Hey, welcome to Beyond the Scenes. Look, this is the podcast that's like, you know, you know, you know what this podcast is. Like. This podcast is that big gas bag of Eminem's that you dump into your popcorn right as the movie starting. So did you get a little bit of sweet along with that butter re salty savory? Right? It's that contrast, you know, That's what this podcast is. You know, it's the goodness that you didn't even know you needed until that weird kid Marcella's did it that one time and now you can never go back. There was a kid one time he put he put his French fries in his ice cream and I was like, that is disgusting, And then I tasted it. I was like, that is brilliant. I need to figure out where the kid is these days. Anyway, speaking of my failing health due to an unsustainable diet of ice cream and French fries. Today we are diving into the latest debacle to hit the American health care system, the nursing crisis. Give him a clip, nurses understanding me pistol right now. And no matter how dedicated you want to a profession, everyone has a breaking point. And nearly two years into serving on the front lines of this war, a lot of them are starting to update their LinkedIn's. Some hospitals experiencing critical staffing shortages, as frontline workers say they feel like they're underwater. Survey during the pandemic found that six of intensive care nurses are burned out burnout, stress grueling hours. There are multiple reasons career nurses are choosing to leave. Mississippi has at least two thousand fewer nurses than it did at the beginning of the year. In Kentucky, more than twenty hospitals report critical staffing shortages. In hard hit New York, there was a four increase in nurses looking for new jobs. We are joined today to break down this Daily Show segment with number one Daily Show associate producer. You've heard on this wonderful program before, Madeline. Coon's Madeline. How are you doing today? I'm good, Roy, It's good to be back. Always a pleasure. What is this third? Fourth time? I think it's third. I think I'm tied with CJ. Now I don't know. It's it's all a blur. I'm just heady. Also joining us on the program today is a longtime nurse and nurse educator, a doctor of nursing, a doctor of nursing, you know, just to show those physicians what's what Dr Christopher Freeze. Dr Freeze, welcome aboard beyond the scenes. It's great to be with you. Thanks so much for having me. Thank you. And I know that the people um listening cannot see this, but I want to acknowledge how color coordinated your couches with the background in the the your living space. There's a color um what's what's the word, like a palette? The color story. That's yeah, my girlfriend is the color story. Everybody's worried about books in the background trying to impress people, but not you don't. You got the turquoise contrasted with a little bit of a brown. It's very it's very nice, very nice. Thank you. We're going for a ten out of ten, so thank you. Well, we'll see Room Raiders a bunch of assholes. They gave me a six. They can kiss my sorry about that. We're here to talk about things that are much more upright and appropriate, Madeline. This segment that we did on the Daily Show, we just played a little bit of a piece of the original segment, but for folks that that mystic give us a little bit of an overview of what the segment covered up and how it came to your attention to Yeah, so the pieces essentially, uh, it's about how the crux of how we have a critical national nursing shortage which is only getting worse. By the way. It's not magically solved since we did this piece, and a lot of that is due to nurses burning out on the job. And this particularly why we did it when we did earlier this year, is because it's you know, after after I feel like the vaccines came in and we were all, yeah, we have a vaccine, the pandemic is over. Except well, we were going dining nurses and all the healthcare workers were being thrown into another pandemic, and that was the pandemic of the unvaccinated. And the ridiculous and really like truly awful fact of that is that unlike the first wave, when we were all kind of dealing with something we couldn't control, this one was completely preventable and it did not have to happen. So then, as you were piecing this together for the show, the thing we've talked about on this podcast in the past about is how we can find an issue and then you can find eight different aspects of this issue to address. What were the ones that you all decided to dial it in on and why I know that on the one hand, we could talk about the mental health part of it, but then you can also talk about the staffing part of it, but then you can also talk about the public negligence part of it. So just how did you all, as you all were producing and putting this piece together, how did you all decide the hierarchy of important things to make sure it stayed in the piece and didn't get edited out part of it? I will say, I think the heart of the piece that I really wanted to try to address in some way. I'm not a nurse, but I've had some I've had more interaction with the hospital system, I think than the average Americans. So like when I was young, I was in the hospital, I was hospitalized a lot for pneumonia. And I'm definitely a product of my parents health insurance and modern medicine and I am fine. But the you know, one of the reasons I'm still here is because of the you know, I mean fantastic doctors, but fantastic nurses. So a lot of my earliest memories are of just like nurses in that care and just like experiencing firsthand what a difference like that level of like human care makes like. Okay, So for example, um, I'm gonna go off on an anecdote now that I thought of, But when I was so, I was a young kid in the hospital and they would always put these i vs in my