Tristan Kate Smith (pictured left) was a former ER nurse in Dayton, Ohio

Tristan Kate Smith (pictured left) was a former ER nurse in Dayton, Ohio

A ‘devoted’ nurse who killed herself and left a note slamming the American healthcare system epitomizes the crisis facing hospital workers, her devastated family has said.

Tristan Kate Smith, who worked as a nurse in a hospital emergency room in Dayton, Ohio, died at her home by suicide August 7, 2023, at 28 years old.

Her family later found a letter she had written five months prior to her death on her laptop titled ‘A Letter to My Abuser,’ with ‘abuser’ referring to the American healthcare system.

In the note, Ms Smith described the system as abusive and said the toxic work culture crushed her spirit.

She said she did not feel protected from violent patients, nor from making mistakes in her job.

Ms Smith’s suicide comes as a report from the US Centers for Disease Control and Prevention (CDC) found record levels of burnout, harassment and desire to leave the field among healthcare workers.

Healthcare workers are at a higher risk of suicide compared to the general population, a study found, with specific roles particularly at risk

Healthcare workers are at a higher risk of suicide compared to the general population, a study found, with specific roles particularly at risk

Ms Smith (center) described the healthcare system as abusive and said the toxic work culture crushed her spirit

Ms Smith (center) described the healthcare system as abusive and said the toxic work culture crushed her spirit

The news follows a slew of healthcare worker strikes over pay and working conditions, with 75,000 unionized Kaiser Permanente employees citing feelings of burnout and staff shortages as they staged a walkout in five states and the District of Columbia.

In September last year, the largest nursing strike in US history took place in Minnesota, where 15,000 nurses embarked on a three-day strike.

They said their hospitals had failed to hire and retain adequate nurses, causing a staffing shortage that reduced the quality of care.

The nursing crisis is particularly bad in Minnesota because of its aging population, which is placing additional stress on hospital staff – coupled with a low unemployment rate across the state, with less incentive for people to join the profession.

The average registered nurse in Minnesota earns $84,030 a year, or an hourly salary of $40.40 – making the state the 13th ranked in the nation, according to Nurse Journal.

In California, registered nurses earn $124,000; Southern and Midwestern states pay the least, with Alabama nurses earning $61,000 per year.

Minnesota was not the only state with strike action: in Oregon, 7,000 healthcare workers worked out of their jobs, and in Hawaii and California, mental health care professionals went on strike amid protests over inadequate staffing. 

And earlier this year, in New York, more than 7,000 nurses from Mount Sinai, one of the biggest healthcare systems in New York City, went on strike.

Nurses are continually asked to ‘do more with less’, Ms Smith had written.  

Research suggests female nurses are twice as likely to die by suicide than the general female population and 70 percent more likely than female physicians.

Ms Smith’s letter was published in a local Ohio paper The Oakwood Register this month, alongside a letter from her father, Ron Smith.

Mr Smith wrote: ‘You’re reading this now because Tristin’s story needs to be told. We need to take action. Our nation’s healthcare system is broken, and it broke our girl.

‘Her passion for nursing has turned into a nightmare. Tristin was in trouble. Nurses are in trouble.’

Addressing the healthcare system in her letter, Ms Smith said it had ‘taken my heart and slowly crushed the goodness it had.’

She said: ‘You asked my colleagues and me what we needed to help patients and improve satisfaction scores, and we told you the truth. But then you sent us to online courses that taught us to just smile more and be friendlier to the patients. 

‘That’s when I began to understand your true cruelty and manipulation.’

Casey Chosewood, director of the National Institute for Occupational Safety and Health’s Office for Total Worker Health, told CNN employers need to take the information from the CDC report and ‘take immediate preventive actions,’ such as ensuring employees are more involved in decision making.

He said: ‘To label our current and long-standing challenge a “crisis” is an understatement.’

In her letter, Ms Smith called her ‘abusive partner’ ‘relentless’ and detailed how ‘each day’ she was asked to ‘do more with less.’

She said she heard about nurses who were hit by patients and how they were advised ‘not to fight back’ and instead to ‘lay with their hands up’ and wait for security.

The CDC report found the number of healthcare practitioners experiencing harassment at work shot up from six percent to 13 percent between 2018 and 2022.

Examples included violent threats, bullying and verbal abuse from patients and coworkers.

The data was from 226 health workers in 2018  and 325 health workers in 2022.

The report also found harassment had a big impact on mental health. Nurses who said they’d been harassed were five times more likely to report anxiety compared to those who were not, three times more likely to be depressed and nearly six times as likely to report burnout.

Ms Smith wrote in her letter: ‘You beat me to the point that my body and mind are black, bruised, and bleeding out.’

She added: ‘You use and exploit us to line your pockets, using the common citizen’s money for overpriced healthcare.’

Ms Smith referenced nurses not being protected by the law or their employers. Some believed this was a reference to RaDonda Vaught, a nurse who was found guilty of homicide after her 75-year-old patient died when Ms Vaught administered the wrong drug.

‘Caring for people who are sick can also be intensely stressful and emotional,’ said Dr Debra Houry, the CDC’s chief medical officer.

In the CDC’s latest survey, 44 percent of health workers said they wanted to look for a new job – an increase from 33 percent in 2018.

In her obituary, her family said: ‘Tristin had a smile that lit up any room. She was brave, smart, and beautiful. She will be desperately missed by all whose lives she touched.’

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