Uncovering the hidden struggles of NYC nurses: an insider’s perspective [PODCAST]

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In this episode, Molly M. Murray, a physician assistant, shares her personal experiences of working alongside nurses who are overworked and undervalued. From being spit on and cursed at, to being denied proper breaks and cost-of-living increases, nurses in NYC are pushed to the brink. The pandemic has only exacerbated their suffering, with many experiencing trauma and PTSD. With a recent survey showing that two-thirds of nurses are considering leaving the profession, it’s clear that something needs to change.

Molly M. Murray is a physician assistant.

She shares her story and discusses her KevinMD article, “New York nurses strike for dignity and respect on the frontlines.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show, we have Molly Murray. She’s a physician assistant, and her KevinMD article is titled “New York nurses strike for dignity and respect on the frontlines.” Molly, welcome to the show.

Molly M. Murray: Good morning. How are you?

Kevin Pho: Very well. Thank you so much for joining me, and we’ll get into your article in a little bit, but first off, just briefly share your story and journey to where you are today.

Molly M. Murray: Sure, I’ll keep it as brief as possible. So I became a physician assistant about a decade ago in Brooklyn. I went to Long Island University, and then I started practicing in emergency medicine in hospitals throughout the city as well as New Jersey. I adore that practice, and I can’t see myself anywhere else or in any other role.

And recently, about a year ago, I moved from the city to Boulder, Colorado, and had a son. So in the meantime, on a brief hiatus, I’m working in telehealth with an amazing company called StationMD, which provides tele-emergency medicine for patients with intellectual or developmental disabilities who live in group homes. And I’m also still practicing on the East Coast here and there. I also spend a lot of time in animal rescue and rehabilitation, and I recently started a Buddhist practice specifically designed for clinicians. So that’s what I’m up to most of my time.

Kevin Pho: All right, so regarding your telehealth practice, walk me through a typical day and tell me some typical cases that you would see.

Molly M. Murray: So I work a variety of hours. Usually it’s around 12 to 10 p.m., so 12 noon to 10 p.m. Eastern time. And with this company, we service many different states. I’m licensed in about nine of them, the big ones being New York, New Jersey, Missouri, and Ohio.

So we’ll get calls that can be anything as simple as a missed medication: Should we give it now, or should we not? These are caretakers who aren’t necessarily RNs or LPNs. They do amazing work, and they need a little bit of guidance. And as you can imagine, it’s very hard to call a primary and get through in a timely manner. They’re just so inundated. So we’re happy to help with little issues like that and provide some documentation.

And we also get higher-acuity issues. I get probably a couple of calls an hour during a 10-hour shift, which I do a few times a week. I will get things like vomiting, bradycardia, tachycardia, high fevers, seizures, and of course, a lot of altered mental status or behavior changes, which can be a little bit hard to sift through for a patient with an intellectual or developmental disability but can indicate some really big things, like a urinary tract infection or a stroke.

So we are especially trained to kind of work through some of those. And if the patient does require a transfer out to an emergency room, we call ahead and speak with the accepting team, sort of give a handoff, and try to make the process as seamless as possible, especially for a population where, as you can imagine, going to the emergency department can be a real schlep. It often involves an ambulance trip, just not necessarily for acuity reasons, but for the ease of transport. Some of these patients find it very overstimulating or stressful to be in an emergency room. And these emergency rooms, of course, are very busy, so oftentimes there’s a long wait, and sometimes they have a need for sedating medications. It’s also a significant staff burden to go and sit with someone in the emergency room for long periods of time.

So we try to make that process, if it has to happen, as painless as possible, but we’re also able to resolve a lot of issues in place, which is nice. It’s a real change of pace for me, coming from an ER background where we have the luxury of ordering labs and urines and everything being back within a couple of minutes, really. And now, with this type of practice, it’s much more: How does the patient look, what’s the most likely diagnosis, and can I reasonably treat this in place safely, without the need to spend hours and hours in an emergency room?

Kevin Pho: All right. So your KevinMD article is titled “New York nurses strike for dignity and respect on the frontlines,” and you have that background in the emergency department setting, so you’re able to observe what’s been going on, especially in New York, where, as we’re recording this in mid-January, 7,000 nurses at two New York City hospitals went on strike. And as of today, January 12th, when we’re recording, they recently returned to work. But tell us, what were the events that led you to write this article?