hands all the time, And as a kid, I hated that because I wanted to play with my hands, because you're when you're in the hospital for long time, is actually kind of boring because you just not much to do as a patient, not as a hospital worker, as a patient, as a kid. Um, And when they listened and they put the ivy in my foot, and what you think would be hard because I wouldn't be able to walk around, But what the nurses did is they let me ride you like those long, big i V polls. They would let me ride around the hospital on those like the silver Surfer or something. And so I think, when when I think back to that time, I think it's something that could have been a very scary memory is actually very warm, and that all of that had to do with the level of care I received, and so when I was looking for pieces and seeing how nurses are being affected by COVID, there was a part of me that remembered the level of care that you can get wh nurses are able to do their job versus what we're seeing happening now. And that's what I started looking at, saying like, how can how how can we tell that story? How can we show what should be? And how can we show it is? Because Dr Freeze, you know, when you look at healthcare in the modern era in this country now, like it's not just about knowing your job from a ticky technical I v find the main standpoint you also, it seems that the job of nurse is a little bit part sociologists as well, where you have to be able to relate to people. And I would even argue that there might be a little small element of social work and trying to just connect with people on a normal human basis, But you have a lot of different confluences happening. What do you believe are the primary challenges for nurses and the health care system right now? Well, how much time do we have right now? So first I want to say that each and every day, nurses are delivering exceptional care across the country. They are they are getting it done for their patients technically, socially, physically. They are problem solving behind the scenes there you know, I call it, you know, part technical, part psychology, part air traffic controller, and and that's the part that a lot of people don't see. So a lot of excellent nursing care is still happening. But we're on the brink, and we've been on the brink for about almost two years now. So when we think about the priorities, what I'm really worried about is at some point our public health officials will have a lower level of concern for COVID than they do right now. They will say, we're in a phase that we can quote manage this. We we have an ability. You know, the case counts are very very low. We're not seeing these big white spikes that we're still seeing. And everybody's gonna say, oh, great, problems solving. They're gonna walk away and they're gonna leave nurses in the lurch without solving the underlying structural things that are happening to nurses every day and have been happening for a decade. So my team has been studying nursing work places for two decades now. A couple of things that I'm very worried about. One is executives are not spending enough time on understanding the working conditions of nurses and how they need to fix them. They're not listening to nurses and solving their problems within the health care system. Exactly right, okay, Executives in the health care system are not listening carefully to nurses concerns and acting upon those concerns. When nurses tell you they have a problem, they have a problem. They're not making it up. And when nurses have problems in their workplaces, we've known that patients are more likely to die, patients are more likely to have complications, patients are more likely to have to stay longer in the hospital. None of us want any of that. So firstus, we have to have our health care executives listen deeply and carefully to nurses and work very strategically on those problems. Then we have a couple of structural things, not very sexy, but we still allow many nurses, as you point out, to work mandatory over time, their boss can come to them, they've worked a twelve hours shift. It's five o'clock at night. They've worked ten hours NonStop, and their boss can come to them at five pm and say, guess what, you're staying in another four hours. And we don't do that to pilots. Your pilot flies you from New York to l A. They get off the plane and they go home and rest drivers and they drivers to make sure they're not even cheating exactly right. So so we've got a couple of structural things like that. We also have well, guess what, we're running short on a nurse, so you're gonna take another one to three patients. And right now in the COVID area, we're seeing that in the I c U. I've never heard of that in the I c U and twenty five years of nursing. So executives have decided to put the labor problems on the backs of nurses rather than solving the underlying problem. And I think that problem predated COVID and it's only gotten worse during COVID. So if we really focus on those issues, we're going to have a healthy, safe nursing workforce that can care for us during COVID and after COVID and if we don't pay attention to that stuff, we're going to be in a whole world of hurt and we're going to see more of the stuff that we're seeing now, Nurses leaving in droves, too many, too many patients to care for, unsafe staffing, etcetera. It's a vicious cycle. If we don't break the change, I'm gonna ask a question, it's gonna seem more of it. But it's from a fiscal place. Why would the executives by break the backs of the employees whose job it is is to help keep the customer a lot? Like if we're just going base level making money in health care, if people die that it's not good fiscally for business. So why would we create a place where the workers cannot do their job the right What what is the advantage