This story is from the Anamnesis episode called Breaking Point: Why We Become Activists at 19:46 in the podcast. It’s from Katie Best, RN, a pediatric sedation nurse at Ascension Via Christi St. Francis Hospital in Wichita, Kansas.
So 7 years ago, I was pregnant with my youngest son. We found out at 22 weeks that I was high-risk to go into preterm labor, ended up with an emergency cerclage to try and stop that from happening, and was off of work for about 2 weeks trying to make sure that we didn’t end up going into labor. Once I was supposed to get to 25 weeks, my high-risk ob specialist was fine with me going back to work. But Thursday night, before that happened, when I was 24 weeks and 5 days pregnant with him, I started having contractions.
So I ended up going into the hospital; I got there about midnight. By the time I got there, my contractions were about 6 minutes apart. And I’m not an ob nurse, but I’m enough of a nurse to know that was not a good thing. I had tried to drink about 3 liters of water. That hadn’t slowed anything down. Shortly after we were in ob triage, my water broke.
And I remember being quite angry with that. The triage nurse — she was trying to make me feel better — she’s like, “maybe you just peed yourself.” And I’m like, “I do know the difference.” Indeed, they tested, and my water had broken. I knew that meant that I was either going to have the baby soon or even if I didn’t, I would be in the hospital until the baby was born, just because having broken, the risk of infection was too high.
At the time, my oldest son was about three and a half, and so that is either a problem for me of having a kid at 24 weeks or being in the hospital for 3 months, neither of which were good options. We were able to do some IV magnesium and get my labor slowed down throughout the morning and into the afternoon. That morning, I had ended up requesting to talk to the NICU [neonatal intensive care unit] doctors. And so the NICU doctor came in to talk to me and my husband about code status and outcomes and to have the conversation with our child, do we full court press this or do we not?
Part of my background, too, is at the time I was working in cardiac ICU and there were lots and lots of times that, medically, we do things that may prolong life, but doesn’t necessarily prolong quality of life. And so that was just one of the conversations that we had to have, is do we do everything for this child that we desperately wanted, or is it better to not?
And the NICU doctors had told us that at 24 weeks and 6 [days], the chance of having some sort of medical long-term problems was about 90%. But that being said, they considered viability at 24 weeks and recommended that we do absolutely everything, and so that was our decision.
Throughout the afternoon, my labor had slowed down, and at one point, my contractions stopped for a couple hours. But as my contractions started back in the afternoon, our nurse, who was delightful and had been in the room with us all morning, ended up getting another admission. And as a mom and as a nurse, I wanted my nurse in there with me because I knew that I needed her to help monitor.
Part of what was so concerning, too, is little nugget was so tiny that he wouldn’t stay on monitor. He could swim around and get off monitor. So he’d pop off monitor, and we had no idea what he was doing. And it would take her 5 or 10 minutes to get back in the room to get him on monitor. And I know that she was trying so hard, and she was frustrated, too, that she couldn’t be where she wanted to be.
The nurse in me fully understood what short staff looks like. The mom in me was terrified for my child.
As a Mom, I Wanted Better
Then she got that admission settled, and then later that afternoon got a second admission, because evidently one wasn’t enough. And just as a mom, I wanted better and wanted somebody to be there. And I knew that we needed somebody there.
This kid was extremely — this is a high-risk pregnancy. We’re at 24 and 6, this isn’t when babies are supposed to be born. We did end up delivering that evening about 5:30 with a C-section. And he, at this point, is a happy, healthy 7-year-old child with very few issues — all things considered, doing extremely well. But as a mom and as a nurse, I was well aware of the fact that wasn’t the kind of care that I wanted, and that wasn’t the kind of care that my nurse wanted to give me.
She was very gracious about it and tried to not — I think as healthcare providers, a lot of times we say, “oh, well, we’re super busy and we’ll get there,” and we try and be kind to people who’ve made policy decisions that put us in those positions, even though as nurses we’re not happy about it and super pissed off. But yeah, it wasn’t safe staffing that day, 100% wasn’t safe staffing and just absolutely heartbreaking. And it’s a happy story because it ended well, but I know that in the ob world, things can happen so quickly that we got extremely lucky that it ended well.
