Taylor Daiello knew it was time to quit her job last year after she crashed into a car on her way home from work.
She was coming off a 12-hour shift as a charge nurse, responsible for overseeing her department. She had left the hospital just before midnight. There were hardly any cars on the road. But Daiello was drained, and her mind was blank.
“I was just in that fight-or-flight-like trauma response,” she recalled.
Daiello has a heart for helping others. She also loves being challenged by science and enjoys the fast-paced, unpredictable nature of nursing. But on Nov. 16, she became part of a nationwide trend by ending a 9-year career as an emergency room nurse at Methodist Hospital in St. Louis Park and moving to a less stressful position in outpatient surgery.
Much of Daiello’s exhaustion came from not being able to provide care she deemed quality.
“I feel like I’m just pouring from an empty cup,” she said. “I have to fill a gallon container with an itty-bitty mason jar that’s empty.”
During her last shift, a patient had an unwitnessed seizure in the lobby, but there were no empty beds. After seizing, the patient was alert, so Daiello told them to wait on the floor. While this advice had the patient’s best interest in mind, she knew it was not ideal. But if the patient were to seize again, the floor would be safer than furniture. Resting on furniture comes with the risk of falling.
Daiello was tired of being asked to do more with less. “All of the things that had been making me want to leave happened [during my last shift], so I felt very solid in my decision when I left,” she said.
Many Minnesota nurses feel the same way.
“It is impossible to provide good care in the current environment of health care,” said emergency room nurse Amanda Kosek. “We are far too busy, too overwhelmed, too short staffed.”
Kosek has worked for Hutchinson Health for over 20 years. She became a nurse because she wanted to care for the community and brighten patients’ days.
“I used to leave work feeling overall satisfied with what I was able to accomplish and the care I provide,” she said. “It’s rare I get that feeling in our current environment.”
Corporatized health care is pushing nurses beyond their limits, said Mary Turner, president of the Minnesota Nurses Association (MNA) and an intensive care unit nurse at North Memorial Health Hospital. Treating nurses like “robots” results in moral injury.
“We’re not a car factory. We’re not an assembly line putting pieces and widgets and things like that together,” she said. “It’s people, and so you can’t run it that way.”
In September, Minnesota nurses hit a historic breaking point. Fifteen thousand went on strike for three days, advocating for more staff and better pay. It was the largest private-sector nurses’ strike in U.S. history. A second strike planned for early December was narrowly averted when the union reached agreements with seven healthcare systems just days before.
The union nurses won big raises of at least 17% over three years. Statewide, nurses average $82,000 per year, according to state data.
The union also won some provisions on staffing levels, including protection for nurses from discipline when they raise concerns about assignments they think are unsafe, and requirements to review staffing levels if negative outcomes for patients and nurses rise by 50%.
Legislators introduced the Keeping Nurses at the Bedside Act (SF1651/HF1700). About 70 bedside nurses helped draft the bill, and they believe it will address the job vacancies by prioritizing workers and “patients over profits.”
“This piece of legislation merely sets up committees at every hospital, so they can talk about it in a hospital-by-hospital way how to handle these issues,” said Sen. Jim Abeler, R-Anoka, in a statement.
Abeler, who is married to a nurse, is the sole Republican supporter. “There’s a hole in the bucket, and nurses are leaving. It’s time to make them feel safe at their work, to get the quality people expect.”
The legislation’s advocates say it will also ensure that patients receive the care they deserve, nurses feel safe at work and student nurses have proper training and recruiting.
“The Bedside Act is going to make sure that every single patient in Minnesota, no matter where you are, is going to have access to the same level of adequate staffing,” said Rep. Sandra Feist, DFL-New Brighton.
Last month, the Oregon Nurses Association and Oregon Association of Hospitals and Health Systems reached a compromise on new legislation which reevaluated staffing ratios to keep hospitals safe for workers and patients.
But Minnesota hospitals are unwilling to compromise with Minnesota nurses.
“Minnesota’s hospitals and health systems are already managing an unprecedented crisis in workforce shortages, financials, volumes, and discharge backlogs,” said Minnesota Hospital Association in a statement. “Introducing the unnecessary mandates called for in this bill on hospital operations will inevitably lead to unit closures, rising costs, longer wait times for patients, and the loss of vital services that communities rely on.”
Moral injury is taxing
Nurses say their work can be painful – physically and mentally. Stomach aches and migraines are common. Ill temper and exhaustion come with the job.
Daiello recalled working an 8-hour shift. She was too busy to use the bathroom. Her abdominal pain turned to full-body pain, which was burdensome on top of the required walking and standing during her shift. This is how most of her shifts went, she said.
Nurses are increasingly applying the term “moral injury” to their work. The term originates with a military psychologist, who was examining the effect on soldiers when their job forces them to violate deeply held moral beliefs.
In the health care context, nurses say understaffing forces them to make untenable choices between patients, which is a form of moral injury.
As nurses grow more tired, their compassion fatigue increases. They become more irritable and less sympathetic with ailing patients.
When nurses are rushed and juggling numerous responsibilities, they’re more likely to brush off patients who are vague when describing symptoms and needs.
Moral injury also results in what’s called decision fatigue. Nurses spend their whole shift noting people’s pain levels. They have to decide whose discomfort is the most urgent and what needs to happen first. Fatigued nurses struggle to make these life-and-death decisions.
Moral injury among nurses concerns the general public
Jahred Stephens, an interventional radiology nurse, estimates that people could wait 5-8 hours in the emergency room before getting seen by a provider, due to staffing and space shortages.
“That is a cold hard truth for anyone to hear,” Stephens said. “But that is the truth of our health care system right now.”
Nurses stress the importance of patients advocating for themselves. When going to a hospital, be prepared to share exact symptoms with a corresponding timeline. After leaving, fill out surveys that ask about the quality of care.
When asked what she wanted the general public to know, Daiello said, “[Nurses] are going to do their best. But these systems are keeping them from giving you what you deserve and letting you have the life you deserve, which is a healthy life.”
Editor’s note: The Minnesota Reformer is an independent, nonprofit news organization dedicated to keeping Minnesotans informed and unearthing stories other outlets can’t or won’t tell.
Mary Ellen Ritter wrote this piece. It originally appeared in the Minnesota Reformer on April 11.
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