I’m The “Nurse Who Called 911” For Help With Unsafe Staffing - Here's What I'm Up To Now
By guest writer, Kelsay Irby
Disclaimer: The views and opinions expressed in this article are those of the writer and do not necessarily reflect the views or positions of nurse.org
Update 10/31/2023
Late last year, I was at the center of a media blast after it was reported that I called 911 to ask for help in our overwhelmed ER during a cyberattack that took down all our electronic resources.
The initial story wasn’t quite relayed correctly, but the resulting discussions were, I hope, valuable in ways that are still being played out. In that moment, I wasn’t thinking about thinking outside the box, or creating new possibilities. I was literally grasping at straws and trying to address a circumstance in which I saw no known solutions or remedies.
In the last year, I’ve developed a new, very personal lens through which to see organizational disconnect and how it directly affects burnout and nurses leaving the bedside, despite a love for the job, altogether.
The Aftermath: A New Lens
One of the things that has instinctively both intrigued and bothered me in the informal and formal problem-solving discussions I’ve witnessed since that “911” call is the free-flowing, sometimes contradictory nature of the discussion process.
Chaos Challenged My Problem-Solving Skills
In a grad school class on organizational leadership that I’m currently taking, I realized the curriculum redefines this somewhat chaotic experience as exploring a different approach to solving problems within organizations. Instead of focusing on what isn’t working, there are methods that challenge us to look at what is, and use that as a jumping-off point to further develop solutions.
In essence, it’s a more elegant form of brainstorming. I don’t know about you, but I remember learning to brainstorm and feeling anxious about the whole “don’t worry if it’s right or wrong, just throw every idea out there” process.
Humans have two conflicting needs
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The need to belong
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The need to be recognized as an individual
This conflict is brought into terrifying focus when asked to participate in brainstorming sessions, especially as a middle school student, where every action and thought has the potential to expose you to ridicule from your peers.
Brainstorming felt dangerously full of risk, of deviating from the more ‘acceptable’ method of identifying the problem, developing a solution, and only then, in well thought out, clear, concise (and hopefully intelligent sounding, at least to your very important 13-year-old peers) language, describing how you got there.
Leaders vs. Problem Solvers
Most of us have had, in one forum or another, a discussion about leadership, the qualities an effective leader has, and the way they influence the people around them to hopefully move the team in a positive direction. You’ve probably identified traits like “intelligence, good listening, follow-through, organized, walks the walk….”
In a little twist on that, I’d like to invite you to take a moment and think about a person you believe to be a good problem solver, either in your personal or professional life. What are some qualities you see in them?
They probably have some of the same leadership qualities, but in my opinion, they must often be in possession of some unique things that allow them to move off the beaten path of recycled and reframed, but ultimately failed methods.
Maybe they are people who, as children at the beach, were the ones who were actually able to figure out how to reroute a little stream to more efficiently float a piece of driftwood to the sea. A kid who could look at the flat sand and the direction they wanted the wood to go and instinctively realized that sometimes a straight line wasn’t going to get them there. Instead, they’d work with the various forces at play – the wind, the waves, the continuously changing sand, and the resources of rocks, shells, and other beach debris to create a channel where one didn’t previously exist.
These are the ones who calmly took “failure” as a lesson instead of a definition of their personal worth. These kids have the courage to try without knowing if it would work, the humility to admit their prior attempt didn’t achieve the desired outcome, and the creativity to come up with a new method.
Are Problem Solvers Good Leaders?
Most of us are lucky enough to have come across someone who thinks like a kid at the beach. But unfortunately, in my experience, they are often not in positions that allow them to be great catalysts, or their outrageous suggestions of new ways to do things get shot down out of fear, ego, or the inability or big corporations to adapt to a fresh but less definable perspective.
It takes a strong personality, someone with a firm sense of self, someone who refuses to allow professional pushback to define who they are at the core of their being. I’d like to say I am in possession of a full set of these qualities, but I admit, I am a work in progress.
Chaos. Is It Really So Bad?
One of the things that jumped out at me from the very first reading in class was the discussion of three major steps in generative change: disruption, differentiation, and cohesiveness.
My organization, during the time of my EMS call, was in chaos, and yet we were still being instructed to follow the same algorithm we were using during times of ‘normal’ operation (and it wasn’t often effective then.)
The resulting media coverage around my phone call that night, in effect, my jumping the procedural train off the tracks, was a massive disruption in the status quo, in the impression our hospital tried hard to project, that it was business as usual despite our technological darkness.
