‘I can’t do this any more’: US faces nurse shortage from burnout(theguardian.com)
theguardian.com
‘I can’t do this any more’: US faces nurse shortage from burnout
https://www.theguardian.com/us-news/2021/nov/19/us-faces-nurse-shortage-burnout-covid
41 comments
Corps are so used to workers coming to them. Degrees were cheap 30 years ago, not anymore. If you want workers, you have to pay upfront and make them. Because they didn't start 10 years ago, they're paying the price for it now. We are going to continue to see the price being paid until we admit the system is broken and has to be rebuilt from the floor.
The same is true in Germany, many nursing staff have either quit or reduced hours. We're down to about 22k critical care beds from 26k last year.
https://www.berliner-zeitung.de/news/intensivmediziner-tause...
https://www.berliner-zeitung.de/news/intensivmediziner-tause...
Going through an extended close-family medical situation at the moment in a U.S. top-10 metro. A few anecdotes:
- Almost everywhere is short staffed. This has dragged out simple things like medical transport tremendously.
- There appears to be plenty of beds and equipment. In 3 different facilities 40 miles apart from each other there were numerous empty beds from ER to rehabilitation.
- Low-end jobs like in-home medical assistant are basically vacant at the moment. After a month we've been unable to find anybody who can come provide basic support services.
- Specialist doctors are generally available.
- Supplies of medical equipment, blood, etc. seems basically normal. I even offered to supply a transfusion and was turned down as they had enough units on hand.
- Medical imaging systems seem to be very overtaxed with very delayed appointments at two different imaging centers and 3 different machines.
- Travel nurses are everywhere - these are contract-guns of the nursing world, fly in and make very serious money while filling staffing gaps. One nurse we spoke to is making north of $200k/yr at current rate.
- Vaccine mandate has had 3-5% attrition. The low levels of staffing appears to be almost entirely from people burned out on the high workload.
- There's interesting "pockets" of ethnic groups in different parts of the medical system at the moment as people are in-sourced to the U.S. to make up gaps. e.g. All West Africans in one ICU, East Africans in rehab and some home care, Latinos and Philippinos in home services. It's absolutely fascinating.
- Some nurses and technicians seem woefully untrained. We (me and my immediate family) seemed to have better training than some dedicated staff, which was quite scary.
- Some facilities are absolutely filthy. We're reporting those.
- One facility we went to had just laid off a huge number of support staff and technicians. Not sure why, but somebody mentioned that Covid has basically broken provider's financial models.
- Insurance provider seems entirely unfazed by all of this and is attempting to operate with a business as usual policy. As a result I've never seen people have to fight so hard for so little, many things that would actually improve care and be cheaper for the provider.
- Almost everywhere is short staffed. This has dragged out simple things like medical transport tremendously.
- There appears to be plenty of beds and equipment. In 3 different facilities 40 miles apart from each other there were numerous empty beds from ER to rehabilitation.
- Low-end jobs like in-home medical assistant are basically vacant at the moment. After a month we've been unable to find anybody who can come provide basic support services.
- Specialist doctors are generally available.
- Supplies of medical equipment, blood, etc. seems basically normal. I even offered to supply a transfusion and was turned down as they had enough units on hand.
- Medical imaging systems seem to be very overtaxed with very delayed appointments at two different imaging centers and 3 different machines.
- Travel nurses are everywhere - these are contract-guns of the nursing world, fly in and make very serious money while filling staffing gaps. One nurse we spoke to is making north of $200k/yr at current rate.
- Vaccine mandate has had 3-5% attrition. The low levels of staffing appears to be almost entirely from people burned out on the high workload.
- There's interesting "pockets" of ethnic groups in different parts of the medical system at the moment as people are in-sourced to the U.S. to make up gaps. e.g. All West Africans in one ICU, East Africans in rehab and some home care, Latinos and Philippinos in home services. It's absolutely fascinating.
- Some nurses and technicians seem woefully untrained. We (me and my immediate family) seemed to have better training than some dedicated staff, which was quite scary.
- Some facilities are absolutely filthy. We're reporting those.
- One facility we went to had just laid off a huge number of support staff and technicians. Not sure why, but somebody mentioned that Covid has basically broken provider's financial models.
- Insurance provider seems entirely unfazed by all of this and is attempting to operate with a business as usual policy. As a result I've never seen people have to fight so hard for so little, many things that would actually improve care and be cheaper for the provider.
> There's interesting "pockets" of ethnic groups in different parts of the medical system at the moment as people are in-sourced to the U.S. to make up gaps. e.g. All West Africans in one ICU, East Africans in rehab and some home care, Latinos and Philippinos in home services. It's absolutely fascinating.
