[jgalecki]

This is a topic that I'm pretty close to. After programming for four years in the Bay Area, I decided to become a nurse. I spent three and a half years bedside nursing before returning to coding: two and a half at the Cleveland Clinic (a respected hospital) and another year doing 13-week travel contracts across the US. My goal was to find problems affecting nurses that might be solvable through programming. After my time on the floor, I've come to see that the deeper issues are more structural and organizational in nature.

One fundamental force in nursing is that a nursing shift is unpredictable. Some shifts go very smoothly, some are absolute trainwrecks. Patients are, definitionally, sick enough to be in a hospital, and they can start declining very quickly. This means that whatever you are doing at any given moment is often interrupted by a new priority that must be handled RIGHT NOW. It means that your 'plan of attack' for the day (which patients get [meds | baths | food | mobility | turns | dressing changes] when) is often delayed, sometimes by several hours. Any number of things could push the schedule back - incontinence care, a doctor stopping by to discuss a patient with you, a patient fall, a medical emergency, a lonely patient. A few curveballs can put you way into the weeds.

Consequently, the culture on a floor is key to how good your shift is gonna be. If you help others out when you have some slack and they help you out in turn when you are behind, it really smooths out those rough days. If other nurses let you drown, you drown.

The biggest thing that a hospital can do to help nurses is to adequately staff their floors. If everyone is drowning because the floor is understaffed, no one has time to help each other. If you're caring for six patients instead of four (on a med-surge floor), there are days where there literally isn't enough time to do all the nursing care everyone deserves. Documentation can be, and often is, done after passing off your patients in report. After you've already "dropped" documentation from your during-shift schedule, patient mobility - getting people up and walking, or even just sitting up in a chair for meals - is the usually the next thing go. After that, hygiene. Nobody dies if they don't get a bath, but another patient certainly could die if you don't do X. Next up comes pain medication requests and incontinence care. For me, it was enormously stressful not being able to provide the quality of care that the patients deserve.

This can be a huge factor in burnout. The pandemic made things worse in a bunch of different ways. Besides the stress of caring for patients with a deadly virus, you also now have to add on several minutes to every patient interaction for donning and doffing PPE. That's even less time to do the nursing part of the job while you're dealing with a more critical patient population (who will need more care). Burnout rates increase and nurses leave, either leaving the profession or taking contracts that, even if the conditions are no better or much worse), at least pay a premium. Hospitals that were well-staffed face staffing shortages, and hospitals that were already short on staff are now in a staffing crisis. The hospitals have to spring for travel contracts, and the nurses that did stay are angrier that other nurses are making multiples of their pay for doing the same work.

Given that this thread has some 900+ comments already, this comment will start off pretty far down the list. But I see some people mentioning that you are working on trying to make things better for nurses - I'm guessing that those people will read the thread more thoroughly. I would love to chat with you about whatever it is that your startup / company / weekend hackathon project is doing in this space. I've dedicated five years of my life to the problem space and would happily share my thoughts and experiences.