The Daily - ‘Somebody’s Got to Save Us, While We’re Saving Everybody Else’

Episode Date: February 18, 2022

As hospitals in the United States battled another coronavirus wave in the past few months, another crisis was steadily growing more acute: a shortage of nurses.We speak to some of the “forgotten warriors” of the nursing profession, at Pascagoula Hospital in Mississippi, to find out what life is like on the front line of the pandemic.Guest: Andrew Jacobs, a global health reporter for The New York Times.Have you lost a loved one during the pandemic? The Daily is working on a special episode memorializing those we have lost to the coronavirus. If you would like to share their name on the episode, please RECORD A VOICE MEMO and send it to us at [e-mail]. You can find more information and specific instructions here.Background reading: The exodus of medical workers during the pandemic has been especially brutal for the small, nonprofit safety-net hospitals where millions of Americans seek care.Want more from The Daily? For one big idea on the news each week from our team, subscribe to our newsletter. For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Sabrina Tavernisi. This is The Daily. Today, hospitals are beginning to emerge from yet another wave of coronavirus cases. People are getting tired. This is a long marathon that we are running right now. But for months, hospital leaders around the country have been increasingly concerned about another problem. We are losing nurses weekly. We've seen some who've just decided, I can't do this anymore. A shortage of nurses.

I just feel very helpless. We're working so hard to continue to try to find more personnel. We're in a very critical state right now. My colleague, Andrew Jacobs, takes us to a hospital in Mississippi to understand the impact of these shortages on the health care system and on the nurses who are still left. It's Friday, February 18th. Andy, tell me about this hospital you went to in Mississippi.

So in mid-January, I went to Pascagoula Hospital in a place called Pascagoula, which is a city of about 22,000 on the Gulf of Mexico. And the nearest big hospital outside this hospital system is about 40 minutes drive away. So if you're in Pascagoula or one of the nearby towns and you're experiencing an emergency, by that I mean a car accident, a broken arm, maybe your child's suddenly sick with a raging fever, this is where you're going to end up. Got it. And they've been pretty hard hit by COVID. The latest wave of infections had pushed nearly all the state's acute care hospitals to capacity, including Pascagoula. And so I was eager to get inside

and document what this crisis looked like. But before I even got into the hospital, the CEO, this guy named Lee Bond, made a beeline to talk to me in the parking lot. made a beeline to talk to me in the parking lot. If there was one takeaway that I wanted y'all to have, is that Omicron is not the main problem. The RN shortage is the main problem. I think that's the headline. And he was eager to tell me about what he said was the real story. And my little thing I wrote is called The Forgotten Warriors.

And if I finish that today, I'll send it to you. That his hospital's biggest problem wasn't COVID, but rather a shortage of nurses. Thank you all for coming out. I appreciate it. Thanks, Hugh. And so I started out my tour of the hospital to see what that shortage looked like. I first met with Kelly Cumbas.

He's the head nurse of the ER, meaning he manages the nurses there. I've been working here since 2004. He's the head nurse of the ER, meaning he manages the nurses there. He was actually born at the hospital. He's worked there for many years. And he's a very warm open and gracious guy um so can we can we just walk around see what's going on yeah come on wherever you want to go i'll take you and he seemed proud of the place and in 1967 the er opened 24 hours a day and it was the first 24 hour er in the state of Mississippi. It was just when you're standing in. No way.

That's crazy. There's an old physician by the name of Catfish Allen ran it back then. As we walked around. But this is the back of triage. I was first struck by how calm it seemed. So these four rooms are our negative pressure room. There were about two dozen patients

in the ER waiting room, but it didn't seem too chaotic. Hello, good morning. What's up, good morning, where you up? Good morning. Where are you going? Everyone was pretty cheerful. Which one do you want? It didn't seem like a place in crisis. Okay, that's not exactly what I was expecting.

Right. But then I met a nurse named Teresa Phillips. So I myself just got back from being sick. She's been working at the ER for years, and she's just recovered from COVID. And as we talked, she was pretty candid about what it's like to be working in the ER right now. So tell me about, yeah, tell me about what's it like for you right now? What's going on here? Very strong, very stretched, very thin. And I think for her there was a real a sense that she can't always provide the best care

you know i expect myself to give a certain level of care to patients and whenever you're stretched too thin you you don't have the time to go through and do all the things that you would want to do and now we're kind of reacting to things because you're not on top of it. And it is not a good feeling whenever you go home and you know that you didn't do the best that you could. You did the best you could, but not the best for the patient. It's pretty rare in healthcare to get a healthcare worker to admit that they are providing substandard care and i thought that was really telling of a desperation do you i mean before the pandemic did you like or love your job or what how's that changed or and and i still do some days um some days i drive home