in an executive doing that? Like if we said they're not a sponsor, let's just use Amazon for example. Okay, yeah, Amazon is gonna pay you as little as possible and not put you in the union because it makes them more money. Overworking nurses doesn't make you more money. The patient is the patient. The cost just the cost, So why would you want the patient to die like, what are the advantages in the executive infrastructure of a hospital in being assholes like this? Well, I have a lot of friends who are executives, so let me put that on there, and I think a lot of that. Then they're cool, you know what I mean? Those other people right, So you know I think that first of all, a lot of the executives are trying to do the right thing, but we don't have the incentives lined up. And I spoke about this earlier. So Number one, when you, unfortunately are in the hospital and you get a bill when you go home, do me a favor and look at your bill and you tell me. This is a quiz for everybody listening. Go take a look at that bill and tell me where the bill for nursing services is. You know where it is. Room and board nurses are part of the room and board part of a hospital bill. So if you have cancer and I'm on college nurse and I am giving you expert care for you, Lukenia, and I'm in your room every hour drawing blood and checking your giving you blood products to save your life, and giving you antibiotics and all that stuff, and and the person next to you or the room down the hall has an appendix removed, and they're there for twelve hours, and I give them to tile and all and send them on their way. The bill for the day is the same. So right now, nurses are widgets in the hospital and they are the largest part of the hospital budget. And so when times get tough, guess where they're gonna cut. Guess where they're gonna cut the corner without nurses stepping up and saying this is no longer safe, this is no longer acceptable. We need a different structure. And so it's a it's a tricky thing. It's gonna be hard to solve. But what I'm what executives can do right now is really listen carefully to what their nurses are telling them and act on it. And what they can do tomorrow is eliminate mandatory over time because that's unsafe, and we know it's unsafe, and they can work carefully to get those numbers right so that we have an adequate number of nurses to care for the patients because it's unsustainable. But the primary problem is we do not value, either numerically or monetarily, the kind of nursing care that patients in the US need in hospitals. One of the things that I found researching that you really struck me was just, you know, not just the level of care, but just all of the different types of care that nurses do that I don't think we really think of that. You know, it's not it is drying blood and it is giving medicine, but you're also you're helping patients shave, you know. The nurses are the ones holding the phones that people can talk to patients. Like. There's a lot of things that if you did put them on a hospital bill, it would probably look like a CBS receipt, you know, because it's like, all right, that's like, you know, maybe maybe we should start, you know, putting those on so people can actually understand that that type of care because or talking to the doctor and the pharmacist when you're not even the room to say you just ordered an errant medication that's going to put this patient at risk. Do you really want to do that? Yeah? Are? You know? So there's all this work happening behind the scenes, this air traffic control function. Nobody sees it and nobody's paying for it. It's just happening, and it's part of my work. And so you can either have me overloaded where I'm trying to do that for too many planes, too many patients in this example, or we can do it in a way where I have the time and space to really care for patients or teach them about their new leukemia diagnosis or their new surgery whatever they just had done. So you get what you pay for. And right now we're lumping this into room and board. It's basically a Hyatt bill. Sorry if they're a sponsor of yours, but you know we don't. I love this idea of the scene because if we did that for a nurse, what did you do for this patient for twelve hours? It would be a sicker tape parade because that's the thing that I think is interesting as well, because it's all hidden under room and board. I don't even think Americans even know what. We don't know everything that a nurse to do. Like, all you know is that the nurse is the person who is in charge of apparently from what you're saying, Dr Freeze everything from medicine and the right dosage to batteries for my TV remote, which is always my concern when I'm visiting someone in the hospital. Is that the television has an inadequate amount of channels. But um, what I'm gathering is that that's probably not a bigger issue in the eyes of the administration right now. Well, you know, if you're visiting, you shouldn't be inconvenience if you can't access cable. So what is the point of visiting you in the hospital if I can't watch Comedy Central? Wink wink, shameless plug. So then, with all of that happening, Madeline, how do you all It seems like and I could be wrong, Dr Freeze jumping in if I am, but it would seem like the issue of the stress of this job and what the pandemic did um to morale. It's also somewhat of a, if not a newer issue, definitely more prominent and more prevalent now, So how did you all decide on how to sparse that into the story? I think the challenge with trying to put together a piece like this is that you have to figure out when you're going to make jokes, but also when you're going to take it seriously. I would say the best asset that we have, I mean, and you know this at the Daily Show, Roy, is that like, we just have a lot of I