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Nurses weather "moral injury" in the midst of staff shortages

Tired depressed female african scrub nurse wears face mask blue uniform gloves sits on hospital floor. Exhausted sad black doctor feels burnout stress of corona virus frontline protection pray at work
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On top of the physical strain of working 80 to 110 hours each week, nurses have also had to handle the increased emotional weight brought upon by the pandemic.

This story is part of a Michigan Radio series about the ongoing health care staffing crisis in Michigan.

The nursing field has changed drastically since the start of the COVID-19 pandemic, and some hospital staff are full of new faces.

“My colleagues aren't there anymore,” said Nikia Parker, an ER nurse and paramedic in the Traverse City area. “The people that I grew up in nursing with and the people who trained me up in nursing are no longer there.”

Parker joined Stateside to offer her perspective on the working conditions among nurses today, why those conditions have caused so many nurses to leave the field, and what this means for patient care.

Patient to nurse ratio

Parker noted that ten years ago, three or four patients to one ER nurse was considered normal. Now, however, it’s common for ER nurses to see four to six, sometimes even seven or eight, patients at a time.

With these changes in staffing models, treatable cases have been rendered untreatable due to a lack of resources.

“When all of your staff is consumed with putting out the infernos, small embers that were once not priorities turn into big fires, and then they become fires that aren’t fightable anymore,” Parker said.

What causes burnout

How many hours per week did Parker work during her first few years of COVID?

“Too many,” she said.

On top of the physical strain of working 80 to 110 hours each week, nurses have also had to handle the increased emotional weight brought upon by the pandemic. Nurses are not only faced with the fear of what is unknown about COVID but also with the fear of what is right in front of them.

“To be worried that you might be the vector that spreads that disease to your family is a whole other emotional toll, or the vector that spreads that disease from the first patient you encounter in the day into another patient later in the day that doesn't have the disease,” Parker said.

This emotional and physical toil has not necessarily eased up since hospitalization rates have slowed down.

“The stress level in the bedside nursing has not improved, and I actually think it’s gotten worse,” Parker said. “It’s a different kind of stress … Now, because working conditions haven’t improved, there’s this despondency. Because before, when we were in the midst of pandemic stress, … you could try to pretend that when the pandemic is over, this will all get better. But now, we have the pandemic controlled and it’s not getting better.”

Effects on patient care

Nursing retention rates are low, and, today, new nurses rarely get the benefit of being surrounded by more experienced nurses. And when there’s a limited number of other nurses, Parker said, “you have to ration.”

“I mean there’s only one pie, and the more you cut into it … the smaller the servings are going to get. And that means patients are not going to get the small level of care they would have gotten 10-15 years ago when the demand on each nurse was lower,” Parker said.

This demand on nurses creates what Parker calls a “moral injury.” Most nurses enter the field out of a deep desire to care for patients. When they are stretched too thin to care for patients in the way they intend, that contributes to moral injury and job dissatisfaction.

The impact of nursing shortages extends to other hospital departments as well.

“It's the nurses that have to pick up the slack when you don't have respiratory therapy, and all of the tasks that would normally be dispersed across the house,” Parker said. “It usually comes back on the nurses if part of the health care team isn't available, the tasks that that person would do falls to the nurses.”

Parker could choose to leave, as many of her former colleagues have. But she expressed that guilt that comes along with the thought of leaving the field.

“If I leave, I’m just contributing to the same problem that I’m complaining about," she said. "Selfishly, I feel like being a bedside ER nurse is … such a big part of who I am that I wonder what I would be if I weren’t that.”

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April Van Buren is a producer for <i>Stateside</i>. She produces interviews for air as well as web and social media content for the show.
Olivia Mouradian recently graduated from the University of Michigan and joined the Stateside team as an intern in May 2023.
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