WASHINGTON
A strike at two New York City hospitals that saw more than 7,000 professionals walk off the job last week has placed attention squarely on the shortcomings of the US health care system.
While inflated health care costs and unequal access have dominated the news cycle in the past, last week’s standoff between health care workers and employers has centered on a less talked-about but nonetheless critical crisis in the nation; a shortage of nurses caused in part by the coronavirus pandemic and resulting overcrowding and bottlenecks at hospitals nationwide.
The acute problems forced workers to take the highly unusual step of striking at Mount Sinai Hospital and Montefiore Medical Center, demanding employers hire additional staff to help alleviate long-standing problems that have steadily been coming to a head.
Ridana Atkinson-Thompson, a nurse at Mount Sinai who took to the picket line last week, told Anadolu that she and many of her colleagues decided to take the extraordinary step to strike because of a lack of staff and severe overcrowding that has imperiled the health of patients.
“We have patients being placed in hallways that are actually sick and need beds. It’s inhumane, it’s demoralizing to put somebody in a hallway,” she said.
“What we’re saying is we need numbers, we need nurses in numbers. We need the environment to be safe for us and the patients. So that's what we're fighting for.”
The short-staffing has gotten so bad that the five-to-one patient-to-nurse ratio needed to ensure the safety of staff and patients in most units is nearly double what it should be, leading to burnout among nurses and inhumane conditions for patients, she said.
“We're tired, we're exhausted,” said Atkinson-Thompson.
Michelle Gonzales, an intensive care unit nurse at Montefiore Medical Center in the Bronx, echoed Atkinson-Thompson’s grievances, saying they pose a “moral injury” for nurses when they go home knowing they were unable to provide patients with the care “they need or deserve.”
“When we lose patients because we are not able to give them the care that they need, it breaks us in ways that I don't think anyone who is not a nurse or a health care worker could ever understand,” she said.
Nursing shortage not new issue
The crises experienced in New York are not limited to hospitals that saw walkouts, nor are they particularly novel. They have instead been manifested in health care networks across the US for years, an emergency room doctor who works in Baltimore, Maryland told Anadolu on condition of anonymity due to internal prohibitions on speaking with the media.
“The nursing shortage is not necessarily a new thing that just happened. It's been happening. That's why there's frustration about it, especially in New York and places that are chronically understaffed and overworked,” he said.
The comments are borne out by a 2017 study published in the American Journal of Medical Quality that estimated a 150,000 deficit of registered nurses by 2020.
That shortage likely grew more acutely given the blows to the workforce caused by the pandemic. A study published in the peer-reviewed Health Affairs journal in April found a "worrisome drop" in the number of young nurses, which contributed to a 100,000 decrease in the number of registered nurses from 2020 to 2021.
During the coronavirus pandemic scores of nurses left the profession due to concerns for their health amid rampant shortages in protective equipment and a surge in COVID-19 patients, particularly in 2020 when cases were rampant.
Droves of nurses never returned while others chose to pursue careers as “travel nurses” or ones that work for multiple hospitals rather than accept a contract with a single hospital or hospital network.
Challenges for hospitals
Many who chose to pursue a new role sought better pay than what was afforded by working for a single hospital. But the physician who spoke to Anadolu said the shift in the job market poses challenges for hospitals, many of whom have unique internal systems and regulations that are not easily adopted by non-permanent staff.
Some of those systems take up to a year “to fully understand,” said the doctor.
“If you're moving around as a traveling nurse, you don't always get the opportunity to learn that and therefore it takes you longer to do. So patient care suffers anytime anyone new comes in,” he said, noting it results in “an impact on the quality of care provided.”
Further compounding personnel issues for hospitals, many nurses who were set to retire during the pandemic but opted to stay on to care for the ill out of a sense of professional duty, are now entering retirement with the worst days of the crisis hopefully behind the nation.
That is further restricting an already tight labor market, particularly given the relative dearth of new entries into the field. Roughly half of all registered nurses are older than 50, according to the Department of Health and Human Services.
The staffing shortages have resulted in significant overcrowding and major bottlenecks at hospitals across the US. Without the needed number of nurses, many patients have been forced to stay in units without adequate resources to aid them, particularly emergency rooms.
The phenomenon is known within the health care community as “boarding,” and it occurs when a patient is forced to stay in the emergency room while waiting for a bed to open up in the unit that can provide needed care.
Woefully equipped
Emergency departments excel at addressing life-threatening emergencies and can do “everything possible” to provide it for the first two or three hours a patient is in the hospital, said the doctor who spoke to Anadolu. But they are woefully equipped to handle longer-term care.
“Once you get beyond that four-hour mark, the care, the level of care that we can provide to patients significantly drops off, because there are other sick people walking through the door. I can stabilize the heart attack and take care of them, and treat them for the first few hours to make sure that they get to the next step of care,” he said.
“I don't know the treatments that go beyond my level of training in emergency care that is particularly routine care after I see the patient.”
Without sufficient nurses, however, it becomes near-impossible to get patients out of the emergency department, creating log jams that hospitals cannot address without creating the hazardous conditions that forced thousands of nurses to strike in New York City.
Those disputes were ultimately resolved last week following three days of strikes that resulted in a tentative contract that increased staffing levels.
Overcrowding at hospitals
The New York State Nurses Association hailed the agreement as a “historic victory” with the two hospitals agreeing to “concrete enforceable safe staffing ratios,” it said.
Those battles may have been won but the fight to secure better staffing and tamp down rampant overcrowding at hospitals nationwide is far from over.
It takes a minimum of two years to graduate from nursing school as a registered nurse and it is unclear how dire conditions currently affecting the health care system will affect aspirations to enter the field.
For some, the realities are all but certain to be a major deterrent.
*Mucahit Oktay contributed to this report from New York City