I think the first thing when the nurse ended up getting an admission — and then a second admission when I was in active labor and my contractions are 6 minutes apart — was just disbelief. Like how is it even possible that we’re in a situation that somebody who is carrying a child at 24 weeks and 6 days doesn’t have a nurse in here constantly — with contractions, with active labor, and contractions 6 minutes apart.
The System Is What Fails Us as Nurses
I think there also was just a lot of anger at the system that’s set up. There’s certainly no anger at the nurse. She tried everything she could to make the situation better. The charge nurse was in there a lot. They tried everything they could to make the situation better, but the system was broken. And the system is what failed us at the time, and the system is what fails us now as nurses. And that’s why we need to fix the system.
Yeah. Just betrayal. And also just fear. Like we didn’t know — we had desperately, desperately wanted this child, and we didn’t know if we were going to leave the hospital with this child. And in fact, I mean, he ended up being in the NICU for 89 days. He was supposed to be a Halloween baby and was born on July 15. So when we went to the hospital, we went in shorts. And when he got to come home from the hospital with me, we came home in winter coats.
I have loved my hospital and I have loved to be able to take care of patients. And I know that the other nurses that I work with and the nurses that have worked on labor delivery absolutely feel the same thing.
As nurses, we show up to work every day and want to be the best nurse. I don’t show up to work to be a mediocre nurse. It is heartbreaking to us when situations like that happen. And I can see that as a co-worker and a nurse who I know that there have been times that I haven’t been well-enough staffed to take care of my patients in the way that I need to. And that’s heartbreaking to me, but also terrifying and heartbreaking to my patients. And I see both sides of that as a nurse and a mom.
At the time, I was working cardiac ICU and was on leave, obviously, having had a C-section. One of the things I had wanted to do was to sit down with the manager or the director of nurses over at St. Joseph Hospital. And I ended up sitting down with the director of nurses, but I didn’t feel like I could push very hard as a current employee because I’m the healthcare provider — or because I have a full-time job with benefits; I’m the benefit carrier of the family. My husband has a full-time job too, but is self-employed, so he doesn’t have access to benefits, or at the time didn’t.
Fear of Retaliation by Complaining
And so I didn’t feel like I could complain or advocate for my child and didn’t have a way to advocate to get the system changed because I was too afraid to lose my job. The last thing I needed was to be unemployed with a child in the NICU. And just the fear of retaliation by complaining about the unsafe staffing was very real at the time.
On the flip side, that’s my personal story of being a patient at the hospital and seeing the very real effects of unsafe staffing.
About 9 months later, I ended up moving from cardiac ICU to pediatric sedation, and my very last shift in cardiac ICU, we were short-staffed. We were five nurses short in ICU. I was tripled with a fresh STEMI [ST-segment elevation myocardial infarction] patient who was unstable, on a vent, on a balloon pump, multiple pressors, and I was tripled with this patient. And just the absolute moral distress of knowing that I am not able to be present in the way that I need for this patient and I was not able to provide the kind of care that I wanted for the patient because there just wasn’t enough time. And when I had other patients to care for, either that patient or the other patients got shorted.
There’s just so much that we do as nurses and as healthcare providers that being constantly understaffed and not having safe staffing just isn’t OK. And one of the things that I have really appreciated about a union is the ability for me to stand up and say this isn’t OK. And to have a way for me to push back against management and know that I’m going to be safe from retribution, that I can’t get fired, that I can stand up for what’s right and what’s right for our patients.
I think one of the things that I know that we talk about at the hospital is the distinction between burnout and moral distress. And I think that is an important distinction, as healthcare providers, that we need to do a better job of correctly naming many of the emotions we’re feeling at work as moral distress, in that when we know that we are not able to provide the kind of care for our patients that we want because the system is set up that we can’t, I don’t think that’s necessarily a burnout issue. That’s moral distress.
When I have 14 babies that I’m taking care of and I know that each baby gets 4 minutes an hour, that’s moral distress. When I’m tripled in ICU with a balloon pump, vented, unstable STEMI patient — that’s moral distress. And as healthcare workers, we 100% know that this is not the situation that it should be, and know that it needs to change.
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