No one is listening to us
November 13, 2020 10:48 PM   Subscribe

“In the imminent future, patients will start to die because there simply aren’t enough people to care for them. Doctors and nurses will burn out. The most precious resource the U.S. health-care system has in the struggle against COVID-19 isn’t some miracle drug. It’s the expertise of its health-care workers—and they are exhausted.” [SL Atlantic]
posted by supercrayon (86 comments total) 47 users marked this as a favorite
Meanwhile there is no consistent data collection globally on the number of health worker infections. It is estimated that as many (or more) nurses have died from coronavirus than died in WW1. 2020 is the international year of the nurse though, so keep clapping I guess?
posted by supercrayon at 10:58 PM on November 13 [12 favorites]

Pretty skeptical of the underlying premise. The article doesn't have a lot of data on actual shortages of doctors or nurses from fatigue.
posted by crazy with stars at 11:06 PM on November 13 [1 favorite]

Data would be nice. However, there is no framework or incentive for hospital systems to report on their staffing situation. Back in March an ER physician in Seattle was fired for talking to the press.

There have been a few nurse's strikes, which were quickly suppressed by mass firings. More are brewing. Apparently the hourly rate for RNs has risen to something like $120/hr, indicating a shortage in supply.

When the doctors and nurses are taking the time from their busy days to tell us urgently that *#$@ is getting real, we would do well to believe them.
posted by dum spiro spero at 11:13 PM on November 13 [94 favorites]

I want to say this sounds over dramatized but I worked in healthcare before the pandemic and a lot of the industry favored lean processing, under staffed and overworked. I've been on disability since around when the pandemic hit and wanted to move away from the industry before that.
It's a thankless job at the best of times and at the worst someone is depending on you to solve a problem you aren't qualified to do, and also someone's life depend on it. Depending on what position you have and your location, you might be having similar to sex worker risks without the pay. The insurance is shit, when someone isn't screaming at you you're listening to hold music.
I regularly cried at work before 2k people were dyeing a day from something that could have been managed with public health.
Anyone who thinks it may not be that bad should step up and get training, nothing like dealing with human fluids, that could kill you and yours for $18/hr. no set schedule or location and mandatory overtime. The blood waterwheel that is phlebotomy is always hiring.
posted by virtualpilotlight at 1:27 AM on November 14 [68 favorites]

The NHS staff in the UK are definitely struggling with exhaustion and overwork, particularly in our 2nd wave. Underfunding for ther last decade, plus Brexit, meant that services were short of staff even before covid. Low pay and high stress meant a lot of vacancies in the posts that did exist. Public trust in government instructions has collapsed due to incompetence and lies (thought at least we're not at US levels of covid denial) leading to rapidly rising case numbers, hospital bed use, and more pressure on NHS staff.

e.g. this NHS pressure group, pre-covid:
100,000 staff vacancies reported by trusts....There are more than 41,000 registered nursing posts reported vacant in the NHS in England – more than 1 in 10 posts.

Research suggests 70% of nurses leave the NHS within their first year of qualifying. Additionally, 28% of EU nurses have quit since the result of the Brexit referendum and overseas applications have halved. Cuts to nursing bursaries has also led to 33% drop in university applicants.
Over the last three years the GP sector has been characterised by practice closures and increasing difficulties of recruiting staff. BMA estimates that from 2018 England is set to lose between 618 and 777 practices in the next 4 years. So far, closures have seen more than a million patients displaced since 2013.

To make matters worse a record 15.3 per cent of GP posts in the UK are unfilled. Currently in England there are more than 6,000 full-time GP posts unfilled.
Then you add Covid-19.
Fears are mounting for the wellbeing of thousands of NHS doctors and nurses who are suffering from burnout during the coronavirus pandemic, with mental health conditions accounting for up to 20 per cent of absences at leading hospitals.

Use of the BMA’s mental health helpline has risen by 80 per cent since September last year, The Independent understands.
Research by the group found that high levels of absence attributed to anxiety, stress and other psychiatric illnesses continued in the months after the spring peak.

In one member trust, 20 per cent of absences in September were due to mental health conditions, representing an increase of about 10 per cent compared with the hospitals’ pre-Covid rates.
Widespread nursing shortages across the NHS could lead to staff burnout and risk patient safety this winter, the Royal College of Nursing has warned.

The union said it was worried the extra responsibility and pressure placed on senior nurses could lead to staff "burnout", as hospitals struggle to clear the backlog of cancelled operations from the first wave of coronavirus and cope with rising numbers of new Covid patients, as well as the annual pressures that winter typically brings.

The boss of NHS England, Sir Simon Stevens, told a Downing Street press conference on Thursday that flu and other winter conditions usually brought in 3,000 additional patients to hospitals, but there were already more than 10,000 coronavirus patients in England before winter pressures have even arrived.
Mike Adams, RCN England Director, said: "The NHS is now at its highest level of preparedness as it faces the prospect of an extremely challenging winter. 
"We already know that frontline nurses - in hospitals, communities and care homes - are under huge strain. Anecdotally we're hearing that in some hospitals they [nurses] are becoming increasingly thinly spread on the ground, as staff become unwell or have to isolate, at the same time as demand on services continues to increase. "
Winter is always tough on the NHS staff even in a normal year, but 2020/2021 is looking to be really, really bad. Then we're almost out of time to avoid a no-deal end of the Brexit transition on Jan 1, with masses of new customs checks with software not even tested yet, which would have a catastrophic impact on PPE and medication imports due to logjams at the ports; which are already struggling. I am genuinely scared of what happens in January.
posted by Absolutely No You-Know-What at 1:49 AM on November 14 [29 favorites]

nursing strikes in the works

Governor okays hospitals to let Covid positive workers work
Anecdotally recruiters are paying well for travel nurses and locums positions for physicians.
posted by roguewraith at 1:49 AM on November 14 [5 favorites]

It's not burnout, and using burnout is a word infuriates me. It's structural. It's literally a lack of space, equipment, and trained personnel. It's a bunch of social policies. It's about hospitals that don't want to pay for care, lack of insurance coverage for America, a thousand tiny factors of indifference, heaped with politics and personal beliefs mashed together.

