In the Butler Memorial Hospital ICU, where I have worked for the last 23 of my 28 years as a bedside nurse, the alarms, shrill and insistent, shriek nonstop. Ours is a 24-bed unit. Every patient on it is monitored as closely as the technology allows. They have heart and oxygen monitors. They wear blood pressure cuffs. Their ventilators are alarmed. Even their beds are alarmed to prevent patient falls.

Whenever any of the measures monitored is even slightly out of the norm, an alarm sounds. Some are pings. Some are double beeps. Some are higher pitched — when those sound, you know you have to run. And I mean, run.

With this editorial, I’m sounding a higher pitched alarm.

I’m not a whistle-blower. I’m not a canary in a coal mine. Nurses across the nation have been sounding this very alarm for decades: There are simply not enough nurses at the bedside. What this means in ERs and on hospital floors in many hospitals throughout Pennsylvania and the U.S. at large is that nurses are being asked to care for more patients than is safe for either the patient or the nurse. When this happens, it’s called chronic nurse short staffing, and it’s a crisis for our patients and our profession.

Many years ago, long before I graduated from nursing school, hospitals began adopting a shortsighted strategy — they began trying to save money and further line their pockets by cutting nursing hours, a strategy that routinely endangers patients. Think about it: Fewer nurses means less medical attention at the bedside. Fewer people to come running when your loved one’s alarm sounds.

A nurse’s sole purpose is to provide excellent, attentive care for people at often the most vulnerable times in their lives, and we have fought fiercely against short-staffing for years. At Butler Memorial, we have grids defining normal numbers of patients per nurse in our contract. But COVID has indelibly changed the hospital care landscape, and we can only meet our grids if we have enough nurses to staff the floors.

Let me be very clear: There is no real, absolute shortage of nurses. Pennsylvania is training and graduating more than enough RNs. According to the Pennsylvania Department of Health, enrollment in RN programs across the commonwealth has increased by almost 50 percent in recent decades.

What we have is a shortage of nurses who are willing to work at the bedside under normal circumstances which include working shifts, weekends, and holidays or especially under the current conditions which include higher acuity assignments, working extra hours to cover the needs that exist or call-offs of our coworkers who become sick, and mandatory overtime to ensure safe staffing is maintained.

COVID patients are sicker. They need, require and deserve constant attention. Their families, who are unable to visit due to COVID protocols, need, require and deserve attention. To meet those needs is the job of a nurse, yes. But hospital representatives and patient communities at large need to understand and acknowledge: That job, under the current conditions, is grueling. It’s emotionally and physically draining. It’s heartbreaking. It’s just ... breaking.

In the state Department of Health’s most recent licensure survey — mind you, the survey was taken pre-COVID — the highest factor of “job dissatisfaction” for nurses was staffing, and the most common reason young nurses reported for planning to leave the profession was stress/burnout.

At Butler Memorial, we are in the midst of a surge in COVID and an ebb in staffing. These two things are inextricably intertwined, but when they coexist, the cracks in our hospital care system that have existed for decades become immediately apparent.

Nurses with seniority who have been able to retire have done so — they got out after our first COVID surge. Others are out sick with COVID. We cannot open up all of our surge capacity units because we don’t have enough nurses to staff them. My unit director — typically a managerial job — now works almost every single day doing patient care. He works weekends and night shifts, too, because we desperately need nurses on the floor. We are working together, management and staff, to continue to provide safe, excellent care to our community.

Butler Memorial Hospital, like many hospitals in the region and, really, across the state, is offering financial incentives to nurses to try to entice us to work overtime so they can safely staff the hospital. And many of us do so when we can for the health and safety of our patients and our community. But how many excess hours can we put before we become too physically and emotionally exhausted to keep doing the job? Even our younger nurses, recent nursing school graduates who started working as nurses during the pandemic, are burned out.

This is not a sustainable model for patient care — even without the significant stressors brought by the pandemic — because over the years, as hospitals have not put enough resources into the bedside, the acuity of the patients in those very hospitals has been rising even without the pandemic, since insurance companies require patients to be sicker in order to be admitted.

These profit-driven strategies succeed or fail on the backs of our nation’s nurses, and our backs are breaking.

I’m sounding the higher pitched alarm.

Tammy May, RN, is a surgical ICU nurse at Butler Memorial Hospital and the president of Pennsylvania Independent Nurses, represented by the Pennsylvania Association of Staff Nurses and Allied Professionals. PASNAP nurses and techs across the commonwealth conducted a Safe Staffing Day of Action Thursday to call attention to need for more nurses at the bedside and for passage of the Patient Safety Act, legislation in Harrisburg that would ensure it by mandating safe nurse-to-patient ratios in hospitals across the commonwealth.