In the emergency department at South Shore Hospital, nurse Svenja Sjoquist prepares to tackle the next assignment on her shift. The hallways are full of stretchers with new patients. The hospital is overcrowded, staffing is short, and more patients have been assigned than can be handled. Alarms blare throughout the hallways. A phone rings at the nurses station: it’s a family member looking for an update that isn’t available yet. A phone rings again: it’s another department requesting information that isn"t available yet. Sjoquist, already feeling overwhelmed, is greeted by a table with gifts for the nursing staff from hospital administrators. Sjoquist picks up a rolled sheet of bubble paper with a gold ribbon on it. A note reads, “pop these bubbles to relieve your stress. Happy nurses week.” She rolls her eyes, remembering "it felt like a punch in the gut. Last years gift was chapstick.”
The year is 2014. Coronavirus doesn’t exist.
Nine years later, hospital administrators' inability to handle discontent and stress among their staff has led to further staffing shortages, higher patient loads, and more difficult working conditions. According to the US Bureau of Labor Statistics: "More than 275,000 additional nurses are needed from 2020 to 2030.”
The American Nurses Association also states that nursing is projected to be the highest growing job in the US at 9%. Retention will be critical in the coming years, and nurses ultimately hold hospital administrations responsible for forcing them to decide between leaving their positions or safeguarding their mental well-being.
Sjoquist earned her degree in exercise health science from UMass Boston in 2012 and quickly became enthralled with the idea of becoming a nurse. Having had an opportunity to shadow and watch nurses during her undergrad years, Sjoquist said, “they were the ones with the most intimate relationship with the patient. They knew everything about them. I looked up to them.”
Sjoquist enrolled and completed an accelerated nursing program and opted to look for work at emergency rooms close to her home in Weymouth, Massachusetts. It didn’t take long before Sjoquist felt a lack of resources and support from administrative staff. “You wish you could clone yourself ten times so that you can do all the things that can be done on your shift," Sjoquist said. “You take care of the sickest patient with the most dire needs and then, unfortunately, you work your way to the next.”
Sjoquist describes the ER at South Shore Hospital in 2014 as "busting at the seams.” Shortly after the bubble wrap incident, Sjoquist took a new assignment at Maine Medical Center, where she worked during Covid. Svenja decided to go back for her master’s degree online while working through the pandemic with the intention of leaving nursing and the ER. In 2021, she achieved that goal and is now working as a nurse practitioner.
Amanda Mckee of Windham, Maine was another nurse on the front lines of the pandemic. Needing a well-paying job as a young single mother, Mckee went to school to become a medical assistant. “I really liked it and I wanted to do more, so I started nursing," said Mckee Then COVID-19 hit shortly after that, and everything changed, Mckee states.
When Mckee talks about the very beginning stages of the pandemic, she describes a chaotic environment with mixed messages, a lack of planning, and limited support from senior administrative staff. “One of the managers didn’t even remember my name after a year of orientation.”
Mckee says that the first wave of nurses that left during the pandemic were close to retirement or had preexisting conditions. The second wave quit over issues with how administrators were handling their job.
Mckee maintains that the triage plan for patients arriving during the pandemic was developed by one doctor and one nurse with no support from administrative staff. “We separated our waiting room in this little nook area that used to be pediatrics. We put them all in this area. We closed off a little pediatric area, closed all the doors, and started wearing “pappers” — a hazmat suit covering the wearer from head to toe. Mckee describes shifts of 12 hours in the now infamous papper. The nurses that were brave enough to stick around for the beginning phases hated wearing the papper for long shifts. “It’s loud. You can’t hear. “There’s this fan blowing in your ear - that’s the ventilation system. You can"t even listen to people’s lungs.” Nurses repeatedly asked administrators to reduce the amount of hours nurses were asked to wear the papper during a shift, but the hours were not reduced until many nurses left their jobs and hospital Environmental Health and Safety Managers stepped in.
Mckee takes issue with those who say nurses that resigned were abandoning their duty. “I didn’t sign up for unsafe conditions. I got shoved into the bathroom by a psych patient and had a bag of heroin thrown in my face.” Shortly after this event, administrators failed to respond to several similar incidents, and Mckee left the ER to pursue a job at a specialty surgery center.
Nick Durand had originally wanted to be a doctor, but opted for nursing out of high school after shadowing his uncle, who was an ICU nurse in Massachusetts. “Nurses have more of an opportunity to build a relationship with a patient than doctors do. Doctors don’t have time to sit and listen to the patients, which often is the number one thing they need,”, said Durand.
Durand worked for five years in emergency medicine at MidCoast Hospital in Brunswick Maine, before getting "burnt out,” which is something he says, “comes with emergency medicine.” Durand described a time where each of his grandparents passed away within short periods of time and he felt numb to it; “I built up these defense mechanisms and coping strategies that weren’t beneficial to my mental health in the long run.”
Durand feels that administrations do a good job of touting nurses as "heroes,” but he says that’s mostly for show. “That wasn’t reflected in their actions,” said Durand. “It’s a lot of politics and PR stunts. You can say that nurses are heroes and are on the front lines and all this kind of stuff, which is true. But nurses didn’t get into this job to be heroes, they came into this to do their jobs and take care of people.’ Ultimately, Durand thinks that the hospital should do a better job of focusing on retention rather than recruitment. During the pandemic newly recruited nurses received $20,000 sign-on bonuses and the current staff received nothing.
Durand left his job in the emergency room and is now working for the federally-run Veterans Affairs Hospital.
Dr. Amanda Choflet is the Interim Dean at the School of Nursing at Northeastern University with research involving the emotional wellbeing of nurses, nursing students, and other vulnerable populations. Choflet’s research finds that there have been high turnover rates for decades now and that nurses are most at risk of quitting their first job within two years and the profession entirely within three years.
She asserts that nurses were under-prepared to handle the type of response that was necessary for the crisis situations they encountered during the pandemic. “Typical care is that you prioritize the sickest over the healthiest using your resources,” she explains. “Crisis standards of care are that of survival. Think about the limited resources you have. Who is most likely to survive given those resources.”
Choflet describes a world where nurses are expected to fall in line and follow orders. If an order is flawed and what they"ve learned suggests it shouldn’t be followed, they are held accountable to that, too. This can lead to stress and nurses needing resources to cope. The administrators, as the only ones capable of giving out those resources, are often seen as holding themselves at arm’s length.
Nurses inability to connect with much-needed resources leads to a feeling of organizational betrayal. Choflet explains, “You psychologically become the institution. You subjugate your individual interests and needs to what you believe the institution needs or is about. Prison guards, firefighters, and police officers are examples. A few researchers have been saying that those theories can readily be applied to nursing as well.”
Choflet argues that when nurses give themselves up to the institution in this way, they are ultimately left feeling distraught when it fails them. “The fundamental sense of self and priorities and moral obligation comes completely at the expense of the institution, and they lose faith, trust and hope in the actual institution that they are a part of,” says Choflet. “It’s that betrayal that becomes the main part of their trauma story.” Choflet asserts, “If you ask most nurses today about their safety standards and nurse to patient ratios, many of them will tell you that they are working shorter than they were prior to covid. And there isn’t an end in sight.”
Mckee says, “I miss emergency medicine. I miss that kind of nursing so much. But you are just abused. I went in there the other day and nothing has changed. I looked around, I didn"t recognize a single face. They are all new. And ERs are still breaking records for patient loads every day.”
Produced by students at the Northeastern University School of Journalism. © 2023
