The ship sinks, the band plays on.

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Jan 25, 2022, 2:23:14 PMJan 25


I Was An ER Nurse For 10 Years. These Are The Nightmare Conditions That
Made Me Quit. "I refuse to watch my patients die because of absolute
chaos that could otherwise be avoided, while, sadly, we are told to keep
quiet as the ship we’re on sinks." By Sally Ersun, 01/25/2022 09:00am

I am an emergency room nurse in a large U.S. city, and after a decade of
working in hospitals, I want out. And I’m not the only medical
professional who is quitting ? hundreds of thousands of us have since
2020. The stress we are encountering currently because of the fallout
from a mishandled pandemic is what is finally breaking my colleagues and
myself. I would like to give you a glimpse of my last day spent in the
ER ? my latest, as I received assignments at various hospitals
throughout my career by using a travel contracting company ? to
understand the gravity of what is happening.

I rush from one end of the emergency room to the other, dialing the
pharmacy for some antibiotics that I have been waiting several hours
for. I have just finished unsuccessfully coding one patient, while
another decides to forgo her call light, and, instead, unsteadily walk
out of her room to get me while I’m signing the other patient’s death

The patient who left her bed to get me falls and hits her head. The
doctor, who witnesses the fall too, does not look up from his desk when
it happens. “She’s going home,” he tells me. “No she isn’t, because she
JUST FELL AND HIT HER HEAD. She needs a CT scan and this is a sentinel
event,” I argue. “Ok, I’ll order a CT. Then she is leaving,” he replies.
I guide her to a bed closer to the nurses station so that I might be
able to hear her better if she needs me. The reality is we do not have
enough staff to assist her with her needs while I am stuck in emergency
after emergency.

Moments earlier, the patient who died just before that woman fell was
pushed into Room 9 with firefighters pumping on his chest. He was
waiting outside with them in critical condition and he coded in the
ambulance bay. Because we are so short-staffed, I asked the firefighter
to continue to assist with the chest compressions while I provided
medications to try to save his life. As I received the report from the
transporting nurse, I learned that the patient had an active bleed and
was given two units of blood at the previous facility where he was being
treated. They ran out of blood there.

“Would you like me to run and get STAT blood, doctor?” I asked as I
looked down at the pale, motionless body in front of me. “No,” he
replied. “We only have two units left, and we are saving it for any
emergency pregnancy complications.” This is when I learned that all of
the local hospitals are in dire need of immediate blood. Two units will
not save a hemorrhaging pregnant woman ? not even close. I am watching
my country’s health care system crumble in front of me, and this man is
just one of its many casualties.

“I am watching my country’s health care system crumble in front of me,
and this man is just one of its many casualties.”

A little while later I ask the doctor, “Are you planning on speaking
with the deceased patient’s family? Would you like the phone number of
his daughter?” He tells me to call the man’s primary provider to take
care of the death certificate and speak with the family. I follow his

Shortly afterward, I see a young couple standing outside the code room.
They are the distressed family members of the deceased patient. I ask
the couple if anyone has spoken with them yet. They tell me they were
led by hospital security to the body of the patient without anyone
speaking with them. I ask the doctor who coded the patient if he will
speak with the family to explain that we tried to save his life and
hopefully ease their pain. He tells me no. I ask the on-duty social
worker if he will speak with the family. He refuses.

Suddenly, I hear a wailing sound from Bed 6 — the patient who fell. I am
unable to provide a moment of comfort to the family of the deceased man
in Room 9. I run to the bedside of the woman in Bed 6. She needs
medicine for pain ? immediately. I obtain a STAT morphine and Zofran
order from the doctor. I enter the orders in the computer because the
doctor, with so many ER patients solely under his care, is too busy to
do so.

Soon after, the woman’s discharge paperwork comes in, but she is still
crying from intractable pain. She is a multiple myeloma patient and the
medications she is taking at home are not helping with her pain today.
Are we allowed to admit her because she is unsteady and her pain is
severe? The answer is no. We can’t allow her to occupy the bed ? there’s
simply no room for her.

