Hospitals in Crisis: Why Nurses Are Burned Out and Quitting

CHRISTIANE AMANPOUR: And we turn now to the U.S. health care system which say, our next guest, is on the verge of collapse. Almost one in five health care workers have quit their jobs during the pandemic according to a “Morning Consult” poll. Rachel Ellsworth is one such person abandoned her 12-year career because of burnout. And Chelsea Walsh, a travel nurse, sees the channels that hospitals are facing country all across the country. And here they are speaking to Hari Sreenivasan about the loss of so many nurses and what can be done about it.

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HARI SREENIVASAN: Christiane, thanks. Rachel Ellsworth, Chelsea Walsh, thanks both for joining us. You know, we’ve had multiple conversations on this program with what is happening to nurses today and still important to keep covering. And, Rachel, I want to start with you. When you think of what’s necessary inside a hospital, people are going to say doctors and nurses, right, but give me an understanding of why it is that we need the number of nurses in an ICU unit as we do or what is too much for one nurse to handle?

RACHEL ELLSWORTH, FORMER ICU NURSE: Thank you for that question. There just — for your knowledge, there is an entire semester on studying this in different health education situations because it is such a complex issue. But the gist of it is, different patients require a different level of care. That’s why we place them in different positions in the hospital. And most of that comes to how much nursing care they need and what kind of skills those nurses have to possess. In the ICU, which was the focus of most of my career, whenever you have a standard, which is two patients to one nurse ratio, the who is nurse responsible for those two patients holds a vast amount of knowledge in her head. Everything from their lab values to what they have eaten, what they’re allowed to eat, their output, their skin, their family members, what doctors are coming when, this is all just information that lives on their brain paper and inside their head for a 12-hour period. When you add another human being to that patient point, just one more person, you’re asking nurses to stretch that knowledge capability to a point where mistakes are made, things get missed. It’s in the patient’s best interest for the nurse to have her knowledge base focused on the right number of patients. There are studies that show that when you increase a nurse’s patient load by just one patient, their mortality rate goes up. The patients who are in the ICU, there are subtle changes in their condition that can be a red flag to something else that’s coming, a bigger problem. And a lot of times, ICU nurses are the ones to notice those, to inform physicians or alter nursing interventions and create a new plan of action to head off a much bigger problem down the line.

SREENIVASAN: There’s a survey recently I want to pull up and it was a statistic from “ShiftMed.” This is was a staffing agency survey, I think featured 60,000 nurses. Found that 49 percent of its nurses are somewhat likely to quit the field in the next two years. That seems a staggering number. Chelsea, since we had you on last time, you have gone to even more locations. I think your current tally is somewhere around 16 different hospitals that you worked at as a travel nurse, seven different states. So, what are hospital systems doing wrong in the first place at not seeing this level of discontent?

CHELSEA WALSH, TRAVELING NURSE: So, we’re running on survival mode right now across the country as health care workers. And there’s only so long we can run on in survival mode. There are two main things I’d like to bring up. The first thing being the staff to patient ratio. So, to fix that, we either need to increase staff, which it seems impossible right now because of the level of burnout and the amount of health care workers leaving, or we need to decrease the amount of patients being admitted into these hospitals, which is something we’re entirely capable of as a country but need to work with the health care corporations, with the insurance companies or the government to create better preventative care more urgent and we can do that. We need to decrease the amount of people walking into the hospital doors. And we can do that. Now is that time to make these changes. On top of that, we also need a full financial disclosure from these hospitals as to where money is going, because they said that they will not pay nurses and doctors more because they can’t afford it. Yet, they still keep getting million- dollar bonuses for their CEOs every year. So, how exactly is the money being distributed if it’s not distributed to the heart of the hospital, which are doctors, nurses and patients? Where is that money going?

SREENIVASAN: And, Rachel, let’s talk about the money part of this equation. Are any of your colleagues or have any of your colleagues decided to step back from full-time nursing to do what Chelsea is doing, which is to go and work as a travel nurse?