uh just in silence and you know i don't even know how I made it through this day. And then other days are better. It just, I never know what the day's going to hold. I think that's really hard for healthcare workers who are committed to, you know, saving lives and providing the best medical care they can. And right now they just can't. Because there's not enough of them. providing the best medical care they can. And right now, they just can't. Because there's not enough of them. That's right. And you could see these quiet signs around the ER of what Teresa was talking about. For example, above many of the doors, there were flashing purple lights,

which indicate a patient calling for help. It could be something as simple as a patient wants more water or ice in their cup. But often it's a patient who needs help going to the bathroom and sometimes a patient who didn't get help in time and soiled themselves and needs help cleaning up. And what was striking to me is that there were so many lights flashing and not being dealt with. And basically the staff told me that's because they didn't have time to get to everyone as quickly as they would like. So essentially it's this long line of patients needing something and not getting it right away. Yeah, and then there was also other signs of the troubles they're dealing with. There was a whiteboard on the wall of the ER. It had about two dozen names up there.

And Kelly pointed out that several of those patients had been in the ER for upwards of 24 hours. How do you tell how long they've been waiting? TC is total time. 21 hours, 21 hours. So they're admitted with nowhere to go. So these patients have been admitted and were ready to be transferred to different units of the hospital to receive proper care. But instead, they were stuck in the ER because the rest of the hospital was already at capacity. And the more time I spent in the ER, the more I started seeing

doctors and nurses really struggling with the situation. As Kelly was showing me around the emergency room, there was suddenly this commotion. There was a flashing light and an alarm coming from one room. And Kelly and a bunch of other nurses ran in. And Kelly and a bunch of other nurses ran in. It was a woman, a COVID patient, who had torn off her oxygen mask in sort of a moment of agitation. She was in her 60s.

She had underlying lung disease and her oxygen levels were plummeting. Put your arm on your belly, we're going to sit you up. It was a pretty chaotic moment and it took three people to sort of subdue her, lift her up. Sit up and breathe in. One, two. There we go. That'll help you. Into more of a seated position and put the mask back on her face. So that moment turned out okay. They got the mask back on. It was seemingly fine. But afterwards, Kelly explained to me why situations like that are so worrisome.

And why is that? You know, that patient really should have been in the ICU, which is set up to administer specialized care and where patients get much more attention. Emergency medicine with ICU in patients is not a good setting. It's a bad combination. Remember, this woman has an underlying lung condition. So this is not a short-term emergency. She's going to need extensive care. And when a patient like that is stuck in the ER for longer than they should be,

their chances of having a bad outcome are greatly increased. The fear is there and there with her whenever she should be upstairs. And then you run out of people. You get to the point where you run out of staff. And on the flip side, when the ER is overwhelmed... Then you have a heart attack or stroke come in and that's where things get dangerous. The staff there

doesn't have the bandwidth to give the kind of attention that, say, a car accident victim or someone who's had a stroke needs. So basically what Kelly was telling me was that there's this traffic jam in the hospital with patients stuck in places where they should not be. And it really has a sort of system-wide impact on the hospital's ability to provide top quality care. Right. So what you're seeing in the ER was really the end result of that traffic jam, right?

This huge pileup. Exactly. But I wanted to get a fuller picture of this traffic jam and to understand why it had gotten so bad. So I went further into the hospital. And I'll take you upstairs if you right. If you want to see. Yeah. We can just take this elevator. I took the elevator upstairs with a nurse named Bobbi Ann Sison, who showed me around.

This is our nurse's station. Hi, y'all. My mother's here. And tell me about Bobbi Ann. Well, like Kelly, Bobbi Ann was also born at Pascoville Hospital. She's 36, a mother of two young kids, and she spent the last six years working there. Hey, Miss Deidre.

She is very chipper, very upbeat, and just really has this great rapport with other employees, you know, as we walk through the hallway, sort of greeting everyone she passed, giving out hugs. And she is both a registered nurse and also is the manager of the medical surgical floor. It's commonly called the med-surg floor, which is where patients go after they've been discharged from the ICU. It's a place where you go if you're recovering

from a car accident or from surgery. How long have you been doing this? How long have I? I've been with the system for five years. But we've been the hot nurses since July 2020. Hot nurses? Yes. So you've got the hot nurses, which are the ones that deal with COVID. Or from COVID. From here down is my COVID pod, just on this side.

