By Rose Hoban
We’ve heard throughout the pandemic about nursing shortages, but there was no scarcity of nurses gathering this past Thursday in the nation’s capital.
Thousands of them, including many from North Carolina, marched from the White House to the U.S. Capitol to demand better working conditions that could ultimately benefit those in their care.
They rallied at the culmination of National Nurse Week, a seven-day celebration of the frontline workers that ends on the birthday of Florence Nightingale, the 20th-century reformer often described as “the founder of modern nursing.”
The marchers hope to continue to reform modern nursing with better nurse-to-patient ratios and national laws setting staffing standards, fairer wages and statutes that protect them from the violence against health care workers highlighted by the pandemic.
Lalisa Fulwilie, a nurse working in Charlotte, said she had never participated in anything like the march. Her experiences during the COVID-19 pandemic compelled her to make the trip to Washington this year.
“[COVID] was as awful as you could think it was,” Fulwilie said. “It was as bad, if not worse than what they showed on TV. It’s not normal for people to see people die in front of you after they’ve only come in for a day or two. That’s not normal.”
Fulwilie and her colleagues went to hospital management asking for extra help to deal with the fatigue and stress created by caring for pandemic patients. They were galled by the response, when they were told to seek their own counseling, even as management publicly called them “heroes.”
“The hospital didn’t offer anything,” she said. Like most of the other nurses NC Health News spoke to, she declined to name her institution. “It was like, you know, ‘Keep going, keep going, the patients are still coming.’”
For Asheville-based nurse Heather Drummond, the pandemic was also the last straw. The pandemic exposed pre-existing fissures in health care, she said, showing how the system creaked and groaned under the onslaught of so many perilously sick patients.
“We’re ready for our government to do something about the unsafe conditions in our hospitals,” Drummond said.
The frustrations that Drummond expressed were echoed by dozens of nurses interviewed by NC Health News. They marched because of higher workloads with sicker patients, lack of pay increases, lack of respect from hospital managers and burnout.
Almost to a person, the nurses said they hoped to build a national movement to push Congress to act.
‘Safe staffing saves lives’
One of the primary demands being made by nurses on the street was for the creation and implementation of national minimum staffing ratios for nurses at the bedside.
California passed minimum nurse-patient staffing ratios in 1999 that many of the nurses said should be rolled out across the country. Nurses in California now care for fewer patients per shift than in most of the rest of the country.
“There are massive bodies of evidence that support these ratios and better outcomes for patients,” Drummond said.
Research from many decades has shown that adding registered nurses to a floor results in reduced chance of death for patients, fewer infections, fewer bedsores, fewer medication errors, less nurse burnout, better staff retention and higher patient satisfaction.
Durham emergency nurse Kristin Monesmith said she and her co-workers routinely care for too many patients on the night shift. Monesmith recounted how she was reprimanded recently after she, as the nurse in charge of delegating assignments and maintaining a smooth and efficient flow of care, stopped accepting patients into one of the emergency department “pods.” In the area, she had one staff nurse and two recent graduates who lacked significant experience and a triage nurse who had to shift from her duty of assigning where patients would go to caring for them. They were tending to 10 patients.
“Every single patient they had was a critical care patient,” Monesmith recalled. “They coded one, they intubated three. All they did was run from one emergency to the next.”
In California, the standard staffing for critical care is two patients per nurse.
Monesmith’s friend Krista Lee is a trauma nurse from Prospect Hill who works in a busy emergency department. When a trauma case comes, Lee said she shifts from working with emergency medical patients and moves to the area where trauma patients are taken. This leaves the nurses caring for critically ill patients shorthanded.
She recounted how, on one recent shift, nine trauma patients came in overnight and she had to respond, leaving one coworker alone to care for eight critical care patients.
Other emergency department nurses told similar tales.
“You have an ICU patient in the emergency department and you’re expected to take care of that ICU patient and three or four other patients, and you’re expected to give them the optimum care,” Jessica Burton, a nurse from Statesville, said. “However, you can’t because you have so much stuff and they’re hollering at you, ‘Get this patient in, get this patient through, get his question to the floor.’ But if there’s no beds on the floor, you’re stuck with four or five patients.”
Fulwilie said that when she started nursing in 1997, she would never have more than three patients in the ICU.
“Now, I see our new nurses who have five or six patients at a time,” Fulwilie said. “Psych nurses … we’re having to run a unit with 18 and 20 psychotic patients and two nurses and maybe two techs.”
“It’s a patient safety issue by having more patients than you can handle, which is stretching us and [we’re] basically not able to provide the care and the adequate care that they need,” said Victoria Williams, a nurse from Fayetteville. “Because you have so many patients, the patients are kind of neglected in a way, you know?”
Then her friend Lucy Hudson, a nurse from Tennessee, chimed in, “And it’s easy to make mistakes and when that happens they want to come for your license.”
Many of the nurses wore t-shirts and carried signs expressing solidarity with RaDonda Vaught, a Nashville-based nurse who was recently found guilty of negligent homicide after she made a medication error that resulted in a patient’s death. (Vaught was sentenced to three years probation on Friday.)
