Strike by 15,000 in Minnesota a clear sign of growing crisis in nursing

minnnursesstrike-150x150The coronavirus pandemic has not only caused sustained damage to the U.S. health workforce, it also apparently has accelerated a looming crisis in nursing care, as has been shown by a three-day strike by 15,000 private-sector nurses in Minnesota.

Theirs was the largest such walkout by nurses and it sought to underscore how pay inequities, staffing shortages, exhaustion, working conditions, and other management-employee issues strike at the heart of the quality, safety, and excellence of direct patient care, the Washington Post and other media outlets reported.

As Kelly Kelley Anaas, an intensive care unit nurse for 14 years at Abbott Northwestern Hospital in Minneapolis, told USA Today of the strains confronted by some of medicine’s most crucial frontline caregivers:

“We’re doing twice as much work essentially for the same compensation and with fewer resources.”

USA Today reported these important measures of nurses’ burdens after months of battling the coronavirus:

“Although the nation added 48,000 health care workers over the past year in hospitals, doctors’ offices and nursing homes, the number of Americans with health care jobs still falls below pre-pandemic levels, the Bureau of Labor Statistics says. ‘The challenges that we highlighted around the fatigue and the mental well-being of nurses continue to this day,’ said Zina Gontscharow, a senior policy adviser at the American Nurses Association. ‘Nurses are really feeling a lot of stress with not having adequate (staffing) on the floor, overtime, and long shifts.’”

Nurse shortages, already forecast to be difficult, have turned grim, especially with the anticipated wave of practitioners leaving the field due to retirement, burnout, or to seek other opportunities, the McKinsey consulting group has found, reporting:

“By 2025, we estimate the United States may have a gap of between 200,000 to 450,000 nurses available for direct patient care … To meet this demand, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years straight.”

Health Affairs, a medical journal, has reported this about the growing problems in nursing:

“Even before the Covid-19 pandemic, health care leaders warned that hospitals face a nursing shortage. The repeated surges of Covid-19 have made the situation dire, in part due to nurse burnout and moral distress. In a survey of more than 6,500 critical care nurses released in September 2021 by the American Association of Critical Care Nurses, 92% of respondents reported that that pandemic had ‘depleted nurses at their hospitals, and, as a result, their careers will be shorter than they intended.’ 66% said they were considering leaving the profession because of their Covid-19 experiences … Addressing the shortage of nurses is no small matter. Research over the past three decades has established that inadequate nurse staff in hospitals is associated with increased patient morbidity and mortality. As such, in August 2021, 47% of nurse executives identified staff retention, furloughs, and layoffs as a significant challenge. The pandemic has already cost hospitals an estimated $24 billion to mitigate the staffing shortage. Despite the impact of the pandemic on the nursing workforce, pre-Covid-19 factors for nurses’ dissatisfaction with hospital working conditions suggest that nurses may seek other employment options that provide them with more control over where and when they work. “

Hospitals, clinics, doctors’ offices, and other employers of nurses are dealing now with their decisions and behaviors that occurred during the pandemic’s depths, experts have told various media outlets. Big institutions, for example, responded to nurse and other health worker staffing issues, in part, by paying pricey traveling professionals on short-term contracts. Hospitals took federal pandemic relief aid they received to magnify exponentially pay, working condition, and other workplace inequities, critics say.

The boom in this expensive option has gone bust, the Wall Street Journal has reported:

“Nurses willing to pack up and travel to a new hot spot every few months earned as much as $10,000 a week at the height of the pandemic to fill in a shortage of medical staff. The economics of nursing was further thrown out of whack by federal subsidies, which allowed hospitals to pay distorted wages, briefly creating a new class of highly paid nurses … The shortage of nurses, a persistent problem in the U.S. even before the pandemic, has hurt profitability at hospitals, which have had to increase pay not only for traveling nurses but also for their regular staff, sending average nurse salaries soaring nationwide … But the traveling-nurse market might finally be coming back down to earth …”

The newspaper reported that several big hospital chains are seeing not only higher profitability with reduced staffing costs, especially for travel nurses. But this also may be fueling the resentment and restiveness of nurses who stayed put, showed their employers loyalty — and now are disheartened that their struggles have not only not eased along with the pandemic but also may have worsened, USA Today found.

Patricia Pittman, a George Washington University professor and director of the Fitzhugh Mullan Institute for Health Workforce Equity, told USA Today that frustration over pay and morale has soared among many hospital-employed nurses:

“You’re creating basically a vicious cycle of low morale of the people who stayed behind. They’re fundamentally angry about being put in a position where they could lose their license and patients could die because there are not enough nurses.”

In their defense, hospitals and other nurse employers say they, too, have been hard hit by pandemic health economics. They have seen months in which care of non-coronavirus patients plummeted, and revenues hit the floor. As conditions have recovered, they have sought to address staffing, pay, morale, and working condition problems. But administrators insist that they cannot hit some of the demands from nurses, especially when they seek pay increases above the offered 10% and 15%.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal with the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Patients must have great nurses if this country hopes to have superb medical care. Doctors know this, and hospitals do, too. The way our health system is set up, nurses are the medical caregivers most often at patients’ bedside offering direct care, as well as heartening help to families in distress and concerned friends. Nurses now can have the education, training, and experience that makes their medical judgment crucial to be considered in patients’ care. These attributes in the economic world cannot be undervalued.

As we seek to address the challenges of nurses, doctors, and other health workers, regular folks can help in an important way: We are far past due for a major reset in how we think and act toward medical personnel. The unbalanced and political and social extremists who popped up during the pandemic to attack health workers verbally and physically — after the nation initially almost canonized them — need to be pushed back. Violence against health workers and in health care settings is unacceptable, It is unacceptable that a leading industry database shows, as the medical news site MedPage has reported: “On average, 57 nurses are assaulted every day in the U.S. That’s two nurses attacked every hour.”

We need to embrace evidence and science anew. We must reject those who peddle wild conspiracies about medicine and the U.S. health system, which is, of course, imperfect. It is unacceptable that ogres, acting on extreme nonsense, can campaign to threaten and harass hospitals and medical personnel who treat desperately ill children. We have much work to do to ensure we bring up, keep, encourage, reward, and praise the valiant nurses, doctors, and other health workers — most of whom do us all great service in applying their talent to our treatment. The poor performers who put patients at risk, well, maybe this is a great time for them to find other ways to spend time.

Photo credit: pickets as posted on Twitter by Minnesota Nurses union
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