If the frontline stops showing up, who will be there to care for the sick?

We are in the midst of a healthcare crisis that extends beyond COVID-19.

The direct patient care workforce is exhausted, burned out and more-than-ever at risk of becoming permanently disengaged. Nurses, who are consistently ranked as the most trusted professionals and are responsible for the majority of direct patient care, are disproportionally impacted. They are also leaving the workforce. Current estimates of open nurse positions across the U.S. may be as high as 220,000 and a majority of health systems identify clinical staffing as their top concern, putting patient care and safety at risk. This begs the question: if the frontline stops showing up, who will be there to care for the sick?

Nursing shortages have been present for years. Today the problem is particularly dire as we see the continued onslaught of COVID-19, requiring our healthcare heroes to buckle down for each new surge. Over the past 18 months this workforce, which represents the last line of defense for the sick, has had no days off, no remote work-from-home options and increasing workplace violence, all while managing the daily life challenges associated with the pandemic.

The availability of widespread vaccinations provided a tangible glimmer of hope. With an end in sight, this battered workforce buckled down in early 2021, determined to beat the pandemic. But the hope has been stifled as we experience another COVID-19 surge. This surge, however, is different. It is different because it is preventable. Seven in 10 adults in the U.S. are vaccinated, but more than 90% of severe cases leading to emergency department and hospital admissions occur among the unvaccinated. While some adults have legitimate reasons for not being vaccinated, such as for religious beliefs or medical conditions, most unvaccinated are refusing vaccination by questioning the evidence and science. And their reasoning is tied up in partisan ideologies and has nothing to do with the facts, or the science, that has helped them live well up to this point.

Not only is our healthcare workforce at risk by servicing unvaccinated patients, but their day-to-day stress is soaring as emergency rooms, ICUs and hospitals continue to be overwhelmed. It is increasingly difficult for healthcare teams to understand why some of their neighbors aren't taking this step to protect them by getting vaccinated yet still expect to be cared for with compassion.

We know that by conventional measures, the healthcare workforce is remarkably 'resilient'. The calling to care, the mission to heal and the privilege to earn the respect of our communities as compassionate dedicated professionals has always kept us going. Working one extra shift away from families, staying late to manage the overflowing ICUs and depleting personal emotional energy for each dying patient is simply "what we do" – without question.

But what will happen if we do see this historically resilient and dedicated workforce question why they keep showing up? What will happen if they question why they continue treating patients who disregard the science or the safety of the very healthcare workers they are asking to care for them? As we see more direct attacks on nurses, hospitals, doctors and science itself, there is increasing withdrawal from the core tenets of compassion and empathy. Fatigue is setting in. If this continues, then the allure of the most noble of career callings will wane. When caring is lost, who is left standing when we need it the most?

The feeling of desperation among U.S. healthcare workers has been pushed to the edge. If the unvaccinated continue to stay that way, America's hospitals and communities face a bleak future. But perhaps one of the longer-lasting effects of today's unvaccinated will be the damage to our nursing workforce, risking driving them out of their professions and serving as a warning for those who wish to enter the profession.

This is an existential threat to healthcare in the U.S., and we must issue a call to action to protect our protectors. The solutions aren't simple, but we must start with facing the problem head-on, recognizing and supporting these heroes and committing to wellbeing and caring as core principles. Foundational changes to training, innovating to create wellness and resilience and holding to account those who impede the progress of the caring industry are necessary. It is critical that as vaccination policies are established and updated, we keep in mind the preservation of both today's and tomorrow's nurses. Dr. Jean Watson noted: "Caring is the essence of nursing," and we have an obligation to assure this remains true.

Stephen J. Motew, MD, MHA, FACS, is Chief of Clinical Enterprise at Inova Health System. He is a fellow with the American College of Surgeons, and a member of the Southern Association of Vascular Surgery and the Society for Vascular Surgery.


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