The lack of care began long before the pandemic; Problems are deeply rooted

From Rebecca Love, Chief Clinical Officer, IntelyCare.

The news media has done an excellent job covering the country’s ongoing lack of care since the pandemic began. But one problem I have with reporting is that most of the reports suggest that the pandemic and the subsequent burnout of the nurses are responsible for the shortage.

Let’s be clear about what we know all too well in healthcare.

Years before February 2020, when COVID-19 began to spread around the world, there were a growing number of care facilities across the country chronically understaffed. The truth is that the pandemic has worsened and put dramatic downward pressure on an already strained workforce. The issue came to the fore because nurses were at the forefront of the pandemic and in the spotlight. It should have come as no surprise that the many failures of the health system – dating back decades – have been pushed into the public domain.

At the beginning of this month, the St. Louis mail delivery published a story about the high fluctuation in the district hospitals. In a hospital system, managers of 8,500 employees lose 160 nurses a month, the newspaper said. The story is similar across the country. The Bureau of Labor Statistics estimates that the care facilities in the country just under 1.1 million registered nurses next year. One problem is particularly serious for post-acute care facilities, which recorded an annual turnover rate of 128% before the pandemic.

Before the pandemic, bottlenecks in facilities didn’t attract much attention because there was always a way to put layers together. Managers could hire day care workers or travel nurses. Then the pandemic struck and the backup resources that administrators normally relied on dried up. With so many hospitals overcrowded with COVID patients, there have been few places to have extra nurses.

In recent weeks, National public radio tried to trace the roots of burnout in nursing. What too few reporters seem to understand, however, is that the factors that are driving many dedicated nurses out of business today are the same ones that have discouraged them for years. COVID was the bus that broke the camel’s back. Some of the most agonizing problems nurses face are the lack of a seat at the table in hospital administration, the inability to make changes in their system, low investment in training and career development, wages that do not keep up with the cost of living. Most importantly, nurses are too often the scapegoat when staff shortages result in deaths. One of the darkest secrets of the health care system, though well researched and documented, is that when hospitals have too many patients treated by nurses, the likelihood that one patient will die increases.

Five patients per nurse is the optimal ratio for general practice in the United States. When facilities are understaffed, the ratio rises to six, eight, even one in twelve in some of our rural hospitals. If someone is dealing with these acutely ill patients, they may have 12 infusions. When these drugs run out, the patient dies.

Just do the math. If one nurse is responsible for six patients, they can only spend 10 minutes an hour with each. If you have 10 patients, they can spend six minutes an hour. Setting up one of these IV systems alone can take 30 minutes. This means that nurses are chronically behind and the error rate is getting smaller and smaller. If a nurse is wrong, a patient can be harmed or worse, die. For the nurse, this type of mistake can result in her losing her job, losing her license and, in some cases, risking jail.

Then there are the hours. During the pandemic, there is simply no stopping it. Many administrators demand overtime, and even when nurses go home they’ll be called with questions and requests to work on days off. This problem also existed long before the pandemic. What is different now is that all pressure valves have disappeared due to the crisis. A number of staff shortages would finally end before March 2020. An exhausted nurse might go away for a few days to relieve the pressure.

Not now. The tension builds up incessantly. People cannot be exposed to this kind of pressure and trauma for two consecutive years – with all the chronically ill patients, the severity, the long absence from the family, and the number of deaths.

For even the most dedicated people, daily life in such an environment demoralizes the human mind. Burnout is the wrong way to describe what caregivers have suffered. This suggests that the person is simply mentally exhausted. What caregivers have experienced is more like post-traumatic stress disorder.

To fix these serious problems and keep more nurses at the bedside, healthcare must go through a complete reorganization of nursing staff. Basically, the system will stay broken until we address the nursing care payment model – unchanged since the 1920s. Currently, care expenses come from the same budget that is used to pay for a device in a room: a bed, a chair, or an IV pump. If we continue to include nurses in the room rate, there will always be a cost to them. Companies don’t invest in costs, they eliminate them.

Solving some of the staffing problems means giving the caregivers more control. In the 1980s, when HIV hit the US and the healthcare system was overwhelmed, Institutions asked nurses Take on staff and things went a lot smoother. Administrators also need to invest in sophisticated software tools for planning and recruiting that give nurses much more freedom and flexibility to manage their own schedules while meeting staffing needs more efficiently. I think the public would be shocked to see how outdated the technology is in many facilities today.

We can’t wait to address these issues. Nurses are one of the cornerstones of quality health care. In order for the United States to provide the best of care, the country needs people who are mentally and physically healthy, rested, and feel valued by their employers.

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