Molly M. Murray: Well, I’ve been thinking about this for a long time, and I think anybody in medicine, especially in New York City, where COVID really changed the landscape, has been thinking a lot about what it means to practice in a system that doesn’t feel like it’s set up for the health and safety of its practitioners, as well as, unfortunately, its patients. So I think that this has sort of been a long time coming. And it’s something that I believe most clinicians really support, in terms of our nurses as part of our team.

New York has always been a gritty, intense place to practice medicine, whether it’s the ER or the hospital. It’s busy, it’s crowded, there’s high acuity, and there are a lot of languages spoken. That’s what makes it really fantastic, but it also makes it very challenging. And I think nurses rose to the occasion in a way that we previously hadn’t seen in the United States in the pandemic. But they kept pushing and kept pushing. And really, now that we are kind of out of, I would say, crisis mode with COVID-19, they’re really feeling like, “Wow, this isn’t sustainable. I can’t keep practicing like this.”

So what I observe in the emergency department are really seasoned veteran nurses, as well as new nurses, but very passionate. They see nursing as an extension of who they are. It’s not a job that they go to; it’s part of their identity. And that’s what makes it so sad, that they feel there’s no other way to accomplish what they really need to do their job well than to strike.

So I think anybody who’s been working in the city for a while has seen this coming for quite some time, because the conditions are rough. Unlike California, which has state-mandated staffing ratios, New York up until now has not. So it wouldn’t be uncommon for you to see one nurse managing 12 or 15 patients in an ER, some of whom are very sick, some of whom are ICU holds. It’s also not uncommon to see them working 16 hours due to staffing shortages, helping train traveling nurses who are coming in to fill empty roles, which, of course, is very time-consuming and energy-consuming. And they’re also doing so in a really crowded environment, where sometimes you have stretchers so close to one another that you have to shift a couple of them out of the way just to reach a patient. This is just not sustainable.

Kevin Pho: Now, while you’re working in the emergency department, tell me, what kind of recourse do nurses have? Obviously, a strike is kind of a last resort. So when these nurses went to administration to talk about some of their working conditions, did anything improve? What kind of response did they get?

Molly M. Murray: Yeah, it’s a great question, because I want to really make it clear to anybody who maybe isn’t in this environment that this was really a last resort, and it was really pushed off as far as possible. It came to this because repeated attempts to speak with administration, from what I observed, were met with sort of empty promises, or at least that’s what it felt like.

So it would be, “All right, we’re going to bring in more nurses.” Well, more nurses, of course, were brought in. There were a lot of travelers brought in, some of whom were actually just former employees of the hospital who had said, “I can’t take this anymore,” and became travelers, upped their hourly rate by four to five times, and now they’re back at the hospital doing the exact same job they were doing before. But many were also from other states, and of course, there’s a learning curve.

So yes, extra staff, extra hands, and extra skill were helpful, but it also required that the nurses on site help to sort of bring them up to speed. So it wasn’t as easy as, “Oh, now we have 10 extra nurses. You should be good to go.” So that really felt like a Band-Aid.

The extra nursing staff was also unreliable. I don’t mean that the nurses themselves were unreliable, but some days they would be able to get in five extra, and some days they could get two extra. And nurses have always been expected to really just rise to the occasion and meet whatever they needed, because ultimately, it’s the patients who need them the most, and administration, I feel, knows that. They know that no matter what situation you put these New York City nurses in, they will do their best to take care of their patients. But these empty promises of more nursing staff, or more hours off, or promising a lunch break really never actually came to fruition, because the system wasn’t set up to actually make that sustainable.

Kevin Pho: Now tell us a story or a case study of something that you’ve seen that would really paint a picture of exactly the trials that these nurses have been going through.

Molly M. Murray: Oh, wow, you know, that’s hard. Whenever someone asks me for a story, I always have to just narrow it down to my last day, because so many come to mind. So I’m trying to think of my last shift. I would say that it was a time where I witnessed one nurse who was training, and so had a more seasoned nurse with them, responsible for 16 emergency room patients.

Some of these were simple cases, so fractures, or a respiratory illness, but not terribly sick. But also, one of them was an RSV baby that needed to be transferred, and they were having a hard time getting hold of someone who was capable of transferring an infant at this level of acuity. So in the meantime, they’re really responsible for taking care of this really sick infant who, in all likelihood, should have been one-to-one. And administration said, “Well, technically there are two of you, so this seems like a fair staffing ratio.” But of course, it’s not, because one of them is still in training.