There have been some positive changes that came about because of that night, but I truly believe those changes could have been greater and more impactful to both patients and staff if the lines of communication were more open, if the idea of “freezing” the positive changes was more widely recognized and practiced.
Restructuring the Hierarchy
The course also talks about the verbiage we use to describe methods of information exchange, as I did just there, with “lines of communication.” I don’t know about you, but when I hear the term ‘lines’ in that context, I picture ideas moving in one at a time, one direction at a time method. This also implies a difference in power, or a gatekeeper of some sort, preventing access to some members of the organization by others.
The other thing that comes to mind is “waiting,” as in waiting in line. Show of hands, anyone here like to be kept waiting? If you’ve ever been kept waiting by a teenage girl who has to change her outfit JUST ONE MORE TIME, you comrades have a particular insight into the torture waiting can be.
Instead, the curriculum material uses the term “field” of communication, describing it as an area in which all ideas are free to roam and interact, being allowed to linger at the edges or move toward the center at will, and also allowing ideas that are less effective to exit the field altogether without leaving a vacuum or causing disruption in their departure.
So, What’s Next For Me?
As you can probably see, the last year, and the current class, have challenged my thought processes on how to elicit change in some startling and mind-blowing ways. The newness makes me slightly uncomfortable, yet also speaks to me on a level that tells me there is something important to be had here.
I won’t lie, I am burned out on constantly working shorthanded and being asked to do more with less. I’m burned out on the lack of human connection between senior leadership and those of us at the staff level. I’m burned out working for a company that continues to seem like it doesn’t even care that I, and so many of my coworkers, are going up in flames.
I was injured in a work accident in May, and the handling (or mishandling) of the situation caused a delay of almost 5 months in getting a fairly extensive surgery approved. The lack of concern for my medical needs has left a very bad taste in my mouth, and I do not yet know if I will be able to return and be a part of the solution.
I refuse to return and be part of the problem. My coworkers and our patients deserve better than that. What I do know is, no matter where I end up, I will be taking the lessons learned from this new, unfamiliar, yet exciting way of thinking into that future with me.
Original article 11/11/2022
Kelsay Irby is the ER Charge Nurse who made national headlines for calling 911 desperate for help with unsafe staffing at St. Michael Medical Center. Here’s her first-hand story of what really happened on the night of October 8, 2022.
This content used under license from "Ask Nurse Alice."
As I sit down to write this article, I’m trying to come up with a catchy start. How can I possibly sum up the events that led me to ask for help from our local emergency services in a sentence? Healthcare is chaotic, this we all know. What about that night was so dire? Literally, what was I thinking?? The best piece of advice I received was, “Write from the heart.” That I can do.
First, a little history. My hospital, St. Michael’s Medical Center, started out as a privately owned community hospital during the Spanish Flu pandemic. In the last five years, it has gone through a series of name changes as it was absorbed by a conglomerate of non-profit organizations. In the winter of 2020, in the middle of an unprecedented pandemic, we moved to a much larger building, one in which most of us feel we never really have gotten settled. We’ve seen several changes in hospital leadership, at all levels, including my department, the emergency department, where I have been a charge nurse for less than a year. It’s a challenge, but I love the chaos, the moving parts, and the camaraderie that comes from working with some really sensational doctors, nurses, techs, and ancillary staff.
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Unsafe Staffing
Unfortunately, our hospital, and particularly my department, has seen some serious problems. We are incredibly short-staffed, more so than other hospitals in our area. Our beautiful new hospital has technical and mechanical problems. Our department has been through several managers and is operating without a full staff of mid-level managers and office personnel. Less than a month ago, our corporation was the target of a system-wide cyber attack that left us without EPIC and sent us back to paper charting.
Lucky me, I had signed up for five charge shifts in a row before the attack. I cannot overstate how chaotic it was. Labs got lost, orders got lost, and patients got lost in the back and forth to exam rooms, imaging, and other assessment areas. Doctors were frustrated, nurses were frazzled, and wait times climbed as high as 12 hours, unheard of in our hospital. We were in full crisis mode, yet our senior management continued to tell the public that we had a well-developed plan in place and that we were “business as usual.”
What Happened The Night of October 8, 2022
Caring for and monitoring patients was extremely difficult. I have never heard so many nurses say, “I am in serious fear for my license.” Things came to a head the night of October 8, when I made the decision, after exhausting all other available options, to call the non-emergent line and ask the dispatcher if they had any available crews that might come and help us.
We were even more short-staffed than normal, operating at less than 50% of our ideal staffing grid. Waiting to be seen were some patients with cardiac issues, respiratory issues, and children with high fevers, all patients that made us very nervous to have in the lobby, unmonitored for extended periods of time.
