Belabored Stories: What If Nurses Ran the Healthcare System?
Belabored Stories: What If Nurses Ran the Healthcare System?
“We take in a lot and don’t talk about it,” a nurse in Chicago said. But healthcare workers are talking now—not just about how to save their patients, but about rebuilding the system from the bottom up.
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Belabored is a labor podcast hosted by Sarah Jaffe and Michelle Chen. Belabored Stories, a new feature, will present short accounts of what workers are facing during the coronavirus pandemic. Send us your stories at belabored@dissentmagazine.org.
Nurses and healthcare workers across the country took part in a day of action on Wednesday, April 15 to demand proper personal protective equipment (PPE)—for their own and their patients’ safety. Elizabeth Lalasz was one of those nurses, and we spoke shortly after the action concluded in Chicago, where she is a nurse at John H. Stroger Hospital and a member of National Nurses United.
“We had about fifteen or twenty nurses. I was actually pleasantly surprised,” she said. Many of the nurses who came out worked in the emergency room, and they wanted to express what they’d seen, working on the front lines of the pandemic in a big safety-net hospital in a major city. Working at a safety-net hospital, she explained, means that “We don’t refuse anybody.”
In that hospital, nurses are being told to reuse N95 masks, sometimes for up to forty-five days. “Three months ago or less, we were told one-time use per patient.” Maybe, she said, you’d use the same one through a shift, but never for multiple days. “We’re told to put them in a paper bag and hold them in our lockers . . . How you can take it out without somehow contaminating yourself or anyone else or another patient is kind of a mystery.”
The nurses were also discussing the price increase for the masks. “It was under a dollar prior to this and now we’re talking about $6 and $7 and $8 a piece,” she said. “So it becomes really difficult to obtain it because there is so much competition across states because of the federal government telling states to act on their own.”
But the cost of masks was just a symptom, she said. The real problem was that the whole system was failing. “My chief steward was talking about how the federal government has really failed us, that the system is broken, which is obviously one of the hashtags for today’s national day of action,” Lalasz said. The “feeling is that there is a great inequality that exists across this country from those who are in power. Then, the rest of us who are clearly on the front lines and experience some really frightening situations where we feel very uncertain going into work every day.”
In Chicago, as elsewhere, the inequalities of the broader system were showing, and the nurses were already planning future actions, including one on Friday at Provident Hospital, where the emergency room was shut down in the middle of the pandemic.
“It is actually the first African-American hospital in the United States,” Lalasz said. “There wasn’t much explanation except that there was one worker in the ER who was COVID positive, so they shut it down and they gave the union about three hours’ notice on a Friday afternoon. There are a lot of African Americans dying from COVID in the City of Chicago.” Roughly 70 percent of the people who have died from the virus in the city are African American. “This is an ER that is not as busy as the one at my hospital, but clearly serves an African-American population that is working class and poor,” she said. “So, not having access to that ER means they have to go, potentially, to my hospital which is about a twenty-minute drive away, which could be the difference between life and death, especially with COVID and issues around breathing or anything else that is going on, because it comes on suddenly and is very deadly.”
In the discussions leading up to the day of action, she said, the nurses had also been talking about what the system should be replaced with.
With this crisis coming up and really hitting us front-on, we were talking about why there needs to be much better coordination in the healthcare system, that the system is run for profit, and that it just doesn’t make any sense. If there was a need to have PPE—let’s say in New York when things were and have been apocalyptic or Detroit where things are getting much, much worse and it is definitely affecting the African-American population exponentially—especially [with] all the crisis around water that pre-exists within Detroit—we would shift things like N95 masks to places where it was needed.
A functioning system, she continued, would have seen use of the Defense Production Act to manufacture necessary equipment already. The conversation the nurses were having, she noted, was moving beyond Medicare for All to
building on that idea and saying that we need to actually talk about nationalizing healthcare and that we should be the ones running it, meaning frontline healthcare workers, because it’s been stunning to see how little our hospital administrators have any idea about what makes sense and what doesn’t make sense—basics about infection control and [not] putting patients who are COVID positive with patients who aren’t COVID positive. We have to change this healthcare system after this pandemic.