But ultimately, there is just only so much the human body can do. Healthcare workers are people who are hitting the limitations of being human. It's not breaking down, it's fundamental biology. The human condition. It's not changeable. Sleep is required. No one can do two things at the same time. Attention isn't an infinite resource in the brain for anyone. You can't fix that with encouragement, you can't fix that with signs or praise, you can't fix that with pay, you can't fix that with anything but more staff to do the job, in a combination of trying to address the problem. People with COVID require equipment, attention and care from trained personnel or they die. We don't have enough equipment, we don't have enough attention and we don't have enough trained personnel. That's the end of it.
posted by AlexiaSky at 2:07 AM on November 14 [174 favorites]

well stated, if i were to boil it down: individual human effort cannot overcome large scale structural deficits, and it's immoral to suggest that it could. the only people failing are the suits.
posted by j_curiouser at 2:17 AM on November 14 [57 favorites]

I'm currently involved in a qualitative study with participants from different emergency rooms across Canada and our findings echo this big time. We were expecting them to tell us about PPE shortages and fear of contamination, but they ended up talking a lot more about slashed vacations, moral fatigue, exhausting safety theater and bad staffing decisions. Coronavirus is just another germ they have to deal with daily; the pandemic is a whole other socio-political mess and they're caught in the middle.
posted by Freyja at 2:55 AM on November 14 [29 favorites]

Pretty skeptical of the underlying premise
That when health care workers speak out they are not believed?
Is Ironisterical a thing?
posted by fullerine at 3:06 AM on November 14 [54 favorites]

More infuriating than “burnout” is its proposed panacea of improving “resilience”, implying that the problem is a lack of fortitude among healthcare workers.

Why bother with better work conditions and hazard pay when a mandatory mindfulness course will suffice?
posted by ianK at 3:10 AM on November 14 [74 favorites]

Wow... Someone has been living in a fantasy land if they believe there is an infinite supply of magical medical personnel that will appear when needed to save us all from COVID-19.

Meanwhile, in our ‘dumpster-fire’ reality:
While Sanford Health denied the allegations, several Sanford nurses tell Valley News Live over 70 traveling nurses have ended their contracts in Fargo early due to what they cited as ‘poor working conditions.’

One former traveler says she left after three weeks due to little staff, calling her time working in North Dakota ‘a s*** show.’

“Horrifically understaffed, they took an old hospital slated for renovating and set it up for a COVID hospital. Little staff, mostly travelers swimming in the deep understaffed with a hastily set up supply room without supplies! Room don’t get Cleaned, there are NO NA, and very unsafe conditions. Electricity went out twice with all patients on vents!! Pharmacy can’t keep up so meds not available. I left after 3 weeks stating physical, mental and moral. It’s not worth it and my license is too precious. Sanford doesn’t want anything but bodies. Never again.”
posted by rambling wanderlust at 3:31 AM on November 14 [31 favorites]

I can't find the article again, but one of the issues which might lead to a strike in Philadelphia is that the people in charge didn't get rid of any nurses. Instead, they fired support staff, which meant that nurses had to spend more time on record-keeping.

This means less time on nursing and/or less time off. Not mentioned in the article, I think, but those records are also a matter of life and death.
posted by Nancy Lebovitz at 3:55 AM on November 14 [9 favorites]

It's not burnout, and using burnout is a word infuriates me. It's structural.

Genuinely curious: In the UK, burnout means emotional, physical, and mental exhaustion caused by prolonged and chronic stress - usually due to poor working practices. This can be include excessive workloads, understaffing, bullying, sexism, or discrimination among other things. Staff burnout is, and is seens as, a failure of managers to properly look after their staff, i.e. putting them into an untenable position until they burn out or quit. It's not the fault of individuals - it's a systemic failure, as you say, pushing people well beyond their limits, and a failure in a company's duty of care. Where the workplace is entirely toxic due to mismanagement from the top it may be denied as their fault within the org itself (and certain industries are particularly prone to this) but it's not viewed that way from the outside, in my experience - companies with a high turnover of staff often indicate burnout issues, and quickly get bad reputations. The NHS being a case in point, it's well known as an awful place to work right now (some areas worse than others, obviously), which certainly doesn't help recruitment any.

Is burnout in the US seen as a personal failing, rather than one caused by bad management and toxic workplaces?
posted by Absolutely No You-Know-What at 5:15 AM on November 14 [24 favorites]

Is burnout in the US seen as a personal failing, rather than one caused by bad management and toxic workplaces?

Judging by how many conferences and meetings I’ve seen aimed at nurses and physicians on how they can/should prevent their own burnout, the administration sure seems to think so.
posted by obfuscation at 5:19 AM on November 14 [52 favorites]

See also

I'm no health administrator but that person seems, to me, like someone you'd want to retain.

Incidentally: I'm no health administrator, but I would not like that person to die because their bosses are arseholes.
posted by pompomtom at 5:30 AM on November 14 [1 favorite]

Is burnout in the US seen as a personal failing, rather than one caused by bad management and toxic workplaces?

In Canada: yes, all too often. The main communication to medical professionals about burnout comes in the form of mandatory "eat right and exercise and get enough sleep" wellness seminars from one's hospital or university. The clear message is that burning out is a personal failure to Be Well Enough. The profit motive may not be the same as in the US since it's a public system, but cost savings initiatives and budgetary pressures add up to basically the same dynamic.

In the Before Times I was part of a group that gave a presentation on this subject at our hospital called "Wellness is a Lie", somewhat against our boss's advice. Fortunately we didn't get fired and the suits who were present made little chagrined noises about recognizing structural problems. But I'll give you one guess whether anything has changed. (Hint: the mandatory seminars are on Zoom now.)
posted by saturday_morning at 5:36 AM on November 14 [41 favorites]

Fortunately I didn't get fired... one guess whether anything has changed

Thank you for trying.
posted by pompomtom at 5:39 AM on November 14 [12 favorites]

I’m too tired to look for data on it right now but remember that doctors and nurses are not the only health care workers... Nursing Assistants and other titles for the low wage caregivers who work in long term care are out here too, in the millions.

And no I don’t have this data either but as a manager trying very very hard to manage and hire nursing assistants in clinic and home care settings and getting constant inquiries from other companies about how my hiring is going I can tell you that here in my metro area we are threadbare on staffing and resilience in healthcare. People are just done, man, and I am terrified of this winter and just praying (and I’m not much for prayer) that Deus Ex Cashina comes from somewhere to pump money into hiring and equipment and resources because we who are caring long term for the populations most at risk are just losing our shit trying to get through it.

Okay, happy Saturday, back to rearranging a home care schedule that includes COVID positive patients with 60% of the required staff. That’s what this crisis looks like now.
posted by skookumsaurus rex at 6:27 AM on November 14 [24 favorites]

More infuriating than “burnout” is its proposed panacea of improving “resilience”, implying that the problem is a lack of fortitude among healthcare workers.

I've said this elsewhere, and apologize for the self-link, but: as far as I can tell, 100% of the google results for “burnout” or “recognizing burnout” boil down to victim-blaming; they’re all about you, and your symptoms, and how to recognize when you’re burning out. Are you frustrated, overwhelmed, irritable, tired? Here's how to self-diagnose, and then: resilience!

