Just before the new year began, I sat with my adult son in the emergency department of one of Boston’s premier hospitals that was overflowing with sick patients, their beds lining the hallways. Although a decision was made to admit him for an overnight stay, there were no available beds. He was assigned to a small room in the the department, with a sliding glass door and a curtain that shielded him from the sad parade of hallway gurneys and a caveat that he might be moved into that hall if his space were needed for a higher priority emergency.
Emergency departments are not equipped to care for patients for an extended period, even as they are increasingly called to do so. Throughout my son’s two-day stay, there was only a commode available for the severe gastrointestinal problem that plagued him and exacerbated the symptoms of his rare genetic disorder. He was never given a meal, although he’d been told it would be provided. When someone suggested we purchase food for him in the cafeteria or at a local restaurant, we were given no guidance about dietary restrictions. We wondered about the many other patients in the emergency department without family members available to tend to these needs.
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Medical personnel were caring but brief in their interactions, seemingly inured to the constant beeping of monitors and the moaning of unattended patients. Their daily grim reality is the lack of both time and resources to comfort the endless stream of sick patients needing attention.
There are many reasons for the deplorable conditions hospital workers encounter each day. Hospitals are being crushed by staffing shortages and an insurance industry with misaligned priorities. Short-sighted management decisions have decimated the nursing workforce as administrators view patients as sources of revenue, not people needing care. A systemic lack of sufficient preventative care resources and incoherent insurance coverage have made hospitals the first, rather than the last, resort for health care.
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COVID was responsible for the barrage of severely sick and dying patients who overwhelmed the health care system in 2020 and 2021, but it can no longer be used as a protective shield that excuses grossly ineffective responses by legislators, insurance companies, and health care administrators to the hospital crisis in America today.
In those miserable two days that we spent in an inadequately staffed emergency department stretched to its breaking point, we asked staff members about their working conditions. Their responses indicated that what we observed was not an aberration but their new normal, contradicting the convenient trope that COVID is the cause of their chaos. Instead, they described a dysfunctional communication system and leaders who don’t understand what staff and patients face on a daily basis.
We learned that front-line workers are the target of frequent hostility as patients and families often lash out in anger — sometimes physically. They expressed frustration at the internal communication failures that leave them unable to clearly respond to basic questions about care, timing, room availability, doctor visitation schedules, testing, and even the accessibility of food.
Hospital leaders fail to ask staff about measures that might help relieve the burden imposed by massive worker shortages. Attrition of new hires and seasoned professionals is both the cause and effect of the worker shortage, administrators and trustees seem unwilling to fix the root cause of the constant turnover.
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In the absence of direct scrutiny, the crisis festers. Patient privacy means that reporters cannot adequately cover this story; yet mere words and data cannot convey the despair that our visual observations revealed. This darkness diminishes any outcry, as those who experience the misery are too sick to do more than try to survive.
Even as a massive effort is needed to fix the health care challenges facing hospitals today, intermediate measures can ease some of the severe conditions facing front-line workers. A first step is to start at the top.
Administrators and trustees must spend time on the floors and in the emergency department, observing conditions and listening to the staff. This cannot be in the form of a prearranged group tour — I was once a hospital trustee and know how meaningless those are — but as individual leaders at unannounced times when they can observe actual conditions and the impacts of absurd staffing ratios.
An internal feedback system is also needed. Nurses and aides must have ways to voice their concerns and suggest needed changes without fear of reprisal. Hospital administrators should avoid issuing platitudes about patient care and listen with their minds open to creative change and a willingness to answer all questions, even the ones that make them uncomfortable.
Health care workers chose this profession for the opportunity to comfort and heal, not operate in chaos and exhaustion. We cannot accept today’s hospital conditions as our new reality.
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Lauren Stiller Rikleen is president of the Rikleen Institute for Strategic Leadership and the executive director of Lawyers Defending American Democracy. She is the editor of the forthcoming book, “Her Honor: Stories of Challenge and Triumph from Women Judges.”
