The shortage of nurses in the emergency department has been a beleaguered issue for years in which the staffing grid has never quite matched the help in the field due to calls, mentorship, management or of a handful of other shell game explanations that makes an ED feel fully staffed and run dangerously thin.
We used to say, “You can’t find a nurse!” like a hyperbolic appeal to the hospital administration for more nurses in the emergency room. Sometimes they overheard us and hired PRNs or paid travelers high salaries, much to the dismay of our regular nurses who didn’t get a raise but continued to be team players taking shifts work not covered.
Then, in the spring of 2020, the volume of emergency drugs dropped dramatically and “the company” (which had received $800 million for the COVID crisis) cut off all PRNs and travelers literally overnight to “ save the quarter”. Six months later, when COVID descended into the core (which we knew it would), we were suffocating in crowded wards with dozens of “admitted” COVID patients and not enough nurses in the hospital, including Ed, who was left carrying all of the wounded and dying from the hospital on his backs and beds. And, unsurprisingly, nurses who were laid off in the spring of 2020 were unwilling to return.
Now Omicron is here. Nurses’ salaries have not changed. Staffing is worse, much worse, because more nurses, especially more experienced nurses, have quit in the past two years. Now, when we say, “There are no nurses,” that’s not hyperbole.
The ship sinks. This is a real and immediate question of operational management: “How to do emergency medicine without a nurse?”
Real change starts with transparent truth. Let’s start by refusing to say the phrases “We don’t have beds” or “We don’t have rooms”. It’s rarely true. More cautious administrators may occasionally announce “Due to lack of staffed beds”, but the word “staffed” is too easily dropped. These phrases are psychological marketing ploys to give the impression that the hospital cannot do anything about the situation. After all, you can’t build a new room overnight.
Instead, we need to tell the truth to each other and especially to patients and their families: “We’re sorry, but it’s like this because we don’t have enough medical staff.” We need to erase the pending phone recording that says, “Due to capacity issues related to COVID….” This type of mistrust is insulting. You don’t have fewer hospital operators because COVID has increased the number of patients and phone calls; our emergency and hospital numbers are actually down overall from previous years. Another diversion from total honesty.
It’s not just COVID that’s on the rise; this is largely due to business decisions made when COVID was not around! Stop lying for the hospital. Stop pretending you’re taking a little extra water until the COVID storm is over. There is courage and a newfound resilience in the franchise in saying without guile, “I am so sorry. The hospital does not have enough staff.
COVID and substandard nursing staff are not the worst tragedies in emergency medicine today, however. Every emergency medical response is a supply chain of human resources. The whole chain is broken. You could have life-saving medical intervention for COVID with highly trained doctors available to administer it, but they die at home if you don’t have an ambulance available, or they die in the waiting room if you don’t. don’t have an ambulance available. Emergency nurse. In fact, without a doubt, your most precarious position in emergency medicine is the nighttime ultrasound technician. When you lose a critical link in the chain, nothing holds together. EMS, X-ray techs, and housekeeping may be even more critical than our nursing shortage.
Our communities must be made to understand that if COVID were to disappear from the face of the Earth tomorrow, we would have severe difficulty providing reasonably good emergency medical care in the United States, as we would not have essential hospital staff. for six months to a year – maybe never!
There are no reserves of nurses. And with Amazon Care coming this year, the nursing ecosystem will face deforestation as nurses choose to work from home via telemedicine and will likely be paid more. (New English J Med. 2021;385:2401; https://bit.ly/3GyhxZq.)
Patients will die in greater numbers, not from COVID but from heart attacks, strokes, trauma, sepsis and RSV bronchiolitis due to insufficient human resources. It sounds shocking, but it shouldn’t surprise anyone. These data – and we have known for years that morbidity and mortality increase when admitted patients are held up in the emergency room – are solid and have been repeated loud and clear. Tell yourself and your community to expect more medical errors and more deaths in 2022 in routine emergency care and routine hospital admissions. To turn away from this fact is to refuse to solve a problem.
Next month: Part 2: Building a lifeboat.
Dr. Mosleyis an emergency physician in Wichita, KA.