If this was advice about a broken leg or anaphylaxis we’d see it for the trash it is, but because it’s about mental health somehow we don’t call it out. Is that a shattered femur? Start by believing in yourself, and believing that change is possible. Bee stings are just part of life; maybe you should take the time to rethink your breathing strategy. This might be a sign that breathing just isn’t right for you.
posted by mhoye at 6:41 AM on November 14 [51 favorites]

Anyway, yes, burnout is an avoidable workplace injury, no different than a forklift accident. You deal with it with training, rules, guardrails and structure, not with "self-care", a "wellness mindset" or "resilience". Those are all just bullshit terms for victim blaming and covering up institutional negligence.
posted by mhoye at 6:48 AM on November 14 [27 favorites]

I work non-clinically in a hospital network, so let me add to the structural problems that are exacerbating this:
There was a while during the summer, during the big spikes of covid in july, that everyone was required to take vacation. Apparently the budget is different paying for vacation time and paying for wages, so the administration demanded that a small but significant percentage of labor for each department come from paid leave. We were already short staffed, as were most departments, a lot of people just left after covid because they didn't want the risk.
Our ESD department (janitorial) is one of the most important, and they've gotten an insane addition to their workload. They're not hiring any more people. Instead, they've decided to just not service locations in the building, ours being one of them.
posted by FirstMateKate at 6:57 AM on November 14 [13 favorites]

In the US, the Republican party has been defunding schools, healthcare and such for decades while pumping up public sentiment that police, prisons, and military can never be defunded but must be eternally enhanced. And when Democrats get elected, do they refund social programs? Not really, no. Because by then the Republicans have trashed the economy and we have to take austerity measures. It's maddening that we can't have socialism because of all the people obsessed with military toys and private yachts.
posted by rikschell at 7:02 AM on November 14 [32 favorites]

My favorite story about burnout and administration is when my department got a $20,000 grant for "fatigue risk management", and then we found out the one specific thing we weren't allowed to spend the money on was... hiring extra help so that our workers wouldn't be so fatigued.
posted by saturday_morning at 7:02 AM on November 14 [52 favorites]

I work in the mental health field and burnout is still routinely addressed as something individual. So many goddamn self-care workshops. The best they’ve done is provide us the phone numbers of other low-cost clinics to get our own mental health treatment. But even that frames it as an individual problem, go deal with it yourself. We certainly aren’t going to change anything structurally.
posted by brook horse at 7:05 AM on November 14 [11 favorites]

I work in a healthcare setting in a non-clinical position, and can verify a lot of what's being said. New COVID-19 infection rates are skyrocketing, and yet there are a lot of people who run bars and restaurants who insist that they can't and won't follow state guidelines regarding masking, social distancing, and even sheltering in place because they value the continued existence of their businesses over peoples' lives. The temporary panacea of outdoors seating is going away with the onset of winter, and that's the choice that they're making, studiously ignoring that they are literally killing off business. (Oh, and our state's voters just shot down a progressive income tax, so, so much for an additional source of funding to compensate affected businesses. Way to stan for the billionaires, small business owners!)

And what does that mean for us, and me? Well, thirty years after I gave up janitorial work to go to work in libraries, I may end up doing that again because we'll be short in all sorts of positions and it may get down to closing the library again for the duration of the emergency. And I'll consider myself lucky, because I'll still have a paycheck.
posted by Halloween Jack at 7:19 AM on November 14 [15 favorites]

temporary panacea

It's not a panacea if it's only temporary.

/pedant derail

posted by eviemath at 8:19 AM on November 14 [4 favorites]

This is my family right now.

There is definitely a nursing (and other healthcare provider) shortage across the country. It is fairly regional though. Some areas are flush with nurses. Other areas have nurses, but no facilities. Some areas lack both. Arizona has both a lot of hospitals and a lot of nurses because of our demographics and even with that privilege in our access to healthcare, we still don’t have enough nurses (or support staff) to keep patient/staffing ratios safe.

My husband is a cardiac PCU nurse in Arizona who spent 5 months working Covid.He has seen ALL THE THINGS. He was the first to volunteer to take Covid patients when they designated part of his unit as the Covid ward in March. He came home apologetic like it wasn’t something I already knew he would do. He's that guy.This is his calling.

March and April were weird. Our state cancelled all elective surgeries and the hospitals emptied out, but our numbers didn't get bad in Spring here. When my husband went to work it was stressful and busy and completely overwhelming. They didn’t have enough PPE for housekeeping and lab work people coming in the rooms, so the nurses were doing that in addition to their normal duties. Many of the Doctors themselves refused to come into the rooms. They were still figuring out how to treat the patients. His shifts were brutal. But - at least once a week for the first few months, my husband was called off work. They were overstaffed because the only thing happening was covid. We used up all of his vacation time making ends meet during this period. Yay! What the hospital should have been doing during this period was cross training nurses and gathering PPE. They really didn’t seem to do any of this. Likely because they were losing money like crazy when so much of the medical system shut down, PPE purchasing was like some crazy libertarian wild west and they are also just generally uncaring asshole capitalists.

Things started picking up in May, but he got sick with what at first we thought could have been Covid and was forced to quarantine for 2 weeks. We all tested negative multiple times (and negative for antibodies after) so I'm pretty sure it was something random he picked up at work, since other diseases still exist.They didn’t trust the tests at that point, so home it was.

The summer was terrible. He is in his second year of nursing. His first year, he lost one patient. The entire year. Someone would die on his unit around once a month or so - usually someone already on comfort care. He lost 5 people over the summer. His unit was losing at least one a day for a while. This doesn’t count the people that my husband sent to ICU for ventilation or other treatment that subsequently passed. He really has no clue what that number was, because he has no desire to take on that additional emotional burden. I know 5 deaths in a few months during a Pandemic doesn’t seem like a huge number, but it really is. They weren't good deaths. They were lacking peace and family. They involved my husband holding up phones or ipads for family to say goodbye. They involved my husband being the only one in the room for comfort. They involved family calling in moments too late.

The patients that did not die weren’t much easier. Covid nursing is hard. Wearing full PPE including gown, surgical mask and CAPR for 12 hour shifts is draining. Dealing with scared (and sometimes not scared, but conspiracy minded) patients is emotionally difficult. Covid itself can have neurological or mental effects and makes people act in weird ways. He works in an area with lots of elderly folks and poverty. His Hospital takes in many from both the San Carlos Apache reservation and parts of the Navajo Nation. One of the reasons he chose this hospital was to serve the marginalized, which he is doing. But seeing how disproportionately the marginalized have been harmed by this pandemic is gut wrenching for him.

Two co-workers have died of Covid. Many many other co-workers have been sick with Covid. Some have long Covid. My husband has a beard, and in March I suggested shaving so he could wear an N-95. At the time, his unit had enough CAPRs (space helmet thing) for him to always have access to one, so he put it off. Access to it never became an issue, so here we are 7 months later with a beard. We honestly think the CAPR is what has kept him Covid free. Fellow nurses have been reusing N-95s this whole time. They still are. And they are getting sick. This is not ok. He feels some amount of guilt having the CAPR, but he has a moderately high risk wife and two kids at home, so I feel that guilt is misguided.

