Melissa Harris-Perry: On Friday, House Democrats finally came together to pass the $2 trillion Build Back Better Bill. It's legislation intended to improve the social safety net in the US. Now about $19 billion in the Act will be directed towards public health spending, and of that, hundreds of millions will be spent training and supporting nurses. You've probably heard headlines sounding a bit like this.

Female Speaker: Tonight we look at how their shortage of nurses is affecting healthcare workers and hospitals.

Male Speaker: There's a nursing shortage, not only here at the hospitals in Texas, but also in Louisiana.

Female Speaker: There's a devastating nursing shortage that we're experiencing here in the US.

Male Speaker: We have seen a national shortage of medical professionals, specifically nurses.

Female Speaker: The on-again, off-again nursing shortage, is on again and it's not slowing down anytime soon.

Melissa Harris-Perry: During the pandemic, many hospitals say they've struggled to find enough nurses to continue typical day-to-day operations. This is particularly true of hospitals in rural areas. The organizations that represent nurses say that all hospitals are framing the story is not entirely accurate.

Jean Ross: I've been a nurse for over 46 years, and there has been a huge change since I first started working.

Melissa Harris-Perry: That's Jean Ross, President of National Nurses United. The largest organization of registered nurses in the US.

Jean Ross: You can see that not just during this time of pandemic to employers cry that there aren't enough staff. They have said that every time. They themselves have engineered a shortage. In other words, their bottom line is the most important thing to them. Therefore, if they don't want to pay for enough of us to work, they don't.

Melissa Harris-Perry: I spoke with Jean to find out more about why nurses say there's more to this crisis than just the stress of COVID-19.

Jean Ross: We have been, I would say harping on this for decades now before the pandemic. The pandemic has shown many, many things to us in this country, obviously, and it's highlighted this for people who didn't understand what we were going through at the bedside. There are things, I guess you could point to California, as an example. We've been trying for some time and we'll continue to try to get federally mandated staffing ratios, saying every registered nurse must not, in this setting, ER, Med surge, ICU have any more than this number of patients. She can have fewer, but no more, we've been trying to get that.

California's the only state that's had it for a number of years now. All of the horror stories about, "Oh my goodness, we won't have enough nurses. Where will they come from? There's already a shortage." Well, lo and behold, what we said would happen did. Nurses came out of the woodwork, nurses who hadn't worked in months, nurses who hadn't worked in years because the conditions were such that they could do their job without fear of harming someone or themselves because they had adequate staffing. We know that it works, it's just a lack of willingness on the employer's part.

Melissa Harris-Perry: How is this different in rural areas versus in big cities, or is it different?

Jean Ross: It is very different. You should talk to a rural nurse sometime about that. I don't want to say Jack of all trades, master of none, but in those smaller community hospitals, you do a lot of different things. You would find maybe not a specific labor and delivery department, the nurse who works ER runs up when a woman comes in labor, and that kind of thing. They're all experienced, they're very good at it. We all use a lot of critical thinking or we wouldn't be able to continue to do what we do.

In those smaller communities, because of this push for only wanting services that make money, you start closing down facilities. In larger facilities, you would close down certain departments that don't make you money,

as I mentioned, labor and delivery. Women are having to travel farther and farther and farther away to deliver if they choose to deliver in a hospital, which most women still do. People who need emergency care have to travel farther away.

You will find doctors and nurses leaving those rural communities because they can't do their job with the conditions that they're placed under. We are one of the few groups, I'd say, that get out in mass and say, "Don't you dare close that community hospital." Sometimes we've been successful, sometimes not. It's generally smaller communities, rural communities, and areas in larger cities where there are a lot of people of color. They just don't want to leave them open.

Melissa Harris-Perry: How then, given that we're two years into the pandemic-- It seems to me that new incentives would have emerged. Just as we've seen in minimum wage roles, in food service, we have seen rising wages as a result of COVID-19 because fewer people are willing to work in these circumstances. I'm wondering if wages have gone up or the capacity to negotiate these working conditions for nurses.