But we have so many right now that I have these who are also COVID groups. It's basically your routine care hospital floor. And it's sort of a pressure valve that if it's blocked up, patients from other parts of the hospital can't move towards recovery. Like the woman with a lung condition from the ER. Right. And part of Bobbi-Ann's job is to prevent that from happening by making sure she has enough people to staff the floor.

But that's been a real challenge. I've got two staff members that are out today. One, another nurse that's going to get tested. And then another that's reached out. The day I met Bobbi Ann, she was dealing with a couple of nurses who were asked to stick with COVID. But it was clear she was dealing with a much bigger problem. I have two other floors that aren't even open right now, but I can't staff. Because the ratios are going safe.

She was so short on staff that she was forced to close down two whole floors of hospital beds. How many beds are on those floors? 18 and 15. Sorry, 30? 30, what, 33 total? That's almost half. That's pretty serious. That's a lot.

Yes. Meaning she had 30 fewer beds for patients who needed to be moved out of the ER or the ICU. And how many empty beds do you have? Right now? None. None. Yeah, that's why they're having to hold them in the ER. Because they don't have any room. We'll have the patients at discharge today.

And it was at this moment that really drove home for me just how big of a problem the nurses at this hospital had on their hands. We'll be right back. So, Andrew, as you're going through the hospital, you're seeing this severely reduced nursing staff. And that's led to this kind of perverse situation of having to leave entire floors of the hospital empty, really precisely at the moment when people most need them, right? So what's going on here? Why is this happening? Well, fundamentally, what's going on here? Why is this happening? Well, fundamentally, what's going on here is that nurses are leaving. And there are a lot of reasons for that. But I should start by saying that we can't underestimate just how difficult nursing is. It's a really,

really tough job. And it's always been. You know, a normal shift is 12 hours. You're on your feet all day. It's just physically exhausting and it can be emotionally draining as well. And there's this underlying sense when I talk to nurses over the past two years that even before the pandemic hit, they didn't feel respected in the profession. They don't feel respected by doctors often and they don't feel respected by doctors often. And they don't feel respected by administrators who, nurses say, keep asking them to do more work for the same pay. So at baseline, morale isn't great. And then COVID hits. And while most of the country starts isolating, nurses did what they had to do in the trenches, often working without PPE or inadequate PPE.

Many, many of them got sick. You know, we're talking 3,600 healthcare workers died in the first year of the pandemic alone, but they did what they had to do because it was a sense of a national emergency. Obviously two years ago, it's probably different. What is that an evolution in life, would you say? So the first waves were stressful because we didn't, not that we didn't know what we were doing, but we didn't really know what we were dealing with and things were changing so quickly. And as cases surged in the summer of 2020,

in the hospital in Pascagoula, Bobbi Ann's unit had to take on more and more COVID patients. You know, everybody was like, oh yeah, nurses are heroes because they could kind of see some of what we were doing. more and more COVID patients. You know, everybody was like, oh yeah, nurses are heroes. Because they could kind of see some of what we were doing. And, you know, in the beginning, everyone held them as heroes. We hung out our windows and clanged on pots. You know, they were our COVID warriors.

But as the pandemic wore on, that started to change. People aren't as patient. You know, people aren't as understanding as what they were when we first started dealing with it. So on top of all this, you know, incredible physical and emotional stress, the fear of getting infected and the trauma of watching so many people die, you have this hostility that they're getting from patients. And so all this is playing into this sense of being abused and unappreciated. And I mean, yes, this is what we signed up to do, and yes, this is our job,

but we have feelings, we have emotions. It wears on you and bobby ann did what she could do to try to keep her unit together you know she'd cover for their shifts or let them use her office if they needed a break i mean i had one that i kind of i'm i'm in a psychotic episode pretty much. Like, she broke. Like, she lost it in my office. I didn't know what to do. She was just breaking.

Like a psychosis. She just... She came and nursed six people. She no longer works for me. Because she left. But, you know, once Delta hit, the departures really started to snowball. To the point now where she's lost about half of the nurses on her unit. Wow, half of her entire staff? Half of her entire staff, yeah.

When they leave, do you have a little party for them right now, or do they just go, disappear? No, they don't. No one has time. We don't really. I mean, we've lost that many between all the floors. We haven't had one for a year. So where were all these nurses going? Well, some of them decided to retire early.

Some of them went to work in less stressful nursing jobs. And some of them left the profession entirely. But really, most of them went to do travel nursing. So explain what travel nursing is. I mean, it's something I've heard of, but I'm not quite sure I understand. And how does it fit into this overall moment in the pandemic? Well, travel nursing is something that's been around for a long time. It's basically a short-term contract, a temporary arrangement, and a nurse will travel to a distant city and work in a hospital temporarily, but for much, much higher pay.