The numbers got better here and for the purpose of … combating burnout, his unit (the first to go Covid) after over 5 months was the first to convert back into a non covid unit. But staffing was still up so he started getting sent home once a week again. This time we are out of any personal time, so it’s been unpaid. Yay. He never did get any hazard pay (and he makes about ⅓ of that 100 dollar going hourly rate for travel nurses) though he did get a one time bonus of 2000 dollars. One of the most frustrating things about people being sent home - it is happening at the same time as nurses are flexed to care for more patients than their staffing ratios would normally allow. His floor has a ratio of 4:1. Covid is supposed to be 3:1. My husband has been flexed at 5:1 more often than not over the past 7 months. Fixing this would be one of the most helpful ways to actually avoid burnout.

So yeah, he's burnt out. He has PTSD. He has been drinking too much. He is so angry. At the Covid deniers and anti-maskers. At the corporate people making short sighted decisions at his hospital. At both our national and state (lack of) leadership. At the people who just won’t. stay. home. At the fact that every part of our medical system in this country is broken. During our surge, he wasn't mentally present to the rest of the family. Right now he's present for the kids, but useless for sharing the domestic workload. I was a homeschooling mom even in the before times, so that has been somewhat helpful but we aren't used to being isolated. I’m used to doing 100% of house/child duties during the time he is working, but a more equitable mix when he is off. I’m used to a support network of moms and friends to share the burden of schooling - but we are super strict about distancing as we dont want to be vectors in either direction. My kids are scared for him and us. And while we are sitting in the corner by ourselves keeping everyone safe, we get to watch friends and family taking ill advised vacations and go to weddings and other gatherings. And we have been watching the numbers rise.

Yesterday my husband's unit was turned back into a Covid unit. So we get to do it all again. And it will probably be worse.
posted by Lapin at 8:22 AM on November 14 [204 favorites]

In one year COVID is going to kill more Americans than WW2 did in 3+ (~400,000), and leave a similar number of surviving "casualties".

“It’s one person coming in from China. We have it under control. It’s going to be just fine.” -- President Trump on January 20, 2020.

irony that January 20, 2021 is a significant day for the country for other reasons
posted by Heywood Mogroot III at 8:32 AM on November 14 [5 favorites]

Hey, Lapin, please accept some virtual hugs. And please accept some more, on your husband's behalf.

Thank you for sharing.
posted by meese at 8:54 AM on November 14 [18 favorites]

I think the predictive model numbers in the 100Ks are way off. That's with hospital staff and facilities. Without those things fatalities go up to 20% or more. I've seen it happen. My zip code (just outside manhattan) saw 2.8% fatalities. NOT 2.8% of those that had covid. 2.8% of the entire zip code. Hospitals are filling up everywhere to the point where there just won't be any outside help or traveling nurses running to the rescue this time. I think fatalities may get into the millions this time. I'm bracing for that.
posted by sexyrobot at 8:56 AM on November 14 [14 favorites]

Lapin, please accept more virtual hugs from abroad. If there is anything we can do for you, I'm sure everyone following this thread would want to help.
posted by mumimor at 9:03 AM on November 14 [9 favorites]

you can't fix that with pay, you can't fix that with anything but more staff to do the job

So, I think you can, but not under capitalism and not in a way where there’s political will.

Here’s some things I doubt they’ll even try:

-high-quality meal delivery of all meals for the entire family for all staff who work in a hospital, whether nurses or reception or janitors
-cleaning services for everyone involved
-tutors/nannies for their kids
-enough money that people just don’t have to worry anymore. For all staff. Not just a 4$ pandemic bonus, but like doubling people’s salary and enabling them to relax from financial pressure
A five year commitment not to fire any healthcare worker that has worked through the pandemic
posted by corb at 9:34 AM on November 14 [28 favorites]

But corb, almost all the things you list there DO involve more staff. Just not more nursing staff specifically.
posted by showbiz_liz at 9:48 AM on November 14 [17 favorites]

you can't fix that with pay, you can't fix that with anything but more staff to do the job
So, I think you can, but not under capitalism and not in a way where there’s political will.

And certainly not this week. How many more days can our hospital capacity deal with 180k new cases/day? Or more?
posted by sexyrobot at 9:50 AM on November 14 [5 favorites]

I don't think you understand, people are litterally staying at hospitals for days at a time, eating prepared food when they can shove it in their mouths and feeling guilty that somebody isn't getting the care that they need. Because they aren't. People are dying. Every meal break, every nap, every time they take a vacation day or advocate for any perks. How about going home without being told you are essential and that you are needed? That would be amazing . None of us should be essential. We should all have multiple people to take our place. It shouldn't be well you take five or she takes 10 patients and yet that's exactly what is happening. It's this bare bones well you can do it so... But we can't. It's not possible and people will die. For the love of god we need trained people to do this in mass yesterday.
posted by AlexiaSky at 9:55 AM on November 14 [16 favorites]

That post makes it sounds like I'm a nurse and I'm not, but like these are teams I work with and my support role is very much involved in covid response at this point. But if I don't work... They just don't cover my shift. Period. And then those nurses and doctors have to figure it out themselves, or don't do it at all , or prioritize getting someone discharged so they can look at someone new. That's just the way it is right now, and it's infuriating.
posted by AlexiaSky at 10:05 AM on November 14 [11 favorites]

I want to say this sounds over dramatized but I worked in healthcare before the pandemic and a lot of the industry favored lean processing, under staffed and overworked.--virtualpilotlight

Reminds me of this comic (press the right arrow to see all panels).
posted by eye of newt at 10:13 AM on November 14 [4 favorites]

OH is an intensivist (NHS) and they get the data each week from a generated automated report. This is in the area of the UK with the least amount of infections. So far so good, but the burnout is real. The contrast with surge 1 -where ppl were almost wishing it to come to our neck of the woods as the waiting game was agonising and the talks with friends in London Hospitals was so grim- is vast. It's a dread now and already a few people have started moves for early retirement or are on long term sick leave with stress.

But what has me amazed and profoundly horrified me are the accounts I'm hearing across a number of soMe platforms from the USA of doctors refusing to attend Covid wards, WTF? The have a choice???, and their choice is to let both the patients and the other Health Care colleagues swing???

We observed the exact opposite in surge 1 here, seniors coming in to work junior jobs, ophthamologists assisting on gen med wards where ever they could. A senior surgeon came to the Med registrar (outside of A&E THE worst job at night in a hospital) and said, for staffing purposes treat me as an extra pair of hands but for Med knowledge like I'm an FY1. Foundation year 1 is the lowest rung of the training ladder. Senior surgeons get to sleep at home are are supposed to get called in at night only for life or limb threatening surgery. The numbers of examples like this were too numerous to set down here. A doctor refusing to go in to a Covid+ pts ward would be a reportable offence under Good Medical Practice, there would have to be some life threatening condition with another pt to explain it, and then the second on-call would go. What happens to Drs refusing to attend?

