Young Ohio nurse leaves behind suicide letter naming for-profit healthcare system “My Abuser”

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Tristin Kate Smith, a 28-year old emergency department nurse from Dayton, Ohio, died by suicide at her home on August 7, 2023.

Following her death, a letter was found on Smith’s laptop by her parents, who sent the letter to the local paper, The Oakwood Register. Following its publication, the letter quickly spread among healthcare workers on social media.

The letter is a condemnation of the for-profit American healthcare system that exploits nurses, healthcare workers and patients. It is a sincere, tragic and in-depth look into what registered nurses (RNs) are experiencing on a daily basis.

Smith titled her suicide note, “A Letter to My Abuser.” It was written in March of 2023, five months prior to her death.

Tristin Kate Smith, daughter, nurse, aunt, friend. [Photo: Family of Tristin Kate Smith]

In making the decision to share her letter with the public, Ron Smith, Tristin’s father 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. Female nurses commit suicide at more than twice the rate of females in the general population.

In her letter, Tristin writes, “Ever since I was young, I expressed interest in healthcare and becoming a nurse, so I began my study. I gave my heart. My body, and my mind to you...” 

She continued, “I told you I would be there through the good and the bad, but you have taken my heart and slowly crushed the goodness it had. … You told me I was going into a career that matters. I could make a difference.

“You made me feel comfortable, despite the rumors of your abusive past—rumors I didn’t want to believe. The compliments, the pizzas and the ‘thank you’ letters gradually had less meaning to me, though.”

Smith went on to describe her hostile work environment, which places profits above all else, and blames nurses for mistakes that result from poor staffing, overwork and exhaustion. Smith wrote that the law does not protect nurses and makes a specific reference to the RaDonda Vaught case.

“You created an environment of fear and blame in a place we already felt unsafe. You blamed us for things out of our control. You criminally charged my colleagues for things that happened as a direct result of your own actions. The law doesn’t protect us...”

Vaught was a former Vanderbilt University Medical Center (VUMC) nurse in Tennessee. She was fired and found guilty of the death of 75-year-old patient Charlene Murphey after a fatal medication error. Nurses and healthcare workers around the US rallied to Vaught’s defense because they understood the real cause of medical errors are chronic understaffing, inhuman workloads and the subordination of medical care to corporate profit.

Pointing to the capitalist system as the source of abuse and her torment, Smith concluded, “You use and exploit us to line your pockets, using the common citizen’s money for overpriced healthcare....

“Each day, you ask me to do more with less. You beat me to the point that my body and mind are black, bruised, and bleeding out.

“I’m only sorry to my patients and colleagues. You deserve so much better, but my abusive partner is relentless.

“If I stay, I will lose my sanity—and possibly my life—forever.”

Tragically, Smith’s suicide is also not an isolated incident.

A study published last month by the Journal of the American Medical Association, which observed 1.84 million people in and outside the healthcare profession between 2008 and 2019, found that RNs, health technicians, and healthcare support workers were at a higher risk of suicide compared to the general population.

A 2019 report by Judy Davidson, a University of California-San Diego nursing and psychiatry researcher, found that nurse suicides were 41 percent higher for male nurses and nearly 58 percent higher for female nurses as compared to the general population.

On January 18, 2022, Michael Odell, a 27-year-old intensive care travel nurse working at Stanford Health Care, walked out of his shift early amid another COVID-19 wave and never returned. After a frantic 48-hour search by colleagues and police, Odell’s body was found at a wildlife refuge in the Bay Area. 

On April 27, 2022, a nurse at Kaiser’s Santa Clara Medical Center died by suicide while at work in the emergency room. Sources told NBC Bay Area that the nurse brought a loaded gun to work and shot and killed himself halfway through his shift. 

According to findings from a literature review from the Journal of Clinical Nursing, Post Traumatic Stress Disorder (PTSD) has become increasingly commonplace among nurses. Nurses who have experienced violence, aggression or trauma in the workplace reported higher rates of PTSD.

Other catalysts include workplace frustrations, such as lack of staffing or other resources, as well as a negative perception of patient care, lack of organizational support, patient suffering and the deaths of pediatric and adolescent patients.

Unable to tolerate worsening conditions, many nurses are leaving the profession altogether. A 2023 study done by the National Council of State Boards of Nursing (NCSBN), found that approximately 100,000 RNs left the workforce in the last two years due to stress, burnout and retirements.

The study found that another 610,388 RNs reported an “intent to leave” the workforce by 2027. An additional 188,962 RNs younger than 40 years old reported similar intentions. Overall, about one-fifth of RNs nationally are projected to leave the healthcare workforce in the next five years. This will have devastating consequences for RNs who are already working in intolerable conditions, and will have a direct and deadly impact on patient care. 

While many healthcare workers are leaving the profession, thousands are fighting back against dangerous working conditions and poor pay. Nurses at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, New Jersey have been on strike since August 4 after walking out to demand increased staffing, safe nurse-to-patient ratios, better wages, a cap on healthcare costs and healthcare benefits in retirement. 

At healthcare giant Kaiser Permanente, 75,000 workers went on a three-day strike earlier this month. Workers demanded an increase in pay, safe staffing levels, an end to mandatory overtime and a broad expansion of infection control measures in healthcare facilities.

On Friday, the Coalition for Kaiser Permanente Unions (CKPU) announced it had reached a tentative agreement following the intervention of Biden’s Acting US Labor Secretary Julie Su. The intervention of Su underscores that healthcare workers, as is the case with every section of the working class, are not only engaged in struggle against Wall Street, but the US government and their lackeys in the trade union bureaucracies.

The terrible conditions healthcare workers confront exist throughout the privatized American healthcare industry, the most overpriced and dysfunctional of all advanced economies.

The fundamental question is: who should control the healthcare industry? Will power remain in the hands of the overpaid hospital administrators and corporate executives who pour millions into preventing safe patient ratios, who develop lean staffing models that prioritize profits over lives? Or will it be run by healthcare professionals, such as doctors, nurses, technicians, for the benefit of all of humanity?

The only means to ending these criminal and deadly policies is through a broader struggle by healthcare workers and their class brothers and sisters throughout the working class for socialized medicine. This means taking control of their workplaces, and finally removing the profit motive from healthcare, guaranteeing it to all as a social and human right.