Before the pandemic, they could make multiples of a staff salary, but travel nursing really took off during the pandemic. As coronavirus cases continue to rise, hospitals across the country are urgently in need of travel nurses. When hospitals were so short-staffed. It's really traveling nurses to the rescue here. High demand for travel nurses during the pandemic means higher salaries than for staff nurses. To the point now where some nurses make five times the salary of a staff nurse.

Five times the salary. What does that look like in Pascagoula? Well, to start with, nurses in Mississippi are among the lowest paid in the country, $60,000 a year on average. You know, they make half as much as a nurse in California or New York makes. So, you know, the nurses in Pascagoula are already pretty low paid. So a lot of them took these contracts. And in some cases, the nurses got jobs in Mobile, Alabama, which is about a 45 minute drive away. And that allowed them to stay at home and make much more than their base pay. And, you know, it's really an attractive option.

And for a lot of nurses, despite how loyal they are to the hospital, it's hard to stay a note of that kind of money. And so you got to the point where the staffing levels fell so low that the hospital for the first time in its history was forced to hire travel nurses. And this, you know, is not something that's sustainable for kind of a non-profit county owned hospital. sustainable for kind of a non-profit county-owned hospital. I guess what I'm wondering is, why didn't Pascagoula just pay more money to its existing nurses to try to keep them? Well, I mean, you know, talking to the CEO of the hospital,

he laid out the math for me. He said if they gave an extra $100 a week to the 1,200 nurses in that system, that would be about $6 million a year extra in staff costs. And, you know, from their point of view, travel nursing is a temporary expense. They hope it's one that will just last a few months. And they say they can't afford this permanent increase to their bottom line, though it should be noted that a lot of nurses will say that this is about greed and that there are many, many hospitals, especially for-profit hospital systems, that could be paying more and should be paying more. And they cite these, you know, multi-million dollar salaries that are given to hospital presidents and top administrators. So a lot of nurses say it really comes down to priorities.

So have hospitals ever faced this kind of a problem before? Well, in a way they have. There's long been this kind of a cycle of shortages and gluts that ebb and flow with the economy. As the economy gets better, some nurses leave more lucrative jobs in hospitals to go to less intense nursing jobs, and we'll see a shortage. As the economy gets worse, some nurses go back to nursing in hospitals for the stable paycheck. So these shortages usually kind of correct themselves with time. But heading into the pandemic, there were other forces at play. We have an aging population. You've got over 10,000 baby boomers that are turning 65 on a daily basis.

Guess what? They're going to be consumers of health care. We've had this demographic shift where more than 70 million baby boomers are at an age where they just need more health care. The increase in the elderly population as well as chronic diseases creates an even greater demand for nurses, leaving them over. And then you have about a third of the nurses who are baby boomers themselves and are nearing retirement age. And there aren't enough new nurses entering the profession. Now, on the other hand, over the past few years, this fragile balance between supply and demand was starting to unravel.

It's a health care crisis that's only getting worse, and it could affect almost all of us in the coming decade. But of course, the pandemic just made all that a whole lot worse. And now nationwide, we're facing a really severe deficit. Government figures show that there are almost 400,000 fewer people working in healthcare than when the pandemic started. That's a lot. What can actually be done about the shortage? There aren't really any easy fixes. It's kind of like a staggering math problem. You're trying to recoup potentially hundreds of thousands of nurses who have left their hospital jobs. You could, for example, try to increase enrollment at nursing schools, but that's something that's challenging

because you can't just flip a switch and churn out more nurses. It's a two-year program, and schools are really struggling to hire enough instructors to train more nursing students. There have also been legislative efforts to address the problem. Some of these efforts have aimed at boosting nursing pay through, for example, increasing Medicaid and Medicare reimbursements. There's also been proposed legislation that's tried to lessen the burden on nurses and prevent burnout by setting limits on how many patients nurses can take care of at any one time. But most of these efforts have failed. Ultimately, you're up against the power and might of the healthcare industry, which has really stood in the way of any significant changes.

has really stood in the way of any significant changes. Andrew, you described this real kind of snarl of problems facing hospitals right now. And I'm thinking of Bobbi Ann and of her unit and those two floors that are closed with all those empty hospital beds. What's going to happen? Well, she's in a pretty tough spot. We just can't compete. You know, we're a small hospital system and some of our ones have felt guilty leaving us before. Our family is going to travel. They're like, I just can't not get the money anymore. Many of the nurses I've spoken to who have

hung in there with her up to this point admit they've thought about taking that big paycheck from travel nursing. But that hasn't stopped Bobbi Ann from hoping they'll stay. What do you have to offer that other places don't have? Like, what would you say? I would say the atmosphere and the familiness that's around here and the work environment. I mean, you can't beat it. No, I feel, I definitely feel like a camaraderie, yeah. Yeah, like you can't beat it. No, I feel, I definitely feel like a camaraderie.