Now retired but years ago I was involved with regulating surgeons and taking longer than 30 minutes to get into the hospital when on call at night routinely was grounds for an investigation. It simply beggars belief, the resignation rate for Fargo now makes perfect sense.

(also that data point up page about 70% of nurses in the UK leaving after year 1 of practice correlates with their first time either on a palliative care warn or a geri ward as its their first time dealing with death and dying, not something you can really teach. Lots of innovative stuff happening as a result, my fav is Portsmouth where they've managed to do simulations. memail me if interested)
posted by Wilder at 10:23 AM on November 14 [27 favorites]

But what has me amazed and profoundly horrified me are the accounts I'm hearing across a number of soMe platforms from the USA of doctors refusing to attend Covid wards, WTF? The have a choice???, and their choice is to let both the patients and the other Health Care colleagues swing???

I mean maybe you'd risk your life participating in that insane meat grinder the first time around, when it was arguably an unprecedented occurrence. But this is round two, when the government and larger society know it's coming. You want people to go through that again because the rest of the society couldn't be bothered staying home and wearing masks? Fuck right off.
posted by ryanrs at 10:48 AM on November 14 [7 favorites]

Lapin, I'm sending some virtual hugs from the Netherlands....
posted by DreamerFi at 10:59 AM on November 14 [1 favorite]

A nurse on Twitter describes her experience in El Paso, Texas, where patients are put into "the pit" and basically left to die.
posted by They sucked his brains out! at 11:00 AM on November 14 [14 favorites]

And yet I still know doctors and healthcare workers who voted for Trump. White supremacy is a hell of a drug.

My condolences for all the healthcare workers in this country -- in a just country full of sane people we would see the people responsible for coordinating covid denial / anti-masking hang.
posted by benzenedream at 11:04 AM on November 14 [9 favorites]

In Norway, where they crushed wave 1 with an early lockdown and have only had 294 deaths total, doctors went on strike about a month ago to challenge high workload and working conditions. I believe it's now going to arbitration.

(Wave 2 looks like it's incoming for Norway, but in the area I'm in, they just implemented a mask mandate and it went from near zero masking to near 100% overnight, so I wouldn't be too surprised if they manage to crush wave 2 as well)
posted by knapah at 12:17 PM on November 14 [10 favorites]

It's not burnout, and using burnout is a word infuriates me. It's structural. It's literally a lack of space, equipment, and trained personnel. It's a bunch of social policies. It's about hospitals that don't want to pay for care, lack of insurance coverage for America, a thousand tiny factors of indifference, heaped with politics and personal beliefs mashed together.

It's absolutely burnout. You've just described the causes of burnout. Burnout is the end result of all the structural problems.
posted by gaspode at 1:03 PM on November 14 [11 favorites]

I’m too tired to look for data on it right now but remember that doctors and nurses are not the only health care workers... Nursing Assistants and other titles for the low wage caregivers who work in long term care are out here too, in the millions.

My spouse is currently about to finish an RN program in spring, and these folks are a significant fraction of their classmates--more or less all of the ones who are currently working while in school, honestly. Everyone is frightened. The students who are working tell stories about how badly the hospitals are handling things; the ones who aren't working are openly talking about how little their expertise will be valued. (Clinicals are more or less entirely online right now, and labs are inaccessible. Nursing students in this brave new world post COVID are not going to have as much scope for practice before they are shoved out the door as fully qualified, and every single one of them knows it.)

There are a lot of people who are burning out right now. There are a lot of people looking for alternate work options, or trying to retrain themselves. You think we don't value doctors? Whoo boy are the health care workers ranked at RN and below getting a swift lesson in how much our society values their labor. Even if you only care about RN-level nurses and nurse practitioners, these lower-level certified nursing and care staff are a massive source of the higher-trained nurses and medical staff that we rely on. We are not only going to deal with a nursing shortage, we are going to also purge our pipelines of many of the people who would ordinarily progress throughout their careers and accrue training in a hospital setting.

And nursing shortages are not only regional, but when hospitals shut down everything not absolutely essential for COVID, a lot of people wound up unexpectedly furloughed. You'd think that nurses would always be in work in a pandemic, but what we actually saw was instability on all sides. Can't rely on your job to be there for you if you do the smart thing and close down as much as possible to quell the spread before you need to burn out your local nurses doing COVID care.

It's so fucked up.
posted by sciatrix at 1:39 PM on November 14 [23 favorites]

It's absolutely burnout. You've just described the causes of burnout. Burnout is the end result of all the structural problems.

When workers repeatedly see their workplaces consider burnout only in the context of worker responsibility to invest in self-care, the notion begins to sour and become rejected. Burnout is a systemic issue, but I have never heard anyone who worked in an institution which chose to respond to burnout with anything but exhortations for workers to do more to address it.

It becomes to feel like mindfulness does for me: a cop-out for institutions to slap a band-aid over structural and systemic problems without bothering to do anything that costs significant money and resources to fix. You start seeing backlashes as, yes, burned-out workers go "Fuck you, the problem is that I am trying to do too much with too little support, and you tell me I can fix it with a seminar? Fuck you! Pay me!"

That is what is happening here in this thread. This is not a rejection of burnout as a theoretical concept; it's a rejection of burnout and "treatment" for burnout as it is practiced in reality. Which is to say, something for individual people to just try harder to fix on their own without support--worsening the problem.
posted by sciatrix at 1:42 PM on November 14 [36 favorites]

Institutions are the only ones who can fix burnout and they categorically aren't going to spend the time and money on it. They literally don't care. It's easier to churn and burn people.

YOU are the only person who can save yourself from burnout. PERIOD. "Get help" is absolutely not an option and if you can't save yourself, you're going to drown and die. That's all there is to it. That's YOUR problem. Not ours. We're perfect.
posted by jenfullmoon at 2:57 PM on November 14 [7 favorites]

This thing where a governor says COVID positive nurses may work if asymptomatic - is that cover for allowing their employers to require them to work? Like, no sick days for merely having the virus?
posted by clew at 3:31 PM on November 14 [1 favorite]

This thing where a governor says COVID positive nurses may work if asymptomatic - is that cover for allowing their employers to require them to work? Like, no sick days for merely having the virus?

Nurses have more leverage than that, but not much more. So, for now, no. Next month? Who knows.
posted by ocschwar at 3:42 PM on November 14 [1 favorite]

Thank you for the hugs and support. My in-laws have been able to help us get through the tight money times this fall, and we will likely be able to dig out with all of the overtime unfortunately coming my husband's way. He called on his lunch and things are indeed already a shitshow.