So you’ve got a very sick baby. You’ve got many patients who don’t understand the reality of just how swamped these nurses are, so they’re asking for medications, they’re asking for water, they’re asking for discharge paperwork, and they’re very upset and they’re yelling at the nurses, and that’s, of course, not uncommon. There was an intoxicated patient who ran into the bathroom and overdosed on heroin, and so that subsequently became an emergency. This patient also had an open head wound. So that was creating a lot of chaos.

There were two ICU holds, one of whom was a GI bleed. If you imagine the amount of interaction with the patient and families that this entails, in addition to speaking with consultants, carrying out orders, and picking up blood products, it’s unfathomable, almost like a wartime situation. You can’t possibly juggle all these things and not have something slip through the cracks. And that’s what I think these nurses are responding to: You can’t have all these balls in the air without sacrificing safety.

So that was my last shift. No physician or PA or NP could imagine single-handedly managing such sick patients, and that’s what they’re being asked to do every single day. And when they call down to charge, or up to administration, the answer is, “Well, what do you need?” And they’ll get maybe an hour of coverage here or there, but it’s such a Band-Aid. They end up spending hours after their shift is over finally doing their documentation. It’s just wearing them down.

Kevin Pho: I’m reading today’s New York Times. It says that “a tentative deal would include a 19.1 percent wage increase over three years and the creation of more than 170 new nursing positions.” So I’m just going to put you on the spot here. What’s your reaction to that deal?

Molly M. Murray: Well, I am so happy for the nurses of New York that this deal was struck at about 3 a.m., just before they needed the 7 a.m. shift to start. And what I really loved about seeing this article was that, yes, 170 new nurses, and specifically this applies to Mount Sinai and Montefiore, who struck the deal last night with the New York State Nurses Association.

But it wasn’t just the 19 percent pay increase, which, by the way, may sound like a lot, but for people who are in health care, this is coming after five to 10 years of no raises, and of course, a significant cost-of-living increase, as well as inflation. More than the 170 nurses and more than the 19 percent pay increase, what I was really pleased about was that this deal also included guaranteed safe ratios, which initially were not part of the deal. And nurses actually said no when they were just offered the 19 percent pay increase. They held out, and they said, “No, it’s not only about that. We want safe ratios.”

And that’s when Mount Sinai and Montefiore agreed to change their patient-to-nurse safety ratios, significantly increasing their ER nurses. And actually, Montefiore agreed to pay penalties for when these ratios are exceeded. And really, I think the ratios and the patients’ safety are what the nurses were dead set on. So I’m so pleased that was part of the deal.

Kevin Pho: I’m sure nurses across the country are looking at this example here, and I’m sure they’re going through situations similar to what the nurses in New York did. What do you anticipate the path forward to be? Do you anticipate more strikes similar to what happened in New York City?

Molly M. Murray: I do. I think that New York City really brought this to a head because of the intensity of the practice environment and just how tough COVID was on the infrastructure and on the staffing. But I do think that they’ve set an example that if nurses find themselves in a situation that isn’t sustainable and isn’t safe, and they consistently work with administration to try to remedy that and it doesn’t work, striking may be a last-resort option.

And it’s something that I know the New York City nurses really didn’t want to do. Many of them held out because they were so afraid of the impact on their patients. But ultimately, that is what it took to make administration wake up. These hospital systems really hurt when the nurses struck. Many of them were operating at half capacity. They had to transfer patients out via ambulance. They had to cancel elective procedures. They had to go on divert, and they had to bring in travelers who are sometimes four to five times more expensive. And unfortunately, I think that was the only way to get through, and I think the rest of the country, if they find themselves in a similar situation, will follow New York City nurses.

Kevin Pho: And my final question, Molly. What are some of your take-home messages that you want to leave with the KevinMD audience?

Molly M. Murray: Well, I think that the KevinMD audience probably knows this very well, but many of them, if they don’t practice in New York City, may not understand just how difficult the situation was. So I hope that everyone knows that New York City nurses are some of the toughest people on the planet, the toughest people in health care. They were driven to this. And ultimately, it is going to benefit everyone. I’m so proud of them for doing what’s best for the patient, and I’m just thrilled that administration has heard them.

Kevin Pho: Molly, thank you so much for sharing your time and insight, and thanks again for being on the show.

Molly M. Murray: Thanks for having me, Kevin.

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