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May 7, 2023

From Bad to Worse: The Nursing Crisis Has Changed Our Hospitals.

Photo by Pixabay on Pexels.

The soft click from the latch woke me as the nurse opened our door, flooding the dark exam room with fluorescent light from the hallway. I slowly opened my eyes but didn’t have the energy to lift my head from the side of the stretcher my husband was laying on.

It was 8:45 a.m. and I’d been awake for almost 24 hours.

Not long before the nurse opened our door, the caffeine from the Red Bull I drank nine hours before had worn off, and my body was shutting down—demanding sleep. I was desperate to lay down. My legs kept going numb from propping my feet up on the metal base of the hospital bed, attempting to stretch out. My back was aching from the chair I was sitting in, its thin gray pleather cushions and black plastic arms were designed to be cheap, not for comfort.

I had the idea to lay my head on the side of the bed, hoping the support would allow my body to relax a little and catch a catnap during our never-ending wait for answers. I lowered the side rail, scooted my chair across the white linoleum floor close to the bed, and rested my head against the thin plastic-upholstered mattress covered with a scratchy fitted sheet.

I still couldn’t get comfortable. Having to contort myself in an awkward angle to keep myself from sliding off my makeshift pillow made the pain in my back spread to my hips and ribs.

My brain began to low-key panic, telling me that my attempts to get any sleep were futile, and I wanted to cry.

My husband knew I was beginning to lose it. I’d started to softly whine aloud and my constant twisting and jerky movements to relieve my achy muscles were jarring the bed, keeping him from getting the rest he was also desperate for. He gently encouraged me to calm down, grounding me with a reminder to relax my body, and the exhaustion finally took over.

I had fallen asleep just moments before the new ER (Emergency Room) nurse started her shift and began checking on her patients for the day. When she came in the room, she turned on the lights to meet us, asking my husband the standard questions. What’s going on? How are you feeling? On a scale of one to ten, what’s your level of pain?

I was too tired to move and scared to disrupt the precarious position my body had managed to relax into, so I kept my head against the side of the bed while we talked. I mentioned how long we’d been there and how exhausted I was after being awake all night. She left to get him some medication, turning the lights off as she closed the door. I must have fallen asleep again, because it seemed like she was back in mere seconds.

When she opened the door again, I noticed that she brought a much bigger chair—one that reclines into a flat position and had much more cushion than the one I was sitting in, with two white blankets and a pillow stacked on the seat.

I immediately perked up and gasped, “Is that for me?” My soft voice sounding childlike to my ears.

When she said yes, my body was flooded with feelings of gratitude and relief, bordering on instant love for this kind and considerate spirit the heavens had sent to my weary body’s rescue.

I told her she was an angel, and fully meant it. Her gesture touched my heart, renewing some faith that had been lost over the lack of humanity from the other nurses and medical staff we’d encountered that night.

Since our arrival to the ER over 10 hours before, we immediately noticed a big change from our past experiences.

We’ve spent a lot of time in this hospital in the last 11 years, after my husband’s first heart attack and the many other health issues that have plagued him since. We would often joke with his nurses that we should have a customer rewards punch card—five punches, get one stay for free. We’d punched enough holes to fill a whole card and were working on a second, not counting the stays at a few other hospitals over the years.

Upon walking into the ER lobby, we were taken aback by how different it looked since the last time we were here. They had remodeled, and the waiting room was much smaller and had many more patients than we’d ever seen before.

Usually, when my husband goes to the ER complaining of chest pain, breathlessness, a sore jaw, and numbness in his left arm, we’re immediately taken into a triage room and spend no time in the lobby. In triage, they’ll start an IV (intravenous line) to do some bloodwork, run an ECG (electrocardiogram) and hook him up to a machine constantly monitoring his heart, respiratory rate, oxygen saturation, and blood pressure.

This time, we were treated a bit differently.

I couldn’t go into the triage room with him, and not long after our arrival, they determined he wasn’t actively having a heart attack and sent him back into the waiting room—with the IV still in his arm—to wait for the results of his bloodwork. Considering his long medical history and the fact that only one of his heart attacks has ever been recorded while it was actively happening, I was concerned about him not being on a heart monitor.

While he was in triage, I noticed that many of the other people in the waiting room had IVs in their arms too, some even hooked up to fluid bags on IV poles. Once and a while, a nurse would come into the lobby and check their vitals. For each of them, she used the same thermometer (with a fresh mouth guard at least), blood pressure cuff, and pulse oximeter on their fingers.

I don’t know how often these devices are normally cleaned between uses, but it didn’t seem very sanitary watching them being passed from patient to patient as the nurse made her way around a room full of sick people.

After about five hours of sitting in the cramped waiting room chairs, an ER bed was finally available, but the bed wasn’t in the room. We stood in the hall for a few minutes waiting for the disgruntled nurse to find one, helping her by holding the wide, glass folding doors open while she wheeled it in and set it up with a fresh set of sheets and blankets.

It was 4:00 a.m. and we were put in a large, freezing room that I’d never been in before. It was a trauma room. We learned that it was only being used because the ER was so slammed with patients that they had to turn away ambulances to catch up on the overwhelming amount of care needed to be given while they were short staffed.

That explained why we had to wait so long—nowhere near as long as the poor gentleman who had been there since three o’clock that afternoon, waiting over 13 hours for a bed, and why there were so many sick people being partially treated for their ailments in the lobby.

We later found out that this is the new protocol since the pandemic, because of an influx of sick people and constant staffing shortages, combined with extreme growth in the area that the hospital isn’t equipped to handle. No longer are people kept in triage rooms while they wait to be admitted to an exam room.

Now, if we come to this emergency room for anything short of actively dying, we’ll have to wait in the lobby.

