Endless Thread - 'He Died in the Goddamn Waiting Room'

Episode Date: May 27, 2022

With unprecedented hospital staff shortages, COVID-19 has upended the nursing profession. But the r/nursing subreddit offers an online life raft for many in the industry — a place where nurses can speak freely and anonymously about their experiences and the choices they face. ****** Credits: This episode was written and produced by Dean Russell with mixing and sound design by Matt Reed. Amory Sivertson and Ben Brock Johnson are the co-hosts.

Support for Endless Thread comes from MathWorks, creator of MATLAB and Simulink Software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at Mathworks.com. Support for WBUR comes from Is Business Broken, a podcast from the Mayrotra Institute at Boston University that explores questions like, why is innovation in health care so hard? Is ESG just greenwashing? of course, is business broken? Listen, wherever you get your podcasts. WBUR Podcasts, Boston. I saw a Craigslist ad, I think, for a caregiver job, and I just thought, you know, I don't mind getting my hands dirty. I don't mind working hard. I think I could wipe a butt. This is Danielle. I've never thought about it like that. I think I could wipe a butt. It's a practical, you know, yeah. A few months ago, Danielle sent us a voice memo for an episode we were doing about the anti-work community. I've always been the type to go the extra mile at work.

She told us she had a story to tell, related to anti-work, but a story unto itself. So we called her up. Oh, and you have a... Is that a cat? That is Bill. I'm sorry. Hi, Bill. Danielle lives in Washington State. And growing up, she was never really sure what she wanted to do with their life. She was in college when an idea finally came to her this one job that given her butt-wiping willingness, she seemed perfect for.

This seemed like the kind of work that really needed to be done. It's not, it wasn't superfluous work. Yeah. What's more essential than life and dignity or what's left of it. In 2015, Danielle became a nurse. She fell in love with the job and the people. I worked with the, you know, older population, and it was just really intense work, but I got to know them and love them. Just a lot of, like, task work, taking blood sugars, giving just so many medications, so many medications.

Danielle started working in a nursing home. After a little while, she moved on to working in hospitals as a charged nurse. I managed the other nurses on the floor who had. have patient assignments and I check in with them, make sure the care is going okay, and try to look at problems that might start snowballing before patients get in a bad way. You're kind of the boss. A little bit, yeah. By her own account, Danielle was proud of her work.

She'd stay late to catch up on projects, make improvements to systems, take on extra duties. But now things have changed. Danielle has changed. COVID has changed her. These shifts during the pandemic were horrible, just people dying left and right. To be someone who is supposed to help people and provide care and to be so utterly ineffective and not able to do your job. It was, I really felt bad, you know. Like a lot of nurses across the country, she's burned out.

It manifested physically for me. I work night shifts, so I would wake up. up at about 5 p.m. to get ready for my shift. And I would have such bad anxiety before work that I would regularly start vomiting before my shift. And it was horrible. By the way, I hate vomiting. I do not vomit. I would rather be in severe pain than vomit. Ugh. At a certain point, these panic attacks would start to overwhelm Danielle and interfere with her ability to do what she once love doing, taking care of people. In the early days, though, she tried to keep going, searching for some way, any way to cope. Did you have a ritual that you did when you got home at the end of a shift to kind of wind down?

Oh, so many shower beers. Sometimes several shower beers. But the other support system I have, quite honestly, is the nursing subreddit. It was very therapeutic. I was checking it constantly during the pandemic because I just wanted to know, you know, this is how much I'm suffering, how much is everyone else suffering, what is everyone else doing?

It was really reassuring to see that healthcare was seemingly falling apart everywhere and not just at my hospital. If you scroll through the subreddit R-slash nursing, described as nursing for nurses and by-nurces, you will start to see patterns, people whose experiences resemble Danielle's. You will also see a story emerge about how two years of COVID-19 has upended nurses' lives across the country.

At least half a million health care workers have left their jobs in the U.S. There are thousands of vacancies in nursing specifically. And according to one recent survey, up to 47% of the remaining workforce plan to leave in the next few years. nearly half, which is why you might have heard about a nursing shortage, or have friends who are getting into the profession. Just as we need them the most, the on-again, off-again nursing shortage is on again. The health care system is still really from the strain of COVID and thousands of nurses. Hospitals are so desperate for nurses that they are hiring students before they even graduate. This month, the World Health Organization estimated the death toll of the pandemic thus far, 15 million people.

