*3.4. Difficulties Working Short-Staffed*

Participants described problems with staffing. Many mentioned staff quit their employment, which participants attributed to fear of working during the pandemic. As Fernando put it,

"You have people that are pregnant, you have people that have small children, you know, everybody has families. Everybody wants to keep safe and so you almost immediately had tons of staffing problems. And you have people calling out because they're scared."

Some of the participants described nurses who quit to take more lucrative travel nursing jobs. Others described colleagues who became burned out and quit. Staffing shortages were not limited to nursing but also patient care technicians and certified nursing assistants, adding to nursing workloads. As Marie noted, "We were kind of forced to take on the role of a tech and a nurse with higher acuity patients. So, I think day in and day out for a few weeks there it was very stressful for those reasons." Because of the shortage, nurse-to-patient ratios increased as did overtime requests. Participants worked extra shifts for a variety of reasons, such as wanting to help the team. Bill described picking up extra hours as, "It's exhausting. But I like what it stands for and being able to help and be there for the rest of my team and the patients." Others worked extra, sometimes excessively, for financial incentives. Emma said, "There used to be all sorts of rules and regulations in place of how many shifts in a row we can work and how many shifts in a pay period you can pick up, but desperate times call for desperate measures, and there were no rules. Some people just did crazy things to make crazy amounts of money."
