It’s About Power

Hospitals are finally realizing the problem of nurse burn-out; likely because it’s getting expensive to hire and orient new nurses in a time where most health systems are looking to tighten belts (blame or thank the Affordable Care Act and pay-for-performance). New grad RNs at my hospital receive a minimum of 10 weeks with a preceptor, but often several more. This is something my unit is good at and pride ourselves on, but despite our best efforts (following all the recommendations of New Grad Residency Programs, mentorship, flexible scheduling, etc.) if a new grad still only stays 1-2 years, we gnash our teeth and feel defeated.

In a quasi-leadership role, I feel the frustration of the constantly revolving door. So now we’re talking about it, but the resolutions feel hollow. We can’t treat this with band-aids.

Yoga matstabletop waterfalls, penlights with our hospital name, cutesy t-shirts extolling the martyrdom of nurses.. these things won’t cut it. “After awhile, you start to realize it is just a game of smoke and mirrors.” Nurses are even “storming” the U.S. Capitol to call for better nurse to patient ratios. Coming from a unit with generally favorable ratios of 1:4 or 1:3, I can unfortunately tell you that med-surg RNs are still coming and going in droves.

I’m currently reading Krista Tippett’s Becoming Wise. Last night I read a passage that talked about words as containers, and asked how many times have you waded through flowery prose and politicking only to ask “doesn’t it feel to you like there should be a thought bubble over it that says, “what I really would say if I could say it is…”

What I would tell hospitals is that, surprisingly, we can’t throw money at the problem (though sure, it wouldn’t hurt to have safe staffing… and what nurse doesn’t love a new coffee cup?).

Though the moral distress, the 100 tiny cuts per shift of slights and frustrations, the long hours and variable pay all add up, the root is poisoned. No matter what administrators say in flowery prose and politicking, nurses are misunderstood and disrespected. Physicians do not fully understand what we do, we do not fully understand what they do, and so we jockey and work against one another.

At a teaching hospital, we see hundreds of physicians come and go. I work in med/surg, and we have 11 different medical teams that come through in two week rotations on our unit. Each team has an attending and several residents, interns, and med students. They round with a Care Coordinator and Pharmacist, but how can a nurse round with 11 teams who come at different times? How can we form a meaningful relationship with the hundreds of people passing through, only to have to start all over again in two weeks?

I hear it’s better in the ICU. Fewer people coming and going, at least the illusion of teamwork. Many new grads will flock there.

But in med/surg, when we send two or three pages in an hour and don’t get a response, we snap and snarl. When the physician is getting paged about something deemed unimportant because he or she is admitting a patient or running a code, they snap and snarl at us. We complete our work mostly in silos because anything else is almost entirely impossible by design.

The stress, the frustrations, the long hours, AND the feeling not being understood or valued… the indifference.. sometimes even the contempt of our colleagues. If at the end of the day we can’t feel like we were part of a team, like we completed some collective good, if our career of caring is reduced to tasks (chart this, check that, program the pump, pass the med, don’t bother the doctor), then nurses will never feel good about what they do. And those bad feelings will eat away until we pack up and try again on another unit or in another hospital; or worse, we hang up our scrubs and leave the profession entirely.

It makes it that much harder for those of us who are hanging on, hoping for better days ahead.

Don’t give us a free breakfast or a t-shirt. We don’t want tolerance or saintly status; we’re asking for something much scarier.

Aretha called it: Respect.

noun a feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements.

We’re asking you to recognize that we’re educated, competent individuals.

It’s going to take a lot to get there. We’ve got to wash away years of sexy nurse Halloween costumes and ill-informed television shows.

Not to mention the whole culture of devaluing “women’s work”:

Culturally, we have a deeply ingrained, often subconscious contempt for women and for the things women do. That’s why when something is marked “feminine,” it becomes humiliating or emasculating for a man to do it. It’s why we smirk at the idea of Bill Clinton taking over Michelle Obama’s vegetable garden.

…If he really wants to challenge gender divides, Bill Clinton should take on these traditionally female obligations. He would send a powerful message: There’s no such thing as “women’s work” and “men’s work,” “women’s issues” and “hard issues.”

I couldn’t agree more.

Maybe there’s even more tied up in this election than I previously thought..

 

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