Concerned Nurses Ask: Are We Heroes or Expendable?

People decide to become nurses for a variety of reasons. However, none of us did so to be exploited during a global pandemic. 

Concerned Nurses Ask: Are We Heroes or Expendable?
“In the face of rapidly rising hospitalization rates, the lack of social distancing, refusal to wear mask or limit social gathering among the members of our own communities sends a clear message: The general public doesn’t think nurses and other health care workers are worth protecting.” (Wikimedia Commons)

As relentless waves of COVID have ravaged the United States, the importance of nurses has begun to surface in the popular press. Despite the fact that nurses are consistently recognized as the most honest and ethical profession, recently nurses are represented in the media largely a commodity that can be bid on, bought and churned out of schools at a moment’s notice. People decide to become nurses for a variety of reasons. However, none did so to be exploited during a global pandemic. 

Countless stories have applauded nurses, and all frontline workers, as heroes during the pandemic. Yet, actions to protect nurses—so they can safely do their jobs—are lacking by the public and places where nurses work.

In the face of rapidly rising hospitalization rates, the lack of social distancing, refusal to wear mask or limit social gathering among the members of our own communities sends a clear message: The general public doesn’t think nurses and other health care workers are worth protecting. 

Equally troubling, is the continued lack of adequate personal protective equipment (PPE), COVID testing, limited transparency of health care worker fatality reporting and punitive policies for missing work due to suspected COVID exposure or illness by employers.

In many states, policies to protect nurses are getting worse, instead of better, in responses to the ongoing surges in COVID cases. For example, some employers and state level policies allow nurses to come to work when they themselves have tested positive. Several news outlets, and practicing nurses on social media, have spoken out that non-nursing colleagues do not “have” to enter COVID rooms;  athletes, actors and others with higher social capital receive daily COVID screening tests while many nurses have not been tested regularly—if at all

The actions of our organizations, communities and governments do not reflect their claims of reverence for our profession and the work we do. As a consequence, more than 1,500 nurses have died in the 44 countries that track health care worker COVID fatalities as of October 28, 2020. This number—which is higher than the total number of nursing deaths during World War I—is certainly underestimated due to lack of reporting of these data. 

Most of the media attention has focused on our Intensive Care Units (ICU) and Emergency Department colleagues. However, nurses across all practice and professional areas are impacted by the ongoing crisis.

Where do people think patients go when ICUs are full? Is anyone aware of the other roles nurses have in our communities that can keep patients out of the hospital?

Similar to pediatric physicians being pulled to care for adult COVID patients, our medical-surgical, pediatric, long-term care, home health, clinic and school nurses have been caring for acutely ill individuals who have nowhere else to turn.

On top of operating outside of our specialty skill zones, nurses are frequently overloaded with unsafe numbers of patients—sometimes caring for more than double the normal patient load patients who require a higher level of care.

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When the majority of work across our profession remains invisible, our collective voices continue to be absent from decision-making tables at all levels—from health care organizations and public education campaigns, to policy-making task forces and beyond. Coupled with the aforementioned lack of care for nurses safety, this sets up conditions for continued abuse of nurses and a mass exodus from the profession from burnout and mismanagement.

The lack of urgency or desire to invest in solutions that will protect nurses and health care workers reflects how little our institutions and communities value our work. Over time, this lack of investment in the nursing profession will result in a revolving door of nurses through health care organizations and, consequently, a lower standard of care with potential to impact health outcomes for years to come. 

If institutions wished to retain their nurses long-term, they would do more to secure PPE, test their staff and voice their concerns and knowledge of how badly the virus is ravaging our systems to the public. 

Concerned Nurses Ask: Are We Heroes or Expendable?
“Although our concerns and calls for action have consistently been ignored, nurses continue to provide the best care possible.” (John Twohig / Flickr)

These problems are not going to go away once the vaccines are distributed. If anything, we will have an epidemic of burnout and post-traumatic stress disorder among nurses and health care providers.

