As a Travel Nurse Unsafe Staffing Makes Me 'Feel Like a Failure'

There have been many days after working a twelve-hour shift that I have left feeling like a failure.

And to be quite frank, it has nothing to do with my own ability or actions, but it is often a result of a systemic failure of unsafe staffing on not only the unit but for the entire hospital. I have worked so many shifts prioritizing and juggling a to-do list longer than a mother-of-four’s grocery list. The physical and emotional fatigue of constantly living in sympathetic response slowly breaks nurses down. 

It is a horrible feeling to realize that a patient had to sit in their wet briefs, had to wait hours for pain medications or even started to decompensate without anyone noticing because I had been stuck in a room of an actively dying patient. In those moments how do I choose where to be and which patient needs me more? Ultimately, I shouldn’t have to, there should be someone to help with my other patients but there isn’t. Our country has been dealing with safe staffing issues for decades, and the pandemic has only exacerbated an already detrimental problem. 

After spending 5 years as a travel nurse and experiencing hospitals in 11 different states, I am personally familiar with the large discrepancies within the staffing ratios across our country. Depending on the hospital’s normal ratios, the role can feel like two completely different jobs entirely. I have worked in Emergency Departments where I was responsible for 9 different patients at a time, but I have also worked in hospitals where I have only had to care for a max of 3 patients at any given time. That means that just based on hospital location and management, I essentially have had to work the role of three nurses. 

One of the most shocking details of this scenario that onlookers from outside the medical field do not realize is that even though nurses in the states with higher ratios essentially do the work of three nurses, they oftentimes get paid even less than the hospitals with smaller ratios. As a general rule, the west coast far surpasses the east coast in terms of safe staffing as well as pay. With a higher concentration of nursing unions (specifically California) and legislation that supports safe staffing, the west coast, as a generic blanket statement, provides some of the most ideal working conditions in terms of staffing ratios. Although nursing wages fluctuate nationally based on the cost of living, it remains mind-blowing that our country will not implement national standards for staffing demands. 

I will never forget the moment when I became so overwhelmed with my patient load, that I just stood in the hallway, gazed at all of my rooms as the list of tasks I needed to complete scrolled through my head like the beginning of Star Wars. At that moment I thought to myself, “who is going to die first; because I certainly can’t keep all of them alive right now by myself.” 

It was a November day and I was working a mid-shift, and the day started out like many of them did at that hospital. Chaotic. This was my very first travel assignment and I felt unsure of myself in so many ways, and insecure about what “normal” was. I didn’t want to complain, because maybe this is how all hospitals in the country function, and my first job was some diamond in the rough that only had a 4:1 ratio instead of a 7:1. 

I was responsible for four rooms and three hall beds. My first sick patient to arrive was morbidly obese, experiencing massive cardiac problems, and we had to call anesthesia to intubate him due to his large habitus. I was giving cardiac meds I had never hung before through a single 22G IV in his chest, and the physicians wouldn’t take the time to put a central line in him in the ED, because they wanted to let the ICU residents do it. Unfortunately, I couldn’t advocate for them to place one in the ED.

Approximately 30 minutes after his arrival, they put an elderly lady experiencing a stroke next door. We ended up hanging TPA which normally would have required a nurse to stay with her for at least the first hour, but we didn’t have any additional staff to come help. So, in between all of my NIH’s, I would peek in next door, secure the soft restraints a bit tighter and crank the sedation as high as I could, and just pray that both of them were stable enough to safely make it upstairs when the time would allow.  

But, then I got a call about 45 min after her arrival from the charge that said “Hi, sorry but you have the last available room. I’m sending you an LVAD patient in V-Tach to your last room.” 

This was the moment. 

This is when I looked down the hall and wondered which patient’s care would be so horribly mismanaged that I might unintentionally kill someone. Not only did I have three patients that a lot of hospitals would dedicate one nurse to each of them, but I also had the additional four patients that I hadn’t even looked at in hours. 

Unfortunately, this enormously unsafe scenario is not a rare scenario, especially given the current events over the last several years and nurses leaving the bedside at an unprecedented rate. ICU nurses have been forced to often double and triple their normal patient load, and floor nurses have been asked to do dramatically more work for more patients with even less payout and resources. 

The saying “safe staffing saves lives” not only applies to patient lives but also directly relates to helping preserve as many nurses at the bedside as possible. Thankfully crisis travelers and additional government funds have helped decrease the load on many hospitals, but they are only a temporary fix that allows the staff to come up for a few gasps of air, but as soon as they leave, the staff returns to their drowning. Staffing issues will continue to be one of the most concerning problems in the field of nursing for years to come, and I can only hope and pray that my fellow nurses will find relief quickly. 

Source: nurse.org