I've been thinking more on this today and realizing how incredibly overwhelming this problem is and will continue being. In spite of our challenges, my little family is incredibly privileged. We have a safe home with a backyard. I don't have a job and am able to focus almost all of my energy on meeting the needs of my family. We talk openly about mental health in our house and have fostered a warm and loving environment for us and our kids. I am extremely good at listening and helping the people I love through their problems. I am here to support him.

During the pandemic, the only thing my husband has really had to do is work. Other than financial worries (which we have mostly because of expensive medical conditions - the reason for my lack of job), he is likely more privileged than most of his co-workers. Many of them are women, who even if they are married go home to a second shift of childcare and housework. Many of them are single and living alone outside of work right now to protect others - with no emotional support. Many are CNA's who do even more work than him for less money. He is able to do all the bullshit stuff the inspiration pushers tell him will help him avoid burnout. I am a fucking miracle worker of support and a beacon of calm for him! He has every advantage.

AND HE IS STILL BURNT OUT! (Or whatever we want to call it instead)

Because no one can do what healthcare workers are being asked to do (while understaffed, underprotected, underpaid) and not suffer personally. It is absolutely an institutional problem that can only be fixed when profit or efficiency aren't the primary motivators for decision making in healthcare.
posted by Lapin at 3:43 PM on November 14 [31 favorites]

Thank you Lapin for your post which I feel captures exactly what it’s like for my nursing colleagues in the states. You also capture the toll it takes on the families and loved ones of health workers, which is often swept under the rug. Give your husband a fist bump from me from across the pacific and tell him kia kaha from New Zealand.

There is a global nursing shortage which was projected to only get worse, and this was pre-pandemic. I’m afraid that covid will only accelerate this as more nurses leave the profession due to sickness and burnout, and we fail to attract and retain replacements because who would look at this situation and go yes please sign me up for that.

Most people who put their hands up to be health workers know that we’re not picking easy careers, but there’s a difference between dealing with our normally hard jobs, and dealing with a bunch of incompetent dysfunctional systems and individuals who treat us like literal cannon fodder.
posted by supercrayon at 3:48 PM on November 14 [13 favorites]

I had a breakthrough moment a few years ago when one of my nursing school classmates shared this video about calling provider burnout what it really is: “moral injury.” It makes a sobering double feature with the other video linked earlier where the El Paso nurse talks about working in the COVID “pit.” Short version; if you’re a fundamentally caring person who’s trained to give the best possible care to patients and then you’re thrown into an environment where profit rules and doctors literally won’t touch COVID patients, that’s a deep blow to your moral compass. It’s not just burnout, it’s an injury to your entire sense of being. Changing my entire frame of thinking from burnout to moral injury lifted some of the burden I held about “not doing self care right.”

That said, I wish that moral injury video had more concrete ideas, besides the extremely self-serving push to share. Other nurses I’ve shared the concept with have all said “yup, that’s exactly the right framing,” but then our management continues to be shit regardless. The best any healthcare worker can do as an individual, I think, is to stand in solidarity with co-workers. Right now I have an administrative job where people higher up the chain spend a lot of time grilling me about why front-line nurses and social workers make care decisions that aren’t designed to maximize profit. Combatting moral injury to me is thinking of my job as, first and foremost, advocating for the people on the front lines who actually know the patients in question and can therefore make better care decisions than me or any other administrator.

Really the whole American healthcare system needs to be burned to the ground and rebuilt, but until then maybe this framing will be helpful to someone.
posted by I am a Sock, I am an Island at 7:30 PM on November 14 [32 favorites]

I think fatalities may get into the millions this time. I'm bracing for that.

Case fatality is somewhere in the 2% range with available care. If everyone in the US comes down with it that is 7.5 million Americans dead. But the fatality rate is going to skyrocket; if this doesn't burn out expect 10+ million American fatalities.
posted by Mitheral at 7:35 PM on November 14 [1 favorite]

YOU are the only person who can save yourself from burnout. PERIOD.

Another perspective is collective action, usually but not necessarily through unions, is the only reliably effective method for changing our working conditions, our paid leave access, our medical benefits, our schedules and compensation. And also collective action, usually via community organizing, is the only reliably effective tool for changing the oppressive and harmful conditions our patients live in. And the combo of our working conditions and the secondary trauma of caring for people who experience unjust harms are the sources of burnout.
posted by latkes at 7:41 PM on November 14 [7 favorites]

I'm an ICU nurse in Seattle. I had two zoom meetings with co-workers this week in which we reviewed deaths in the unit in the last month and discussed so many of the things in this article and the direct impacts to our entire team.

Cure your skepticism with some education. Our health care system is propped up on the backs of very, very tired people.
posted by Pantengliopoli at 7:53 PM on November 14 [18 favorites]

Thank you for your service...

And imagine how much worse it is for ICU nurses in places that have done so much worse than Washington.
posted by Windopaene at 10:06 PM on November 14 [1 favorite]

The end may be near for the pestilence that has haunted the world this year. Good news is arriving on almost every front: treatments, vaccines, and our understanding of this coronavirus...

We have reasons to celebrate, but—and you knew there was a but—a devastating surge is now under way. And worse, we are entering this dreadful period without the kind of leadership or preparation we need, and with baseline numbers that will make it difficult to avoid a dramatic rise in hospitalizations, deaths, and potential long-term effects on survivors.
It’s Time to Hunker Down

I think a case for immediate impeachment and a treason trial can be made. In a just world.
posted by y2karl at 11:23 PM on November 14 [5 favorites]

So, "burnout" is one of those terms that sounds like nails on a chalkboard for me. The other is "wellness." We are not suffering from a smoothies and yoga deficiency.

There's an increasing move to rename what's happening as "moral injury" -- a term which is also imperfect but captures the sense of betrayal much, much better. It's a phrase that originated with Vets suffering from PTSD, and while I tend to find military metaphors in medicine to be reductive and lazy, but this one works.

Health care workers are in the middle of a terrible collective trauma. Angry and betrayed doesn't even come close. And apart from maybe psychiatrists, we are not a group that deals well with trauma. When, pre-covid, I floated an idea to run a sort of monthly Schwartz seminar (where participants discuss an ethically challenging case and its impact on their unit), one of my old white male colleagues said "If you let people talk about bad things, you'll make their burnout worse."

I've been running a global survey on HCW covid experience since April (Memail me if you'd like the link to participate/share with others) and although stories in spring were mostly about PPE, now it's just straight up exhaustion. Stories of patients and parents dying alone. Fear of infecting loved ones. And anger. Lots of anger.
posted by basalganglia at 3:29 AM on November 15 [19 favorites]

During dinner last night, after what turned out to be one of his hardest days of nursing ever (already!) I asked my husband if he'd heard the term moral injury. He nodded so hard I thought his head would fall off - and proceeded to talk about how that is the perfect term for what he is experiencing (unbeknownst to me, he too really hates the way burnout is used). He came out of nursing school well prepared by some awesome teachers - and moral injury as a concept was talked about extensively In a few of his classes.

