Imagine you are in a bad car accident. You are in and out of consciousness. There are lights and sirens and the smell of gasoline. Everything hurts more than you can bear. Hands pull you from the car and place you on a hard backboard with a rigid cervical collar around your neck. You bump down the road in the back of an ambulance as you start feeling like you can’t breathe.
You arrive at a local trauma center where they are short 50 percent of their ED nurses. There is only one experienced trauma nurse on duty, and she is actively resuscitating another new trauma patient. You lay on your back in the hallway on the EMS gurney for 20 minutes waiting for a room. You wait another 10 minutes in the room for a nurse. The nurse is inexperienced and still in training; it takes her 20 minutes to finish your triage documentation and a quick assessment. She has no experience with trauma patients. Her precepting nurse has 1 year of experience and has been pulled to help with the trauma resuscitation in the trauma bay. You beg, “Please, please, I need something for pain. I can’t stand it. I feel like I can’t breathe.” She seems kind, covering you with blankets and explaining that she can’t give you any pain medications until the doctor sees you. “Sorry, it’s really busy today,” she says before she leaves. You lay there strapped to the backboard feeling like your chest will explode. Why is there so much pressure? Why can’t you breathe? This headache is so awful, why isn’t anyone helping me?
The doctor sees you 30 minutes later, and suddenly, everyone is rushing into your room. There are so many people. Pain meds, finally! Thank God. Unfortunately, the pain meds are followed by a chest tube to decompress your collapsed lung, and you are later transferred to the ICU for a subdural hematoma and hemopneumothorax.
This scenario is reflective of our nurse staffing at almost every emergency department in America. Except sometimes the outcome isn’t as sunny; sometimes, the ending is that you die because the staff fails to rescue you from imminent demise. I write from a position of experience.
I have worked in trauma rooms and emergency departments across Phoenix, AZ, for 12 years. The southwestern U.S. is among the worst in the U.S., with as little as 6 nurses to every 1,000 residents. Projections of the nursing shortage anticipate that western states will be hit hardest by continued nurse retirements and the loss of bedside nurses. The mortality rate increases by 6 percent in hospital units that are short of nurses. It has also been well established that surgical site infections, pressure ulcers, urinary tract infections, hospital readmission rates, and “failure to rescue” incidents are higher when there aren’t enough nurses. Experienced nurses are an especially endangered breed: Buerhaus wrote that from 2020 to 2030, the U.S. nursing workforce will lose “2 million years of nursing experience each year” due to the retirement of baby boomer nurses.
You didn’t read this correctly if you aren’t sitting at your computer wide-eyed and open-mouthed by this point. People are dying. Your loved ones could be in the body count. YOU could be in the body count. These patients are reported as “mortality” digits on a spreadsheet; they are people who are irreplaceable, loved, and who matter. And they are dying because we aren’t fighting hard enough to keep experienced nurses at the bedside.
As an experienced nurse, I can do a quick Google search to find a job near me with a “$15,000 sign-on bonus!” More money? Sign me up! My career field is incentivizing me to move from job to job. When a nurse does this, they lack the ability to invest in that particular institution – joining nurse-led committees, nurse career ladder programs, and rooting themselves in improving the quality of patient care at that hospital. They are one person noticing problems that they won’t stay long enough to fix. Patient safety issues, quality of care issues, and other organizational hazards to the hospital’s patients’ well-being are often addressed by bedside nurses who choose to step up and create change in their unit. With successful change, this often ripples to other units and then other hospitals. But nurses who aren’t planning to stay will not participate in any of that. You’re the nurse “just passing through town.”
Experienced nurses should be wooed and cared for by the units they serve. When I put in my 2-week notice at my last job, my director immediately told me not to return. I was in the process of training a new nurse. She was dropped into a pool of floating trainee nurses on the unit and suffered greatly without a consistent, experienced preceptor. My director treated me like trash, like my work on the unit and skills held no value to her at all. Why are we allowing this kind of treatment of our most valuable assets? It’s no wonder that 87 percent of nurses are burned out, 33 percent of new nurses will leave the profession in their first two years, and 50 percent of our workforce is working regular overtime during the most stressful time in nursing history (nurse.org, registerednursing.org). How do we keep the experienced nurses? How do we help establish new nurses on a path to success? How do we save our patients?
I have an answer. We need to demand that funds used as sign-on bonuses for new nurses be allocated to experienced staff on the unit. Those funds should be bi-annual retention bonuses. Every experienced nurse on your unit should receive $15,000 every 2 years to sign a contract committing themselves to your unit. Committing themselves to participating in ongoing quality and patient care improvement. Committing themselves to training incoming staff. New staff joining the unit should not be receiving the greatest financial incentives.
We must demand that experienced nurses remain at the bedside, committed singularly to their institution and unit and the training of new nurses. We cannot stay silent and let our patients die while the new nurses carry the guilt of a preventable patient death because they simply didn’t know what they didn’t know.
Rachel Basham is a nurse.