ELLSWORTH: Absolutely. And I think that to speak on Chelsea’s point, which I thoroughly agree with, one of the most enlightening experiences about COVID is that we would be in these crisis staffing situations. So, they would bring in travel nurses. Now, that had happened on my unit before. But what was happening is that it was an extended crisis situation. So, these travel nurses were having longer and longer contracts. So, then the staff nurses and the travel nurses were now friends and we’re going out to dinner after our shift and everybody’s waiting for that one question. How much are they paying you? Because in certain situations, it’s twice if not three times as much as the staff nurses. So, what it — and these are oftentimes, these are not necessarily travel nurses from across the country. These are nurses who sign travel contracts within their state and then travel within their area. A lot of these nurses have a one-hour commute and were working at the same hospitals as the staff nurses. So yes, financial disclosure is, I think, paramount to moving forward. Because for so long, they told us we can’t afford it, and they obviously can. And I want to also touch on the importance of ancillary staff. That’s something that has a tendency to fall out of these conversations, we really focus on the doctors and the nurses. Respiratory therapists in COVID, their burnout rate is just as high as nurses and they are highly skilled, bedside professionals who no one seems to be really talking about when they’re full necessity in the ICU and other places in the hospital. Certified nursing assistants, unit secretaries and dietitians, dietary staff members who deliver trays and help with feeding of patients, these are all tasks that when we minimize their importance, those tasks fall on nurses, contributing to burnout, contributing to low morale. They are underpaid and underappreciated and are just as much part of that supportive network that make the hospital run as anybody else. So, that’s what I think is a focus missed in the pandemic as well.

SREENIVASAN: Chelsea, what do you do you say to those folks that says, wow. Wait. Chelsea is going to make two or three times what Rachel is making by moving around the country, should she be making that much, should this system be the way it is?

WALSH: So, I have to say to that, I make up to 10 times what staff nurses make. If we’re going to be real honest about it, my pay is different than a staff nurse because my pay is dictated entirely by supply and demand. The less nurses there are in the country, the higher my pay goes up. And I keep getting paid more and more because more and more staff are leaving. That’s a problem. There needs to be some mediation in this figure out what’s happening and what’s going on. We need to do it now. We’re losing too many staff. I’m getting paid too much, people.

SREENIVASAN: I want to ask, what is the situation like by the time a Chelsea Walsh gets there, right, by the time a hospital is willing to pay you five or 10 times what they would be paying their staff, nurses. Walk me into that scenario when you get in there.

WALSH: When we get there, we hit the floor running. We have to be resourceful and we have to be creative. There’s times where we don’t have enough supplies, we don’t have enough medicines. We are definitely walking into staff that is burnt out and is tired, and they’re tired because they’ve had too many patients and they’ve been running on survival mode for too long because it takes — it usually takes us weeks to get in there. So, they’re struggling. And again, the less staff there is the harder it is for everyone to get through the day as a nurse or even the doctors. We’re forgetting about the doctors too. Nurses are burning out, yes, but guess what, the doctors are there all the time as well and they’re burning out. After the nurses keep walking out the hospital, how long do you think it’s going to take before the doctors follows? When we talk about patients as nurses, we are talking about the American people. We’re talking about you. We’re talking about you and your family. You will suffer, your family is going to suffer if we’re not there to help you. This is why people should start paying attention to what’s going on inside the hospital walls because we’re trying to keep you all alive.

SREENIVASAN: Now, at the same time, you also have nursing schools graduating kind of bumper crops of people that are coming into the profession. You have reports that more people are joining on to become nurses. So, what is actually happening here? Is there a shortage of people who can do the job or who are willing to do the job the way it is today?

ELLSWORTH: So, that’s a great question. And I’m going to start it off by saying there are people who are profiting from the misconception that there’s a shortage of nurses. There is not a shortage of nurses. There is a shortage of nurses who are willing to work at the bedside in the current conditions. We didn’t disappear. We left the field. And there are nurses that are being pumped down at the same rate as they have been since the ’90s during the real nursing shortage, the first time there was a nursing shortage, at the same rate. The problem is retention. The problem is, we’re putting out nurses using higher to fire practices in full knowledge that they’re going to burn out in two to five years. That’s how long it takes to become a nurse. There is a sickness in the profession if the amount it takes to become a nurse is how long your career is going to be on average. The focus being on creating new nurses creates a culture where you are not going to have a concentration of experienced nurses on the floor to help new grads, to train new grads and to lead new grads. The position of charge nurse being taken on by a nurse with less than five to 10 years of experience is a new phenomenon. That position should be the most experienced nurse on the floor, and the reason is because that nurse is pretty much, in a way, responsible for every patient on the unit. And when things go bad, they are the ones you grab. They are the ones who, because they have spent 10, 20 years in these high stress situations, have a really good skill set of checking their adrenaline, thinking clearly, and using their experience to apply interventions that literally save lives. Those are practices that don’t come from anything but experience. You have to train your brain to think in really intense situations. It is a very dangerous situation to have entire ICUs where there’s maybe one nurse with more than three to five years of experience. So, yes, we can make more nurses, but unless we focus on retention, then the problem is not going to get any better.