But knowing about it and talking about only goes so far when (so many) circumstances prevent you from avoiding it. On the surface, collective action for better conditions and staffing seems like a good idea - since healthcare workers should have so much leverage right now. But how on earth could anyone expect or ask them to add organizing to the list of neverending tasks in the midst of their collective trauma? They have nothing left. No spoons.

It's just so fucked.
posted by Lapin at 5:58 AM on November 15 [12 favorites]

I have a night off from the hospital. As I’m on my couch with my dog I can’t help but think of the Covid patients the last few days. The ones that stick out are those who still don’t believe the virus is real.
posted by They sucked his brains out! at 5:59 AM on November 15 [9 favorites]

Thank you so much to all you exhausted people who took the time to talk about what you're going through. I have a lot of HCW friends who are really going through it, and your stories are helping me be smarter with my empathy.
posted by lauranesson at 9:09 AM on November 15 [2 favorites]

The last non-US Covid thread is closed, so I’m not sure whether this is the right place to link this surprising finding out of Italy: Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy

We investigated the presence of SARS-CoV-2 receptor-binding domain (RBD)–specific antibodies in blood samples of 959 asymptomatic individuals enrolled in a prospective lung cancer screening trial between September 2019 and March 2020 to track the date of onset, frequency, and temporal and geographic variations across the Italian regions. SARS-CoV-2 RBD-specific antibodies were detected in 111 of 959 (11.6%) individuals, starting from September 2019 (14%), with a cluster of positive cases (>30%) in the second week of February 2020...

There had been odd results from Spanish water samples that seemed to have detected the virus itself already in March 2019, now this... maybe the history of this pandemic remains quite significantly yet to be written...
posted by progosk at 9:36 AM on November 15 [6 favorites]

Moral injury is the perfect term. One of my nursing lectures had a background in bioethics and he taught that term to us in undergrad. The way he described it in simple terms was that during ethical dilemmas, nurses knew the right thing to do but were unable to do it, usually due to circumstances beyond their control.

I had to leave ICU nursing after only six months due to moral injury for just that reason.
posted by supercrayon at 9:36 AM on November 15 [4 favorites]

Pretty skeptical of the underlying premise. The article doesn't have a lot of data on actual shortages of doctors or nurses from fatigue.

Not quite what you are looking for, but here. Scroll down to the part where 92% of ICU beds are occupied in the Texas Medical Center.

Go ahead and go to their about page and read just the first sentence.

So, yeah. We are understaffed. And all of us are working a helluva lot harder than usual. And, yeah, you now have a link to some data. I am just tech support, and I am exhausted. Heck, I have spent more time in the Morgue in the last 6 months than in the last 5 years, because of the CoVid fatalities. Tell me that doesn't qualify as fatigue.


In Summary: Can you please keep your "pretty skeptical" comments to yourself when some of us are... working in CoVid units and stressed out? For me, at least, it is hurtful.
posted by a non mouse, a cow herd at 9:51 AM on November 15 [33 favorites]

(Just as a counterpoint to that new Italian study, here’s a Googletranslation of an article that points out a number of issues: 1. it’s published in the Milan institute’s own journal, 2. the antibody test used have been shown to yield false positives, 3. there have been studies showing that exposure to common cold coronavirus can cause the development of antibodies to SARS-CoV-2, and 4. the species crossover of SARS-CoV-2 has been determined to have occurred in October 2019. So, grains of salt, as with so many breaking stories about this pandemic...)
posted by progosk at 10:40 AM on November 15 [1 favorite]

But how on earth could anyone expect or ask them to add organizing to the list of neverending tasks

Organizing is what gives me energy right now. If anyone here wants to talk about how to organize a healthcare worker strike in the middle of the pandemic, message me!
posted by latkes at 10:57 AM on November 15 [6 favorites]

I feel like "moral injury" is a euphemism for "shocks the conscience," except the latter implies a crime. Which...yeah. Compare COVID to the Flint Water Crisis and we see a developing history, differing only in degree, not in kind. Who will be the next population sacrificed to political aspirations?

So, moral injury addresses the experience, and shocking the conscience speaks to the cause. To use STC requires the identification of, oh, let's say "politicians" who are helping it to rise to the level of injury. Conceivably, a few communicable patients at a time could be taken in stride by a hospital, but the fact that there is a whole intentionally dysfunctional system producing the excess of patients makes it way worse. Criminal, one might say, and probably could make a case for.
posted by rhizome at 1:03 PM on November 15 [2 favorites]

Pandemic skepticism--doubt that the virus exists (IT DOES), disbelief that our daily experiences at work could possibly be as bad as we're describing (THEY ARE), disregard for basic public health and safety measures despite skyrocketing numbers (NO, IT'S NOT OK TO TRAVEL FOR THE HOLIDAYS AND NO, YOUR SPECIFIC PLANS ARE NOT THE EXCEPTION)--is heartbreakingly painful.

It's so hard not to take it personally that people seem to have come to the collective decision that they're done caring about the pandemic when I've done nothing BUT care about it for the last nine months. My entire life has been subsumed into it. I worry about my patients. I worry about getting sick at work. I worry about my colleagues getting sick. More than anything I worry about making other people sick, so I restrict all my non-work interpersonal interactions to masked, outdoor, physically distant encounters with either my three closest friends or my mom, one person at a time. Speaking of moms, I haven't hugged her in nine months. I do this because I care about you, yes, you, random internet stranger, and I don't want you to die. I'm a nurse. My job is to protect you, and I'm going to keep doing my job. But my god, so many people are making it really, really hard.

It is absolutely bewildering to me that the same people who were afraid to touch their groceries back in April when the seven-day average of new cases in the US was 10 per 100,000 are now blithely going to the gym and having drinks at bars and making holiday travel plans when it's 44 per 100,000 and rising exponentially.

Nor do they seem to have any awareness that the rate is 44 per 100,000 precisely because people are blithely going to the gym and and having drinks at bars and making holiday travel plans. I barely manage to suppress the screams when I look at my Facebook or Instagram feed and see the selfies: you don't have to be an epidemiologist or even especially good at math to see that the pandemic is worse now than it's ever been! Your chances of getting sick are higher now than they've ever been! They'll be worse tomorrow! If there were ever a time to be afraid to touch your groceries, this is it!

There are days when I genuinely feel like I'm losing my mind.

Please don't actually be afraid to touch your groceries. That's not how the virus spreads. But I hope my point was clear--it's more important now than it has been at any point in the pandemic to stay home, wear a mask when leaving home for essentials, avoid indoor gatherings of any size, and maintain physical distance.
posted by jesourie at 2:30 PM on November 15 [33 favorites]

how to organize a healthcare worker strike in the middle of the pandemic

That seems like a terrible idea.
posted by ctmf at 3:36 PM on November 15 [1 favorite]

What they did in Norway as regards striking was to start small, with around 20 doctors across a few towns and cities. It was basically a statement of intent.
posted by knapah at 3:56 PM on November 15

I collected graphs for the hospitalization counts for all fifty states and DC and put them up on my blog.
posted by dances_with_sneetches at 4:00 PM on November 15 [4 favorites]

That seems like a terrible idea.