It is not fascinating to me. It is still the same old playbook of trying to get away with increasing the supply of cheap labor, quality be damned.
The government (society) could drastically increases wages for all those in home care and changing bed pan jobs from $15 per hour to something reasonable that could entice locals who speak American English and can easily communicate. But we will not because that will result in an unacceptable wealth transfer to those at the bottom. Well, technically, we are okay with the wealth transfer to the bottom, just not to those already in the country.
It is not fascinating to me. It is still the same old playbook of trying to get away with increasing the supply of cheap labor, quality be damned.
The government (society) could drastically increases wages for all those in home care and changing bed pan jobs from $15 per hour to something reasonable that could entice locals who speak American English and can easily communicate. But we will not because that will result in an unacceptable wealth transfer to those at the bottom. Well, technically, we are okay with the wealth transfer to the bottom, just not to those already in the country.
My wife is a nurse. The job sucked before the pandemic. Patients would grope her (geriatric care), family members would berate her. Management never stood up for her. She was overworked because the center wanted to save money by giving less nurses more patients to the point where she couldn’t provide adequate patients care. She worked straight through COVID and caught it and was crazy sick. Then decided not to get the vaccine because she has natural immunity. She will lose her job December 6th, and she’s not sorry.
You can disagree with her on the vaccine. I do. But the fact is that nursing always has been an incredibly difficult job. It’s a wonder we have any at all.
You can disagree with her on the vaccine. I do. But the fact is that nursing always has been an incredibly difficult job. It’s a wonder we have any at all.
> My wife is a nurse. The job sucked before the pandemic. Patients would grope her (geriatric care), family members would berate her. Management never stood up for her. She was overworked because the center wanted to save money by giving less nurses more patients to the point where she couldn’t provide adequate patients care.
That's the beauty of an industry where there's no result-based compensation. Quality can slip and overwork creep in and there's no mechanism to stop it.
That's the beauty of an industry where there's no result-based compensation. Quality can slip and overwork creep in and there's no mechanism to stop it.
Interesting. Which country is this? In Germany vaccinated or immunized (natural immunity after a Covid infection) are both treated equally.
USA. We don’t recognize prior infection. And we assign 21 beds to a single nurse.
21 beds?! What kinds of patients? I'd be thrilled if we could assign more than 4 beds to our nurses (SW US); instead we end up flying our (usually destitute) patients >500 mi away to find nurses that will take 5 or more.
Rehab Center. Which is fancy speak for “nursing home”. Which makes it all the more tragic. These patients aren’t getting proper care because the staff is stretched far too thin.
The worst thing is that the nurses do not want to work for peanuts while being abused anymore. What is wrong with this world ? What's wrong with a little abuse ? And why do they need "so much" money when they spend almost the entire day at work anyway ?
In Canada, most direct patient care is done by practical nurses and health care assistants. They make a LOT less than 80K (in the neighbourhood of CAD 40-60K) and suffer all the hardships. The burnout rates appear to be high and those who continue to work are covering for missing workers (including both those who are burnt out and those who refused vaccination), working long hours, etc. It's a complete mess.
They should just come down here! With Covid we could use the extra help and surely pay more than CAD 40-60K. I mean that's less than what people make flipping burgers in the Bay Area...
Nurses have to wear burdensome levels of PPE, and are forced to get vaccinated (despite many of them already getting COVID during the initial outbreak, and their natural immunity providing broader and longer-lasting protection than vaccines).
Go back to complete normal and this shortage will resolve.
Go back to complete normal and this shortage will resolve.
My understanding is that disease induced immunity is a bit more unreliable compared to vaccine induced immunity - perhaps antibodies may be generated that target a part of the virus that is not highly conserved or important for infection, so leaving the individual vulnerable to slight variations, whereas vaccines produce highly targeted antibodies. Also, the virus contains components that interfere with the immune response, perhaps degrading the immune memory?
Vaccination after infection does appear to provide excellent protection though.
We are still doing the science on all this of course.
Vaccination after infection does appear to provide excellent protection though.
We are still doing the science on all this of course.
I'd expect the opposite, and from what I understand, this is particularly so for delta. Consistency is an issue though, as natural immunity is more variable in it's response.
> https://www.science.org/content/article/having-sars-cov-2-on...
This report on an Israeli study seems to imply that natural immunity was superior to the vaccine for protection against delta, though a combination of vaccination and infection provided the best response. This, to me is intuitive.
Note: 1, educated conjecture ahead
It seems intuitive to me that the natural immune response would provide greater protection against variants like delta, stemming from the nature of their targets. The vaccine is highly tuned for a specific target: the spike protein. Conversely, natural immunity performs multiple "training" runs in parallel, targeting a wider variety of antigens. If you'd take a ML perspective, this is somewhat analogous to an overfit model vs a more generalized model.
