Sarah Warren is a nurse and influencer with over 100,000 followers on her @shesinscrubs Instagram account. We talked to her about the state of nursing and the healthcare industry, and what can be done to better support nurses so they can take better care of patients.
What attracted you to pursuing healthcare as a profession?
My mom is an immigrant from the Dominican Republic – it took her about 10 years to become a nurse, because she finished some college in the Dominican Republic, but when they moved to the United States, none of that transferred over. She applied to a nursing program in New Jersey and there was a four-year waiting list, so she kind of gave up on her dream.
When my family moved to Florida, there were openings at this nursing program at a community college and she saw this sign in a bathroom that said, “You can be a nurse!” and it drove her to go back to school and become a nurse. She ended up graduating, and at her graduation, I was so inspired. That moment, I was like, “I need to be a nurse like my mom.”
Is there a direct relationship between access to education and the amount of nurses in the healthcare profession?
The barriers have only compounded and sadly, the research also shows that the nursing field has kind of become its own worst enemy. We wanted to become respected professionals, so to do that, we decided that we wanted to start only pushing for bachelor’s in science degree nursing programs, without actually bolstering those pathways for all nurses.
Magnet status — requirements that nurses must obtain a higher education within a certain timeframe — has increased gatekeeping within the profession. But because of the pandemic, magnet hospitals are now opening their doors to nurses who don’t have this education. For a lot of these nurses, it’s almost like a slap in the face: You didn’t appreciate us for our labor when we had our diploma program, but now you want us to do the same work that you closed the door on us for in years prior.
I think nursing has a lot to do in terms of revisiting what our priorities are. Do we care more about looking like the most respected profession? Or should we be working on removing the barriers that we’ve created ourselves as a profession?
What changes have you seen directly affecting nurses?
When I became a nurse working in adult progressive care in an acute care hospital, I experienced burnout, disillusionment, bullying, and lateral violence from my colleagues. We doubled our unit in six months because there was an incentive to have as many observation beds as possible.
I thought that if we need to care for a patient a bit longer, let’s incentivize that, instead of trying to kick them out as quickly as possible. We became overextended because you’re expecting and demanding an unrealistic amount of labor from your workforce. Then we blame the individuals, instead of the environment that is causing patient harm.
What is systemic exploitation in healthcare and how does it lead to burnout?
Throughout 2020, I was using social media to talk about the fact that before masks were mandated in hospital settings, my colleagues were being retaliated against for wanting to wear masks because they were told we needed to make the public think everything was fine. I was receiving countless messages and emails from healthcare workers across the country who had similar experiences and were being retaliated against for advocating for themselves.
To me, that was healthcare systems exploiting us for our labor and sacrificing us for our labor. At that time, a lot of the people who volunteered for COVID cohort units were people in our 20s who felt like we weren’t at high risk, so we decided to put ourselves on the front line so our other colleagues wouldn’t be harmed. Once the noise from pots and pans and the clapping in the streets faded, standards began to decline even further.
How can patients stand up for their own rights within the healthcare system?
I started a national peer support network for healthcare workers, Don’t Clock Out, to talk about how exploitation leads to moral distress and emotional numbing. Through peer support, we help connect other healthcare workers to each other who are going through similar things.
We have to build community together with the help of patients through telling our stories, and helping patients understand that if we aren’t cared for, and if we’re abandoned by our institutions, that impacts patient safety and our ability to care for them. It’s not that we don’t want to provide safe, high-quality care. It’s that under these systems, and all of these layers that contribute to harm, we’re just navigating them and treading water.