I am an emergency room nurse in a large U.S. city, and after a decade of working in hospitals, I want out. And I’m not the only medical professional who is quitting ― hundreds of thousands of us have since 2020. The stress we are encountering currently because of the fallout from a mishandled pandemic is what is finally breaking my colleagues and myself. I would like to give you a glimpse of my last day spent in the ER ― my latest, as I received assignments at various hospitals throughout my career by using a travel contracting company ― to understand the gravity of what is happening.
I rush from one end of the emergency room to the other, dialing the pharmacy for some antibiotics that I have been waiting several hours for. I have just finished unsuccessfully coding one patient, while another decides to forgo her call light, and, instead, unsteadily walk out of her room to get me while I’m signing the other patient’s death paperwork.
The patient who left her bed to get me falls and hits her head. The doctor, who witnesses the fall too, does not look up from his desk when it happens. “She’s going home,” he tells me. “No she isn’t, because she JUST FELL AND HIT HER HEAD. She needs a CT scan and this is a sentinel event,” I argue. “Ok, I’ll order a CT. Then she is leaving,” he replies. I guide her to a bed closer to the nurses station so that I might be able to hear her better if she needs me. The reality is we do not have enough staff to assist her with her needs while I am stuck in emergency after emergency.
Moments earlier, the patient who died just before that woman fell was pushed into Room 9 with firefighters pumping on his chest. He was waiting outside with them in critical condition and he coded in the ambulance bay. Because we are so short-staffed, I asked the firefighter to continue to assist with the chest compressions while I provided medications to try to save his life. As I received the report from the transporting nurse, I learned that the patient had an active bleed and was given two units of blood at the previous facility where he was being treated. They ran out of blood there.
“Would you like me to run and get STAT blood, doctor?” I asked as I looked down at the pale, motionless body in front of me. “No,” he replied. “We only have two units left, and we are saving it for any emergency pregnancy complications.” This is when I learned that all of the local hospitals are in dire need of immediate blood. Two units will not save a hemorrhaging pregnant woman ― not even close. I am watching my country’s health care system crumble in front of me, and this man is just one of its many casualties.
“I am watching my country’s health care system crumble in front of me, and this man is just one of its many casualties.”
A little while later I ask the doctor, “Are you planning on speaking with the deceased patient’s family? Would you like the phone number of his daughter?” He tells me to call the man’s primary provider to take care of the death certificate and speak with the family. I follow his orders.
Shortly afterward, I see a young couple standing outside the code room. They are the distressed family members of the deceased patient. I ask the couple if anyone has spoken with them yet. They tell me they were led by hospital security to the body of the patient without anyone speaking with them. I ask the doctor who coded the patient if he will speak with the family to explain that we tried to save his life and hopefully ease their pain. He tells me no. I ask the on-duty social worker if he will speak with the family. He refuses.
Suddenly, I hear a wailing sound from Bed 6 — the patient who fell. I am unable to provide a moment of comfort to the family of the deceased man in Room 9. I run to the bedside of the woman in Bed 6. She needs medicine for pain ― immediately. I obtain a STAT morphine and Zofran order from the doctor. I enter the orders in the computer because the doctor, with so many ER patients solely under his care, is too busy to do so.
Soon after, the woman’s discharge paperwork comes in, but she is still crying from intractable pain. She is a multiple myeloma patient and the medications she is taking at home are not helping with her pain today. Are we allowed to admit her because she is unsteady and her pain is severe? The answer is no. We can’t allow her to occupy the bed ― there’s simply no room for her.
I provide her with a walker and wheel her out in a wheelchair to a taxi as tears roll down her cheeks. “I’m sorry,” I say and then instruct her to call 911 if anything becomes “worse.” Earlier, I was forced to discharge a young homeless man with no shoes and no pants who was disabled from previous multiple strokes and who today was unable to even use the toilet by himself. I had already “gone up the chain of command” with my concern about what I felt was his dangerous discharge, but I was brushed off. I am worried he will not live the next few days.
Meanwhile, I finally have the antibiotics for my patient in Bed 7. I had been waiting several hours for an emergency PICC line (which is a catheter in the vein) to be placed so that they could be administered to him. All of his veins were shot from drug abuse and this is the only way to provide him with his medication. He has a septic hip, and hours without antibiotics could prove critical for him. I run to his bedside but I now have another new patient in another room who needs me. Thankfully, another nurse is able to assist and provide the first antibiotic to the man in Bed 7 while I help the new patient.
I am then called to the nursing station to finish the code paperwork from earlier in the day. I’m told to leave my patients once more to hand-deliver the paperwork to the nursing supervisor’s office. I text my travel contract company, which is how I got this job. “I can’t do this another day,” I write, adding, “Please take me off this contract.”
I approach the nursing office at 7 p.m., which is the end of my shift. I let my superiors know about the fall, reiterate my concern about the unstable discharges (which I did not agree with), and apologize for pulling my contract. They respond by stating, “Why didn’t you call us at the time of the fall? Did you make an incident report?”
“No. I was in a code. You can look through my chart notes and write your own incident report, because I am no longer in contract with you,” I reply. The mechanical responses from upper management further indicate a total failure of leadership. I am the third nurse (that I know of) in the last few days that has quit this unit.
“I spent days on the unit without a break for food or to use the restroom. By the end of just three days, I developed a urinary tract infection and lost a few pounds off my already small frame.”
This day was just one of many, many days like this at many different hospitals. The past years have been marked by chaos stemming from the total mismanagement of staff ratios, which have resulted in abysmal patient care and, ultimately, deaths.
On my first day at this particular ER, the unit had run out of pulse oximeters, which measure oxygen levels, for several hours. I had two patients going to the ICU, both of whom were incredibly unstable, one other in respiratory failure with COVID-19, and another with SVT (a dangerous heart rhythm).
There were only three nurses working in the ER. An entire ICU floor had been closed due to a staff COVID-19 breakout, which meant there were seven ICU patients stuck on hold in the ER. I said a prayer and placed two monitors from triage in my deteriorating patients’ rooms so that I could see their oxygenation.
I spent days on the unit without a break for food or to use the restroom. By the end of just three days, I developed a urinary tract infection and lost a few pounds off my already small frame.
These are just a few examples of what ER nurses are struggling with every single day in hospitals across the United States. This is why we are quitting in droves. And much of our system was broken even before COVID-19 came along. The pandemic just made it all that much clearer.
I want to help my patients ― when I graduated nursing school I dedicated myself to saving lives ― but I refuse to be responsible for the systematic failures of the facilities that I am beholden to. I refuse to watch my patients die because of absolute chaos that could otherwise be avoided, while, sadly, we are told to keep quiet as the ship we’re on sinks. When we ask for help, we are threatened by administrators and told to remain “professional” in the face of extreme emotional turmoil.
We are understaffed, under-resourced, and physically and emotionally exhausted. We continue to give and give, even when there’s literally nothing left to give, because we want to help our patients, even if it means hurting ourselves. I have seen horrible things and watched people die but the thing that I think has traumatized me the most is what I now know about the internal workings of the health care system, which prioritizes finances over lives, while the public remains trusting and unaware.
Where do we go from here? How can we transform this system in the wake of such unbelievable catastrophe? Are we failing because health care remains a “for profit” enterprise? Are we failing because multiple other societal structures are collapsing and everything is intertwined? Where has the humanity in the world gone? I don’t have the answers. I don’t even know what’s next for me. But I know things can’t continue this way ― not for me personally and not for our country. We need to have this conversation before it’s too late. I pray it isn’t already.
Sally Ersun is a pseudonym used by the author to protect her privacy.