SREENIVASAN: You know, at the beginning at the start of the pandemic, I mean, I remember we were opening our windows at 7:00 this New York and we were banging our pots and pans and we were treating our first responders as heroes. And here we are not quite two years, but a year and a half plus into this. And I wonder what you’ve experienced in how the rest of us have normalized living in a pandemic in the context of the frontline workers. Chelsea, have you seen this culture shift?

WALSH: Well, going across the country, I definitely get to experience something very unique. And my last assignment, first time in my career that I had a family member calling the ICUs saying that we were giving the patients something to make them sick, that we were killing patients. They were yelling F the nurse, F the doctor. They were demanding that we get intubated patients out of the hospitals and back home, which is physically impossible. But there has been a cultural shift that I have experienced in that the communities do not trust us anymore, and that is very hurtful because we are literally putting our lives and our family’s lives on the line to keep you and your communities safe. We’re trying to help you. We want more than anything to send people home to their families, and that has gotten so hard to do. But the reciprocation has gotten difficult to deal with and that’s why I don’t see myself doing this job no matter how much you pay someone two years from now.

SREENIVASAN: Rachel, you were a nurse for, what, 12 years and you, through this pandemic, decided finally to leave. You have literally moved out to a farm in Kentucky, right?

ELLSWORTH: Yes.

SREENIVASAN: I mean, the idea that you bought the farm. You really did it. And after stepping back from this. And I wonder, if you had a chance to become either a full-time nurse again or maybe a travel nurse like Chelsea, would you do it?

ELLSWORTH: I would if we passed legislation to mandate patient ratios and support the mental health of health care workers. I would agree to go back to work for two years in an ICU full-time if they passed mandated ratios, because I really believe that it is such a massive contribution to burnout and I think that in order to profit from poor working conditions should be illegal because it is dangerous. It is dangerous for the health care system at large, and it is dangerous for the patients that nurses are taking care of when they’re in those situations. If I may, if I may, think about the amount of money that comes in from a patient and then, you apply to that a ratio to a nurse. In COVID, the hospitals didn’t stop getting paid for patients. They still have medical bills. And the patient load doubles, sometimes triples. But the amount of money they had to pay nurses didn’t really go up very much. So, the incentive to hire new nurses when the profit margins were getting bigger wasn’t really there until they started having to pay travel nurses because supply and demand, like Chelsea said, drove the price up. This is fixable. The money is there because the patients are there.

SREENIVASAN: So, Chelsea, now what? What is the — what are the — what’s the top three things that you would tell hospital administrators or people who have power over the health care system in any lever of it to do?

WALSH: Stop insulting us and start listening to us. As nurses, doctors and health care workers on the ground floor dealing with these patients on a daily basis, it’s about time that we had some proper communication. We need to make changes as well to the system. We need the cooperation of the health care companies, the insurance companies and the government to start focusing on new technologies and new methods, possibly even to start a triage system that start at home. We have the technology out there to start new programs to prevent hospital admissions to save up bed space, to decrease that patient — nurse to patient ratio, to improve quality care and improve life. The main thing is, it’s going to cost a lot of money though. And that’s what’s going to keep a lot of people back. But we already — I hate to be the doomsday person here, but we’re on the verge of collapse as a health care system today. They’re going to lose a lot of money when we’re not able to work anymore or they can start investing that money in new technologies for tomorrow. Increase staffers pay. Because, guess what, if the hospitals would go to the level to a normalcy where we were treated appropriately and fairly and we were paid fairly, I would stop travel nursing and I would become a staff nurse. So, a lot of changes needs to happen and they need to start happening today.

SREENIVASAN: Rachel Ellsworth, Chelsea Walsh, thank you both for joining us.

WALSH: Thank you.