This is truly scary considering my husband’s medical history. His heart is like a fickle car that tends to act up when you drive but performs perfectly when you take it in to the mechanic, because none of the routine tests find or replicate the problem and only the expensive and more complicated diagnostics will figure out what’s really going on.

Just once—after his first heart attack resulted in open-heart surgery—has a simple blood test, looking for elevated and rising troponin levels, confirmed that something serious was happening. Troponin is a heart muscle protein that only shows up in the bloodstream when the heart is damaged or stressed, and his cardiologist doesn’t raise his concerns based off this biomarker alone. The standard ECGs and stress tests have never shown anything abnormal.

The only way we’ve found out about, and ultimately repaired, the many artery blockages he’s had since the first heart attack, was by doing an angiogram—an invasive diagnostic procedure where they insert a catheter in an artery near the groin that goes up to the heart to look inside the vessels.

The ER doctor gave my husband the choice to go home because he wasn’t having a heart attack but didn’t know his heart was still acting abnormally because he wasn’t being constantly monitored. He even claimed that the cardiologist agreed, which we would later find out was not the truth.

I was astonished by the dramatic change in care during this visit.

For more than a decade we’d been coming to this hospital, and it had never, ever been like this. It seemed like this place had really gone downhill and fast.

Our nurse came to check on us soon after being set up in the trauma room and we mentioned our observances of how bad things seemed. He shrugged with indifference and said that most hospitals are like this now. We empathized, thinking he must be stressed, likely burned out, and understood how this probably contributed to his apathy.

It wouldn’t be the only time we heard this kind of comment during our visit.

My husband asked for the fourth time to get something to relieve his chest pain, explaining that the ER doctor had offered it three hours before, but he still hadn’t received anything. The nurse made excuses for the staff being busy, but admitted it was only ordered just over an hour before we were taken to the trauma room—proving a miss in care that was only the beginning of a number of misses throughout our stay.

It also seemed as if he hadn’t read much of my husband’s chart. I was shocked to learn that he didn’t even know who his cardiologist was.

That was a first and wouldn’t be the only nurse we encountered that morning who didn’t know our doctor.

My husband’s cardiologist is not only nationally renowned—once in charge of setting up the cardiac department for the newly built Veteran’s Hospital in San Antonio for President Lyndon B. Johnson—but he practically lived in this place, often calling it his home because he’s there so much. He is widely respected, sometimes even feared by many of the ER, ICU (Intensive Care Unit), and cardiac nurses we’d met in this hospital through the years.

When we reacted with surprise that he didn’t know our doctor, he told us he was a traveling nurse. This would prove to be a common occurrence. We learned that several of the nurses were also travelers, including the angel who brought me my heavenly chair to sleep in later that morning.

Four-and-a-half hours passed before we were moved out of the trauma room and into the regular exam room we would remain in for the duration of our 43-hour stay. I stood to the side as my husband’s gurney was wheeled into place and the ECG leads were reattached to the white electrode pads all over his chest and belly.

I looked around the room with dread, seeing the little gray chair I’d be calling home for the next unknown number of hours.

I tried to find comfort from the stick-on wall art pretending to be a white-paned window looking out at the red rock hoodoos of Bryce Canyon National Park. The cheesy art made me think of our recent travels in Utah, and I smiled remembering the stunning places we camped in.

I turned my head away from the fake window and noticed an uncapped syringe left resting on the edge of a medical device attached to the back wall.

I pointed it out to the nurse and again, he defended how busy they’d been. I was stunned that something this serious would be forgotten, though. He crossed the room to grab it and commented that he didn’t realize it was open, acknowledging the severity of the mistake and emptied its thick, clear fluid before capping and properly disposing. I was just glad I noticed it before sitting down and possibly bumping it off the ledge to fall on me.

Hours later, after our new angel nurse brought me the cushy chair, I reclined it completely flat, covered myself up with the blankets and conked out. When I woke up, I was surprised when my hubby told me it was 1:00 p.m. I had been asleep for four hours, but it felt like only minutes.

Soon, we found out that there were no beds upstairs and that some people were waiting in the ER for days before being admitted. We wondered if we would ever get out of the ER and into a comfortable room with the elevated care that usually comes with specialty nursing.

The cardiologist finally came to our room around 9:00 p.m. that night, which wasn’t unusual for him. We already knew he liked to make his rounds late at night and were happy to finally get some information about what might be going on.

We talked at length about my husband’s heart and lungs, as well as the standard of care that was so different than before.

He essentially told us the same thing we’d already heard multiple times. Most hospitals are suffering right now because of the mass exodus of experienced nurses that quit or retired after burnout from the pandemic, on top of the nursing shortage that already existed.

He said it will take a lot of time for the newly hired, just graduated and less experienced permanent nursing staff to gain the knowledge that has been lost.

It reminded me of our last stint in this hospital, at the end of 2021, when it seemed that most of my husband’s nurses were kids fresh out of school, being trained on the procedures he required at that time.

Temporary travel nurses, once only a supplement for staffing shortages, now seem to be common in most places and don’t have the institutional knowledge that a well-trained permanent staff affords. They are having to take on many of the essential duties of running a hospital unit, without much training or mentoring from experienced nurses because so many have either left beside care or the profession altogether—taking with them years of valuable expertise and familiarity within their local hospitals and communities.

This is becoming a tragedy to everyone involved and is resulting in a striking change in the quality of care to patients.

It’s one thing to read about the problems with our healthcare system, it’s entirely different to experience it first-hand. It’s frightening to think we may hesitate to rush to the hospital next time, after going through this eye-opening and exhausting ordeal.

I wonder how many others may choose to take the same risk.

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