For the nurses to get out and express themselves, Lalasz continued, was important because many of them feel isolated on the job. “They work twelve-hour shifts and . . . a number of them in sections of our ER that are COVID only, the isolation rooms.” There are probably between 950 and 1,000 nurses at the hospital, she said, and the conversation they’re having has grown rapidly. “There were a couple of us who have been longer-standing union activists. But the other people that were there, it is clear that it really shakes you. My chief steward has said that nurses are calling her having anxiety attacks on the way to work. It just hits you right in the face.”
It is really hard to fathom, at one level . . . the reality that we are just cannon fodder. We just keep going back in. I was just on quarantine, and I’m coming back in and my unit, in the last two-and-a-half weeks since I’ve been gone, has been turned into a COVID-only unit for the inmates at Cook County Jail. The reality is so in your face. It is radicalizing people quite quickly. We are finding a lot more people willing to say something and to fight, because it’s our lives.
Lalasz is used to working in a hospital where inmates from the jail are taken when they’re sick, but it’s a big shift to have enough of them ill that they’re an entire unit. “Under a month ago, I remember asking some of the Department of Correction officers, because they’re there with the patients, ‘So, what is the plan for the jail?’” she said.
I said to my immediate supervisor, “Do you understand the risk inmates will have at the jail?” The Department of Corrections officer said, “There is no plan.” I said, “What do you mean there’s no plan? You can’t do social distancing in the jail.” I did a paper on this for one of my classes in nursing school . . . [Cook County Jail] has historically been extraordinarily overcrowded for as long as it has existed over the last 100 years. Every jail is like that, and the fact that there is no plan means that it is going to spread really quickly, and it is going to affect the people who already don’t get the kind of healthcare that they actually need in that jail just because they’re incarcerated. Then, the response from my immediate supervisor was like, “Oh, well, you deal with underserved populations all the time.” I said, “We are talking about COVID where we don’t have a cure! We have no vaccine!”
The protocols around the patients from the jail, she said, make her job more difficult. “I am in and out of my patients’ rooms a lot. That is part of being a nurse. But we’re really limited because the protocol is not to go in more than two to three times, and that means I don’t really know what’s going on with them during the course of a twelve hour shift.” Many of those patients were in jail for petty offenses, because they can’t afford bail, or even because they were detoxing. “These are human beings. It puts me in a situation where I can’t take care of them in the way that I need to, and it’s not even just the PPE issue.” And nurses are not supposed to give family members of the incarcerated patients any information. “Now you’ve got people who have family members who are seriously concerned about ‘Is this person there? How are they doing?’ And we can’t talk to them about the patient because there are restrictions on that.”
The crisis is pushing healthcare workers in a way that Lalasz sees as similar to the recent waves of teacher organizing and striking. “We take in a lot and don’t talk about it, and there’s been sort of an assumption that if you’re in healthcare, that’s what you do: you just accept the reality of what you’re doing and the short-staffing and the lack of supplies and the long hours and all the paperwork and the bureaucracy and all the blaming of us as nurses because we are predominantly women, so we are to blame for everything because we are there with the patient all the time,” she said. “Now, it is hard to really get yourself ready to go through your day because you’ve got COVID now on top of that. It just feels so, so uncertain.”
The newness of the virus means that caring for patients, she said, is an ongoing experiment. “We are figuring it out as we go, how to do the best we can for these patients while trying to figure this disease out and what it looks like.” Through the union, she said, they can share and demand more information on best practices and figure out what’s working in other parts of the country and the world.
“We are certainly trying to figure out what works and doesn’t work, which is what we should be doing—which, also, is why we should run healthcare, because we have the skills,” Lalasz continued. “Collectivizing helps us to be able to talk to each other about what seems to be working better and trying that on our patients to try to save them.”
Sarah Jaffe is a reporting fellow at the Type Media Center, the author of Necessary Trouble: American in Revolt, and the co-host of Dissent’s Belabored podcast.