Hudson, Williams and her nursing school friend Sheree Hayes said the chilling effect of the Vaught prosecution was leading them to reconsider the profession in light of the increased caseloads, which they said set them up for medical errors.
The women pointed to research that shows that overburdened health care professionals are more prone to errors, especially in health care systems that force nurses to perform workarounds such as creating shortcuts to open electronic medication closets to get things done. That’s what allegedly happened in the Vaught case.
“That’s why nurses are walking away from this profession, because we’re afraid because of something like that what happened and then we’re the ones to blame,” said Hayes, who works in Charlotte.
They all argued that better staffing both reduces errors and improves patient outcomes.
A bill introduced to Congress on the day of the march, H.R. 3165, would require hospitals to submit plans to the federal Department of Health and Human Services that would comply with minimum nurse-to-patient ratios based on the California ratios.
The three, who all work as travel nurses, also were indignant that some lawmakers have suggested capping nurses’ salaries in the wake of the pandemic, which drove up the earning power of health care workers who were willing to move around and fill in at understaffed facilities during peak need. Many of the signs hoisted Thursday protested potential salary caps.
‘We are not OK’
Veronica Marshall, a nurse from Alabama whose Facebook post sparked the idea for nurses to descend on Washington last week, said she was part of an online group where nurses were expressing their concerns in late January about conditions they were seeing in their facilities.
“I made a suggestion, saying, ‘Hey, we need to march in D.C,’ and everyone responded to the post,” Marshall recalled. “They were like, ‘if you create it, we are coming.’”
That weekend, she created a Facebook group for the march. “By the following Friday, we had over 175,000 people in the group, now we have over 210,000 people.”
A U.S. Park Police spokesman said his agency does not make crowd estimates. March organizers claimed some 11,000 marchers filed down Pennsylvania Avenue from the White House to the Capitol. NC Health News estimated a similar amount using videos, photographs and the mapchecking.com crowd estimation tool.
The protest came together quickly and lacked some of the slick programming of larger demonstrations often seen in the nation’s capital. But the nurses made up for it in enthusiasm, making up chants, dancing, snapping selfies and carrying handmade signs as they waited and walked. Some of their messages included:
- “Show-me state says show us safe ratios”;
- “Safe staffing saves lives”;
- “You need the bedpan, OK you’re 8th in line. Safe staffing ratios = dignified care.”;
- “What’s your mom’s care worth?”; and
- “Patients over profits.”
One group of nurses carried signs made from pizza boxes, a reference to “pizza parties” given by hospitals for tired staff during the pandemic.
“I’ve seen a lot of protests but I’m thrilled that the nurses are here to have their voices heard,” said Scott Hasty, a Washington resident who watched from a corner as the nurses passed. “The medical system would crumble without them. After COVID, they should get whatever they want.”
Asking for action
Many of the signs called for Congressional action. One federal bill, H.R. 1195, would require health care and social service agencies to create comprehensive workplace violence prevention plans. The bill has passed the U.S. House of Representatives and is pending in the U.S. Senate.
Multiple nurses recounted incidents of violence in the workplace, even students. Rileigh Shiver, a student in the school of nursing at UNC Wilmington, said she had a frightening encounter with a patient during one of her clinical instruction rotations on the medical floor of a local hospital.
“He grabs me and he … yanked me towards him,” Shiver said. “He was like, ‘I could throw you around if I wanted to.’ And as a nursing student …that’s a really scary situation to be in because I’m not even out in the field yet and I’m already having encounters with patients like that.”
Shiver’s clinical instructor pulled her out of the room for the day and the charge nurse spoke to the patient, she said. The patient did not face consequences and Shiver did not receive counseling from the hospital management.
Charlotte-based psychiatric nurse Erika Melson peeled back a bandage on her wrist to display a circular wound, the result of a patient biting her as she attempted to keep him from choking a coworker.
“I had 10 days of antibiotics and this is possibly a permanent scar, she said. “But I wasn’t the one being choked to death, having somebody trying to twist my neck off.”
Melson’s friend Fulwilie complained about the response from managers after nurses are subject to workplace violence, echoing a commonly heard complaint among marchers.
“What could you have done differently,” managers ask.
“But nobody is taking into account that you’re understaffed and overpopulated with people, and that population is getting sicker,” Fulwilie said. “There’s more violent patients coming in and they’re not doing anything to protect the nurses who are in the frontline.”
Many of the nurses who marched were energized and ready to chart new paths at home.
“I want to bring these changes and ideas and stuff back home to North Carolina,” said Chris Gilbert, an Air Force veteran-turned psychiatric nurse based in Mooresville. He might even run for elected office, he said.
“The public overall, they trust nurses,” Gilbert said “When they see that there’s nurses out there telling them what’s happening in hospitals, this is where those organizations are gonna really think twice.
“If thousands of nurses paid out their own dollar to come out here, I can’t imagine the ones who couldn’t make it.”