It was seven p.m. when I discovered I was the only nurse on the floor for the shift. There were seven acutely ill patients, one of whom was actively receiving blood and should have gone to the ICU, “but they didn’t have space.” 

I did the math: How am I going to do this by myself?? What if someone needed CPR? Or if someone fell while I was trying to control another’s bleeding? A pizza party or one of those ubiquitous “Heroes Work Here” signs popping up outside of hospitals was not adequate support for this kind of situation.

This scenario happened while I was working a travel assignment in southeastern Wisconsin during December in our first COVID winter. It was my worst shift in almost eight years of nursing, though the memories of many shifts stir up similar feelings of dread. 

Chronically high stress caused me to leave nursing for a career in public health, but my experiences sound tame when compared to nurses on the COVID front lines. Check out #nurseburnout on Twitter, if you’ve got time to spare.

Since February 2020, almost one in five nurses have quit their job. I’m not surprised: pre-pandemic undervaluing and underpaying of nursing staff has been compounded by a crushing increase in patient load, higher exposure to traumatic situations, and constant ethical dilemmas—if burdens at work are already unmanageable, why not take a travel assignment and make a lot more money for it? 

Or, better yet, why not get away from the bedside, where both pay and treatment are better? 

A 2021 McKinsey survey found that 60 percent of nurses stated they were more likely to leave nursing since the pandemic began, with 22 percent contemplating leaving within the year. Based on pre-pandemic numbers, the interactive NC NurseCast website projected a statewide shortage of 12,500 nurses by 2033—with COVID factored in, it’s more likely that number will be close to 20,000. 

North Carolina hospitals have already delayed needed expansions due to inadequate staffing, and over 1,500 nurses are needed at Duke Health and UNC alone. Low staffing levels lead to higher stress and potentially unsafe nurse-patient ratios, which exacerbates burnout—and the cycle continues. North Carolina currently is one of several U.S. states without formalized nurse-patient ratios, and state officials have only just begun investigating what this would look like. Being in the hospital already puts one at increased risk of medical error and preventable death, made worse when caregivers are maxed out.

Multiple websites claim North Carolina pays relatively average nursing wages, around $31 per hour, or $58,000 annually. However, the Duke Health medical system, despite providing care for the sickest patients in the state, currently starts new grads at $25 per hour—$3 lower than the worst-paying state in the country. Based on a 36-hour workweek, this totals an annual salary of only $47,000. The national average salary is close to $80,000. Weekly, Duke nurses make less than $1,000; travel nurses in the same institution can make more than $5,000 weekly.

Why does payment make a difference in patient safety? When nurses are paid well, they are incentivized to stay and contribute their expertise and patient loads are more evenly spread. Not only can nurses keep patients alive and safe, but they have time to act as the go-between for doctors, physical therapists, laboratory and imaging services, and family members of their patients. 

Travel nurses are worth their weight in gold, but they typically only get a couple of days of orientation—barely enough time to find out where all the supplies or the emergency numbers are. 

A staffing shortage of 20,000 nurses could be apocalyptic. What could stem this hemorrhage? A minimum base wage of at least $35 per hour would increase North Carolina’s competitive draw, coupled with state-mandated patient staffing ratios and adequate mental health services. This is only the start of what nurses need to recover from the COVID onslaught. 

Hospitals have shown in hiring travel nurses what they are willing to pay when desperate. From what I’ve seen, it’s an issue of respect and the least we can do for those with front-row seats to daily suffering and death.

Looking at other states, unions advocate for fair pay and appropriate ratios. Should North Carolina nurses unionize? I’m not saying they shouldn’t. Something needs to change, and it can only be for the better for the state’s thousands of patients. 

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