Slow Down Sundays Episode 2: When The Bleeding Is Out Of Control, Who Cares For The Caregiver?: A Look At The Current State Of Our Emergency Rooms & Advice For Self-Care.
- educatednurse1
- Jul 18
- 5 min read
Introduction
Healthcare organizations around the country seem to be hemorrhaging (money, supplies, beds, staff) and the best treatment available to stop the bleed, is to slap a Band-Aid on it. The problem is, Band-Aids are on back-order. When you look at an organization, it’s not management that runs the day-to-day operations, it’s the frontline staff who are the face of healthcare. But what happens when the caregiver hemorrhages? Who cares for the caregiver?
Nationwide, staff are feeling the ongoing effects of COVID-19 citing stress and burnout from long hours, forced overtime, understaffing, budget cuts, high acuity patients, full hospital beds, boarding, etc.; however, COVID-19 isn’t the sole responsible party. Healthcare organizations have been broken for years and COVID-19 only magnified these problems shining a light on the numerous and multifactorial issues straining our healthcare systems.
Current State In Our Emergency Rooms: The Problem
Patients Are Sicker Than Ever
Emergency Rooms (ERs) are seeing patients come out of the woodwork and they appear sicker and more demanding than ever before. Perhaps it’s because patients put off chronic disease management during COVID or maybe our population is actually sicker? Baby Boomers are flooding clinics and ERs to help manage chronic disease management and at this rate, I fear we won’t have enough providers to see all these patients in the next 20yrs. While ER visits dropped during the pandemic by approximately 40% nationwide, ERs are now seeing visits trend back upwards [1].
As busloads of high acuity patients arrive on our doorstep, ER nurses around the country are taking on unsafe staffing ratios to care for as many patients as we can squeeze into the walls of department. Gone are the days of a safe 1:3 ratio and nurses are taking on 1:6 or more and safety is a glaring concern. Aside from the school bus pulling up to triage, don’t forget about the 25 already in the waiting room, and the ambulance parade circulating through your garage. Patients are boarding in the ER waiting for an impatient bed, however, there are no inpatient beds or nurses to staff those beds, so they wait… and wait … and wait. The Band-aid … line the hallways with beds, board patients in the ER for days, or transfer them to an out of city/state hospital for admission. Next bus.
Organizations Are Losing Staff
Organizations are hemorrhaging staff. Good, quality, experienced staff are walking away from the ER and finding new jobs. Why are healthcare workers walking away? Inadequate and unsafe staffing, demanding patients, high acuity, lack of leadership, boarders, staff morale, lack of resources, and forced overtime just to name a few! It's not just nurses who are leaving, entire healthcare enterprises are losing dedicated workers (housekeeping, therapy staff, clinic doctors, nutrition services, etc).
In past experience, when the job was tough, you could always rely on your work family to get you through the day. Now, every time a new shift starts, new faces fill the seats around the nurse’s station and the shift feels lonely.
It’s been said time and time again that, nursing is a calling and ER nurses are their own special breed of dark and twisty adrenaline junkies. Right now, the most caring and compassionate highly trained ER staff are being “called” to jobs where they don’t feel physically sick or anxious just dreading going back to work and where they don’t have to fear of losing their license or worse harming a patient because no one is around to support them. So, what happens when there are no more nurses to replace all those leaving the bedside?
The Band-aid and unfortunate reality is that leadership and organizations are more interested in spending thousands of dollars on advertising, hiring, and training new staff than investing in their own people. Unfortunately, with the state of healthcare losing billions of dollars, many facilities are facing hiring freezes and aren’t replacing open positions. This leaves facilities short staffed and allows open beds to sit unfilled, further contributing to ER overcrowding and lost revenue.
So what’s the fix? Good question! Until we figure it out, why not present incentives for the staff that have worked through the pandemic and carried the department? Let’s figure out quality ways staff can be recognized to show appreciation and value. Often, we find ourselves settling for the giant 4x4 shift bonus because that’s the only thing that makes us feel good about the never-ending blood loss of being understaffed, overworked, and unappreciated. But when does the bleeding stop?
Lack of Resources
Money seems to be hemorrhaging as well. There isn’t enough money to have adequate staffing, or the supplies needed to do the job, however, organizations can offer double or triple Band-Aid bonuses to entice staff to come in on their day off. Sometimes the bonus is enough, but often the shifts go unfilled, and staff are once again expected to take on unsafe staffing ratios and work without a break.
Healthcare facilities are watching staff walk out the front door in droves and this mass exodus is causing the largest healthcare shortage we’ve seen in our lifetime. Can we blame them? No. Where are the new baby nurses that are going to replace the nurses leaving the bedside? Nursing programs aren't even running at full capacity and filling cohorts. Nursing educators are leaving academia too. What happens when there's no one to replace us? That shiny ABD pad bonus they’re waving in the faces of the nurses applying the pressure is a short-term fix for a long-term problem.
Taking A Toll on Mental/Physical Health
Shifts are functioning at sub-optimal staffing every day. Staff are calling in PTOs left and right to tend to real personal issues. Numerous studies post-COVID found that nurses are reporting physical, emotional/psychological, and moral injury symptoms that ultimately lead to burnout.
Patient care is ultimately affected. With bigger assignments, there's less time to spend with each patient. Time is consumed with charting and tasks. When the double bonuses and endless texts messages begging for help don’t entice staff to come in, working staff deal with high volumes by reusing the already blood-soaked Band-aids and muddling through another demanding shift.
Conclusion
Stopping The Bleed
Unfortunately, as the hemorrhage continues, the nurse is responsible for stopping the bleed. We’ve learned in trauma nurse courses that all bleeding stops eventually, but at what expense? The job has always been stressful, that’s the nature of caring for critical patients. The difference now is that the bleeding is out of control. Nurses are physically, emotionally, and morally injured and it may just take a catastrophic event for someone to order some roller gauze.
Nurses are currently stressed and burnt out. When organizations look for ways to decrease stress on staff, many solutions require management and organizational overhaul to meet the needs of the staff. Solutions include adequate staffing, giving staff a voice for change, increased communication, fair compensation, and support from leadership.
So, In The End, Who Cares For The Caregiver?
So, what can nurses do? Who cares for the caregiver? WE DO. Stopping the bleed means prioritizing our own physical, mental, and moral health. We must invest in our own self-care because no one else will.
What does investing in ourselves mean? I know the caregiver in you feels guilty about not being at work or taking a day off. It’s OK. Take the 200 hours of vacation you’ve accrued working all the mandated overtime and step away from the bedside. Invest in your health and wellness. Go get a massage, take up kick boxing, start a new pottery class. If you’re looking to make a difference in the workplace, join a committee you’re passionate about, be the voice of your unit, and stand up for what’s right.
Stopping the bleed may mean a new nursing job or a new profession all together and that’s OK. We know the grass isn’t always greener, it may be just grass, but a fresh perspective and new environment may just be the ABD pad and tourniquet you’ve been dreaming of.
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