'Nurse by nurse, day by day, we are coming undone'

Nurses were already exhausted, disempowered, and demoralised before Covid arrived. It's time to stop adapting and demand change

Nurses are drowning. People are waving kindly from the shore because they don’t understand. They think we are still waving too.

The pandemic has laid us low. Nurse by nurse, day by day, we are coming undone. Not because we are not resilient but for the exact opposite reason.

When the pandemic arrived, Irish nurses were already exhausted, disempowered, and demoralised. Overworked and underpaid. Not allowed to participate in any of the decision making in our own hospitals. 

We are not supposed to admit that for some reason.

We are working in a health system where there has never been collaboration or consultation with us nurses. There is just control from above.

The grown-ups have always been in charge. The senior management, the hospital consultants, the HSE, the Department of Health.

Covid has made everything worse but this crisis has been bubbling away for years and now we are utterly overwhelmed by the volume of patients.

Marie Lyons: 'We must demand something more for ourselves.'

During the last decade, as our health service limped along and became ever more beleaguered, nurses did what nurses always do — adapted.

We pulled up our sleeves and managed the unmanageable, enduring levels of pressure that have become intolerable  — 13-hour shifts turning into 14 as a matter of normalcy, foregoing breaks for hours, spat out at the end of the day with just about enough energy to drive home.

We crossed arms together and staggered under the load, sharing the trenches with other hard-working colleagues — doctors and healthcare workers, paramedics and porters, cleaners and clerks and all of the great people who make a hospital work.

When the pandemic came and we saw what was in store, we cried. 

What? More? We have to do even more? 

And of course, that’s what we did. While some workers got an increase in wages as danger money and college students who only ever had weekend jobs got the PUP, we did more. 

While the media gave the teachers' unions a platform to endlessly express their issues, we just went to work and did more. Worked longer and harder. Melting in our PPE. Thousands of us becoming infected.

And some of us died.

On every single shift, despair and burn-out are starkly obvious.

It makes me sad to admit that I don’t know a single nurse who is satisfied at work.

I work in the emergency department at Mayo University Hospital. 

Aside from a short reprieve at the beginning of the pandemic last year, the trolley problem never really went away.

The media used to blare outrage on behalf of our trolley patients but Covid has taken centre stage and the greatest failure of our modern health system has been brushed away out of sight.

All over Ireland, nurses are up close to the suffering. In the wards and emergency departments and ICUs — in the community.

We listen to the worries of our patients and try to soothe their fears.

We know they are lonely in the hospital. We see that they didn’t really understand what the doctors said on the rounds.

We learn their home circumstances and talk to their families. We know how stiff and sore they are when they lie on narrow trolleys for hours because, along with the care assistants, we are the ones who physically lift and move them.

Our patients are very real to us. Their pain is our pain. We are their advocates as they lie there feeling abandoned, waiting endlessly for that bed.

We desperately want to give our patients the time and attention they deserve but time has to be guarded like a miser. 

The patient I just left behind to greet a fresh emergency, may have a wet pad or have asked three times for a pain killer or can’t find their mobile phone to call their family.

This one coming is not breathing properly, and that one has just been pulled from a car crash.

So off we go, careering from one patient to the next. It never stops and we never stop. Decent breaks are a thing of the past and as for the loo, well, we just hold on as long as we can.

On some days or nights, our nurse-patient ratios are outlandish. On my recent night shifts with overflow patients, the ratio of nurse to patient was 1:15. 

How can I care for 15 patients with a variety of needs even with a hardworking healthcare assistant to help me? 

We have not been supported by our government. Health ministers have come and gone and nothing has ever changed. 

The time has come for us nurses to rescue ourselves.

We must stop our useless bitching to each other and let our collective voices be heard by the right people. We must be seen in the corridors of power where change happens. In the media.

Where are the nurses on mainstream TV and on the radio? We respect and appreciate our doctors who we work alongside, but why is it only their voices that are heard, their faces that are seen, their opinions that are respected?

Nurses are professionals with college degrees. We are problem solvers and multi-taskers. We are great communicators. We need more of us at the top table. We must elbow our way in.

We have seen how resources can be mobilised when the stakes are high. We have watched the herculean efforts of our hospitals, including my own hospital, the HSE and our public health system in managing Covid and vaccination rollout.

There has been so much to admire and be grateful for and we have been proud to be part of it.

But now we must demand something for ourselves. Our opinions matter. Our experience is invaluable. 

We want to be remunerated for our level of expertise, knowledge, and professionalism. 

We want breaks when they are due, all of them.

But most importantly, we need a massive national recruitment campaign and legislation that mandates nurse/patient ratios in every hospital in the country. 

International research and the experience of nurses in Canada, California, and Australia has shown that mandated nurse to patient ratios of one nurse to five or six patients has reduced patient stay in hospital, reduced infections, decreased mortality and massively improved patients outcomes in every way. 

Mandated ratios have also been cost-effective for hospitals because of a huge reduction in the costs of overtime and agency staff. 

Moreover, in these places, nurses have flocked back to the profession. Staff satisfaction means less staff turnover and a decreased need for constant expensive piecemeal recruitment.

We have coped too much and far too well. It’s time to stop being so competent that nothing has to really change. We owe it to our patients. We owe it to ourselves.

The spotlight is here. What are we going to do with it?