandemic, according to Christopher Otto, a registered nurse and executive director of the Delaware Nurses Association.
The staffing issue forces nurses to "ration care and prioritize and determine who's going to get what and what order," he said in an interview with Insider.
A nurse's priority becomes keeping patients alive and attending to other basic needs is secondary.
"If you have a patient that's a higher level of care in terms of their sickness — maybe they're ventilated or on multiple continuous infusions of different medications — then those become the priority," he said. "So you don't always get to the chance of, this patient really needs a bath, or this patient really needs something else, a little more basic."
Sometimes what ends up suffering is communication with worried family members and loved ones.
Otto said he's had to keep family members waiting for hours on end.
"I've had to say that I really want to be able to stop and talk to you and tell you what's going on, but your loved one is needing more support and attention, and then, oh, I've got to go over here and tend to my other patient or my other patient," he said.
More experienced nurses frequently cite burnout and fatigue as the main reason for leaving the job, Otto and Anaas told Insider. Even novice nurses who are a year or two out of school are leaving the workforce in droves, opting instead to go into less-stressful and lower-paid industries, Anaas said.
"They've spent two to four years and tens of thousands of dollars to get their nursing degree and license, and they show up and they're like, 'This is not what I signed up for,' and they leave," Anaas said. Some of these nurses look for jobs in the corporate sector to avoid feeling stressed out and "morally injured" every day at work, she said.
"And I think that's what really scares me, is we see the tail end of the Boomer generation retiring and the population itself getting older and is going to be needing more healthcare. There's not going to be nurses," Anaas added. The American Association of Colleges of Nursing has warned about this problem, citing a report that predicts the nursing shortage will continue to grow until 2030.
Nurses say they're being asked to work overtime
Burnout and unbalanced staffing ratios can be mutually reinforcing. The fewer nurses there are in a given hospital, the more those nurses are asked to work overtime.
Aaron Leis, a Michigan-based nurse, said the ICU unit in his hospital currently has two night shifts that are unfilled. That means nurses are sometimes mandated to stay over or work extra shifts that they didn't want.
A typical shift lasts 12 hours. Full-time employment is considered three days a week, but managers frequently ask staff to pick up overtime hours to fill the gaps, according to Leis.
"You could potentially be working five days in a row," Leis said. "It just causes nurse fatigue and with nurse fatigue, that could lead to potential errors."
One solution, Williams said, is to push the Joint Commission, which oversees accreditation for more than 22,000 US healthcare organizations and programs, to implement a standard that requires specific nurse-to-patient ratios.
Williams believes that the agreement reached between hospitals and labor organizers in New York shows that this kind of change is possible and sets a hopeful precedent for the future.
Nurses in Minnesota reached a similar victory last year. About 15,000 nurses walked off the job in September, demanding higher wages and safer staffing policies. They planned but canceled a second strike in December and reached a deal with hospitals soon thereafter.
But there's far more work to be done, Williams said. "This nursing strike represents a national movement, not a moment."