mean, there's a lot of hands on these pieces. There's a lot of people working on them. It's a really collaborative effort. And so one of the people I mentioned above, the very talented people, is one of our producers, Allison, who did a lot of work on this piece. And when we were talking about burnout specifically for nurses, which again is not a funny topic, it's very serious, it's very depressing. But she found a clip of a nurse speaking about how you know, when they're talking about their burnout, and the solution by there, you know, I guess the hospital executives was to kind of throw a pizza party. People just still, honestly do not understand how severe this is, how bad staffing for nursing is. When tom's are tough and things are getting rough, still have a pizza party. You know, you guys are spread really really thin, and we can't get new nurses, but here's pizza. Okay. No, people, No, you cannot solve a nurse shortage with a pizza party. In fact, it's probably gonna make the problem worse because it's the lost food you want to feed someone who needs to stay awake for a double shift, you know. So it's it's finding things like that to still be able to talk about an issue. Pizza is probably a good problem solving until about the eighth grade. After that, you gotta be taken us at minimum the cheesecake factory after the break. Dr Freeze, I want to throw that same question at you, because I know that you have a lot of colleagues that are still in a lot of these you know, hotspots, and are dealing with all of the problems that you're talking about. And I'm very curious not only about the mental health issues that are happening right now within our within our hospital system with nurses, but also what are y'all telling the new nurses that are coming. How do you convinced to take this job? What did the nursing recruitment post to look like? This is beyond the scenes. We'll be right back. I have a lot of questions for you. I'm sorry, Dr Freeze. You've spoken about the mental health challenges that are faced by nurses. What makes these challenges so acute? You know, what is it about the job that is creating all of this stress and how is that affecting the nursing population, you know, even by gender. So it's a really important topic because I think the take home message for your readers, we're all spending a lot of time worrying about nurses right now, and probably everyone listening has a family member, a friend who's a nurse just because of the numbers. Are four million of us out there in the US, right But but the big take home message for everybody to know is nurses were in trouble before the pandemic. So our team at the University of Michigan had done some work to understand and I'm gonna just give folks mentioned we're gonna talk about some unpleasant topics like suicide, just to prepare people. We actually did some work to show that um deaths by suicide were two times higher among female nurses than the rest of the US population. And that data went through before the pandemic, and the curve was like this for the last eleven years that we studied it. It was a steady increase over time. The all time peak was the when we have the latest data that to our group. Another group, now you could say that's still very rare, you know, but I mean I would say every nurse we lose is you know, a tragedy, and the numbers are still rising, rising numbers, rising numbers, right, So it's a it's alarming finding. But the other point is a survey by the Mayo Clinic just showed that even thinking about suicide and self harm was on the rise during the same period. So, you know, not thankfully, not everyone is going to have a tragic event, but nurses have had behavioral and mental health challenges before the pandemic. I think there's a couple of things going on. Number one is the work is stressful. We've talked about mandatory over time and shifts and workload. The other thing we haven't talked a lot about is violence, verbal and physical violence against nurses is continuing to rise, was rising before the pandemic, and we do not have a strategy in the US to control that. So nurses are in an in an unsafe, hostile environment for their work and then think about what's going on around them. Plus of the US nurse population is female. They're often caregivers at work and their caregivers at home for family members, for kids, for etcetera. So you put all that together in a tough work environment, and you you can imagine why people are having stress. The other piece we know about nurses and other healthcare workers is it's very hard for them to seek health care services for mental health because of the stigma involved. They don't want to be seen that they can't handle their work. They don't want to be seen as a patient for that problem. And the police and pride that comes with the position that white wall is. You know, we'll call it a white wall of silence instead of the blue line. You know, there's we don't want to talk about this stuff because we want to be seen as professionals. We can handle our stuff. But you know, it's like diabetes. You can't just wash this away. If you have a mental health condition, or you have a substance use issue or whatever you have, there's no thinking that a healthcare worker is is less immune to that problem. And they need as much help, if not different kind of help than anyone else. And they repeatedly say in surveys it is hard for them to find services that understand their needs. They feel they can't do it confidentially. They're they're worried about retribution, they're worried about getting fired, they're worried about losing their license. So until we solve that problem, we're not going to solve the mental health crisis among nurses. The final point I want to add on this is some of my colleagues work. Dr Christian chow at U c l A. Has shown in a survey