Burnout has been a struggle for nurses, even before COVID. Health care systems have consistently exploited our desire to help others and be there for our health care team members. Adding to this now, are the cumulative effects of policy whiplash or change fatigue; as well as the hypervigilance and repeated exposure to stressors for month upon month due to persistent pandemic surges. It’s no wonder that we are already seeing the effects of Pre-Traumatic Stress, strikingly similar to those of PTSD, as nurses “prepare and wait for the inevitable.”

Yes, self-care and resilience training may help some people. Many individual-level interventions are available to help with burnout—but mindfulness interventions aren’t going to save nursing or improve long term staffing issues that result from the systematic exploitation of the care nurses provide. In fact, such interventions place the responsibility of ‘fixing’ burnout back on the taxed individuals who are already overextended by systemic pressures within health care organizations. 

Prior works, pre-pandemic, have demonstrated that resilience training and similar individual-level interventions are futile when changes in systems do not occur. As long as our work and voices continue to be absent from decision-making tables, viable solutions to the exploitation of nursing labor will not occur. 

Although our concerns and calls for action have consistently been ignored, nurses continue to provide the best care possible. Nurses aren’t floundering helplessly unable to provide care; we are choosing to continue to provide care in settings that are suddenly and unexpectedly resource-constrained in terms of staffing, PPE and testing.

Nurses continue to prioritize our patients over our own health and safety—which is something we should not be asked to do.

Nurses are not superheroes and cannot actually do it all, nor should they. We have asked, and now we are begging for help from the public and policy makers. We’ve been sounding the alarm and some places are starting to listen. When will everyone else?

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About , , , , , and

Michelle Lynn Wright PhD, RN, FAAN, is an assistant professor at the University of Texas at Austin. Dr. Wright is a NICU and ER nurse by training and a scientist that uses omic-based measures (e.g., genomics, microbiome) to better understand the influence of the environment on health. Follow her on Twitter at @micheome.
Dr. Morse is an assistant professor in the Solomont School of Nursing at the University of Massachusetts Lowell. She currently provides direct nursing care to children with complex conditions, and studies pain in these children in both the hospital and community settings. Her most recent project focused on parent perspectives of pain-related health care encounters for their children with limited or no verbal abilities.
Carolyn Phillips, PhD, RN, ACNP-BC, AOCNP is a post-doctoral research fellow at Dana-Farber Cancer Institute in Boston. Dr. Phillips’s research focuses on professional grief, the impact on the caregiver and care-receiver, and the use of Storytelling Through Music to help health care professionals process the grief and suffering they observe in their work. She is also the co-founder of the 501(c)(3), non-profit, Songs for the Soul, whose mission is to support the wellbeing of society's professional caregivers through storytelling and music and to foster a culture that celebrates and sustains compassionate care.
K. Jane Muir is a PhD candidate at the University of Virginia School of Nursing and an emergency department nurse. Her research focuses on evaluating the direct and indirect costs of nurse burnout in health care organizations. Her research can be found here. Follow her on Twitter at @janemuir__.
Kirstin Manges PhD, RN, is a national clinician scholar at the University of Pennsylvania. Her research focuses on redesigning healthcare systems to work better for both patients and their providers. Follow her on Twitter at @kirstin_manges.
Adam White BSN, RN, is a medical-surgical nurse at the Portland VA Medical Center in Portland, Oregon. His work is helping clinicians develop deeper, more holistic, more sustainable relationships with patients across the region through his role as a whole health nurse educator and facilitator for Re-Igniting the Spirit of Caring. Follow him on Twitter at @rnadamwhite.
Samantha Bernstein, MSN, RNC-OB is a PhD student at Medical University of South Carolina researching maternal morbidity and mortality through a lens of patient safety. She works as a bedside nurse in a rural critical access hospital in New Hampshire and can be found on Twitter at @SamBernsteinRN.