A strike at two New York City hospitals that saw more than 7,000 professionals walk off the job last week drew direct attention to the shortcomings of the US health care system.
While inflated healthcare costs and unequal access have dominated the news cycle in the past, last week’s standoff between healthcare workers and employers centered around a less talked about but nonetheless critical crisis in the nation; a shortage of nurses caused in part by the coronavirus pandemic and resulting overcrowding and bottlenecks in hospitals nationwide.
Acute problems have forced workers to take the highly unusual step of going on strike at Mount Sinai Hospital and Montefiore Medical Center, asking employers to hire additional staff to help alleviate long-standing problems that have steadily come to a head.
Ridana Atkinson-Thompson, a Mount Sinai nurse who took part in the picket line last week, told Anadolu that she and many of her colleagues decided to take the extraordinary step of the strike due to understaffing and severe overcrowding that endangered the health of patients.
“We have patients placed in corridors who are actually sick and need beds. It’s inhumane, it’s demoralizing to put someone in a corridor,” she said.
“What we are saying is we need numbers, we need nurses in numbers. We need the environment to be safe for us and for patients. So that’s why we’re fighting.”
Staff shortages have become so severe that the five-to-one patient-to-nurse ratio needed to keep staff and patients safe in most units is nearly double what it should be, leading to burnout among nurses and understaffing conditions. inhumane for patients, he said.
“We’re tired, we’re exhausted,” Atkinson-Thompson said.
Michelle Gonzales, an intensive care unit nurse at Montefiore Medical Center in the Bronx, echoed Atkinson-Thompson’s complaints, saying they represent a “moral damage” to nurses when they go home knowing they are not in able to provide patients with the care “they need or deserve.”
“When we lose patients because we can’t give them the care they need, we break down in ways that I don’t think anyone who isn’t a nurse or a healthcare professional will ever understand,” she said.
The shortage of nurses is not a new problem
The crises experienced in New York are not limited to hospitals that have seen strikes, nor are they particularly new. Instead, they have been showing up in healthcare networks across the United States for years, an emergency room doctor who works in Baltimore, Maryland, told Anadolu on condition of anonymity due to domestic bans on speaking to the media.
“The nurse shortage is not necessarily a new thing that just happened. Is happening. That’s why there’s frustration about it, especially in New York and places that are chronically understaffed and overworked,” she said.
The comments are confirmed by a 2017 study published in the American Journal of Medical Quality that estimated a shortfall of 150,000 registered nurses by 2020.
That shortage has likely increased more acutely given the pandemic-induced hits to the workforce. A study published in the journal Health Affairs in April found a “worrying decline” in the number of junior nurses, which contributed to a 100,000 decrease in the number of registered nurses from 2020 to 2021.
During the coronavirus pandemic, dozens of nurses have left the profession due to concerns about their health due to a growing shortage of protective equipment and a surge in COVID-19 patients, particularly in 2020 when cases were rampant .
Crowds of nurses never returned while others chose to pursue careers as “travel nurses” or working for multiple hospitals rather than accepting a contract with a single hospital or hospital network.
Challenges for hospitals
Many of those who have chosen to take on a new role have sought better pay than was offered working for a single hospital. But the doctor who spoke to Anadolu said the shift in the labor market poses challenges for hospitals, many of which have unique internal systems and regulations that are not easily adopted by non-permanent staff.
Some of these systems take up to a year “to fully understand,” the doctor said.
“If you’re traveling as a traveling nurse, you don’t always have the opportunity to learn it and therefore it takes you longer to learn it. So patient care suffers every time someone new comes in,” she said, noting that it results in “an impact on the quality of care provided.”
Further exacerbating staffing problems for hospitals, many nurses who were expected to retire during the pandemic but chose to stay on to care for the sick out of a sense of professional duty are now retiring with the worst days of the crisis , hopefully, behind the nation.
This further constrains an already tight labor market, particularly given the relative scarcity of new entrants to the sector. About half of all registered nurses are over the age of 50, according to the Department of Health and Human Services.
Understaffing has resulted in significant overcrowding and severe bottlenecks in hospitals across the United States. Without the necessary number of nurses, many patients have been forced to remain in units without adequate resources to help them, especially emergency rooms.
The phenomenon is known within the healthcare community as “boarding,” and occurs when a patient is forced to stay in the emergency room waiting for a bed to open in the unit that can provide needed care.
Emergency departments excel at dealing with life-threatening emergencies and can do “whatever they can” to provide it for the first two to three hours a patient is in the hospital, said the doctor who spoke to Anadolu. But they are sadly equipped to handle long-term care.
“Once you go beyond four hours, the care, the level of care that we can provide to patients decreases significantly, because there are other patients coming through the door. I can stabilize the heart attack and take care of them and treat them for the first few hours to make sure they get to the next stage of care,” she said.
“I don’t know about treatments that are beyond my level of emergency care training which is especially routine care after seeing the patient.”
Without enough nurses, however, it becomes nearly impossible to get patients out of the emergency room, creating blockages that hospitals cannot tackle without creating the dangerous conditions that have forced thousands of nurses to go on strike in New York City.
Those disputes were finally settled last week after three days of strike action resulting in an interim contract that boosted staffing levels.
Overcrowding in hospitals
The New York State Nurses Association hailed the deal as a “historic victory” with the two hospitals agreeing to “safe and enforceable staffing relationships,” it said.
Those battles may have been won, but the fight to secure better staffing and crack down on rampant overcrowding in hospitals nationwide is far from over.
It takes at least two years to graduate from nursing school as a registered nurse, and it’s unclear how the dire conditions currently affecting the healthcare system will affect aspirations to enter the field.
For some, reality is almost certain to be a major deterrent.
*Mucahit Oktay contributed to this report from New York City
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