that nurses have a lot. In a large survey of nurses and the Nurses Health Study, a substantial proportion of them had childhood trauma, physical, verbal, sexual trauma in their past, far higher than the US population. So we're trying to put all of this together, but we're flying blind because we really don't have good understanding of what the exact issues are. We know what the clumps of things are, but we don't know really how they fit together to create a problem where a nurse is really in trouble. So then you we're dealing with a workforce that themselves may be broken and unhealed from their own traumas while also working in a stressful situation to heal everybody else. Now, then when we talk about just the workforce in general, why has it been so difficult? And this is just me, a layman. This is a guy who I've gone to the hospital a couple of times, really good blankets at the hospital. If you could steal one, please do yourself a favor and get you one of those nice hospitals. UM, as a layman, why can't we just hire more nurses? That's just part of the issue, Like that's always been the approach to if we want to use policing. Isn't a one to one, but that's always been something where that's a job with decent pay, decent over time, decent retirement. So you don't really have the bigger issue in recruiting over there. Why why can't we just add more nurses to the workforce, And why hasn't that been um a solution. Yeah, so a couple of things. So we need special training, right for nurses. You can't just kind of walk in from another sector and become a nurse. There's there's you know, at least two up to four years of training and then you need extensive on the job training. And the problem is we have a pipeline problem. So you we joked earlier, you know, how do you get people into the field. We turn away eight to ten qualify people for nurse, every nursing school position, every student position. There are eight to tend people behind them that we turn away because we don't have enough capacity. Why don't we have enough capacity. We don't have enough faculty. We don't have enough people to teach both in the school of nursing and in the hospital. Those expert nurses who are leaving, we need those folks to help teach our students. So when we have experts leave, we don't have enough people to teach our students, and we don't have enough faculty, we can't teach our students. And nurses make more money practicing than they do teaching. We have an aligned the incentive to say, if you want to be if you're an expert nurse, we want you to be an expert teacher, and we're going to reward you for that. Instead we say, oh, you're gonna take a pay cut. So how's that going to work. Also, I'm wondering dr freeze if there's something like with a I mean, obviously there's a there's a shortage, which is a critical issue, but in terms of like a distribution, because I mean, I think one of the things about being in New York is that I kind of take it for granted, like we do, like we have a lot of hospitals here, you know, like you can you can uber to a hospital, but there's a lot of more rural parts of the country that a lot you know, a lot of nurses have been lured away to be traveling nurses, right because it pays more money, and you know, we don't hold that against them, obviously, but those shortages are so much different than here where I don't think we would feel it. What is the difference between what a traveler nurse is just someone who comes in and they're higher privately by a particular hospital. Hey, come be a nurse here for a little while, contract for higher bouts. Usually if it's like six to thirteen week contracts, and so you pay a print, they pay, they get a premium pay. They get paid to relocate and they're there for six to thirteen weeks, and they typically are placed in the shortest staffed units. You know, they're filled, they're filling holes. And so people will say, I'll go in, I'll do this. I would call it jokingly, hazard pay. I'm gonna do this for for six to thirteen weeks and then I'm gonna leave and then I'm gonna go on to somewhere else. Some people stay um, but it's really to fill that critical whole um. So that's the that's the travel nursing thing, and what we're seeing right now, the big kerfuffle is we've got expert nurses who have been in the same unit with a lot of expertise for ten twelve years caring for these patients, and then an a travel nurse comes in and is making twice the salary for that that blitz of time, and so the ten twelve year veterans looking around saying, why am I staying here? What's this about? So that's the newer phenomena that we're seeing. You know, you're you're you're putting me through the ringer, you're giving me lukewarm pepperoni pizza. The one today I heard is coloring books. So congratulations, you're getting a coloring book. So, you know, the list goes on and then I look around and there's this curse. There's this person from a travel agency who's gonna be here for six to thirteen weeks making double sometimes triple my pay. Why would I stay? And I don't have a good answer for them. I don't have a good answer. So then you look at that's like private sector security who gets sent over to the Middle East and fight alongside our troops, and the troops are like what like, yeah, dude, and my equipment is better than yours. So that's that's wild. So when we when we look at this madeline and we haven't even had time to even unpack what all of these stresses on the nurses and taking on too many patients, what that means for the patients who are actually the ones at the center of all this and the ones who need to care. How do you and the writers, how are you bringing levit? Look, I'm just be honest. This ship is sad. It's very sad because it's very real. How do you all balance the jokes what we want, which when you want? How