Staff Nurse Survival in a New Environment of Nursing
Today’s healthcare setting is a challenging place to be. Whether you are a patient, administrator, physician or nurse, the need to do more with less and do it faster and safer is the undulating chant that just won’t go away. Everyone talks about how bad things are, but no one seems to be fixing it.
Patients are afraid to enter the front door. They have read that it is unsafe, that they are risking life and limb walking into a hospital today. Nasty bugs that can eat your flesh or kill you are making headlines every day. Overcrowding and drive-by status for emergency rooms focus the public on the woes of healthcare. Yet they come.
Administrators are cowering at the latest headline pasting their salary all over the front page and demanding to know what they have done to earn it. Politicians are looking for money and seek to take it away from the largest spending segment, healthcare. Administrators are playing dodge-ball with finances trying to keep their doors open and their nurses paid. Yet the endure.
Even physicians are crying foul these days. Physician income increases fell behind inflation from 1989 through 1998. As a result, the number of medical school applicants dropped sharply from 1990 to 1996 (MECS, 1999). Physicians have seen declining compensation and status, redistribution of power and income, and more paperwork and hassle. Yet the practice.
And nurses are seeing shortage issues erode the quality of care even in the face of evidence that having more nurses equates to better patient outcomes (Needleman, et al, 2002). Worries about mandatory overtime and nurse-to-patient ratios are extolled in all of the nursing literature making it mandatory for nurses to worry whether they are affected or not. And yet they care.
WHAT CAN NURSES REALLY DO ABOUT THE SITUATION?
Now we are getting somewhere. Complaining about the problems, lamenting over the shortage, and blaming administration, physicians, politicians, or anyone else who comes to mind is not productive. Nurses need to move on to the solutions stage. What can we really do about it?
First, what is “it?” It is the real problem. Is “it” the shortage? Not if you have enough nurses. Is “it” the rules? Not if they work in your favor. Is “it” the environment? Yes! No matter what your .practice looks like or where it is done, the environment is “it,” the place you go every day to do your work. When the issues of professional nursing, other disciplines, and/or politics starts to affect our own environment, then it becomes personal, and we need to fix it. I want to respectfully suggest some things in your environment that might be improved and make your life a little better.
Building the workforce: Make the environment one that welcomes new nurses. If new graduates take a look at professional nursing and decide to leave, who does that hurt? It hurts all of us. Money wasted, time and energy that will never be regained, and we are still short-handed. Work to make new graduates feel welcome. Remember that you once had to learn the ropes, and take them under your wing and teach them. They want to succeed, just like you did. Be patient and considerate. They may be your answer to a day off down the line.
Setting boundaries: Decide what you can do, what you can tolerate, where you can bend the rules before an incident happens, then draw the line. Setting boundaries beyond which you will not move is a way to keep both your license and your sanity. It might be fine to bent! the visiting hours rule a bit so that a newly-arrived relative can visit, but it is never acceptable to bend the medication rule and skip a dose because you are busy doing something else. When asked to work and extra shift, decide what you can do safely and what would put you in jeopardy. We have studies that show that nurses are less safe after 12.5 hours (Rogers, et al, 2004). If that is your cut-off, then be prepared to say no and mean it if you are asked to work a double. Boundaries are a way to be in control of your life and your practice.
Getting involved: Speak up at your facility when you see problems or issues that need attention. Do not be afraid to share information that will make the environment safer, better, more nurse-friendly. If there are committees for improvement of the facility, development of policies and procedures, review of new supplies or equipment, volunteer to be on those committees and to be part of the solution to problems. Without nurse input, someone else with make the decisions that affect nurses. It is time consuming, but so is walking to the far end of the hall to the staff bathroom because an architect designed the nursing unit without input from an experienced nurse.
Moving on: It’s time to admit that we love nursing and patients in spite of what the world throws at us. We do it because we love helping people, making a difference, doing something important with our lives. There are people who go their entire time on this earth without ever saying the words, “I really made a difference in that person’s life.” Nurses say it almost every day. If all of the money in the world dried up today, we would still seek care-giving opportunities because caring is what defines us as nurses. Now is the time to move on from the “poor me, I work harder than anyone and get no jrespect” theme that has permeated nursing for many years. We are the most trusted professionals in the U.S.-that’s respect. We have a hard job that many people would not want to dogood, because we work because we love it. We don’t make enough money – true, but who does? Almost every person on earth thinks they are worth more than they are getting. There is nothing wrong with that, we call it self-worth, self-esteem, self-confidence. Just don’t let it get in the way of enjoying all that you do have. It is time to quit whining and complaining about how bad things are and to move on. Be part of the solution, not the problem.
Nurses are intelligent, caring, giving souls who make this world a better place. Now what could possibly be more important and significant than that! Thank you for being a nurse. Celebrate your nurse-ness with each other and work to make things better for everyone. Making the world a better place-that’s what nurses do.
MECS, Medical Economics Continuing Surveys, 1999, AAMC Data Book.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M. and Zelevinsky, K. (2002). Nurse-Staffing Levels and the Quality of Care in Hospitals. New England Journal of Medicine, 346(22), 1715-1722.
Rogers, A, Wei-Ting, H, Scott, L, Aiken, L, & Dinges, D. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212.
K. Lynn Wieck RN, Ph.D.
Lynn Wieck, RN, Ph.D.
Dr. Lynn Wieck is Chief Executive Officer of a Houston based company, Management Solutions for Healthcare, and is a nurse consultant for health policy and workforce issues. Her research area is recruitment and retention of the emerging workforce into health professions with an emphasis on challenges of leading, educating, and managing the twenty something generation.
Dr. Wieck has published six nursing textbooks. Her latest book, Stories for Nurses: Acts of Caring was released in August, 2002, and received an American Journal of Nursing Book of the Year award. Dr. Wieck is a researcher as well as a national speaker on health workforce issues.
Copyright Nevada Nurses Association Aug 2005
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