The Truth about Unsafe Staffing
Nurse.org published Kelsay Irby’s story. She is my new hero. Kelsay Irby is the ER Charge Nurse who made national headlines for calling 911 desperate for help with unsafe staffing at St. Michael Medical Center. Irby called 911 because of dangerous short-staffing. Here is her story:
As I sit down to write this article, I’m trying to come up with a catchy start. How can I possibly sum up the events that led me to ask for help from our local emergency services in a sentence? Healthcare is chaotic, this we all know. What about that night was so dire? Literally, what was I thinking?? The best piece of advice I received was, “Write from the heart.” That I can do.
First, a little history. My hospital, St. Michael’s Medical Center, started out as a privately owned community hospital during the Spanish Flu pandemic. In the last five years, it has gone through a series of name changes as it was absorbed by a conglomerate of non-profit organizations. In the winter of 2020, in the middle of an unprecedented pandemic, we moved to a much larger building, one in which most of us feel we never really have gotten settled. We’ve seen several changes in hospital leadership, at all levels, including my department, the emergency department, where I have been a charge nurse for less than a year. It’s a challenge, but I love the chaos, the moving parts, and the camaraderie that comes from working with some really sensational doctors, nurses, techs, and ancillary staff.
Unsafe Staffing
Unfortunately, our hospital, and particularly my department, has seen some serious problems. We are incredibly short-staffed, more so than other hospitals in our area. Our beautiful new hospital has technical and mechanical problems. Our department has been through several managers and is operating without a full staff of mid-level managers and office personnel. Less than a month ago, our corporation was the target of a system-wide cyber attack that left us without EPIC and sent us back to paper charting.
Lucky me, I had signed up for five charge shifts in a row before the attack. I cannot overstate how chaotic it was. Labs got lost, orders got lost, and patients got lost in the back and forth to exam rooms, imaging, and other assessment areas. Doctors were frustrated, nurses were frazzled, and wait times climbed as high as 12 hours, unheard of in our hospital. We were in full crisis mode, yet our senior management continued to tell the public that we had a well-developed plan in place and that we were “business as usual.”
What Happened The Night of October 8, 2022
Caring for and monitoring patients was extremely difficult. I have never heard so many nurses say, “I am in serious fear for my license.” Things came to a head the night of October 8, when I made the decision, after exhausting all other available options, to call the non-emergent line and ask the dispatcher if they had any available crews that might come and help us.
We were even more short-staffed than normal, operating at less than 50% of our ideal staffing grid. Waiting to be seen were some patients with cardiac issues, respiratory issues, and children with high fevers, all patients that made us very nervous to have in the lobby, unmonitored for extended periods of time.
The one first-look nurse was busy trying to keep up with checking in new patients and could not possibly supervise the almost fifty people in the waiting room. We needed extra eyes. When I called, the dispatcher sent my request to the local fire chief, who then reached out to me, asked how he could help, and then sent a crew over to help monitor the lobby, retake vitals on patients, and do a roll call to ensure our patient list was accurate. We were all incredibly grateful for their help.
I Wasn’t Expecting The Media Attention
Here’s what happened next. While I didn’t recognize the impact of what I was doing that night – I was simply working my way down the list of possible sources of help for my coworkers and ultimately our patients – I faced a very major choice after the story broke. Did I ignore requests for comments, refuse to discuss my actions in public forums, and just put my head down and go back to work, knowing that my hospital was doing very little to facilitate any change? Or, did I make the more uncomfortable choice, and use that momentum to spearhead a long overdue dialogue on the issues facing healthcare as a whole, but my hospital in particular? I think it’s obvious what choice I made.
The resulting media attention has been overwhelming and yet it highlights a problem that has been developing for some time. Nurses in general do not complain. We’re taught that we keep our issues with staffing, no breaks, long shifts, impacts on our own health, etc., to ourselves. We’re taught to suck it up and be martyrs for the cause and for the corporations that own our hospitals, to be grateful for the crumbs thrown to us by hospital “leaders” (that not once show up during a night like the one I described above) in the form of pizza parties and banners, all the while dealing with anxiety while driving to work and tears on the way home, UTIs from dehydration because there’s just no time to drink any water (or pee, after), time away from our families and fear that when we do see them, we might be bringing them some residual disease from work.
“Why Don’t You Just Quit?”
We’re told, “You make good money. You chose this career. If you don’t like it, why don’t you just quit?” Earlier this year, someone asked me that last question. My response to them was, “Do you REALLY want nurses to ‘just quit’ if they don’t like their jobs? Think that one through a little further.” Because there are a LOT of us that have already left. Those of us that remain are hanging on by our fingernails.
I live in this community, as do most of my coworkers. Our families, our children, and parents, our friends, and loved ones go to this hospital when they need care. Myself, my daughter, and my best friend’s dad, who I love as my own, have all been patients in my emergency department. The care provided by the staff is second to none. I literally have trusted my life and the life of those most important to me to my brothers and sisters in the emergency department, and I would do it again.
But I see, behind the scenes, the fatigue and moral distress that is caused by working in a state of chronic crisis staffing levels, for a corporation that seems completely out of touch and apathetic to what is really happening in their beautiful new hospital. I see experienced nurses leaving the department and new nurses – smart, intuitive, and yet still relatively inexperienced – stepping into roles and taking assignments that are, perhaps, asking too much of them, and I worry for their emotional health as they take on more and more stress. I see travelers breaking their contracts because their fear of losing their license is greater than the fear of being blackballed in the traveler community. I see new neighborhoods popping up all over my county, full of potential patients who will then be in my lobby, hoping that this is a day that we are not so short-staffed that they end up putting their life at risk coming there because they have no other option in the area.
Would I Make The Call Again?
At the end of the day, my personal moral code cares less about corporate disapproval and public scrutiny and more about being able to sleep, knowing that I did everything I could to make an impossible situation a little less dangerous.
People ask, would I make that call again, knowing what I know now about the aftermath and its effect on public, personal and professional levels? And my answer is an unhesitating, resounding yes. Without a doubt. Because along with all the other things we as nurses are taught, the number one thing we do, that we internalize on a level most cannot understand, is advocate for our patients, to use our voice and our leverage when they have none, no matter what it might cost us.
Compassionate caregivers are necessary for quality care. We need more truthtellers like Kelsay Irby.