Jean Ross: Hospitals employers are no different than other employers, they're very anti-union. We continue to organize and we've been very successful, but it's very, very tough. They scare employees off from organizing, and nurses are no exception to that. I would say if you look at the rising wage, et cetera, that have come from workers in this country right now and say, "No more, I won't do this." Even though wages are going up, it's very slow, they are very recalcitrant. Look at the John Deere people, they have to go on strike to get decent wages and decent pension benefits, decent health care benefits.

Still a huge thing, even with the Affordable Care Act. Yes, things are changing slowly, but we're still fighting to organize to get the things that we need. For example, PPE, all you could hear about at the beginning of the pandemic was PPE, people who never knew what PPE was, Personal Protective Equipment. We've been fighting for those things for years, and it hasn't been until it's put in the public eye that they show any signs of having any shame whatsoever. Even that didn't do it. They put us in the middle of a perfect storm. We started from behind, that didn't need to be. Unfortunately, even with the pandemic, we do not see signs of them changing their minds.

Melissa Harris-Perry: Thank you so much to Jean Ross, President of the National Nurses United, the largest organization of registered nurses in the US. So appreciate your time today.

Jean Ross: You're very welcome. Thank you for having us on.

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Melissa Harris-Perry: We also asked our nurses out there in our listening community, how has your job been impacted on nearly two years of COVID-19?

Kais: Hi, my name is Keizer. I'm calling from Elizabeth, New Jersey. I'm a registered nurse here in Northern New Jersey, I worked in an assisted living facility. Nursing has changed and I have switched from primary care to preventive care. Now, I'm an infection prevention specialist, working on my Master's in public health, and soon to be an epidemiologist. I just want you to know that our health care workers are out there doing everything we can so we can advocate and educate.

Cammie George: This is Cammie George. I live in Troutman, North Carolina. I am an operating room nurse. The biggest problem that I see right now is short staffing, which has remained and actually gotten worse because many nurses have left the profession, and inadequate pay and benefits, which is hard to swallow when most CEOs still make very high salaries with many perks.

Shelley: Hi, my name is Shelley from North Andover, Mass. I work on a second shift medical-surgical floor of an Inner-City Hospital that became the COVID unit during the second surge in Massachusetts. All of us are just feeling the fire of moral injury, like that feeling that you can't do enough to serve your patients to the standards they deserve and really require. Basically, the staff-to-patient ratios have been blown out the door. We really just have a tremendous problem.

Danielle Landers: Hi, my name is Danielle Landers. I'm calling from St. Louis Missouri. I'm actually a current BSN, Bachelor of Science degree nursing student. The way that we have been impacted as nursing students is our clinicals have been severely impacted. We have limited sites, of course, that we can go to for the clinical portion of our education. They limit the number of students at each site. Some sites have actually stopped taking students as a result. It's really been difficult.

Our staff and faculty are at Methodist College, I'm sure in other nursing schools as well across the country, have had to be really creative as far as clinical sites are concerned. It's really putting a strain, not just on the nursing profession but as well on those of us that are trying to become nurses.

Melissa Harris-Perry: All right. Everybody, thanks for your calls. According to our last guest, Jean Ross who is President of National Nurses United, this crisis is exacerbated by the cost-cutting decisions of hospital administrators. We wanted to find out more about the factors that play when hospitals, staff, nurses and create budgets. Here with me now is Leo-Felix Jurado, who is Professor and Chairperson at William Patterson University Department of Nursing. Professor Jurado, thanks for being here.

Leo-Felix Jurado: Thank you for having me.

Melissa Harris-Perry: Do hospitals, in fact, tend to hire fewer nurses per shift in order to maximize profits?

Leo-Felix Jurado: I would say that it's probably more of looking at the entire budget in terms of how much will they be able to sustain their facilities and operation of the hospital. They look at patient acuity systems to see how many nurses they need.

Melissa Harris-Perry: I know you're based in New Jersey. How much do nursing hiring practices differ state to state?

Leo-Felix Jurado: There's a lot of variations from state to state, from urban to rural or semi-urban. There are different variations. At the same time, there are some legislation from state to state in terms of what the staffing level would be for every single hospital.

Melissa Harris-Perry: One of the things Jean suggested was that there should be a federally-mandated patient-to-nurse staffing procedure. Would that be sufficient to move us beyond this crisis in nursing?