The one first-look nurse was busy trying to keep up with checking in new patients and could not possibly supervise the almost fifty people in the waiting room. We needed extra eyes. When I called, the dispatcher sent my request to the local fire chief, who then reached out to me, asked how he could help, and then sent a crew over to help monitor the lobby, retake vitals on patients, and do a roll call to ensure our patient list was accurate. We were all incredibly grateful for their help.
I Wasn’t Expecting The Media Attention
Here’s what happened next. While I didn’t recognize the impact of what I was doing that night - I was simply working my way down the list of possible sources of help for my coworkers and ultimately our patients - I faced a very major choice after the story broke. Did I ignore requests for comments, refuse to discuss my actions in public forums, and just put my head down and go back to work, knowing that my hospital was doing very little to facilitate any change? Or, did I make the more uncomfortable choice, and use that momentum to spearhead a long overdue dialogue on the issues facing healthcare as a whole, but my hospital in particular? I think it’s obvious what choice I made.
The resulting media attention has been overwhelming and yet it highlights a problem that has been developing for some time. Nurses in general do not complain. We’re taught that we keep our issues with staffing, no breaks, long shifts, impacts on our own health, etc., to ourselves. We’re taught to suck it up and be martyrs for the cause and for the corporations that own our hospitals, to be grateful for the crumbs thrown to us by hospital “leaders” (that not once show up during a night like the one I described above) in the form of pizza parties and banners, all the while dealing with anxiety while driving to work and tears on the way home, UTIs from dehydration because there’s just no time to drink any water (or pee, after), time away from our families and fear that when we do see them, we might be bringing them some residual disease from work.
“Why Don’t You Just Quit?”
We’re told, “You make good money. You chose this career. If you don’t like it, why don’t you just quit?” Earlier this year, someone asked me that last question. My response to them was, “Do you REALLY want nurses to ‘just quit’ if they don’t like their jobs? Think that one through a little further.” Because there are a LOT of us that have already left. Those of us that remain are hanging on by our fingernails.
I live in this community, as do most of my coworkers. Our families, our children, and parents, our friends, and loved ones go to this hospital when they need care. Myself, my daughter, and my best friend’s dad, who I love as my own, have all been patients in my emergency department. The care provided by the staff is second to none. I literally have trusted my life and the life of those most important to me to my brothers and sisters in the emergency department, and I would do it again.
But I see, behind the scenes, the fatigue and moral distress that is caused by working in a state of chronic crisis staffing levels, for a corporation that seems completely out of touch and apathetic to what is really happening in their beautiful new hospital. I see experienced nurses leaving the department and new nurses - smart, intuitive, and yet still relatively inexperienced - stepping into roles and taking assignments that are, perhaps, asking too much of them, and I worry for their emotional health as they take on more and more stress. I see travelers breaking their contracts because their fear of losing their license is greater than the fear of being blackballed in the traveler community. I see new neighborhoods popping up all over my county, full of potential patients who will then be in my lobby, hoping that this is a day that we are not so short-staffed that they end up putting their life at risk coming there because they have no other option in the area.
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Would I Make The Call Again?
At the end of the day, my personal moral code cares less about corporate disapproval and public scrutiny and more about being able to sleep, knowing that I did everything I could to make an impossible situation a little less dangerous.
People ask, would I make that call again, knowing what I know now about the aftermath and its effect on public, personal and professional levels? And my answer is an unhesitating, resounding yes. Without a doubt. Because along with all the other things we as nurses are taught, the number one thing we do, that we internalize on a level most cannot understand, is advocate for our patients, to use our voice and our leverage when they have none, no matter what it might cost us.
St. Michael Medical Center Statement
Nurse.org reached out to St. Michael Medical Center to address the question, “how are you addressing staffing levels at the hospital?” here is what they shared:
“Turnover at St. Michael for healthcare staff is well under the national average, and RN turnover at St. Michael is lower today than it was throughout COVID-19. We believe this is a testament to our ongoing efforts to recruit and retain staff, as we actively hire for full-time, part-time and as-needed employees.
We’re deploying innovative ways to attract and retain team members in the competitive labor market, including incentives such as:
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Sign-on bonuses and loan forgiveness programs
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Staffing incentives and shift premiums
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Increasing investments in professional development and career pathways
In addition to recruiting from the existing labor market, we are working to build a pipeline of providers to address our community’s needs. As part of this effort, we are:
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Working closely with Olympic College to hire nursing residents from their nursing program.
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Training the next generation of family medicine physicians through our Northwest Family Medicine Residency Program.”