Note 2: Alas, you still have to get Covid to begin with to get natural immunity, so you probably don't want to go out of your way to get it if you haven't already.
> https://www.science.org/content/article/having-sars-cov-2-on...
This report on an Israeli study seems to imply that natural immunity was superior to the vaccine for protection against delta, though a combination of vaccination and infection provided the best response. This, to me is intuitive.
Note: 1, educated conjecture ahead
It seems intuitive to me that the natural immune response would provide greater protection against variants like delta, stemming from the nature of their targets. The vaccine is highly tuned for a specific target: the spike protein. Conversely, natural immunity performs multiple "training" runs in parallel, targeting a wider variety of antigens. If you'd take a ML perspective, this is somewhat analogous to an overfit model vs a more generalized model.
Note 2: Alas, you still have to get Covid to begin with to get natural immunity, so you probably don't want to go out of your way to get it if you haven't already.
CDC currently says otherwise.
https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...
> In today’s MMWR, a study of COVID-19 infections in Kentucky among people who were previously infected with SAR-CoV-2 shows that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus. These data further indicate that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections.
https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...
> In today’s MMWR, a study of COVID-19 infections in Kentucky among people who were previously infected with SAR-CoV-2 shows that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus. These data further indicate that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections.
That CDC article is likely outdated. In particular, refer to this line in the cited paper:
>Second, the study period for this analysis occurred before the predominance of the B.1.617.2 (Delta) variant;
In the Israeli study, they specifically were observing efficacy against the delta variant, which is the dominant (or will be dominant everywhere eventually). This is notable, because Delta, while not fully escaped, has shown some degree of resistance to the current vaccines.
As such, what I think is the most correct interpretation, given the current information (and is in line with my intuition) is that yes, the vaccines provided greater protection against initial strains, but the relatively narrow target means that they provide a less robust response against later divergence as compared to the more robust natural immunity.
>Second, the study period for this analysis occurred before the predominance of the B.1.617.2 (Delta) variant;
In the Israeli study, they specifically were observing efficacy against the delta variant, which is the dominant (or will be dominant everywhere eventually). This is notable, because Delta, while not fully escaped, has shown some degree of resistance to the current vaccines.
As such, what I think is the most correct interpretation, given the current information (and is in line with my intuition) is that yes, the vaccines provided greater protection against initial strains, but the relatively narrow target means that they provide a less robust response against later divergence as compared to the more robust natural immunity.
>natural immunity providing broader and longer-lasting protection than vaccines
Supporting evidence, please?
Supporting evidence, please?
https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v...
https://www.liebertpub.com/doi/10.1089/vim.2021.0054
https://www.liebertpub.com/doi/10.1089/vim.2021.0054
Those don't support that conclusion. Rather, they support the conclusion that natural immunity providing broader and longer-lasting protection for survivors than vaccines do for everyone.
my sister (a nurse) got covid, was fine, got it again, got sick, and now got vaccinated
My friend’s entire family got fully vaccinated, and all got as sick with COVID as my ex who was not vaccinated.
I'm glad that you didn't get as sick as my cousin. I know you didn't, because you're typing and she's dead.
Or if you don't like anecdata:
In the country where I live, more people die per hour of covid than the total number who've died from a vaccine. Considering that, what the point of even trying any further comparative analysis?
Or if you don't like anecdata:
In the country where I live, more people die per hour of covid than the total number who've died from a vaccine. Considering that, what the point of even trying any further comparative analysis?
Except countries that don't require vaccinations for healthcare workers have exactly the same burnout issues. And the problems also affect workers that are vaccinated. Having to do the job right now is quite enough apparently.
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$81,376 average wage
Given the risk and cost of just showing up for work, and the clear need to staff up, that average wage seems low to me.
What costs?
Hard to pin down in this case. In addition to the usual costs, being drained and short on personal time is quite expensive mentally as well as physically. I am sure a fair number of these people are basically working and sleeping, or recovering during the limited downtime left to them. Very expensive in terms of basic life opportunity costs.
Risks are obvious, and include getting sick as well as just run down, lack of sleep, other impacts.
I hear talk about hazard pay. Totally warranted and indicated. That has to be driving the higher numbers choosing travelling positions.
Covid is proving difficult and appears to be with us for the long haul. My sense is this pandemic may be generational in terms of it's impact and time for humanity to come to real terms with it.
Very young people today will enter the world with the best medicine and general resilience one gets from youth and the very old will be coping and cautious as they age out. We won't really return to that state of things we all remember being facts of life not so long ago.
And we need these people to be happier, healthier and we need more of them and will for a considerable time.
Given the risk and cost of just showing up for work, and the clear need to staff up, that average wage seems low to me.