In the U.S., one million people have died from COVID. So we're going to hear from three nurses who, facing those deaths, found a much-needed community on R-slash nursing, Danielle, C., and Scott. Three people whose stories serve as a warning about how the pandemic has pushed the health care system to its limits in ways that affect us all and may take years to resuscitate. I'm Ben Brock Johnson. I'm Amory Sievertson, and you're listening to Endless Thread. We're coming to you from WBUR, Boston's NPR station.

How long have you been on the nursing subreddit? Probably as long as I've been a nurse, 11 or 12 years. R-slash nursing was created in 2009. Unlike Danielle, who we'll get back to in a bit, this guy, C, was one of the earliest members. They were sort of a small town field because there were so many fewer people. There were so many fewer posts per day. and sometimes I could participate in every single pose that happened in a given day in the subreddit. We're calling this Redditor C, his nickname, because as someone very active on a forum that dives deeply into vaccines and other contentious topics,

C says he worries about online harassment. In any case, C, like Danielle, is a nurse. My specialty is in emergency medicine, and I work in a trauma center. It makes sense that C would find his way to the nursing suburb. Reddit. He's extremely online and started out as a computer programmer. The joke I tell people is that I used to have an office job, but that was too easy and too clean and too safe and paid me too much. And so I decided to go to nursing school. C thought nursing would be a more interesting day job. He was right.

I've been punched in the face, tackled to the ground, kicked in the chest. I had a colleague who got sent to the ICU by a patient because she was strangled with her own stethoscope. C's initial interest in R-slash nursing was purely informational, because back in the early 2010s, that's what the subreddit was all about. What advice do strangers have for starting IVs or I want to be an ER nurse, how do I go about finding that kind of job? I think that's the sort of thing I was looking at when I first entered it. I was looking for advice from more experienced nurses. He also came for the jokes. Healthcare humor can be a bit dark, so people will post stuff in the nursing subreddit that might not go over well or seem real funny to lay people.

Can you give me an example? One of the jokes that emergency nurses tell is that all bleeding stops. Oh, no. Yeah. C enjoyed connecting with other nurses online. And as he aged into the profession, he became more invested in the community. In 2018, he went from member to moderator. In 2020, he became the top moderator.

And maybe it's no surprise. But at that same time, 2020, the community C was moderating started to grow a lot. If you look at our subscriber numbers, the graph is similar in shape to the spikes in COVID activity. So we had an enormous jump in March of 2020. And then again, when the second spike happened. And then there's another notch again upward when the Omicron spike happened. The subreddit tripled in size to 350,000 members and counting. It also diversified.

And so you'll have maybe an ICU nurse in California talking to a medical surgical nurse from Florida, talking to an ER nurse from Maine, talking to people from other countries and people from other specialties. But the biggest shift, it seemed, was the tone of the posts from his fellow nurses. What was once centered on routine clinical questions and career wisdom and a few laughs became more desperate and more personal. The first one I'd like to point to to is the top post of all time on the subreddit. The title is, he died in the goddamn waiting room. It's very short, but it sort of expresses the attitude that we've all got about pandemic nursing. We do our best.

We struggle and we push. And we give everything that we possibly can and still. There aren't enough of us to help everybody who needs it. This post was written by someone called Waspy One. We reached out to them, didn't hear back, which wasn't a surprise, because as C told us, part of the point of R-slash nursing is that nurses can speak freely and anonymously. The post goes like this. Quote, we were double capacity with seven schedule holes today.

Guy comes in and tells registration that he's having chest pain. There's no triage nurse because we're grossly understaffed. He takes a seat in the waiting room and died. One of the physician's assistants walked out crying, saying she was going to quit. This is all going down while I'm bouncing between my patient from a stabbing in one room, my internal hemorrhage patient with no ICU beds in another, my symptomatic COVID-positive patient in another, and two more that were basically ignored.

This has to stop. Well, this is the most popular post on R-slash nursing. 33,000 upvotes, 3,000 comments. The content is pretty standard as far as the subreddit goes. In other words, there are many, many other posts with similar stories and headlines. Well, it finally happened. A patient coded in the waiting room. They're coding people in the hallways.

It finally happened. Anyone else just waiting for their hospital collapse? Done. I quit. A lot of us were scared, and I'd, I feel like that came across in the subbrata, especially near the beginning when people didn't have PPE, people didn't know what they were going to be exposed to. None of us were vaccinated. And we were literally in danger every time we went to work. It was a really stressful time to be a nurse for, and I think still is to a certain extent.