you balance deciding when to make someone laugh versus when to make them feel This definitely felt more like a feeling peace to me. But I'd lean heavily on the writers for that. I think they have more of a burden to, you know, write the script around the story that we're trying to tell. But it's difficult. I mean it's difficult. You know, sometimes things just you know, they're not funny, but at the same time find you know, finding pockets where we can actually laugh about something is really important. Because I was thinking about Dr Freees what you're saying earlier about the mental health challenges. And you know, one of the things that I hope pieces like this do is, you know, show the show the human side of somebody. Because if if you can relate to someone and see that they're human, then there is room for a comedy and there's also room for you know, having other feelings. But I think, you know, thinking about how we talk about nurses and how we kind of put them as heroes and maybe how that actually isn't that helpful for people who are trying to seek mental health services because that might just be a bigger burden on somebody. Yeah, one of the senior nursing assistance I learned my craft from twenty five years ago. Early on, she said to me, if you're not laughing, you're crying. So having a bit of lightness about and we see the pizza rolled in and we all just kind of roll our eyes and oh, well, isn't that nice? And thank you? Or you know, so we understand that, and I think we appreciate when people are really supportive. You know, my heart went out we saw signs in the parking lot at Michigan when people came and you know, supported us, and you know, as I was driving and I'm like, okay, now, is everybody going to sign up for the vaccine? Is everybody going to do their part and stay safe and stay home and stay out of trouble while they're clanging their pots and pans and while they're putting signs out. And that's the piece that I think a lot of nurses are still struggling with, like, thanks for that, but we're asking you to do these two or three other things that are really a pain in the butt. We get it, but they're gonna keep you safe. And I think that's where a lot of nurses are kind of, you know, looking up up at the sky wondering what's going on here. I think that's the mystery. You are a hero and I can't wait to see in two weeks when I catch COVID with my untroxolated bunks. And that's how badly I want to meet you. And you've just touched on something as well, Dr Freeze. I want to talk about it after the break here, because when we talk about people refusing the vaccine, there's people on both sides of that issue. And I want to get your opinion on people in the healthcare industry who are refusing the vaccination and these higher ups, some of whom that are your friends and very cool, whether or not these vaccine mandates are the right thing to do in a time where you're short staffed. Uh, this is beyond the scenes, and uh, we'll be right back. I'm gonna claim a pot for you, Dr Freeze. Let me go get a pot, right, where's my pizza? Beyond the scenes, we are discussing the crisis that has struck our health care systems. Specifically are men and women that are nurses and apparently, unbeknownst to me, Madeline, Uh, pizza has been one of the biggest solutions now since clearly pizza has been a bridge and boosting morale. Dr Freeze, do we have to go to meet lover's pizza to get our healthcare workers to accept the vaccine? Uh? Stuff, chriss? What do we need to do? Set up to go fund? See pepperonis that have the oil in it? Like, what is it? Little? You know? I'm a scientist, so uh you know, I'm a scientist, So I'd like to do a randomized trial of you know, different pizza compared to coloring books compared to massage chairs, you know, and kind of just see which one of those. Uh, when we can throw in pot clanging at the same time, maybe we'll maybe we'll hit bingo. I don't know. The dwindling number of nurses means that their job is only getting harder, and as an extra insult, some of their colleagues are abandonship for a much stupider reason at a time when they're already staffing shortages. Some nurses are threatening to quit your forced to get the COVID vaccine. One hospital in upstate New York will stop delivering babies after workers resigned over vaccine mandates. Houston Hospital System has fired or accepted the resignations of more than one hundred and fifty nurses and other staff members who refused mandatory COVID vaccinations. Show of hands, how many of you have gotten a COVID vaccine? These are four healthcare workers from different hospitals in North Carolina. Why not? We don't know what the long term side effects are. It also hasn't been proven to be effective. The CDC and many public health experts say that it's more than effective. I have the right to question anybody in this country. I want to question. You're entitled to an opinion. But these are facts, are they though? Are they fact? Wow? You know this nurse is a genius. Yo. She knows in order to stop an unvaccinated person, you must think like an unvaccinated person. In order to kill COVID, you must first die of COVID. It's so obvious. Now, what do you make of healthcare workers who have decided to decline the vaccine? Do you think that reflects poorly on the healthcare system? I guess there are a hypocrisy in that, and that you, being one who cares about everyone's health, not doing the thing that the healthcare system says is healthy. So I've spent a decent amount of time first understanding the science behind these vaccines. They they have. The science behind these vaccines has been around for two decades um, but it hasn't been very publicly shared and hasn't been really well understood, right, And so the entire US population is trying to get up to speed with with what we understand