At 3 a.m. on a surgical ward in Wrocław, I am responsible for 14 patients. Two of them had operations today. One is confused and keeps trying to pull out his drain. One is dying, slowly, and her daughter is asleep in a chair. There is one other nurse on the ward. There is no doctor on the floor; she is covering four wards and is, at the moment, in the emergency department.
This is not a crisis. This is a Tuesday. I have worked nights for 20 years, in Poland and for six of them in Germany, and I want to describe what the rest of Europe does not see, because it happens while Europe is asleep.
The World Health Organization estimates that Europe is short about 1.2 million nurses, and the gap is widening as my generation retires and fewer young people enter. Governments respond with recruitment campaigns, with visa schemes, with bonuses. They rarely look at the roster. But the roster is where the profession is bleeding.
Nights are staffed at roughly half the level of days, on the theory that patients sleep. Patients do not sleep. They deteriorate at night; the research on this is decades old and consistent. Cardiac arrests on wards peak between 2 and 6 a.m. Falls peak then. Confusion peaks then. We respond with the fewest people, the least senior people, and the people most likely to be on their third consecutive 12-hour shift.
The cost to nurses is well documented and widely ignored. Regular night work raises the risk of breast cancer, heart disease, diabetes and depression. In most countries the compensation is a supplement of 20 to 30 percent. In Germany I earned about 3.50 euros an hour extra for nights. I have spent most of my adult life tired in a way that sleep does not fix.
What would help is not complicated. Night ratios should be set in law, so that no nurse is alone with more than eight acute patients after midnight. Night shifts should be shorter than day shifts, not longer. Night work should carry a pension credit, as Belgium is now considering. And hospitals should stop treating the night as a storage period and start treating it as the most dangerous eight hours of a patient’s stay.
None of this is cheap. Neither is a profession that loses a third of its new entrants within five years. I am 52. I would like the young woman who replaces me to have two colleagues, not one, and a doctor on the floor.
At 6 a.m. the lights come on, the day staff arrive, and the ward looks like a hospital again. Everyone who was not there assumes it always did.
Ewa Lisowska is a contributing writer for The Continental Times Opinion section.