Healthcare workers striking is the only way to call mass attention to the normalization of inhumane working conditions, and resulting inhumane treatment of patients, caused by inhumane systems. The Peru doctors' strike at the end of September was only 48 hours. "Included in the doctors’ demands was the distribution of a $200 monthly cash bonus that the government promised front-line medical workers months ago. Dr. Quiñones said most doctors had yet to receive the bonus despite being forced to buy their own face masks while working at hospitals that lacked even the most basic medical supplies.

“Do you know the desperation of tending to patients in these conditions? Without oxygen? Without medicine? To see a patient on a ventilator wake up with a tube in their mouth and not have the medicine to sedate them?

Their strike had broad community support and got officials to come to the table. They achieved a big step forward for healthcare workers and for their patients. The alternative was to keep on suffering and dying, one after the other, as if that's normal, as if their lives weren't worth fighting for.
posted by cybercoitus interruptus at 5:11 PM on November 15 [13 favorites]

I'm on your side. I just don't think the optics of abandoning patients in full ICUs in a crisis is a) going to generate the sympathy they're going for or b) a thing I could bring myself to do if I were them. I'm not saying I have a better idea though.
posted by ctmf at 6:04 PM on November 15

The threat of a strike with good communication about how it is for both the health of the patients and the staff can possibly work. Actual strikes are a tougher sell.

The strikers are not dealing with the public -- they are dealing with hospital administrators and government officials who would be just fine watching doctors and nurses commit suicide as long as there was a steady supply of replacements.
posted by benzenedream at 7:22 PM on November 15 [2 favorites]

There is a lot of romanticism around role of healthcare workers. It's a cultural thing; where it is an expectation for them to exhibit an ability to work beyond what is safely or humanly possible.

Some of this is embedded into narratives of medicine/nursing being a "calling"; leading to a general aversion to actions like striking.
In other regulated industries like aviation, we call it a safety violation if pilots are forced to work without adequate rest. But when doctors and nurses are breaking down, we are embodying a noble ideal.

Couple this cultural expectation with a capitalistic model of administration - the choice about striking comes down to either
a) abandon your responsibilities, your community and your patients
b) put up with it

The only thing keeping healthcare systems from collapsing and patients dying in a stressed capitalistic model is the professionalism of its staff.
posted by ianK at 8:27 PM on November 15 [10 favorites]

Healthcare worker strikes are happening now!

In the US, health workers struck in July at Santa Rosa Memorial. Nurses in Riverside struck for 10 days. Two unions of nurses and healthcare workers in Chicago coordinated to strike their university health center in September, got support from big names like Jesse Jackson, and won $15/hr for their lowest paid staff (can you imagine being a cleaner in a hospital right now, risking your family's life every time you go to work, and not making $15 an hour?) as well as basic demands around PPE and staffing. My union of nurses and other healthcare workers, in collaboration with another union that represents nurses, just struck and got the whole board of trustees that runs our local safety net healthcare system fired. Pennsylvania nurses just took a strike authorization vote and 85 percent voted to support a strike. And maybe biggest deal of all, even if not a strike, is North Carolina nurses just voted to join the NNU in the "right to work" ie: anti-union South.

Every one of these strikes made demands about community well being: We want safe staffing levels, we want guarantees around PPE, and yes, we want to be able to get basic cost of living raises too, and want our employers not to take advantage of this crisis by gutting our contracts.

This is a strategically smart time to strike. It's also a time when healthcare workers are being radicalized and are more willing to strike. And it's a time when the public has much more empathy for us and recognizes that our well being is tied with the whole community.

Big picture, this is an opportunity to make real change for working conditions and to meaningfully shift how healthcare is done in the US, and I'll do my damned best to push for real, big, structural change while we have the chance to do it.
posted by latkes at 8:31 PM on November 15 [17 favorites]

FYI in nursing strikes in the US, the employer asks the courts for an injunction, there's a negotiation process, and ultimately we're usually forced us to keep a few essential nurses who serve specialized roles inside the hospital. And the hospital hires travelers to cover other staff. So inpatient and emergency functions continue. But at a big cost to the hospital which is our leverage. Big picture, our patients will suffer if we keep allowing worse and worse working conditions. I struck in part because I've lived through enough budget crises to see how the patients at my safety net health system are always punished first. And believe me, when my employer lays off cleaners and doesn't replace retiring nurses and hassles us for taking our legally mandated breaks, we suffer, but our patients are the in danger too.
posted by latkes at 8:38 PM on November 15 [13 favorites]

I was part of a 3 day system wide HCW strike last February, shortly before covid blew up. It cost the hospital a ton of money, they locked us out for two additional days and it still took another 3 months to get a contract, complicated by covid.

From a public relations perspective (which is the battleground on which a strike is fought), I think a strike would be really damaging for us right now. We have power only in so far as the public is still behind us - at least that was my experience this year.
posted by Pantengliopoli at 9:13 PM on November 15 [2 favorites]

So true. I think strikes will win to the extent they can truly incorporate all members and build true connections and support from the community, meaning religious institutions, social clubs, activist groups and local electeds. Where was your strike?
posted by latkes at 7:21 AM on November 16 [2 favorites]

I work for Swedish Medical Center in Seattle. It's affiliated with Providence Health Services (who isn't?) And the 5 campuses and 2 stand alone EDs all picketed. Our union (SEIU 1199NW) includes almost all the staff - food service, housekeeping, nursing, respiratory. It was an amazing thing to experience, but torpedoed an already crappy relationship between administration and the staff. CoVID obviously didn't help put things back together.
posted by Pantengliopoli at 8:49 AM on November 16 [2 favorites]

Makes sense.

Impending private sector physician's strike.
posted by latkes at 2:12 PM on November 17 [2 favorites]

From a public relations perspective (which is the battleground on which a strike is fought)

The battleground on which a strike is fought is the employer's bottom line. Although strong community support and negative PR for the employer can certainly help pressure employers to accede to employee demands sooner rather than later, or avoid some of the more obvious strike-breaking tactics like bringing in scabs.
posted by eviemath at 5:38 PM on November 17

Healthcare worker check in in Metatalk
posted by supercrayon at 2:04 PM on November 19

The battleground on which a strike is fought is the employer's bottom line.

If that were all there was to it, we'd have taken three days off and sat at home. I think it's fair to say it's a combination of many things, but public impression is an enormous part of the fight.
posted by Pantengliopoli at 11:54 AM on November 21

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