Taylor Dylo knew it was time to quit her job after crashing a car on her way home from work last year.
She came in for 12-hour shifts as a charge nurse, responsible for overseeing her department. He left the hospital before midnight. There were hardly any cars on the road. But Dailo was exhausted and his mind was blank.
“I was just in that fight-or-flight trauma response,” she recalled.
Daiello has a heart for helping others. She also loves being challenged by science and enjoys the fast-paced, unpredictable nature of nursing. But on Nov. 16, she became part of a nationwide trend by ending a 9-year career as an emergency room nurse at Methodist Hospital in St. Louis Park and moving to a less stressful position in outpatient surgery.
Much of Daiello’s fatigue comes from not being able to provide the quality of care he considers quality.
“I feel like I’m pouring from an empty cup,” she said. “I have to fill a gallon container with an itty-bitty mason jar that’s empty.”
During her last shift, a patient had an unexpected seizure in the lobby, but there were no empty beds. After the seizure, the patient was alert, so Dylo told them to wait on the floor. Although this advice had the patient’s best interests at heart, he knew it was not ideal. But if the patient is seized again, the floor will be safer than the furniture. Resting on furniture poses a risk of falling.
Dylo was tired of being asked to do more with less. “Everything that made me want to leave happened [during my last shift]So I felt very firm in my decision when I left,” she said.
Many Minnesota nurses feel the same way.
“It’s impossible to provide good care in the current environment of health care,” said emergency room nurse Amanda Kosek. “We’re too busy, too overwhelmed, too short-staffed.”
Kosek has worked for Hutchinson Health for more than 20 years. She became a nurse because she wanted to care for the community and brighten patients’ days.
“I would leave work feeling overall satisfied with what I was able to do and the care I provided,” she said. “In our current environment such a feeling is rare.
Corporatized health care is pushing nurses beyond their limits, says Mary Turner, president of the Minnesota Nurses Association (MNA) and a nurse in the intensive care unit at North Memorial Health Hospital. Treating nurses like “robots” causes moral injury.
“We’re not a car factory. We’re not an assembly line putting together pieces and widgets and things like that,” he said. “It’s human, and so you can’t run it that way.”
In September, Minnesota nurses hit a historic breaking point. Fifteen thousand went on strike for three days, advocating for more workers and better pay. It was the largest private sector nurse strike in US history. A second strike planned for early December was narrowly averted when the union reached agreements with seven health care systems days earlier.
Union nurses received a big raise of at least 17% in three years. Statewide, nurses average $82,000 per year, according to state data.
The union also won some provisions on staffing levels, including protection from discipline for nurses when they raise concerns about assignments they deem unsafe, and a requirement to review staffing levels if negative outcomes for patients and nurses increase by 50%.
Legislators introduced the Keeping Nurses at the Bedside Act (SF1651/HF1700). About 70 bedside nurses helped draft the bill and believe it will address job vacancies by prioritizing workers and “patients over profits.”
“Part of this legislation only creates committees at each hospital, so they can talk about how to manage these issues on a hospital-by-hospital basis,” Sen. Jim Abeler, R-Anoka, said in a statement.
Abeler, who is married to a nurse, is one of only two Republican co-authors of the bill in the Legislature. “There’s a hole in the bucket and the nurses are leaving. It is time for them to feel secure in their work, to have the quality that people expect.”
Advocates of the law say it would also ensure patients get the care they deserve, nurses feel safe in the workplace and student nurses have proper training and placement.
“The Bedside Act is going to ensure that every single patient in Minnesota, no matter where you are, is going to have access to the same level of adequate staffing,” said Rep. Sandra Feist, DFL-New Brighton.
Last month, the Oregon Nurses Association and the Oregon Association of Hospitals and Health Systems reached an agreement on new legislation that reassessed staffing ratios to keep hospitals safe for workers and patients.
But Minnesota hospitals refuse to compromise with Minnesota nurses.
“Minnesota’s hospitals and health systems are already managing an unprecedented crisis of workforce shortages, finances, volume and discharge backlogs,” the Minnesota Hospital Association said in a statement. “Introducing the unnecessary mandates called for in this bill on hospital operations will inevitably lead to unit closures, rising costs, longer waiting times for patients and the loss of vital services that communities rely on.”
Moral injury is done
Nurses say their work can be painful – physically and emotionally. Abdominal pain and migraines are common. With work comes bad mood and fatigue.
Daiello recalls working an 8-hour shift. He was too busy to use the bathroom. Her abdominal pain turned into full-body pain, burdened by the walking and standing required during her shift. That’s how most of his shifts went, he said.
Nurses are increasingly applying the term “moral injury” to their work. The term originated with a military psychologist, who was examining the effects on soldiers when their work forced them to violate deeply held moral beliefs.
In the health care context, nurses say that understaffing forces them to make unqualified choices among patients, which is an ethical injury.
As nurses become more fatigued, their compassion fatigue increases. They become more irritable and less empathetic towards sick patients.
When nurses are rushed and juggling multiple responsibilities, they are more likely to exclude unclear patients when describing symptoms and needs.
Moral injury also results in decision fatigue. Nurses spend their entire shift noting people’s pain levels. They must decide whose discomfort is most pressing and what should happen first. Exhausted nurses struggle to make these life-and-death decisions.
Moral injury among nurses concerns the general public
Jahred Stephens, an interventional radiology nurse, estimates that people can wait 5-8 hours in emergency rooms before seeing a provider because of staffing and space shortages.
“It’s a cold hard truth for anyone to hear,” Stephens said. “But that’s the reality of our health care system now.”
Nurses emphasize the importance of patients advocating for themselves. When visiting a hospital, be prepared to share the exact symptoms with a corresponding timeline. After leaving, fill out surveys asking about quality of care.
Asked what he wants the general public to know, Dylo said, “[Nurses] Going to do their best. But these systems allow them to give you what you deserve and get the life you deserve, which is a healthy life.”
*This story has been corrected to reflect that two Republicans co-authored the Keeping Nurses at the Bedside Act.