about these vaccines and why they are safe and clearly why they're effective and just like the US population, there is a subgroup within the health care sector who have questions and concerns. I don't like to use the term anti vacts or vaccining hesitant. What the way I like to frame it is people have unanswered questions. And the way I like to approach that is come to people and have open conversations where I'm not their boss, I am their peer, I am their colleague trying to answer questions. And you know, when I staff, I usually come in a little bit early and spend some time with the nurses and just have informal conversations about what's going on and answer to their questions because there's a lot of uncertainty out there, even if you're a healthcare provider. It's literally changing every day for a lot of the recommendations. So what I've come across are some very common questions about long term safety, about nursing or childbearing issues. And the way I've tried to tackle that is get the experts to those colleagues who have questions. Rather than command and control, rather than bosses, rather than punitive strategies, is to have a conversation and for folks to do that, and you know, I remember a particular own nurse, not that I worked directly with this person, but someone I know pretty well and new baby and a lot of questions and said, you know, I'm just not ready yet. And so I could turn that conversation off and say alright, good luck, you're on your own or whatever. But we've kept the dialogue open, and I think that's the strategy, is to continue to have a dialogue and answer questions. The final thing I'll say about this is I think in some ways the media got this a bit wrong. They looked at the same statistics I did, and they came out with one out of however many nurses, nine or ten nurses is decline. It will say they'll leave their job or decline the vaccine. I saw an overwhelming majority or more of healthcare workers are ready to sign up and get the vaccine. And then we fast forward that story a few weeks later, and what we see is very few people actually leaving their jobs because of this. So I we were in a unique snapshot in time. It was a highly emotional, um challenging period. There's still a lot of unanswered questions, and I felt like as we were watching that story unfold and time, we got a little ahead of ourselves and not really stressing the positives and then following up to say, well, actually, how many people really are gonaic journalism? The NYPD was having was going to have all of these officers and ended up being like thirty, it's going to be thousands and murder will Reigne Supreme isn't like there are tens of us? Yeah. Uh, I did have a question for you, Dr Freeze. You know, one of the things that we touched on in the piece was I guess how burned out nurses affect patients? Uh? You know, cancers don't stop just because there's a pandemic. Other things. You know, you don't stop breaking bones, you know, everything else doesn't stop, Like the hospital system doesn't stop, and people don't stop getting sick. So like, how is that? I guess how how have you seen the knock on effects of all of this happening? Yeah? So two things on that. One is that even if you're not caring for COVID patients, you saw a dramatic change in your work during this period. That continues because your patients are coming to you with more complicated problems because they couldn't get their cancer screening, and so now they present with a cancer at a later stage, or they have a complication that we couldn't manage before they got diagnosed. Number one. Number two, we had a lot of visitor restrictions, and so we didn't have family members and loved ones who could provide that extra emotional support for patients in the hospital. And as you said, we had nurses with face times and yeah, no, no one's checking the batteries. Uh, no one's making sure the channels on the right channel at you know, nine tenths t nine cents or whatever. Uh So those pieces add up. I mean, I don't want to trivialize that. You know, when you are alone and scared in a hospital or you know, in my in my family member's case, you know, they had to go a very complicated diabetes. They had to go to the office by themselves. Their loved one couldn't come with them to make sure everything was being monitored properly and carefully, and they follow up with questions, so everything got more complicated and and and much of that stays to this day. And then for the patients, as we said, cancer doesn't wait, and heart attacks still happen, and in my case, broken ankles still happen, and so I needed to seek care in this pandemic. And you you are worried that are am I going to get the care that I need? Is everything going to work out? In my case, it worked out beautifully. I couldn't have been more comfortable or treated better. But but we have seen very clearly that some care is falling through the cracks and continues to do so. So that's bad for patients, and then it's also bad for healthcare workers because they can't give their very best, and so it continues to pour salt on that wound that we're in this vicious cycle that we can't seem to quite get out of. And I'm not able to give my very best to my patients for re sasons that are really outside of my control. And I think that's always been hard for me as a nurse. When I know something could have gone better but it couldn't because of something beyond my control. That's very hard to live with day in and day out. So then do you think things right now, Dr Freeze are trending the right way? Are we still kind of in a bit of a holding pattern where it could still go either way right now, So I think we have a mixed picture. The one thing that I'm amazed at um you know, a few weeks ago to transfer patient to the intensive care unit for management of their