Anonymous Nurse is a column written by nurses around the United States with something to say. If you’re a nurse and would like to write about working in the American healthcare system, get in touch at

I’m sitting at the nurses’ station wrapping up my documentation for my shift. All I can think about is how great it will feel to get a full night’s sleep. I’m on my fourth, 12-hour night shift in a row, and I’m so tired I can barely keep my eyes open.

That’s when the phone rings.

I know it’s the staffing office and I consider pretending I didn’t hear it, but I pick up anyway.

I’m told my unit is down two nurses for the night shift, and a double bonus is being offered if I can “just” work an extra eight-hour shift.

I think to myself, I’m going to stand firm, just say no. I need that day off so badly. My body is screaming at me, begging me to just take the day off.

Then there is my family. My kids need me at home, and it would be nice for them to see their mom for more than 12 hours. Aside from that, a full night’s sleep might just make me look less exhausted.

But then, my mind turns to my coworkers. I know what it is like to work short staffed, to have a patient load so heavy that your head spins as you try to juggle all of their needs and then some.

And now I’m thinking about my patients. What kind of care they will receive if each nurse is so overloaded? Will all of their needs really be met?

The guilt immediately sets in because, if I don’t help out my coworkers, who will? Besides, it’s only eight hours, I rationalize to myself, and my kids won’t even know I’m gone if I head home now (7 a.m.) and start the shift at 11 p.m.

My mouth opens and words come out before I can stop them, “Sure, I’m happy to help. I’ll cover tonight.”

I immediately regret it. I’m already exhausted, and why can’t I ever say no? The true reason is, I know how it feels to work understaffed, and I feel it’s my duty to help my coworkers and protect our patients — even at my own expense.

Throughout my six years as a registered nurse (RN), this scenario has played out more times than I care to admit. In nearly every hospital and facility I’ve worked, there has been a “nurse shortage.” And the reason often comes down to the fact that hospitals staff according to the minimum number of nurses needed to cover the unit — instead of the maximum — in order to cut costs.

For far too long, these cost-cutting exercises have become an organizational resource that comes with extreme repercussions for nurses and patients.

In most states, there are recommended nurse-to-patient
ratios. However, these are guidelines more than mandates. Currently, California
is the only state stipulating that a required minimum
nurse-to-patient ratios must be maintained at all times by unit. A few states, such as Nevada, Texas, Ohio,
Connecticut, Illinois, Washington, and Oregon, have mandated hospitals to have staffing committees responsible for nurse-driven
ratios and staffing policies. Additionally, New York, New Jersey, Vermont Rhode
Island, and Illinois have legislated public disclosure for staffing ratios.

Only staffing a unit with the minimum number of nurses can cause hospitals and facilities numerous issues. When, for example, a nurse calls in sick or has a family emergency, the nurses on call end up taking care of too many patients. Or an already exhausted nurse who worked the last three or four nights is pushed into working more overtime.

Moreover, while a minimum number of nurses might cover the number of patients in a unit, this ratio doesn’t take into account the varied needs of each patient or their family.

And these concerns can have serious consequences for both nurses and patients.

Increasing nurse-to-patient ratios and hours of already exhausted nurses puts excess physical, emotional, and personal stress on us.

The literal pulling and turning of patients by ourselves, or dealing with a violent patient, in conjunction with being too busy to take a break to eat or use the bathroom, takes a toll on us physically.

Meanwhile, the emotional stress of this job is indescribable. Most of us chose this profession because we are empathetic — but we can’t simply check our emotions at the door. Taking care of the critically or terminally ill, and providing support to family members throughout the process, is emotionally exhausting.

When I worked with trauma patients, it caused so much physical and emotional stress that I had nothing left to give by the time I went home to my family. I also had no energy to exercise, journal, or read a book — all of the things that are so important to my own self-care.

After two years I made the decision to change specialties so that I could give my husband and children more of myself at home.

This constant stress is causing nurses to “burn out” of the profession. And this can lead to early retirement or drive them to seek new career opportunities outside their field.

The Nursing: Supply and Demand through 2020 report found that through 2020, the United States will create 1.6 million job openings for nurses. However, it also projects that the nursing workforce will face a shortfall of an estimated 200,000 professionals by 2020.

Meanwhile, a 2014 study found that 17.5 percent of new RNs leave their first nursing job within the first year, while 1 out of 3 leave the profession within the first two years.

This nursing shortage, coupled with the alarming rate at which nurses are leaving the profession, does not look good for the future of nursing. We have all been told about this upcoming nursing shortage for many years. However it’s now that we’re really seeing the effects of it.

A burned out, exhausted nurse can also have serious implications for patients. When a nursing unit is understaffed, we as nurses are more likely to provide suboptimal care (though certainly not by choice).

Nurse burnout syndrome is caused by emotional exhaustion that results in depersonalization — feeling disconnected from your body and thoughts — and a decrease in personal accomplishments at work.

Depersonalization in particular is a threat to patient care as it can lead to poor interactions with patients. Furthermore, a burned-out nurse does not have the same attention to detail and vigilance they normally would have.

And I have seen this time and time again.

If nurses are unhappy and suffering from burnout, their performance will decline and so will the health of their patients.

This is not a new phenomenon. Research dating back to 2002 and 2006 suggests that inadequate nurse staffing levels are linked to higher rates of patient:

  • infection
  • cardiac arrest
  • hospital-acquired pneumonia
  • death

Moreover, nurses, especially ones who have been in this career for many years, become emotionally detached, frustrated, and often have difficulty finding empathy for their patients.

If organizations want to retain their nurses and ensure they are highly reliable then they need to keep nurse-to-patient ratios safe and improve staffing practices. Also, stopping mandatory overtime may also help nurses from not only burning out, but leaving the profession altogether.

As for us nurses, letting upper level management hear from those of us providing direct patient care may help them to understand how severely poor staffing affects us and the risks it poses to our patients.

Because we are on the frontlines of patient care, we have the best insight into care delivery and patient flow. And this means we have the opportunity to also help keep ourselves and our colleagues in our profession and prevent nursing burnout.