The illusion of insulation: What bubble-bursting means for nursing and the world

The soft, intentional, politically correct atmosphere of my SF Bay Area hospital has always been something of a utopia. People come from all over, patients and employees alike, and they are welcomed despite their ethnicity, with or without insurance, without consideration of their immigration status and regardless of their backstory. It's part of being a non- profit: we can't turn people away. But it's also part of being Magnet, a top medical institution attracting both patients and employees from all backgrounds to work and live and seek help from a true beacon in health care.

Rarely is there even an outburst or loud voice (save for that patient on every unit, or a crisis situation evolves). To be honest, any sort of emotion or individual opinion is met with surprise from people, especially those in leadership positions. I believe this is because there is a lot of genuine positivity, and a blanket assumption that we are on the correct course. Dissension is unexpected, though not entirely unwelcome.

This bubble has many benefits, and leads to a mostly smooth professional experience for those involved. But that uber-professional veil thins in places.

Take for example, less formal nurse-nurse communication. We can code switch between SBAR patient care report handoff, discussing lines and tubes and time orientation and medication responses, and having a similarly detailed discussion about the cocktail she designed, or the current elementary school parents’ club drama. I know lots about my comrades from the trenches. I hear about their political opinions, who they are dating, why they can’t stand their sister or why they will have to move somewhere new when their dog dies.

So this professional air wafts off in some places. It’s not a bad thing; in fact, I think it’s the glue that keeps this bubble intact. Not everything can be professionally perfect at all times. The topic I want to touch on today is the bubble: the one that seems to insulate us from the outside world.

A lot of my sustainability work is informed by a culture of excess we see in our bubble. You see, there is a certain cushion to being at an institution like mine. Things get funding. Supplies are available. We are (mostly) well-staffed. Even in crisis situations like natural disasters or epidemics that impact the supply chain, there are tiers of people working to make this place run smoothly. Positions of power are spread to many different people, and it’s mostly justified. There are so many departments: the cogs that make this place tick. Nurses are an important cog, if not the whole damn motor. Here, nurses operate at the top of (or even sometimes above) their licensure (per policy, of course) and major projects are ongoing at any given time with nursing involvement.

So I’ve often felt disconnected from the fluctuations of the outside world, safe in our bubble where we can’t be touched. Where we care about the planet and its people. Where employees are protected and trusted. Though new ideas remain difficult to gain traction, as in most workplaces, at least I am somewhere I can try to bring about necessary change. But sadly, we are no longer insulated from the goings on in our country.

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Supply cuts, layoffs, cracking down on hard-working employees over exact minutes providing healthcare... these are signs of the times.

From a Float Pool nurse’s unique perspective, it can be strange to see these things happen in real time, simultaneously, across units. How the air changes. For example, our historic “5-minute grace period,” long interpreted as It's ok to clock in up to 5 minutes before or 5 minutes after start of shift (based on our contract), has now become “you may clock in up to 5 mins AFTER” 0645/1845. We are being monitored, and must provide justification if we clock out in even 1 minute "late". This means, technically, I also can't look up my patients before then. And 0645 is the start of huddle and report, meaning I have that much less time to research your grandma's risk for stroke or your dad's heart rhythm strips over the last few days before diving into their care.

They are also cracking down on time spent completing required HealthStream modules, meaning for required training it is expected that we just click through at rapid speed, learning nothing, like Hamm controlling the remote on Toy Story 2. “Extra” pay opportunities that once abounded are just not there anymore: overtime, easy reimbursement for additional work and other requirements outside of our 3 12s, opportunities for professional growth. Halted. Not to mention formal or informal hiring freezes popping up across the country.

These may seem like subtle changes and in general they are. And truly, as a sustainability-minded health care worker, I respect the hustle and understand that waste appears in many forms, including inefficient staffing. But the shift in culture is palpable, as my health system gears up for the “headwinds” (so they keep calling them), trying to build up our already large annual surplus by putting the nursing staff under an already close microscope. The fact is, we are no longer insulated. The problems that affect our people, our patients, our communities, eventually affect us as medical staff at work, even in the biggest, most sturdy of institutions. It’s already here.

Do you know what the nurses talk about today? Inequities in hospitals they have worked before, where VIPs pay a cool $1,000USD extra per night to stay in what I can only refer to as luxury health suites, while the layperson shares a room and a nurse with multiple other patients. They discuss fears over deportation, if not for themselves, for their family members or friends. They are cancelling travel plans in order to avoid being misidentified at the border for their skin color or their name. Everyone worries over their children, how they will fare in a world of limited support and lots of hatred. They all express annoyance over this increased micromanagement, and some are even fighting back (in ways that keep them their jobs in this time of uncertainty).

Paychecks are going down; stress is going up. Even my cost to keep this website active is increasing this month by 10%. I don’t know what to do, but I do know I have one little budding talent in writing and I’m trying to use it for good.

I could not be more grateful for my job and the opportunities it has opened up for me. I do feel confident I can operate under the new requirements, and that I am valuable to the business and therefore will keep my job, but I don't believe that rings true for all my colleagues. My hospital is only reacting to the large threats looming over it, and trying to find ways to prop itself up no matter what happens.

This all leads me to state the obvious: sustainability is not a priority in the current environment. Which is the ultimate irony, because cost savings follows waste reduction, but what the f*ck do I know about running a health business? (Yet!!)

Nursing is political. There is no question. And at this particular time of year, my patriotism is strong but my faith in my country is weak. This 4th of July, I’m going to spend time with my family and friends. Not celebrating this country, but celebrating us and others who remain loyal to its original goals: No Kings, No Taxation without Representation, No Persecution on the Basis of Religion, in a melting pot where everyone is welcome to come strike their own luck and fortunes.

To America and Americans and People Living in America, especially the health care workers who are going to fix blown off hands this weekend, I salute you. I fight for you with my pen. I see you and I hope you see me. If nothing else, let this be a recording of one professionally informal voice, shouting into the void, this:

When nurses are threatened, we are all threatened.

—Jacquie, BSN, RN-BC, MEDSURG-BC, CNIV, Masters (MPA) in Sustainability Candidate

Float Pool Nurse | Sustainability RN Fellow 2023 | Nurse Ecologist