their cancer. They had a problem with their cancer complication, but there were COVID patients in a separate part of that ward. And the amount of intensive, unbelievable care that nurses and doctors and respiratory therapists and pharmacists are giving you these patients. We know far much more on how to treat patients with COVID, and we are we are doing a better job of managing COVID because we've learned a lot in the last two years and that's a tribute to the folks on the front line and the researchers who have helped do that. So that's a positive. We have very safe and effective vaccines and we now basically you can walk in almost anywhere you want and you can get them. So those are triumphs and we should celebrate them. And at the same time, our nurses, doctors, pharmacists, respiratory therapists, other folks have kept America's heartbeat going for all their non COVID stuff. For the most part. But but, but the net is fraid, the net is very fraid. And I'm very worried that there is probably a group of folks who are falling through the cracks, either because they can't get in for care or the care that they get is suboptimal because we'restrained so hard. And what I really worry about is we're not going to fix this problem. As COVID eases, We're gonna say, well, back to normal, no problem. We have to learn from this and we have to start making the changes now so that patients today are safer and patients six nine months, nine months a year from now, regardless of COVID or otherwise, they're safer. And I feel like we're going to forget that. Is there anything that the general public can do, because so much of what you're talking about is it seems to be in my opinion or just from my perspective. Again, as a guy who only goes to hospitals to still blankets, No, I don't take the black mantalin, don't clean it up for me, and still them. These are very wonderful blankets. As a person who's just on the outside looking in, it seems that a lot of the solutions here lie within the institution. But how do I, as just Joe blow citizen, what can I do to help alleviate some of these challenges? Is it looking at what our elected officials are doing? How much does politic? Is there someone I need to vote out? Like? What can do I show up to the hospital and try to protest? Like what can we do as regular people to help be a part of the solution on this issue? Yeah, So a couple of things. First of all, it's not just the blankets. The real money is the warm blankets. So make sure you ask for that next time. It will change your life. It will change your life. So thank you all. Thank You're very welcome for that tip. So what can the public do? A couple of things. One is, if you get great care at your facility, right the CEO of the hospital and mention the people who cared for you by name and tell them what a great job they did. And if you saw quality of care concerns, if you heard about mandatory over time or unsafe staffing, put that into and say, hey, this is not what I expect from my community hospital. Because they are accountable to the public. Most of our hospitals in the country are nonprofit and they're supposed to serve the community, so they need to respond to you. If you know a hospital executive, you can say, what are you doing to keep your nurses safe? And the answer shouldn't be pizza parties or coloring books. The answers should be eliminating mandatory over time, humane staffing levels, and listening to nurses and acting on their issues. And do you have a safety committee for nursing and healthcare workers? We have patient safety committees in every hospital. Do we have a group of experts focused on healthcare workers safety? Missing piece? Finally, for the policy piece, a couple of points. Every state healthcare Most hospital issues are managed at the state level. Moving throughout the country is legislation on um panalizing verbal and physical abuses towards healthcare workers. Zero tolerance. You hit or strike a nurse, or you call him a name, you're out, full stop. We're not gonna, We're not gonna, you know, with limited circumstances, you are we we are not obligated to treat you, and you can be charged with a with a crime. UM also mandatory staff, mandatory overtime, and staffing ratios that are humane and safe. There's legislation in many states. California has a staffing mandate uh some states are working on banning mandatory overtime. We know those work that keeps not only nurses safe, but it keeps patients safe. So so those are a couple of things. And then the final thing at the federal level, we talked about the nursing pipeline for faculty. We don't have enough funding to incentivize expert nurses to either stay at the bedside to teach, or to teach in nursing schools. And if we want more nurses, that's where we need to start. And that's a solvable problem. That's a we have money, right, I hope we have money. That's a money problem that we can solve. And our nursing schools, you know, we can work on our back end to make it work that we can add, you know, bring more of those people in that we're turning away year after year after year. Well, I'm happy that you are a nurse educator and that you're a nurse, and that you're a doctor of nursing because with a name like you know, Dr Freeze, you easily could have been a villain, all right, some sort of comic book person that wreak havoc on the city, but instead you reak love. Dr Christopher Freese, thank you so much for going beyond the scenes with us today, and Madeleine, I will see you again on year I don't know, see the next pizza party, right, Thank you all. Hey, listen to The Daily Show Beyond the Scenes on Apple podcast, the I Heart Radio app, or wherever you get your podcasts. We don't care. Just listen to us. Even if you get your podcast from a dude named Tony in a back alley, we don't care. Just listen.