Opinion: When nurses are at risk, our patients are too

Editor’s Note: Lauren Ghazal, PhD, FNP-BC is a family nurse practitioner in New York City. She is also a postdoctoral research fellow at the University of Michigan – Ann Arbor, where she receives funding from the National Cancer Institute T32 in cancer care delivery research. The opinions expressed in this commentary are her own. View more opinion at CNN.

Last year, I wrote an opinion piece that focused on the realities of being a nurse nearly two years into the pandemic. Despite progress in vaccines, boosters and Covid treatments, nurses were still grappling with extremely sick patients in an overstressed system, with little support. I spoke about my experiences as a nurse practitioner, researcher and cancer survivor living and working in New York, the challenges nurses faced, and the emotion that these issues are wrapped up in.

Unfortunately, as we face another impending wave of Covid cases as a result of new variants, we have continued to ignore nurses’ suffering, and we are again seeing the troubling fallout. In New York just this week, thousands of nurses at two major hospitals, Mount Sinai and Montefiore Medical Center, went on strike for three days, after the New York State Nurses Association (NYSNA) and hospital executives had failed to reach an agreement. (As of Thursday, the union reached tentative deals with the two hospital systems, but nurses will need to vote before the deals are finalized.)

Nurses said they had been striking because of low pay, staffing shortages and poor working conditions, and because they could not provide the level of care patients deserve. Some nurses said they had 20 patients at a time, according to NYSNA President Nancy Hagans, instead of three — the standard in the Emergency Department. The union had said the offer to hike nurses’ pay by 19% wouldn’t be enough to solve the low staffing issues.

Both hospitals had criticized the strikes, saying that the union accepted similar offers at other hospitals, including a 19% pay hike. On January 9th, Mount Sinai released a statement on its Twitter account: “The union is forcing Mount Sinai nurses to leave their patients during a COVID-19, flu, and RSV surge. The strike is reckless. New Yorkers deserve better.” Montefiore called it “a sad day for New York City.”

The tentative deals include the 19% pay hike and better staffing ratios, and the union said the deals would allow patients to get better care. Mount Sinai said in a statement, “It is fair and responsible, and it puts patients first.” Montefiore said in a statement, “From the outset, we came to the table committed to bargaining in good faith and addressing the issues that were priorities for our nursing staff.” These tentative deals are a win for both the nurses and the patients.

Of course, I know from my own experience that nurses across the United States are burned out. Low staffing isn’t safe for nurses, threatening our physical and mental health. Nor is it safe for patients, as it is nearly impossible to deliver the high quality and compassionate care patients most deserve with these levels of chronic understaffing. Adequate staffing and resources, along with good work relationships, involvement in decision-making impacting patient care, and trusted management are what my colleagues in nursing describe as hallmarks of good nurse work environments.

Burnout — the exhaustion (physical, mental and emotional) caused by workplace stress that leads to disengagement and depersonalization — contributes to moral suffering/distress among nurses and health care providers. Burnout is often driven by poor work environments, which include insufficient, unsafe staffing and longer hours, for example.

My research colleagues have been fighting to champion safe nurse staffing levels for decades. In fact, hospital nurses often report staffing as a top safety concern, and research studies have shown that better staffing levels are associated with lower hospital death rates. Improving the ratio of nurses to patients saves lives and saves money (in avoidable costs for hospitals, as a result of shorter patient lengths of stay and fewer readmissions). And the pandemic has only worsened nurses’ work environment.

When then-New York Governor Andrew Cuomo signed the hospital staffing committees law in June 2021, there was tremendous hope that the legislation would be a giant step in the right direction to correct the nurse shortage by boosting hiring. Hopefully, we’ll see the full effects of it play out soon, or states implement similar legislation, such as in California.

What do nurses need right now? We need an investment in our health. We need to feel safe, respected and valued at work. As nurses (often referred to as the backbone of health care), we are committed to providing quality care to our community and the patients we serve. And in the end, our health impacts the health of all our patients.