Yeah, like you can't beat that part. Bobbie Ann is really hoping that the other nurses feel like the staff is a family and that that will hold them together. Walking down the hall and everybody speaks to you and they say hey and, you know, you never go through anything alone, ever. Like, you've always got somebody. And this is something that she talks about very personally. She told me about this devastating story at the beginning of the pandemic about this moment that really tested her own resolve. So we think that I had COVID when it started.

And I was 33 weeks pregnant. And I lost my son, I think, to COVID at 33 weeks. I'm so sorry. And so the day we lost and delivered my son is the day we admitted our first case. She was 33 weeks pregnant and lost her son. And she describes how the staff really came together and supported her. And so they planted a tree for my son at the pond. And the family is just like none other.

That's why I stayed. They planted a magnolia tree at the edge of a pond on the hospital grounds to honor his memory. And three weeks after she lost her baby, she was back at work on the floor as the hospital was undergoing its first surge of coronavirus cases. Wow. Can't leave your guys by themselves. You couldn't. As I kept talking with Bobby Ann,

there was this one moment that really stood out to me. We were standing in the hallway with another nurse, and they were sort of going through kind of their horror stories about patients that they had grown attached to who had died. We had a guy that was dying and his kids were trying to get there to see him. And describing some of those moments. You'd like to be able to check it at the door, but you can't. And just then, over the loudspeaker. That's rough.

I had a baby. A baby was born. Comes this lullaby. Daddy, look. had a baby. The baby was born. Comes this lullaby. They were both smiling and looking up at the speaker. A little bit of goodness and a whole lot of awful. We used to play Don't Stop Believin' whenever we discharged a COVID patient. It would play through the whole hospital. Because, I mean, they stay with us so long, typically. So when we were wheeling them out, we'd hit the button and it would play while we took them out. But not anymore.

Not anymore. What do you do? What will you remember most about Bobbi Ann? What will you remember most about Bobbi-Ann? I think her ability to keep going in the face of so many difficulties and both personal loss and just the death and illness that she's been dealing with for two years. She just sounds like this real life force. And our entire healthcare system is depending on people like her.

And she doesn't have the support. She doesn't have the staff. She's doing the best she can with so little. Yeah, I think that's a really good way of putting it. I think our healthcare system at the moment depends on kind of selfless people like Bobbi Ann, who, in the face of a really, really tough situation, just keeps at it. We've got to get help somewhere.

You know, something's going to have to give. Somebody's got to save us while we're saving everybody else. Andrew, thank you. Thanks for having me. We'll be right back. Here's what else you need to know today. Thank you. since 2014. The spike in shelling raised fears that the conflict between the two countries had moved beyond diplomacy into military action. The Ukrainian military said the shelling struck a kindergarten on the Ukrainian side, injuring three adults. At the same time, Russian-backed separatists claimed they came under fire from Ukraine.

Western officials have said that Russia could use incidents like this as an excuse to invade. Russia plans to manufacture a pretext for its attack. U.S. Secretary of State Antony Blinken told the U.N. Security Council that the pretext could take any number of forms. This could be a violent event that Russia will bring on Ukraine or an outrageous accusation that Russia will level against the Ukrainian government. Russia says it is withdrawing troops from the border with Ukraine. But the U.S. defense secretary said Russia was continuing to move troops closer, adding combat aircraft and stockpiling blood supplies.

And Russia expelled the deputy U.S. ambassador, a move the State Department called a, quote, escalatory step that could limit diplomatic solutions for the crisis in Ukraine. The U.S. official, Bart Gorman, is the number two American diplomat in Russia. A State Department official called his expulsion, quote, unprovoked. The top U.S. diplomat in Russia, John Sullivan, remains in Moscow. Today's episode was produced by Rob Zipko, Diana Nguyen, and Eric Krupke. It was edited by Liz O'Balin, contains original music by Marian Lozano and Alicia Vietube, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsberg

of Wonderland. That's it for The Daily. I'm Sabrina Tavernisi. See you on Tuesday after the holiday.