HJNO Sep/Oct 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2021 29 to pursue higher-paying work as traveling nurses. Whatever the reasons, Louisiana is now overwhelmed with new admissions of COVID-19 patients to hospitals, and ICU capacity is barely keeping up with demand. The pandemic has turned an already exis- tent problemwith nursing shortages across the country into a crisis. LSBN recently completed and published its 2020 “Nurse Supply Report.” This is the third year that LSBNwill have licensure data on all licensed registered nurses (RNs) and advanced prac- tice registered nurses (APRNs) available through our Louisiana Nursing Portal. The data below is based on a snapshot of every RN and APRN that had an active license to practice in Louisiana on Dec. 31, 2020. 4 MAJOR FINDINGS • On Dec. 31, 2020, 66,076 RNs held an active license to practice in Louisiana. Ninety percent of those RNs lived in Louisiana, and 10% resided outside of Louisiana. • In 2020, 38% (22,427) of licensed RNs residing in Louisiana were 50 years and older with 18% (10,557) being 60 years and older. • In the U.S. and Louisiana, minorities comprise approximately 41% of the population, whereas minorities com- prise 20% of Louisiana’s RNworkforce. • Between 2016 and 2020, there has been a 12% decrease in the number of stu- dents accepted for admission into Lou- isiana’s RN to BSN programs. • In 2020, 17% (9,331) of the RNs work- ing and residing in Louisiana indicated that they were planning to leave their current nursing position. Nurses have been leaving the profession for a variety of reasons — an aging work- force, increased patient-to-nurse ratios and, what has been called by Rainbow, Littzen and Gelt, the “normalization of suffering.” 5 These researchers acknowledge that most individuals outside of healthcare don’t even know that there is a problem with nurses burning out. They aren’t aware, because when a member of the public enters the On a recent news feed fromWAFB (CBS news affiliate for Baton Rouge), it was reported that a nurse had just completed her fourth 12-hour shift in a row, and she had two more to go before she got a break in her schedule. 2 That is 72 hours of work in what for most people is a 40-hour workweek on top of taking care of the sickest of the sick in intensive care units for a nurse who has only been in practice for eight months. This is neither safe, nor is it good policy. Addi- tionally, it is in direct violation of LSBN’s “Declaratory Statement on Patient Safety for Registered Nurses and Advanced Prac- tice Registered Nurses Working Extended Hours,” which recommends that health- care organizations neither promote nor require nursing personnel to have direct care patient assignments in excess of 12 hours in a 24-hour period or 60 hours in a seven-day period. 3 Nurses in Louisiana are reporting that they have seen more death over the past 19 months than they have ever seen in their entire career. In my own case, I can support that I have never witnessed anything quite like this, and my career spans 47 years. It is draining — physically and emo- tionally. Imagine that you are that nurse who just spent 12 grueling hours caring for the sickest of sick patients, and during that time, you had to also deal with five patients who died and their families. I don’t think that the public can grasp how difficult it is for these men and women. Chief nursing officer at Baton Rouge Gen- eral, Monica Nijoka, estimates that her hos- pital has 20% less nurses than they did after the first two surges. 2 When things started to get better in late 2020 and into the spring of 2021, Louisiana believed it had weathered the worst. Many of the older nurses who had stayed on to care for patients during the cri- sis elected to retire when things began to look better. Others were just overwhelmed and left to pursue other careers. I predict that much will be written down the line about post-traumatic stress disorder (PTSD) as a causative factor for nursing shortages in the next five years. Finally, many nurses also left the bedsides of Louisiana patients hospital, there is always a nurse to take care of them. They usually don’t know that it might be their nurse’s fifth 12-hour shift in a row or that their nurse has been rotated from another unit to cover a nursing short- age on the COVID unit or maybe that a pedi- atric nurse has been pulled to take care of adults or that their normal 12-hour shift has turned into an 18-hour shift. And, nurses don’t talk about these things, because they have been told to be resilient, to be stoic, to pull themselves together and work just a little harder. It is a conspiracy of silence, because nurses truly are committed to their patients and to one another even at the risk of their own well-being and mental health. Nurses will soldier through this crisis. They have done it before, and they will do it now. We must ask ourselves, however, what toll this will take on the profession. In a world where there is already a nursing shortage, where nurses provide most of the direct patient care, what solutions can we bring to bear to create a work environment where neither patients nor nurses suffer? One final word about rationing care: it is a dreaded thought that doctors across the state would have to triage patients, decid- ing who does and doesn’t get care. It is a decision that, in the fourth surge of the COVID-19 pandemic, can’t be avoided, but for the nurses who will have to carry out these orders, it is an anticipated nightmare. Crisis standards of care were developed for Louisiana more than 10 years ago by Ste- phen Brierre, MD, director of critical care at Baton Rouge General Medical Center, and Michael Rolfsen, MD, an internist who teaches bioethics at Louisiana State Uni- versity. 6 No one thought they would ever have to be used. Yet, here we are, on Aug. 6, 2021, with the Louisiana Department of Health (LDH) reporting 5,468 new cases, 33 new deaths and 2,350 patients in hospitals throughout the state. The LDH reports that 90% of cases between July 22-28, 84% of deaths in that same time and 91% of current hospitalizations are in Louisianans not fully vaccinated. Nurses and respiratory thera- pists, the two most prominent direct care