How to make ICU nurses happy

Alberta has become the latest province to offer financial bonuses for front line health care workers. Apparently January 2021 was a very bad month for critical care staff. Because of the Covid crisis, ICU nurse mental health has been at an all-time low. 

"On a unit with seventeen beds, we had, like, twelve deaths in one week," said one nurse. "We cared for them for weeks, watching them struggle for life as they were hooked up to ventilators and a dozen drug infusions. Family couldn’t visit. Then, when we knew they were going to die, their loved ones were allowed in just to say goodbye. It was devastating. Nurses were breaking down all over the place." 

No wonder they were burning out. 

Given this mental health crisis, and my own position as a physician, I took it upon myself to "take the pulse" of the hospital itself. Thus, I conducted a survey entitled: How To Make ICU Nurses Happy. The intended benefit was twofold: (1) gather information, and (2) actually make the ICU nurses happy with the survey process itself. Was it possible for the diagnosis to be the treatment? 

The following options were explained to various groups of ICU nurses. Efforts were made to not obstruct their duties while performing the survey, even though I wasn't very successful at this. But I tried, okay.

Option 1: More money. Surprisingly, not a popular means to make nurses happier. Only 32% favorability. "Free stuff" or free services, however, was suggested as an alternative. Like "a set of tires after a long week of work". Or "groceries on your way out the door". An interesting proposition. Could we turn an ICU room into a dentist office so staff can get their teeth done on the job?

Option 2: Alcohol on the job. Ideally, we’d start with Bailey's (or some other coffee additive) in the mornings, followed by wine/beer in the afternoons. The possibility also exists to supply backpack fluid containers with wrap-around straws to allow for continuous drinking even with masks and other PPE in place. 87% of nurses favored this option.

Option 3: Group hugs (with PPE, of course). 73% of staff favored this, with those not in favor self-described as "not a hugger".

Option 4: Group hugs (without PPE). More intimate, but potentially higher Covid transmission risk. This option was less popular than #2 with only 45% support.

Option 5: Hospital-wide ban on frowning. This may be difficult to enforce, since everyone is masked. However, experts agree that frowning can still be detected in the upper portion of the face. Frowny-face emoji stickers would be available so that if anyone suspected an infraction, they could slap the perpetrator with a sticker. At the end of the shift, each sticker would be punished with public flogging. 92% in favor.

Option 6: Roller skates/blades. 83% in favor, but there was concern for increased orthopedic injuries. Safety equipment (helmets, elbow pads, etc.) would have to be supplied. As a side benefit, Code Blue response time would be drastically reduced. 

Option 7: Exotic pet therapy. Since dogs were banned from hospitals for being too much of a Covid risk (for real?), we have to look at less traditional therapy animals. Possible species include:

(A) Monkeys: as long as others were available to change its diapers (pediatric nurses perhaps?). 

(B) Parrots: excellent at closed-loop communication.

(C) Tarantulas: very low maintenance, but not particularly cuddly.

(D) The always-popular giant sloth: low flight risk, thus less Code Yellows.

Pets were moderately popular among nurses to make them happy (51%), although maybe just getting therapy dogs back in hospital is a better option.

Option 8: Visits from your children at work. This was met with resounding a 'No' from all survey participants. 0% favorability. Most of them work out of the home so they don't have to deal with their own children on a regular basis. 

Option 9: Visits from your significant other at work. We’ve all seen those medical dramas and what Dr McDreamy gets up to in those storage rooms. Well, what if we could make that happen with actual, normal relationships! Nothing like a hot rendez-vous with your spouse to spice things up at home. Most ICUs have a Procedure Room - putting quotation marks around it would help legitimize the "procedural" aspect of this vital function. This was met with variable support from respondents - 45% favorability - with a strong gender bias. 

Option 10: On-site tattoos. Nothing boosts morale like a group tattoo session. That’s why the army does them - to get through those high-stress, life-and-death situations. We could even tie this to immunizations! Can Moderna produce ink-infused vaccines? Just trying to be efficient here.

Option 11: Regular surveys from smart-ass doctors to let them know we're thinking about them. Very popular. 100% in favor. Who knew that a heartfelt, in-person "thank you" would make such a difference? Yes, in the end, the diagnosis was the treatment.

Although this survey was intended to be humorous, there were a couple takeaway points our politicians and administrators can learn from.

First, money can’t solve the problem of health care worker burnout. This is like an absentee parent trying to buy back favor from his estranged child with an extravagant gift. Unlike the rest of the country, health care workers have been working non-stop, earning overtime, and saving money. They don’t need a raise. A sincere, face-to-face (or mask-to-mask) interaction with people on the front lines would be far more effective. To the bigwigs who sign our paychecks, come slum it in the trenches with us for an afternoon. Forget the cameras, don’t tell the press, just show up and tell people how much you appreciate all their hard work. Bring some pizza or a fruit basket. And most of all, don’t make a show of it.

Second, please try to convince the powers-that-be to allow us to share food again. This was a recurring theme during the survey: "Can we please get Waffle Sundays back?"; "Coffee: all I need"; "Potlucks! That's all you have to do, just let us have potlucks again and we'll be fine!"

The hospital I surveyed recently had a number of gift baskets donated to the nursing staff on each unit, full of individually-wrapped snacks. Unfortunately, they were all confiscated due to Covid transmission risk. Are you kidding me?! That was a tough pill to swallow, so to speak. 

Let's be honest: sharing food in hospitals isn't going to cause a third wave of Covid, or fourth wave, or any other mass outbreak. We all have our masks off to eat in the break rooms anyway. But sharing a meal goes a lot deeper than just the food. Risk-managing this issue may be how we can hold our crumbling system together long enough to get through this. Furthermore, food donations can be a way for the public to show their appreciation. We can get Skip The Dishes from a stranger who’s been all over town, but we can’t accept homemade cookies from a widow thankful for how we cared for her husband in his last days? Nursing staff would be thrilled to receive this. At the risk of creating a double standard, can we please relax the rules for hospital break rooms?

In summary, social isolation and high-stress working conditions have hit hospital staff hard. "After all those awful shifts, I just go home and drink while watching Netflix." Despite what we constantly hear, we are not all in this together. Indeed, our front line workers - especially nurses - are bearing far more than the rest of us. Although the second wave is tapering off, the burnout hasn't resolved. Institutions cannot help with this. Only people can. And food can help. 

So, to the people running the system, nobody’s going to turn down your cash bonuses, but this is not a cost-effective measure at reducing hospital staff burnout. A big discount in hospital cafeterias would be far less expensive and much more effective. And try saying "thank you" - sincerely, in person, without the publicity - once in a while.

Now, can we please wipe down all those individually-wrapped snacks and return those gift baskets?

© D. B. Ryen Incorporated, February 2021.