I came to New York City as a travel nurse in 2007. A travel nurse is a temporary employee who is flown from his or her home state, housed in a corporate apartment, provided an hourly wage, and flown back to his or her home state upon completion of the contract which is usually thirteen weeks in length.
At the time, my home state was Washington (no, not Washington D.C.—the REAL Washington—the one that New Yorkers have never been to) and my specialty was cardiac nursing. I was told before I left Seattle that the difference between nursing in Washington (west coast) and New York (east coast) is the staffing ratio. The staffing ratio in my home hospital was 4 to 5 monitored cardiac patients per nurse. It was discussed during the phone interview and written in my contract that I would be caring for 6 monitored cardiac patients in Manhattan and I felt comfortable with that ratio.
On the second day of my contract, the cardiac Nurse Manager threw up her hands, shouted, “I can’t take this any longer!” and never returned. On the third day of my contract, the hospital’s Director of Nursing brought the cardiac nurses into the conference room and informed us that we no longer had a manager. Conditions with a manager were chaotic at best and I could only imagine how the unit would function without supervision.
With a manager in place, I was assigned 8 to 10 patients during busy 12-hour day shifts, rather than the 6 patients I was contracted to care for. Adding to the chaos, nurses were responsible for watching each other’s patients during breaks, burdening us at times with 16 to 20 patients each. As a result, we did not take breaks out of fear that a patient would crash while we were off the floor. Supplies were limited and staff would hoard everything from spoons and straws to EKG electrodes while the aides would hide the rolling blood pressure machines and thermometers behind doors, in bathrooms and behind curtains.
Normally I would discuss nursing issues with a unit manager, but since we were operating without one I took the opportunity to inform the Nursing Director of the dangerous conditions on the unit. I first conveyed my understanding of east coast nursing and expressed my respect for her and the staff nurses. I continued, “But the nursing ratio on this unit is a serious patient safety issue. My contract states that I am to care for 6 patients, and I am comfortable with that, but every day I’m assigned between 8 and 10. What are your thoughts?” She replied, “I think you have a decision to make. You might consider going back to California.” With that she turned on her heel and walked away. The executive responsible for setting the tone and culture among the nursing staff told me to get out of her house with no concern for improving patient safety.
Regardless, I completed my contract despite witnessing abominable health care. I saw nursing aides drawing blood while talking on their cell phones. I saw nurses crying in the bathroom from sheer exhaustion. I saw patients ignored and neglected. It was heartbreaking.
Since my contract ended I’ve seen this particular institution associated with Medicare / Medicaid fraud, embezzlement, and bankruptcy. It is public record that executives and even some doctors continue to put profit ahead of patient safety at this facility. I see a desperate, vulnerable, low socio-economic patient population in dire need of care with few other options. Decision-makers understand that many of the hospital’s patients are naïve and lack the resources to sue if their wellness is compromised. The nurses, mostly internationally trained ESL immigrants, have limited job opportunities which prevent them from finding work elsewhere [see Lack of Education in Nursing and Foreign Trained Nurses blog posts].
As a travel nurse, I had the option of returning to the west coast and never looking back. However I finished my contract and chose to remain in Manhattan. For the past five years I have observed a complex health care system and endeavored to find my place within it. I believe that challenging experiences make me smarter and stronger in the way that I advocate for both patients and nurses. I could not have become the professional that I am today without working in New York City. But when my patients ask, “You’re not from around here, are you?” I smile and relish the opportunity to tell them all about Washington State.
Originally published August 2, 2012.