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Don’t let us drown

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In this moving first-person piece, MUH nurse Marie Lyons exposes the desperate plight of nurses and demands Government action

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. We are not supposed to admit that for some reason; that we are working in a heath system where there has never been collaboration or consultation with us nurses on the ground and our line managers. 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. Now we are utterly overwhelmed by the volume of patients we have to take care of, in a system that is staggeringly unfit for purpose.
During the last decade, as our health service limped along and became ever more beleaguered, nurses did what nurses always do. Adapted. Became more efficient, more organised. We pulled up our sleeves and managed the unmanageable, enduring levels of pressure that have become intolerable, 13 hour shifts turning into 14 hours 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.
But while we all make up the sum of its parts, it is the army of nurses, good men but mostly good women, who have for years now, held together the shards of the broken edifice that is our national health service. It is now totally taken for granted that we will merrily keep those balls in the air and the plates twirling.

‘Some of us died’
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. In worse conditions. Melting in our PPE. Thousands of us becoming infected.
And some of us died.
On every shift, despair and burn-out are starkly obvious, and 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 in MUH, and with the overflow or ‘trolley’ patients. Aside from a short reprieve at the beginning of the pandemic last year, the trolley problem never really went away.
When I left my shift last night after 14 hours of relentless work, the emergency department was packed with sick and elderly people lying around in draughty corridors where they will get no sleep. They will be there this morning.
And when Covid is no longer front-page news, they will still be there. 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.
But nurses see. 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, or this test, or for a busy doctor to decide their fate.
Because in the often crammed Emergency Department in MUH, we cannot stay long at their side. We desperately want to give our patients the time and attention they deserve, but time has to be guarded like a miser.
We have to turn away from our last patient to meet the approach of the next. An avalanche is making its inexorable way towards us. A conveyer belt of new patients with greater needs, at greater risk. 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, but look! 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.

‘Exploitation’
On some days or nights our nurse-patient ratios are outlandish. On my recent night shifts with over flow 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 health-care assistant to help me? Some patients are confused, some need dangerous intravenous infusions, some get acutely ill during the night. And most of our patients are elderly and need personal care and medications.
In this situation it’s not remotely possible to give each and every patient they attention they deserve.  
In the middle of that night, a young man fainted on top of me in the bathroom. There was a moment of comedy as we staggered around for a bit while I tried to hold him together and ease him to the floor so that he didn’t hit his head. He was a lanky six foot two to my five foot nothing.
We were finally both safely on the floor and as I waited for help, he looked up, his face ashen but smiled at me sweetly, patting my arm. I laughed and shook my head and tried to ignore the fact that I was probably kneeling in pee.
Despite our situation he had complete confidence in me and knew that I was going to take care of him. I was the nurse.
In Ireland, everyone trusts the nurse.
We are like the women you see in the kitchen at every Irish funeral, energetically buttering the sliced pan and handing around the sandwiches while the men stand around and sip whiskey and admire the corpse. Everyone is grateful of course to the women in the kitchen, but we all know that at the next funeral, the roles will remain unchanged and the women will be in the same place, buttering and slicing and serving.
Isn’t it time that we left the kitchen to view the corpse, in this case our moribund health service?
Shouldn’t we take advantage of the fact that through-out this pandemic, the critical importance of our role in the national health system has been noticed and there has never been a better time to expose the shocking exploitation of nurses at its heart?

Conditions and pay
We have not been supported by our government. Health ministers have come and gone and nothing has ever changed. The new Secretary General of the Department of Health has just received a further €81,000 bringing his annual salary to €292,000 while a few weeks ago the members of the Dail quibbled over giving student nurses €100 a week for putting away their studies to work full time. The inequality is literally breathtaking.
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 main stream 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.
If we do not take action on behalf of ourselves, and on behalf of our patients, when all of this is over, we will go back to doing what we always did, coping like we always coped.
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 MUH, the HSE and our public health system in managing Covid and vaccination roll out. 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 us.
We must demand transformed working conditions. We want our voices heard and together with our line managers, to play a much more active part in the development of systems and nurse to patient ratios in our hospitals going forward. 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. We can no longer accept conditions that are dangerous for our patients and, on a daily basis, risk our very careers and licence to practise.

Mandated ratios
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 over-time 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 piece-meal recruitment.
We must speak out now. All of us. And if our voices are not heard, if we and our patients continue to be left in such unsafe conditions, then we must learn how to say No. We must take radical action.
Nurses have huddled for too long in the trenches. 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 spot light is here. What are we going to do with it?