C was one of the first staffers in his hospital to catch COVID. He was hospitalized, but ultimately, okay. He said it made him less afraid and less vulnerable than some of his peers. But Danielle, the nurse from Washington State, she had a different experience in the beginning of the pandemic. You know, it was scary. They didn't know. They tried to come up with plans and stuff, but it was all very new. So we were kind of caught flat-footed in implementing isolation protocols. And what do we do with these? At this point, spring of 2020, The panic attacks hadn't started happening for Danielle. The biggest challenge was dealing with what seemed like ever-changing hospital policies.

Our administration came out with a policy that said you were not allowed to wear a mask at work because it could scare the patients. It was just clearly a policy that was for the benefit of, I don't know, public relations or just, you know, wanting to seem like everything was fine. According to Danielle, that policy, which was never written down, changed after a few weeks. There were other problems, though. Probably about three months after those first cases, they opened up another floor of the hospital that usually didn't have any patients on it in order to make that the COVID floor.

And that's when it got really, really out of control. And standard of care dropped momentously. More patients were flooding in, more nurses were dropping out. This forced what's called a change in ratios. You see that word pop up a lot on R-slash nursing. Before COVID, the highest ratios Danielle had seen in her hospital were about five patients to every one regular staff nurse. As the nurse in charge of the other nurses,

Danielle's focus was typically on her staff, to check in with them, to check their work, to help answer questions. This is a critical step in health care to make sure important procedures don't get overlooked. So at most, Danielle would have only one or two patients pre-pendemic. But with COVID? I would have five, six patients of my own. And all the other nurses would have six to eight patients.

Some of them COVID, some of them med surge or like incidental COVID. The nurses were absolutely overwhelmed. We didn't really know how to best to care for these people. Danielle said that out of fear, or just because of the difficulty of messing with personal protective equipment, hospital staff would touch the patients less and they would assess them less. Things would get missed and patients would get left alone for too long. Things started going wrong and people started dying sometimes just because of COVID and sometimes because they were old and we couldn't turn them as often as they needed to be turned. For Danielle, patient loads started drifting lower after vaccines came out, with upticks every time a new variant came through Washington. By then, so many staff nurses had left that even with fewer patients overall, the ratios remained out of whack.

And that took a toll. There was an older gentleman who, and this was actually fairly recent, so after the COVID cases had gone down. He did have COVID. He was seen in our ER, which was very overwhelmed. ER staff were having trouble gauging the man's temperature. They thought maybe the thermometer was just on the fritz. And then he was admitted to our floor, and we were taking vital signs and giving care. And I didn't realize it, but we were also.

Danielle and her staff kept trying to check the patient's temperature. But busy with other patients, the process took a while. And by the time they got an accurate temperature, they realized that he was very, very cold. If you were cold, it's kind of a sign of your body shutting down. So at that point, we called a, you know, rapid response. And things kind of devolved quickly. He started having other issues. And he ended up passing away, I think, the next night.

And it was largely because this, again, this really small thing, just, you know, checking a temperature. If we had been tracking that from the get-go, we would have realized that there was a bigger problem than what we realized. It was around this time that Danielle's panic attacks really took hold. She was burnt out, not simply because of the pandemic, but because her view of the hospital and its executives had changed. I used to drink the Kool-Aid, and I don't anymore. I don't trust my bosses anymore because I saw that they didn't have my best interests at heart. Daniel says they'd stopped communicating about the new. normal about staffing shortages, supply shortages, patient food shortages.

And I knew we were trying as best we could, but I didn't think that they were communicating to both the staff and the patients and the community, what the real picture was inside the hospital. As Danielle saw it, these decisions among others were pushing away her fellow nurses and putting patients at risk. So I told my boss I was going to take some FMLA and that's what I did. FMLA, as in the unpaid leave guaranteed by the Family and Medical Leave Act, with many of Danielle's colleagues gone, she left too.

But if you're thinking about why so many nurses have left and where they went, it's more complicated than just burnout, much more. And recently, the conditions that sparked the great resignation of nurses has driven the remaining workforce to the streets. More on that in a minute. At Radio Lab, we love nothing more than nerding out about science.

