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"It's frightening when you cannot care for the patients under your care, and something could happen," Barnes says. "You can't be in two places at once."
There's a constant concern that something is happening with a patient that Barnes doesn't know about, or can't get to.
"I went into one patient's room, and his blood pressure was 50; that's not conducive to long-term existence," Barnes remembers. "A monitor was beeping, but no one heard it. You can't be everywhere."
Sometimes, when the unit is terribly busy and there just aren't enough nurses to pick up the extra work, Barnes explains, it's a struggle to make sure the patients get their medications on time. Forget about bathing them or brushing their teeth.
"The goal, if you're short, is not to make any errors in medication or treatment. Probably what you let go is the comfort of the patient," Barnes says. "You can't do nursing the way you used to do--give that personal care. You can't make the patient feel like you're there."
Hospital patients today are sicker than ever before, as insurance companies now pay for in-patient stays in only the most dire cases. The situation can only get worse as the population ages and baby boomers start needing more intensive medical care.
The job itself has grown harder, too. Medical technology has become elaborate and omnipresent, medication schedules more intricate. On top of that there's the unyielding bureaucracy and the ever-increasing mound of paperwork nurses must complete in order to meet administrative standards. Though staffing has improved in recent years, it's still very common for nurses to work double shifts. ("There's no mandatory overtime in our contract," notes United float nurse Karmen Rushton. "But that doesn't mean they can't make you feel bad. You don't want to leave your friends hanging.")
It's easy to understand why nurses today are exhausted. Why many of them opt for jobs with nursing agencies, where they can control their hours. Or with hospice or home healthcare programs, reducing the number of patients they care for. Or why they choose to leave the profession entirely.
It's easy, too, to understand why Cynthia Barnes is worried that there won't be anyone to replace her when she finally decides to retire.
Sara Brazil might have been one of those up-and-coming nurses. For her it wasn't a lifelong dream to be a nurse, but she had always been interested in health care. After earning her four-year college degree and working several jobs throughout her 20s, she decided to go back to school to get her nursing degree. "I did it for practical reasons, as well as I just think it was good work to do," the 37-year-old recalls. "It was this everyday-place job where I go, but also an opportunity to make a difference."
For four years she worked as an oncology nurse at Abbott Northwestern Hospital. She worked her last shift on Christmas Eve 1999.
One of the main reasons she quit? The nursing shortage.
"It wasn't just a drag, it was a peril," she says, recalling her time on the night shift. "It was really getting to a level where it was scary to be there. At nighttime, we were almost never at what's considered to be the minimum staffing level. It sometimes felt like you couldn't keep an eye on all of your patients."
To make matters worse, the patients in the hospital seemed to be frailer, their conditions more critical, and turnover among nurses grew steadier, until Brazil was one of the senior staff members. "I had four years of part-time experience. I still felt there was a lot I was still learning," she remembers. "I did not feel ready to be the floor resource.
"You were scared," Brazil continues. "You didn't want people to get hurt, and you didn't want to get in trouble if something happened. And you felt sad because you weren't doing what you wanted to be doing. Most nurses don't want to be task-doers. What you really wanted to be able to do was spend time with people, support them emotionally. Visit with them if they're bored or lonely. That's a big part of healing. That's a big part of being a nurse.
"Rationally, you knew it wasn't your fault, but you went home unsatisfied," Brazil remarks. "Even though you never worked so hard in your life and got so many tasks done."
Perhaps the biggest change in nursing over the past few years is that people are at least talking about the shortage, both locally and around the country. In the Twin Cities it was a hot issue during the 2001 nursing strike. And, while Barnes and her colleagues say the staffing situation is better today than two years ago, the nurses' union had to bring local hospitals to their knees for three weeks in order to get anyone to listen to them.
National research has sparked conversation about political remedies. That research is sobering: Last fall a much- publicized University of Pennsylvania report directly linked patient mortality to the number of patients under a single nurse's care. The study, published last October in the Journal of the American Medical Association, found that if nurses try to care for more than four surgical patients at a time, the chances of those patients dying rise--by seven percent per additional patient.