What costs?
Hard to pin down in this case. In addition to the usual costs, being drained and short on personal time is quite expensive mentally as well as physically. I am sure a fair number of these people are basically working and sleeping, or recovering during the limited downtime left to them. Very expensive in terms of basic life opportunity costs.
Risks are obvious, and include getting sick as well as just run down, lack of sleep, other impacts.
I hear talk about hazard pay. Totally warranted and indicated. That has to be driving the higher numbers choosing travelling positions.
Covid is proving difficult and appears to be with us for the long haul. My sense is this pandemic may be generational in terms of it's impact and time for humanity to come to real terms with it.
Very young people today will enter the world with the best medicine and general resilience one gets from youth and the very old will be coping and cautious as they age out. We won't really return to that state of things we all remember being facts of life not so long ago.
And we need these people to be happier, healthier and we need more of them and will for a considerable time.
> $81,376 average wage
This statistic is insufficient. One also needs to calculate wage per unit time ($/h), work schedule (Mon to Fri 8AM to 5PM or evenings/nights/weekends/holidays), constantly changing work schedules, mortality/morbidity risk including wear and tear, work atmosphere (dealing with volatile or rude people in general public facing role versus working only with other professionals).
All the people who work in positions where they have to physically show up must be aware that they need to be charging extra for being in a position where they have to physically show up relative to others got the benefit of sitting at home.
This statistic is insufficient. One also needs to calculate wage per unit time ($/h), work schedule (Mon to Fri 8AM to 5PM or evenings/nights/weekends/holidays), constantly changing work schedules, mortality/morbidity risk including wear and tear, work atmosphere (dealing with volatile or rude people in general public facing role versus working only with other professionals).
All the people who work in positions where they have to physically show up must be aware that they need to be charging extra for being in a position where they have to physically show up relative to others got the benefit of sitting at home.
Don't forget barrier to entry of the profession in the first place. A very specific degree is required.
>>>All the people who work in positions where they have to physically show up must be aware that they need to be charging extra for being in a position where they have to physically show up relative to others got the benefit of sitting at home.
Heh...this is how I feel as a contractor who works on-site at the client, when our corporate-internal peers are working from home. Client-facing staff are the only revenue generators but we aren't getting any extra compensation for our greater COVID risk. -_-
Heh...this is how I feel as a contractor who works on-site at the client, when our corporate-internal peers are working from home. Client-facing staff are the only revenue generators but we aren't getting any extra compensation for our greater COVID risk. -_-
Right? A short time ago, few of us were thinking in those terms.
While I get your point, the stat is completely sufficient.
Point being serious under compensation.
Everything reinforcing that is good, and gravy.
Point being serious under compensation.
Everything reinforcing that is good, and gravy.
Some might think a national average of $81k in annual income is not under compensation considering the median income by state ranges from $50k to $90k.
I would be unable to compare one’s income to another without knowing all the other details I listed at a minimum.
As a side note, I will start believing the balance between purchasers of labor and sellers of labor will have been achieved when purchasers of labor have to start advertising minimum pay per unit of time and advertise consistent work schedules.
I would be unable to compare one’s income to another without knowing all the other details I listed at a minimum.
As a side note, I will start believing the balance between purchasers of labor and sellers of labor will have been achieved when purchasers of labor have to start advertising minimum pay per unit of time and advertise consistent work schedules.
Given the majority is paycheck to paycheck, many and myself included see under compensation as a chronic problem the result of economic policy building it to the point we see today.[1]
Those details are unnecessary at these income levels. Basic cost and risk exposure most people face are enough to understand sums in that range.
[1] The implied promise was it being far less expensive to live and work. That simply did not happen, and that failure defines the problem in my view, just to be clear.
Those details are unnecessary at these income levels. Basic cost and risk exposure most people face are enough to understand sums in that range.
[1] The implied promise was it being far less expensive to live and work. That simply did not happen, and that failure defines the problem in my view, just to be clear.
Before Covid came along, was it not a risk for nurses to catch infectious diseases?
I'd argue that all the problems with burnout lie in all the paperwork associated with providing medical care and not enough nurses because hiring more nurses is bad for business.
I'd argue that all the problems with burnout lie in all the paperwork associated with providing medical care and not enough nurses because hiring more nurses is bad for business.
There appears to be more to it than that. Your point on understaffing and business makes sense. (And part of why the US health care system needs major league reform)
However, the lack of control, so many deaths (they would argue are preventable) , brutal politics, poor policy, public mistrust, are all crazy now and were annoyances or outlier type ugly scenarios before.
However, the lack of control, so many deaths (they would argue are preventable) , brutal politics, poor policy, public mistrust, are all crazy now and were annoyances or outlier type ugly scenarios before.