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Become a thought leader. Recruit new talent. Reach new audiences. Whatever your goal, we can help. Discover how the magic is made at WBUR.org slash creative studio. Earlier this month, a few thousand nurses marched through Washington, D.C. with a message. We are fed up. What's up, guys? We are the National Nurses March in D.C.

We are ready to march for everyone who can't be here today. They're pushing our ratios, and it's unsafe. It's unsafe for our license. It's unsafe for the patients. Bringing safe nurse-to-patient ratios will bring nurses back into the workforce. And there are two main ways to return those ratios to normal. One, a hospital can set a limit on patients. So if the ratio edges passed, say, five to one, hospitals will start turning patients away. This is a Band-Aid, and for obvious reasons, may prove just as bad for the people who need medical care. The other solution, some argue, gets to the heart of the problem.

Raising pay. The median hourly wage for nurses in the United States is about $35 an hour. And if that doesn't sound low, consider the fact that nursing, a field 90% composed of women, can be a brutal job that requires costly training and years of education. Plus, doctors who are still majority men, make about $100 an hour. It's also worth mentioning that other health care support staff make a fraction of that, $13 an hour. Combined with the mental stress, supply issues, an increased workload, No wonder so many are leaving. In your Reddit post, you wrote the system is fucked.

System is fucked. Yeah. System is fucked. Not from... Scott lives near Philadelphia. His career in medicine started with the military, where he was a combat medic. It was 2012. I joined the National Guard.

I didn't really know what I was doing with my life. I needed some money because I don't really, I never really had much money. When he got out several. years ago, a friend recommended he try nursing. He did, and took quickly to the ER. I just liked the emergency medicine, right? I wanted to be where the action was, all said and done, and work with my hands. By 2020, Scott was in the thick of it, losing multiple patients every day. His hospital had to hire ice trucks because their morgue was full. His colleagues and friends were leaving, so Scott started thinking about doing the same. He didn't want to leave

medicine altogether, but instead he found a management position at another hospital. It was for an emergency department near me, and I did the interviewing process. I went through three interviews. Everything seemed to go well. I was happy how things turned out. They ended up offering me the job, and I was like, great. For Scott, the job would have been a step up. Problem was, they offered me $45 an hour to be the assistant manager. And, you know, depending on who's listening to this, that is a lot of money, and it sounds like a lot of money. But at the time, as a staff nurse at the other facility, I was not only making slightly more, but the time and responsibilities for that job are immense, especially these days. Scott turned them down. A few months later,

he read something on R-slash nursing. I remember seeing a post one day, and it was, I just made $20,000 last month, and it was like, thanks COVID. And that was the post, and I was like, holy crap. Like, you know what I mean? Like, do you want to talk about financial reimbursement or security for your job or the opportunity, whatever it needs to be? I was just blown away by that. There is a loophole to the low pay associated with nursing. Travel nursing.

When hospitals are low on nursing staff, they'll often take temporary nurses, who traditionally would live away from home for 13 weeks, helping to fill the gap. We spoke to one expert who theorized that this kind of work. was formalized in the 1980s in places like Florida, where the population would jump every winter with so-called snowbirds. In any case, during the pandemic, as staff dropped out of the workforce, traveling positions started opening up. In desperate hospitals, we're offering double or triple staff wages. So while staff nurses were leaving their jobs, the number of travel nurses grew by 35% in 2020. Likely more last year.

And once you start looking, you'll see ads for travel nursing all over the place. TikTok nurses are paid to promote travel nursing. I've been an era travel nurse for two years now, and I absolutely love this lifestyle. You get paid so much more money. You can visit any place in the U.S. or other countries, and you have such flexibility with your schedule. I made like $220,000 this year. So, yeah, travel nursing is definitely lucrative. Scott looked into it.

He found a job at the same emergency department that had offered him $45 an hour to be a manager. It was $111 an hour is what I was offered for an easier position with less commitment. And so they accepted me right away. The director knew who I was. It was so desperate just to get some help. She didn't even give me a phone call. She just immediately pushed my application through to accept me. The hospital wasn't far from where Scott lived.

So he doesn't even have to travel. He gets benefits and health insurance from a travel nurse agency, basically a middleman between Scott and the hospital. And Scott says he gets other perks. When you travel, you actually get to choose what you want to do. You want to do nights? Do you want to do days? And they have to keep consistent based off of what you're asking for, which is really nice because that's even more freedom for you as a traveler. Because I don't like to do night shifts. I have an 11-11 shift.

