
“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change” – Charles Darwin
Since the COVID pandemic hit in December of 2019 in Wuhan, China, the face of healthcare has changed forever. The public can no longer ignore the unsafe conditions that medical staff have been operating in or fail to notice the toll this has taken on their wellbeing. Medical staff have both answered the global call for help, while also reconsidering their desire to work in this field any longer. If you consider the state of hospitals across the world which are short staffed and strapped for resources, adding to this fact that providers were already burnt-out before COVID, it makes me wonder who would want to continue to work under these conditions? Kelly Stanton, a nurse in Washington for 28 years, left her role in March to protect her family stating that “it was an extremely difficult decision, but as a mother and wife, the health of my family will always come first”. The first wave was certainly hit hardest, when personal protective equipment (PPE) was dwindling and sometimes non-existent, nurses had to make do by reusing their masks multiple times in a row. Today, there is a more coordinated effort to address COVID cases and to fill the need for equipment and education, but that does not mean things have gotten easier.
Even with fewer COVID patients being admitted to beds in Nova Scotia, any rise in demand for care continues to put strain on an already tenuous situation. Staff are still constrained by high patient admissions, heavy amounts of documentation, consistently monitoring devices and machines, being extremely tired, alongside many other factors that hinder good care. The general vibe of any nursing unit is that of being rushed, feeling stressed, and shared discontentment with the way things are run. This was true before we added COVID precautions, decision trees, changing protocols, and higher exposure risks. So why stay in healthcare at all? Those who have entered medicine know why they do it, it is indeed a calling. But we are giving providers fewer opportunities to use their skills effectively or to experience the benefits of giving good bedside care, because we have made it impossible for them to shine and to share what they have to give. Stanton refers to being compared to soldiers during a war, as the public consistently used the phrase “as a nurse, you signed up for this”. She replies to this statement saying that we would not send soldiers to war without a gun, and I would argue that we do send nurses to the bedside without proper support.
For all the healthcare providers who have not died from COVID exposure or stayed despite the difficult situation they have been put in, many have left medicine altogether. Yet, there is a cost to this choice as well. The decision to leave one’s chosen profession to improve your quality of life does not come easy, as there is a deep sense of failure that is felt in abandoning the hard work and achievement that was sought by nurses to reach the top of their field. Critical or emergency care is the epitome of nursing expertise and garners huge respect. To leave is to abandon not just the patients and the work, but nurses may feel they are also abandoning their own self-respect and sadly, their passion. I applaud those who have come to realize that nothing is more paramount than their own safety and wellbeing, and there is no shame in choosing to take a break or to change direction. However, what can we do for those still stuck on the frontlines? The soldier analogy used by Stanton here is a good one, and it reminds me of a classic example of nursing care during the Crimean War in 1853 when Florence Nightingale carried her lamp through the hallways of the hospital base in Constantinople. At this time, soldiers who were sent to this base for care “lacked sufficient medical attention due to hospitals being horribly understaffed, but also languished in appallingly unsanitary and inhumane conditions”.

A painting of Florence Nightingale carrying a lamp as she walks through a hospital base in Constantinople during the 1853 Crimean War.
Nightingale formed the fundamental tenets of contemporary nursing at a time when nurses were still considered to be uneducated, their profession lowly, and their skills un-honed. During the war, Nightingale rallied nursing troops to clean patients, remove them from unsanitary conditions (i.e., their own urine, excrement, and pesky vermin) and sought to bring them more sunlight, clean bedding, routine health assessments, and humane connections. Her basic understanding of the key elements behind health and happiness were timeless and gained through her understanding of statistics and first-hand experience. By cataloging what she saw in the field, her work revealed that “nearly seven times as many British soldiers had died of disease than in combat”, pointing to hygiene and sanitization as being more important than the horrible effects of war. She recognized the healing capabilities of cleanliness and a proper environment. Today, it is easy to forget how these simple actions can be healing, because they seem too obvious and are profoundly basic.
What does this have to do with the nursing crisis after COVID? Today, our hospital units are extremely short staffed and lacking veteran support as new hires attempt to fill the void created by mass exodus, but who have yet to build sufficient knowledge and experience to effectively bridge this gap. But could nurses be facing a similar situation to Crimea today, whereby the solution to our problems in healthcare might be simpler than we expect? Where is our lady with the lamp? What do our nurses need to work effectively right now? It is clear that more bodies are needed, for even when our ICUs were overflowing with COVID patients in Nova Scotia, I saw a smoother workflow than earlier on in the pandemic, because the call for nursing help was finally answered. Staff had the extra hands they needed to prone (or turn) patients, to assist with care, and to don and doff equipment, etc. We should also stop to question old practices that may have become outdated. I don’t just mean old-school nursing hacks such as how flushing a nasogastric tube with Coca-Cola has become passe, but deeper than that, do we still need 12-hour shifts? Do residents truly need to be on call for such an unsafe amount of time?
My question is: what would Nightingale do? Nightingale believed that heavy curtains should be dusted and opened wide so that sunlight might pour into patient rooms, and patients should face towards the window where they can better envision their life outside of the white hospital walls. Her attention was on the small details, the feeling you had when you walked into a room, the presence or absence of items and people, and the meaning behind them. Can a comparison be drawn here against Nightingale’s brilliant move during the war to shift our thinking away from tending to battle wounds alone and towards the simplicity of meeting basic human needs such as hygiene and being able to see the sun? Hugh Small, who has written extensively on Nightingale, argued that “Nightingale didn’t grasp the role of sanitation in disease prevention until many thousands had died”, to which Lynn MacDonald, a profession at the University of Guelph says that once Nightingale’s suspicions between filth and disease were confirmed “she became determined never to let those conditions occur again”. Once we know what we don’t want in life, it becomes clearer what we do want. So, what do we want for our healthcare heroes? Will we continue to let the detrimental effects of COVID defeat us, or will we learn from this experience?
Header photo by Monstera from Pexels
Painting via Healinghealth.com.