National Nurses United

"It was not like they were sending us to Har- vard," Gaffney said. "The only thing I was offered was online training. I lobbied on my own to get physical classes because I was like, 'Wait, you are telling me this costs $30,000 but you are barely giving me any classes at all.'" Comsti points out that these hospital-run training programs are unaccredited and unregu- lated. She said TRAPs lure new nurses in "with the promise of enhanced training but what they provide varies widely. In essence it's a bait and switch by hospitals, forcing nurses to pay for orientation and preceptorship that's tradi- tionally been viewed as part of the cost of doing business in the health care sector." Day said while she did find parts of her training program useful, she was surprised to find the pro- gram included newly hired experienced nurses. "It just seemed like this is the orientation for the hos- pital and it is not actually catered to the new grads, even though they were [claiming] that it was." Beyond the unfair and unnecessary financial liability for nurses, NNU is concerned that TRAPs effectively silence nurses from acting as advocates for themselves and their patients because they are afraid of jeopardizing their employment status. In its survey, NNU found clear evidence tying TRAPs to poor working conditions. Of the more than 325 nurses surveyed who said they are or were in TRAPs, 34 percent said they felt restrained from complaining about unsafe staff- ing or other unsafe or unfair working conditions. Farrington said during her first year, she kept her mouth shut about the terrible conditions at Mission. "I was afraid I would get fired and not have a job, I would not be able to get the income I needed. I was put in a position where I needed to just mind my own business so I didn't lose my job." But as the months passed, Farrington said the poor conditions took a serious toll on her emotional health. She found herself crying as she drove the 45 minutes to work, crying at work, and sobbing on her drive home. "It got to the point where I would be driving and I would be like: 'I could swerve my car and I wouldn't have to go to work because I just knew it was going to be so bad when I got there,'" she recalled. Then on Thanksgiving 2021, she hit her breaking point. She was caring for six patients at one time, including one who needed con- stant bladder irrigation and another who needed medication every 15 minutes for a brain bleed. After four hours, she had still not been able to see two patients, one who needed heart medication and the other who needed insulin. Desperate, she turned to a relief nurse for help only to learn another nurse was being pulled off the floor. Incredulous, she protested. "I snapped," said Farrington. But when an administrator overheard her complaints, Farrington was dressed down for airing her concerns at the nurses station. The administrator told Farrington to go home, which further infuri- ated her. In the end, she felt the administrator was more concerned with silencing her than in making sure the patients were cared for appropriately. For her part, Day said the poor conditions at her hospital led to deep moral injury as she watched the already under-resourced com- munity suffer without appropriate care. Nurses were caring for too many patients and new grads were working without supervision in the ICU. "[The patients] need so much more help than what is being offered and I don't think they deserve [anything less]," said Day. "Some people are scared to leave family members at this hospital. They have seen bad outcomes with other family members and are worried for their family members. I can't tell them not to be." Day said there were so many codes and calls for a rapid response team at her hospital she started feeling like she was suffering from post traumatic stress disorder. Eventually, her family contacted a lawyer about six months before Day's contract was up. While the lawyer said there may be grounds to 20 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G O C T O B E R | N O V E M B E R | D E C E M B E R 2 0 2 2 Kira Farrington, RN and her daughter protesting short staffing outside HCA's Mission Hospital in April 2022.

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