But that absolutely creates friction with the senior nurses or the nurses that have been there, you know. If you're a staff nurse who has been working at a hospital for years and you're surrounded by newcomers with more flexibility, making double your pay to do the same job, yeah, of course there's friction. Add on top of that, that not all travel nurses have as many years of experience as Scott. Even he admitted that it can be frustrating to have an outsider without a good sense of the hospital come in and make more money. But again, he says it's the system. You don't have any mixed feelings about being, quote, unquote, like part of the problem in some ways? It's really tough.

And I know you're not attacking me, but if you're going to say nurses leaving to make more money is a problem, like that is attacking the wrong part of things. Hospitals are still paying these people who are leaving for better jobs, this insane price, right? For what it's worth, we ask nurses Danielle and C about travel nursing, and they said the same thing. There's very little resentment between travel nurses and core staff.

There's a lot of resentment from core staff to administration who are choosing to, instead of compensating their core nurses and paying them to stay there and improving the working conditions, instead of doing that, they're electing to hire travel nurses to temporarily fill this gap. But if nurses are pointing the finger at hospital executives, hospitals are pointing the finger at travel nurse agencies, accusing them of price gouging. Because it's the agencies that set the wages. Hospitals desperate enough just have to agree. They also have to pay the travel agencies on top of whatever the nurse's wage is. So if Scott makes $111 an hour, the hospital could be paying $200 an hour. Several groups, including the American Hospital Association,

have called on the U.S. government to investigate and intervene by, for instance, setting limits on how much a nurse can be paid. So nurses are asking for pay raises, hospitals are asking for pay caps. Meanwhile, the travel nursing industry is enjoying a windfall. You could look at this a different way, though. Travel nurses are paid more because they have a powerful entity arguing for more on their behalf. In that specific sense, it sounds a little like a union, which brings us back to those protests happening across the country. Most are led by local and national nursing unions, and it's not just the protests.

They've led walkouts and silent strikes. For most, it's unclear if any change is coming. But some nurses are being heard. Stanford nurses are set to end their strike after reaching a tentative agreement. A year's long contract negotiation is now complete. St. Elizabeth Medical Center where nurses, after lengthy negotiations and protests have agreed to a three-year contract. Still, most people we spoke with for this story told us it could take years for the healthcare industry to stabilize.

Even if staff wages went up and most of the travel nurses went back to staff, the pandemic drove many nurses out of the medical field altogether. There are other pressures on the profession too. Nurses are increasingly worried about being targeted. in lawsuits from malpractice, for instance. And they're far from a monolith professionally. Black nurses criticized the march this month for not being more inclusive in organizing efforts.

At least when you look at the departure from the profession, you can also see nurses fresh out of school are starting to replace the ranks. But it'll take time for them to gain the experience that's been lost. This past March, Danielle did something a lot of her former colleagues didn't do. She decided to return to work. She says things have calmed down a little bit, though COVID is forever present.

She doesn't want to be a travel nurse. She prefers the stability of being staff, even if that means she's paid less. She's still afraid of how fragile the system is and of how much things have changed. But she's come to accept how much she's changed. I'm not going to be that amazing charge nurse who solves all the problems and is known for checking in on everyone. I just kind of accepted, I'm going to go to work, I'm going to do what I can do, and I'm not going to fix everything, and that's going to have to be okay.

So, yeah, the anxiety is better. I still wake up with, like, a little bit of anxiety, but I kind of handle it, and thank goodness the puking has pretty much all stopped. Seriously. What about the shower beers? I still dabble in the occasional shower beer, but My current shower beers are more just a reward for a hard day's work. Endless Thread is a production of WBUR in Boston.

Want early tickets to events, swag bonus content, My Scrubs, Amory's charts. Join our email list. You can find it at WBUR.org slash Endless Thread. This episode was written and produced by Dean Russell, and it is hosted by us, Ben Brock Johnson. And Amory Sievertson. Mix and sound design by Matt Reed. Our web producer is Megan.

and Kattel, the rest of our team is Norris Sacks, Quincy Walters, and Grace Tatter. Endless Thread is a show about the blurred lines between digital communities and a job where you might have to wipe a butt. If you've got an untold history, an unsolved mystery, or a wild story from the internet that you want us to tell, hit us up. Email Endless Thread at WBUR.org. And thank a nurse today, will you? Sheesh.

Yeah, seriously.