I provide her with a walker and wheel her out in a wheelchair to a taxi
as tears roll down her cheeks. “I’m sorry,” I say and then instruct her
to call 911 if anything becomes “worse.” Earlier, I was forced to
discharge a young homeless man with no shoes and no pants who was
disabled from previous multiple strokes and who today was unable to even
use the toilet by himself. I had already “gone up the chain of command”
with my concern about what I felt was his dangerous discharge, but I was
brushed off. I am worried he will not live the next few days.

Meanwhile, I finally have the antibiotics for my patient in Bed 7. I had
been waiting several hours for an emergency PICC line (which is a
catheter in the vein) to be placed so that they could be administered to
him. All of his veins were shot from drug abuse and this is the only way
to provide him with his medication. He has a septic hip, and hours
without antibiotics could prove critical for him. I run to his bedside
but I now have another new patient in another room who needs me.
Thankfully, another nurse is able to assist and provide the first
antibiotic to the man in Bed 7 while I help the new patient.

I am then called to the nursing station to finish the code paperwork
from earlier in the day. I’m told to leave my patients once more to
hand-deliver the paperwork to the nursing supervisor’s office. I text my
travel contract company, which is how I got this job. “I can’t do this
another day,” I write, adding, “Please take me off this contract.”

I approach the nursing office at 7 p.m., which is the end of my shift. I
let my superiors know about the fall, reiterate my concern about the
unstable discharges (which I did not agree with), and apologize for
pulling my contract. They respond by stating, “Why didn’t you call us at
the time of the fall? Did you make an incident report?”

“No. I was in a code. You can look through my chart notes and write your
own incident report, because I am no longer in contract with you,” I
reply. The mechanical responses from upper management further indicate a
total failure of leadership. I am the third nurse (that I know of) in
the last few days that has quit this unit.

“I spent days on the unit without a break for food or to use the
restroom. By the end of just three days, I developed a urinary tract
infection and lost a few pounds off my already small frame.”

This day was just one of many, many days like this at many different
hospitals. The past years have been marked by chaos stemming from the
total mismanagement of staff ratios, which have resulted in abysmal
patient care and, ultimately, deaths.

On my first day at this particular ER, the unit had run out of pulse
oximeters, which measure oxygen levels, for several hours. I had two
patients going to the ICU, both of whom were incredibly unstable, one
other in respiratory failure with COVID-19, and another with SVT (a
dangerous heart rhythm).

There were only three nurses working in the ER. An entire ICU floor had
been closed due to a staff COVID-19 breakout, which meant there were
seven ICU patients stuck on hold in the ER. I said a prayer and placed
two monitors from triage in my deteriorating patients’ rooms so that I
could see their oxygenation.

I spent days on the unit without a break for food or to use the
restroom. By the end of just three days, I developed a urinary tract
infection and lost a few pounds off my already small frame.

These are just a few examples of what ER nurses are struggling with
every single day in hospitals across the United States. This is why we
are quitting in droves. And much of our system was broken even before
COVID-19 came along. The pandemic just made it all that much clearer.

I want to help my patients ? when I graduated nursing school I dedicated
myself to saving lives ? but I refuse to be responsible for the
systematic failures of the facilities that I am beholden to. I refuse to
watch my patients die because of absolute chaos that could otherwise be
avoided, while, sadly, we are told to keep quiet as the ship we’re on
sinks. When we ask for help, we are threatened by administrators and
told to remain “professional” in the face of extreme emotional turmoil.

We are understaffed, under-resourced, and physically and emotionally
exhausted. We continue to give and give, even when there’s literally
nothing left to give, because we want to help our patients, even if it
means hurting ourselves. I have seen horrible things and watched people
die but the thing that I think has traumatized me the most is what I now
know about the internal workings of the health care system, which
prioritizes finances over lives, while the public remains trusting and

Where do we go from here? How can we transform this system in the wake
of such unbelievable catastrophe? Are we failing because health care
remains a “for profit” enterprise? Are we failing because multiple other
societal structures are collapsing and everything is intertwined? Where
has the humanity in the world gone? I don’t have the answers. I don’t
even know what’s next for me. But I know things can’t continue this way
? not for me personally and not for our country. We need to have this
conversation before it’s too late. I pray it isn’t already.

Sally Ersun is a pseudonym used by the author to protect her privacy.

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