After experiencing syncope, my husband was rushed to an urban medical center emergency department (ED) on a Saturday evening. I accompanied him in the ambulance and watched him respond positively to the newly started intravenous (IV) line. I asked the attending EMT if they were unusually busy-"No, it's back to normal now. Last March, because of COVID calls we were having 4 to 5 codes a shift in the ambulance-not as intense now, just a normal, busy weekend." As we walked through the ED to the assigned room, I felt no sense of normalcy. Every seat was filled in the external waiting room including patients with IV lines. There were patients on gurneys lining the hallways on both side of the nurses' station. As the ED nurse attached my husband to the monitor and drew blood, I commented about the level of activity, "You are really busy tonight!" "Oh no," she countered, "This is pretty normal." Two hours later, there was a flurry of activity and "normality" was gone. Victims from a mass shooting in the city poured into the ED. Screams of pain and calls for crash carts echoed through the halls. Staff drew the curtains across the doors of the patients' rooms to shield everyone from the sights, but the sounds continued for the next 3 hours as staff worked furiously. When my husband was discharged, 2 hours later, we wove through the crowded hallway and waiting rooms to the ED entrance, now barricaded with police vehicles. And I wondered, "Is this the "new normal?"
Stress levels and managerial disruptions in clinical settings soared throughout the pandemic and societal turmoil of the last few years. Hospital closures and the high rate of resignation of health care staff are the result. The American Hospital Association reported more than 3 dozen hospital bankruptcies in 2020 and many permanent closures, especially in rural areas where the need is great.1 From 2020 to 2021, hospital staff turnover increased by 6 points, from 19.5% to 25.9%, and RN staff turnover rates were even higher, from 18.7% to 27.1%, with the greatest percent increases in Northeastern hospitals.2 Nurses are leaving the profession at higher rates than ever. Thirty-two percent of nurses surveyed by McKinsey reported intent to leave direct patient care positions because they do not feel safe or valued in current work environments and have no work-life balance.3 National leaders of health professions' associations are demanding change including the President of the American Nurses Association who asked the US Secretary of Health and Human Services to declare the nursing shortage a national crisis.4
I cannot imagine working in the "new normal" that I observed in the ED. I am grateful for the nurses who are hanging in, advocating for deep system change, and hopefully caring for each other. Some believe that every crisis is an opportunity. I can think of a no more opportune time than now for major change in the US health care system.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
REFERENCES