This story is part of a Michigan Radio series about the ongoing health care staffing crisis in Michigan.
At the height of the COVID-19 pandemic, nurses, doctors, and other health care staff worked grueling hours to try to get a handle on a virus that kept mutating and bringing more and more patients to Michigan hospitals.
COVID is still with us, but deaths and hospital stays because of the virus have plummeted.
Despite that, many nurses say that their working conditions still have not improved. Some say they’ve gotten even worse.
"I can't watch this happen anymore."
Nikia Parker is a registered nurse who lives and works in the Traverse City region.
“Now there's this, like, despondency," Parker told Michigan Radio. “Before, when we were in the midst of pandemic stress, you could try to see the light at the end of the tunnel and you could try to pretend like, 'Well, when the pandemic's over, this will all get better.' You could pretend. But now we have the pandemic controlled and it's not getting better.”
When she started working as an emergency room nurse, Parker said she would typically care for up to three patients at a time during a shift. These days, Parker said she's often taking care of six patients at a time.
"Now we have the pandemic controlled and it's not getting better.”Emergency room nurse Nikia Parker on current working conditions for Michigan nurses
Parker also sees nurses handling tasks that used to be assigned to other staff, including drawing blood.
"When you don't have phlebotomists, it's the nurses that have to pick up the slack. I'm drawing labs on people," she said. "When you don't have an ortho tech, it's the nurses that have to pick up slack and do all of the splints for their patients."
Parker loves nursing. But after working full-time in the ER for more than 15 years, she now spends most of her time working as a paramedic. She’s only doing one nursing shift a week. What pushed her out of full-time nursing was a feeling of falling short of what her patients deserved.
"The moral injury of not being able to give every single patient the absolute best that I could. At some point I just decided I can't watch this happen anymore," said Parker.
The roots of the shortage
Across Michigan, hospitals have more than 8,500 nursing jobs they're trying to fill. But some nurses say it's not a worker shortage. They say it's the fact that people aren't willing to work under the current conditions.
Christopher Friese is a professor of nursing at the University of Michigan and the director of the Center for Improving Patient and Population Health. He is also a practicing oncology nurse.
"What nurses have told us, both in the state of Michigan and across the country, is very clear and consistent. Their workloads are unsafe to deliver care. And that's not just in the hospital setting, but in other settings," Friese told Michigan Radio's Morning Edition.
Current bills before the Michigan Legislature would set mandatory nurse-to-patient staffing ratios. Similar legislation has failed multiple times in the past decade.
" What they're asking their employers to do is recognize the urgent need to not only retain the current nurses that work in their settings, but to actually bolster staffing so that patients, families and communities can receive the kind of care that nurses know that they expect and they should be able to deliver."
Hospital administrators often blame the pandemic when they talk about staffing shortages, saying people got burned out and no longer want to do the work. Friese said the problem goes back much further than 2020.
"We actually have plenty of nurses, both in Michigan and the United States," he said. "Our [research] team and others have shown that workplaces for nurses have been poor for about ten years. There's very strong evidence that staffing and safety concerns predated the pandemic. And of course, the pandemic made things more difficult."
According to Friese, today's crisis is the result of longstanding practices.
"Facilities, for quite some time, have really worked on a model of what is the bare minimum amount of nurse staffing that they need to keep the lights on, so to speak. And it's really the wrong approach. Patients are more likely to have complications. They're more likely to have to stay longer in the hospital and other settings," he said.
"[Nurses] are caring for more complicated patients over time. And they don't get the help that they need. And so that leads to burnout and that leads to nurses heading for the exits."
What about pay?
"The number one driver of [nurses'] dissatisfaction is adequate staffing."University of Michigan professor Christopher Friese on the results of a recent survey of nurses in Michigan
Nursing is not the highest paying job, but many professions have lower wages. The National Bureau of Labor Statistics reports the median pay for registered nurses in 2022 was more than $39 an hour and more than $81,000 a year.
Friese was the lead author on a recent University of Michigan study that surveyed nurses in the state of Michigan. It found that pay is not among the top concerns nurses' cite when rating job satisfaction.
"The number one driver of their dissatisfaction is adequate staffing. That is their number one concern. Their second concern is administration listening to their concerns and acting upon them. And the third is violence in the health care workplace; physical and verbal attack," he said.
Staff ratio mandates and recruiting
Legislation to mandate minimum staffing ratios at hospitals has been proposed repeatedly over the years in Michigan. There are new bills currently in the Legislature called the Safe Patient Act.
Hospitals typically oppose that kind of mandate. They say it will drive up costs and could force some hospitals to close. But can mandated ratios work?
"The strongest evidence we have for a ratio based approach is from California, and the evidence is very clear. After that implementation of that legislation, fewer nurses left their positions. In most cases, patient outcomes were the same or in some cases even better. [There were] no real changes to costs of care," he said. "If you're primarily concerned about keeping nurses in their position and having safe patient outcomes, then this legislative approach is one strategy."
But right now, with or without a state-mandated ratio, the nursing sector in Michigan still has those 8,500 job openings.
"We really need to, first and foremost, focus on retention," Friese said.
"After that, can we identify nurses who may wish to come back to the field? Could we also harness those who have served in our military in a medical capacity? They have a lot of training and experience, but at the same time, we need to make the environments attractive."
Editor's note: Some quotes in this article have been edited for length and clarity. You can listen to the full interview near the top of this page.
The University of Michigan holds Michigan Radio’s broadcast license.
