ICU Nurse of 33 Years Quits Over New Patient Ratios

Debbie Moore-Black has been working as a registered nurse in the ICU at a corporate hospital for 33 years, but she recently decided to call it quits after management changed the nurse-patient ratios. In a new essay for KevinMD, a blog for physicians, Moore-Black explains her decision to leave the job and how it affected her physical and mental health.

Like many nurses, she devoted her entire life to taking care of others.

“I used to feel like I had a purpose. I used to think I was a dynamic part of saving lives in the ICU. I lived and breathed ICU. I was a charge nurse, a mentor, and a preceptor,” she wrote. “I attended the AACN meetings, was the leader of the shared governance committee, was on the rapid response team (RRT), and obtained Level 4 RN, which was the highest attribute you could earn as an ICU nurse.”

As the years went on, she found herself caring for patients with multiple organ failure. The population was getting older and many of them came into the ICU with DNR papers, but their loved ones urged Moore-Black and her colleagues to “do everything” to save them.

And so, they did.

“Unfortunately, the theory was that we had to honor the family members regardless of the legal DNR papers … because families can sue, dead people cannot,” she explained. “We did everything.”

But caring for patients on life support started to take its toll.

“The patients lay motionless on the ventilator, wrist restrained, turned, and repositioned to prevent decubitus ulcers. Their vacant stare of what truly was their hell on earth. Because this was not living.”

A new manager took over the facility, but they didn’t have any ICU nursing experience. The manager knew the “corporate commandments” and started looking for ways to slash the company’s budget.

“She slowly eliminated our care techs, secretaries, and CNAs, often leaving us with skeletal staff,” Moore-Black wrote. “And then came what I perceived as ageism. Some of the older nurses with incredible experience were being put under the microscope, upper management second guessing us.”

She started to panic when she overheard the manager talking about cutting the number of ICU nurses.

“We can get two inexperienced young nurses for the price of one vintaged experienced nurse,” she heard the manager say.  

“It was a gasping moment for me. Like how could any manager be okay with attempting to eliminate the experienced nurses? But we soon learned that corporate hospital America had sold their souls. Not only are the nurses a ‘number,’ but so are our patients.”

The nail in the coffin came when management announced the ICU would have a 3:1 nurse-patient ratio. It was a 25-bed high acuity facility, and many patients were on ventilators and life-saving IV drips. Moore-Black said the change meant working 12 to 15 hours straight without a break.

“A 3:1 assignment was the end for me, as I truly felt that if I did not protect my nursing license that I worked hard for, then nobody would protect it. Not even my ICU Nurse manager,” she wrote.

Moore-Black ended up turning in her resignation soon after the change was announced.

“I said goodbye to my true love, ICU nursing. I could no longer bear to treat patients with haphazard nursing practice forced upon us by management. I have those flashes of memories, the patients that were triumphs, the tragedies, and sadness, the nurse camaraderie. Memories to last me a lifetime.”

She wishes management could see what it takes to save a life. She also wants to see the U.S. adopt a national nurse-patient ratio to offset the greed of corporate America. “Two for the price of one.”