The pandemic decimated the healthcare workforce. Some healthcare workers died. Others saw their jobs eliminated. But it is the nursing profession which was hit hardest.
Nurses are the foundation of a functional healthcare system. Yet, a recent survey indicates 34% of nurses plan to leave the field altogether or retire by the end of 2022. Here in Kitsap, St. Michael Medical Center and the nurses union there agreed to a three-year contract recently that increases wages significantly, yet one nurse told the Sun that the deal still doesn’t fix the staffing issues that plague the local hospital.
Here’s why the nursing shortage should alarm you: it is hard to know when you or a loved one will face a medical emergency. For me, it was more than a week ago and has led to an experience that still waits to be resolved.
On August 11 our family watched opening night of the "Willy Wonka" production I wrote about in the last column. As we left the theatre, my husband told me he needed to head home right away due to severe abdominal pain, and soon after I was driving him to St. Michael.
My husband is a 20-year veteran of the Army Special Forces. He served in Iraq and Afghanistan as well as a number of other conflicts across the world. As you might imagine, he rarely complains about little aches and pains. That made his comments unsettling, but I was relieved to hear that an excellent emergency room physician, one who saved my life five years ago, was working that night.
I wasn't allowed into the waiting room due to COVID protocol, but after standing outside the emergency room alone after midnight I decided that waiting all night outside the emergency room was not the safest choice to make.
On the drive home, the physician in me started to wonder what was wrong with my husband. He had right-sided abdominal pain, which likely meant a problem with an organ on that side. While not an exhaustive list, the right kidney, appendix, the gall bladder and liver were the most likely culprits. His mild shortness of breath and right shoulder pain pointed to his gallbladder, but the pain he felt when we drove over a pothole was a telltale sign of appendicitis.
The diagnoses was early appendicitis and the surgeon on call recommended treatment with antibiotics and a follow up five days later. The following morning, the pharmacist refused to fill the prescription, incorrectly thinking the dose was too high. Frustrated, I called another surgeon for a second opinion, who evaluated him, agreed with the diagnosis and removed his appendix that same day.
Over the weekend my husband recovered nicely. But Monday morning something wasn’t quite right. His right shoulder pain returned. His temperature was slightly elevated to 100.6, although, did not meet the fever threshold of 101. After evaluating him, the surgeon told us to call if he developed a fever. The next day his pain increased in the right upper quadrant (where his liver and gallbladder are located,) he developed chills and a fever of 102.4, which confirmed my suspicion that something more was going on.
The surgeon prescribed antibiotics and planned a CT scan for the following morning, which revealed an abscess on his liver, a condition which explained all his symptoms. While extremely rare, affecting just .0023% of the population, a liver abscess is a known complication of appendicitis. Unlike other infections, abscesses cannot be cured by antibiotics alone. Abscesses often contain dead tissue inside, which makes healing slow, and a hard outer coating that antibiotics struggle to penetrate. These infections need to be opened surgically and drained. And the longer an abscess goes untreated, the worse it gets.
Because no hospital bed was available until late Wednesday afternoon, the drainage procedure was scheduled for Thursday. After skipping breakfast, putting on a gown and being taken to the procedure room, his operation was canceled due to a patient emergency elsewhere in the hospital. Not having enough staff to treat both my husband and the other emergency meant the hospital would try to schedule it for Friday. But as this column is published Friday morning, the procedure has not been scheduled and my husband is still in the hospital.
We will all be patients eventually. Every single one of us. Maybe you've already had a experience like what I've shared. Right now, we need our healthcare workers more than ever, but they are quitting more frequently than they did before the pandemic, citing burnout and pay and benefits as the most common reasons for leaving. Nursing is challenging, physically, mentally and emotionally.
Patients frustrated by COVID-19 guidelines and understaffing — the new SMMC nurses contract did not institute a lower staff-patient ratio minimum, notably — are taking it out on nurses and their support staff. In one survey 65% of nurses report being verbally or physically assaulted by a patient or a patient’s family member within the last year. It is no wonder we are losing nurses in droves.
Hospitals need to invest in recruitment and retention of nurses because it is better for patient outcomes, and less stressful for families like mine in the situation I've described from the past week. The bottom line is that without nurses, we cannot solve this problem. And hospital CEOs, including the one at St. Michael Medical Center, would do well to remember that.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.