Nurse Author: It's 'Heartbreaking,' But I Can't Return to Medicine

Theresa L. Brown, PhD, BSN, RN


July 22, 2022

While I've been out and about promoting my new book Healing, many people have asked if I plan to return to the bedside. The New York Times's review of Healing preemptively answered that question by lamenting that I no longer walked the halls of a hospital or drove to home hospice visits.

I want to return to the bedside, whether in a hospital or hospice patients' homes. But regardless of that wish, I'm not sure I will. I could say, as readers have told me, that I put more good into the world with my writing than I ever could with my clinical work because being at the bedside is individual and local. That may be true, but it's not the real answer.

Considering a resumption of clinical work is difficult because I dislike the answer I always come up with: I'm unlikely to return to clinical work because I'm unwilling to do the work of a bedside nurse in its present form.

The pandemic hit nurses, doctors, and indeed all healthcare workers hard, but the challenges faced by frontline staff were merely intensified by the pandemic, not created by it (a possible exception is the personal protective equipment shortage).

News reports documented the overwork experienced by clinical staff, overwork that took place in an underresourced environment that years of healthcare cost-cutting and prioritizing of profits brought into being. That probably sounds like a downbeat and alarmist message that we've all heard before. The analogy I explore immediately below may make the personal hardships posed by current clinical work environments clearer.

I love swimming laps for exercise and do it regularly when I can. Imagine, though, that the water at my regular pool was suddenly so cold that I could barely stand it or, alternatively, so hot I felt myself overheating to the point of being unwell. Doing laps might still be good exercise but it wouldn't feel good and would be harder than necessary.

Imagine if I complained about the temperature of the water and was told that maintaining a working thermostat for the pool wasn't in the budget. Then picture how I would feel if the time available for swimming kept getting shorter and shorter, and when I complained about that, I was told that I just needed to swim harder and faster in the lessened time available. Add in that every swim required a long computer assessment, and the time it took to complete the assessment came off the time allotted for my swim.

Finally, imagine that the pool fired all the lifeguards to save money and one day, another swimmer got into trouble and drowned, and I tried to save them but couldn't get to that person in time.

If after all that, someone asked me, "Do you want to keep swimming for exercise?" I would of course answer yes, emphatically, but not in that place. The problem is, from what I hear anecdotally, working as a nurse in so many hospitals right now is very similar to swimming in that underresourced pool.

Intentions to Quit

new report, Registered Nursing in Crisis: National Survey Reveals Insufficient Staffing, Severe Moral Distress, and High Turnover, says, among other things, of 2100 nurses surveyed across the country, only 15% of nurses felt nurse-to-patient ratios in their units or facilities were safe, and 93% of nurses experienced moral distress. Overall, 51% of nurses were considering quitting within the next year owing to unsafe staffing and unresolved moral distress on the job.

These statistics, from the Illinois Economic Policy Institute, are not news. In fact, similar numbers about nurses and moral distress, and intention to quit their hospital jobs circulated during the pandemic. Even before COVID, the US Bureau of Labor Statistics predicted a serious nursing shortage due to older nurses retiring and Baby Boomers aging. I wrote an opinion piece for The New York Times on this exact issue and referenced similar statistics about nurses' alienation from clinical work.

The dire tone of my op-ed was not wrong. As of January, more than one out of every six hospitals in the United States was critically short on nurses, according to the Center for American Progress. Meanwhile, the trend of large hospital systems prioritizing the business side of healthcare and rewarding upper management rather than the rank-and-file continues.

A recent  The Washington Post article on pandemic aid to hospitals showed that some needed government money to be able to pay their employees but that "many institutions reported strong profits and pursued growth strategies without pause," during COVID, helped by government assistance. That included Atrium Health, headquartered in Charlotte, North Carolina, which increased its CEO's salary during the pandemic by 24% — to $9.8 million — according to the report.

To grasp the crux of why all of this matters, we need to return to the swimming pool analogy. I described a swimmer drowning because the pool fired all the lifeguards. I could just as accurately predict a patient dying because there aren't enough nurses working on any given hospital floor. The connection between inadequate nurse staffing and increased patient mortality has been well established by research. I have been talking and writing about this frightening reality for so long to so little effect that I sometimes feel I am talking only to myself.

Investment in Care

But I'm not going to quit because this is an important and solvable problem. Large hospital systems with excess revenue need to invest in care by paying nurses more as a way to bring them back to hospital work. They then need to recognize nurses' value by offering solid benefits, including guaranteed sick days and time off as well as full mental health benefits.

Robust float pools also need to be maintained to ensure that a nurse "calling off" doesn't mean that everyone else works short. Finally, management has to whittle down documentation requirements so that they don't unduly impinge on the time nurses spend with patients.

Hiring "lunch" or "break" nurses so that no one works for 12 hours without some downtime would help, too. These are common-sense solutions that, despite what some lucratively rewarded CEOs will claim, are not likely to break the bank, though they may put a damper on system expansion.

I love — loved? — being a bedside nurse, a career that I came to later in life after getting a PhD in English and teaching the subject in college. I have no regrets about leaving academia behind to become a nurse. None. However, nursing has gotten much harder in the time I have been a nurse, as has being a doctor.

All clinical work has gotten harder. And I can do harder, up to a point; I think I'm wired that way, like a lot of us in healthcare, but I can't do punishing, impossible, dangerous.

I want to return to the bedside, even feel a yearning for it, the same way the smell of chlorine can make me hunger for a swim. However, I can't see myself dipping even my toe back in right now, possibly not ever, because I see nurses all around me drowning in overwork and underappreciation. It's a heartbreaking decision for me. All I wanted was to be a good nurse.

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