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Leo-Felix Jurado: It may or may not be. There are positive and negative aspects of federally-mandated number of patients per nurse sometimes. In California right now, it is legislated that there is a number of patients per nurse. In other places, they would look at patient acuity because you could have one patient, but that patient is extremely acute, you cannot take care of the rest of your patients. For example, you have five patients at the moment, because that's a mandated number of patients you should have as a nurse, and one of them is really, extremely acute, what happens with the four?

I think there should be recommendations, but not necessarily fully mandated federal law in terms of the number of patients per nurse, again, because it should be based on patient acuity.

Melissa Harris-Perry: When you talk about acuity, I'm wondering how COVID may have changed nursing staffing positions.

Leo-Felix Jurado: COVID basically changed the landscape of care in America. Aside from the nurses getting sick during COVID time, at the height of the pandemic, at the same time, many nurses were sick, so there were not enough nurses to take care of patients, especially when there was understaffing in the first place.

Melissa Harris-Perry: Professor, I want you to take a listen to one of our callers this weekend.

Barbie: My name is Barbie and I am a nurse in Alaska. For the past 10 years, I've worked in the emergency room. The stress, anxiety, and emotional mental toll of this pandemic has devastated the nursing field. I watched so many of my co-workers leave the ER for different departments or their nursing careers completely. The saddest aspect for me has been the lack of support and resistance to the evidence-based science to stop the spread of COVID-19, and then this nightmare that we've all been living in.

Melissa Harris-Perry: I'm wondering about that, when you say COVID changed the whole landscape, in changing the landscape, were nurses and hospitals set in opposition to each other?

Leo-Felix Jurado: I would not say that because I'm also working at a hospital. The thing is, the hospital administrator's hands are tied because of the limited budget as a result of many different factors. It could be as a result of a lack of support from state governments or federal government, especially if this is a state-funded hospital. There are many, many factors that come into play in terms of the revenues that are not enough. At the same time, expensive payment for agencies staffing as a result of nursing shortage.

I would say the majority of administrators, they do understand the situation, but sometimes their hands are tied up in terms of they don't have anything to give. Again, especially if the facility is supported by the state or federal government. That's why there are hospitals that are closing as a result, because they don't have funding. They feel so empathetic for nurses because nurses basically drive the hospitals. They're the ones making the hospitals work day in, day out, 24/7.

Nurses work so, so very hard, and people don't understand, that sometimes nurses don't even have the time to take a break, to go to the bathroom, or to eat. Working 8 to 12-hour shifts is completely difficult for them.

Melissa Harris-Perry: As you talk about the way that administrators' hands may be tied by budgetary constraints, I'm wondering if the Build Back Better Act and the resources that are allocated there could make a difference, untie some of those hands.

Leo-Felix Jurado: It may help, it definitely may help. Definitely, the federal government really needs to look into investing more into hospitals, particularly assisting in terms of funding for payment for nurses. They need to value the time for nurses. Otherwise, the shortage will go worse. Right now it is projected that we will have at least 1.2 million shortages in 2030. The only way we could assist that is to help universities of nursing produce nurses by paying faculty. Faculty of nursing are not properly paid, so there's not enough faculty to teach nurses.

If there's not enough faculty to teach nurses, there's not enough nurses to go work at these hospitals. You got to look at the source. The universities really have to look at how they could invest in teaching faculty because payment for faculty is less than working at the hospital. That is a different treatment right there in terms of nursing faculty.

Melissa Harris-Perry: That's such a good and interesting point that I don't think we always hear. We hear about the student loan debt, but not always the faculty side. There must be someone there to teach those classes. We have very little time, but what is the future of nursing based on what you see?

Leo-Felix Jurado: Unless this nursing shortage is addressed as soon as possible, paying faculty, paying staff nurses, we will have a big issue in healthcare. We will have a crisis in healthcare where there's not enough nurses to take care of patients.

Melissa Harris-Perry: Leo-Felix Jurado is Professor and Chairperson at the William Paterson University, Department of Nursing. Professor, thank you so much for joining us today.

Leo-Felix Jurado: You are so welcome. Thank you for having me.

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