Bedside Nursing as Menial and Demeaning

Ian Miller, blogging over at ImpactedNurse.com, notes a disturbing trend in Australia, one, I’m afraid, is becoming more common in North America. “These days,” he writes, “being a nurse is tough. Really tough.”

I look around and see many struggling at the bedside. I see the increasing perception that this is menial or bottom-of-the-professional-foodchain work.

I see more and more of this sort of feeling online.

[SNIP]

What our brightest and best nurses should be doing instead of creating a culture of escaping the bedside or doing time at the bedside is acknowledging that it is the nurse providing direct care to the patient or client that is the absolute most important domain of our increasingly diversifying profession.

Nurses do not really want to be business entrepreneurs, unless they have no other choice. They want to be nurses.

I would even argue that if you are not regularly within arms reach of your patient/client you are not nursing. And if you have not done this for a long time you are not really a nurse. You are something else. Strong stuff1 I know.

The bedside nurse should be re-valuing themselves not re-inventing themselves.

Miller’s solution is “8 in 8,” i.e. having non-bedside nurses work an 8 hour shift every 8 weeks at the bedside as a condition of their registration. This is an idea I like the more I think about it. However, it would be complicated to implement, not the least because of resistance from said non-bedside nurses — and can you see all those functionaries from nursing regulatory agencies or upper management pulling on scrubs and Crocs and tending to stool incontinence and urinary drainage bags?

Hmmm. Maybe not.

But Miller’s premise, that bedside nursing itself is demeaned and devalued to the point where many of us — including myself — are plotting our escape to greener pastures is sadly true. But why? The reasons for this are pretty simple. Despite years of education and rhetoric, nurses aren’t really permitted to practice to the full scope of our knowledge. We all have heard managers speak of their time at the bedside like it was a prison sentence. Television shows like Grey’s Anatomy tell us bedside nurses are stupid. We know that hospitals view nursing not as a valued added service, but as an expensive cost centre, and that Human Resources thinks of nurses as a “problem” to be managed, like the kitchen guys who make the salads, not as practising professionals.

To be clear, we menialize ourselves as well, when we view nursing as a job rather than a profession, or when we see nursing as a series of tasks to be completed before shift change, rather than a process requiring frequent periods of critical thinking.

It’s all pretty overwhelming, and though I will publicly stand up for the value of bedside nursing, and argue strenuously to its central importance in health care, there are times when even I have a little shadow of doubt.

So really I’m not very surprised if nurses of all ranks and positions view the bedside as menial and demeaning. If people around you all day tell you you’re worthless and menial, and if you view what you do as being more or less thankless and trivial, pretty soon you’re going to believe you are worthless and menial — and so is your professional practice.

I would like to tell you my own motives for escaping the bedside are pure, but when I seriously reflected about it, I realized some of my reasons for wanting to leave had much to do with decent hours and status. And something else:  the ability to act autonomously and effect change in a real way.

In other words, it’s all about power, and this explains why bedside nurses are so demeaned and devalued and want to escape.

Because we have none. Or think we do.

(I would argue front line nurses have far more power to shape their practice and workplace culture than they realize, but we all have been indoctrinated since the first day of nursing school never to question their place in the food chain and to always ask permission. And I’m not speaking about “making a difference in patient’s lives” — a phrase which has always struck me as infantile and meaningless. But this is a subject of a whole other post.)

 

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  1. #1 by Ian on Tuesday 31 January 2012 - 1207

    I like the idea.

    I’ll also say that in my time in hospital (a good 3 months in one loooonnnngggg go) I saw a lot of burnt out nurses. I got to the point where any nurse in her late 30s worried me. And the ones I liked most as a group were either the old-timers (usually working part time) or the young ones, new to the job.

    One nurse, in particular, damn well saved my life (she must have been 50) when the doctors fell down on the job – she made them pay attention on a Sunday night. But I can also think of one who damn near abused me (I was completely incapable of moving, couldn’t even pull myself up in bed.)

    The nurses (and the orderlies) are who a patient relies on, who they trust to give a damn. I know it’s hard, and I know patients are often complete jerks, before we even get to how many doctors treat nurses, but at the end of the day, the bedside care is what matters.

    Of course, it would also help if there was proper staffing. I still remember the night I was left covered in my own puke for most of a shift because the two nurses handling something like 40 patients had to care for people who needed it more. (In truth, it didn’t bother me that much. I was too far gone to really care about something as trivial as vomit.)

    Suppose I’m not going anywhere useful here. I think it’s a good idea that every “nurse” do some nursing. I also think it’s good that those who are burning out stop doing it every day.

    After watching those nurses for so long, I came to one conclusion: it’s not a job I could do. So I’m impressed by anyone who can do it, do it well, and still care.

  2. #2 by McDermott Footcare on Wednesday 01 February 2012 - 1914

    Although I sometimes felt worthless and menial as a bedside nurse, those times were few and far between. I left bedside for a change and because I had enough of shift work. I went into community as a visiting nurse but my part-time position turned into 7 days a week, plus the never-ending voicemail from others on my team and CCAC. So I quit. These days, I am in independent practice as a certified foot care nurse. While I no longer stick people, insert catheters, etc., I still perform nursing assessments on clients, most of whom have complex issues. I can handle a scalpel like nobody’s business and of course, since I am an RN, clients talk to me about all their medical issues, not just their feet. I feel empowered, have control of my schedule and my clients are appreciative. Other foot care nurses are competition but the main problem is competing with homecare agencies who provide foot care. They have the business power to snatch up all the big contracts in nursing homes, etc. but their model of doing as many feet as possible means that the care is less than great. But all in all, I’m glad I made the move to independent practice.

  3. #3 by RehabRN on Saturday 04 February 2012 - 2019

    TE:

    BTW I wouldn’t mind doing the 8 in 8 thing if the psychotic Hotel could get it set up right.

    It’s understandable, and I agree with MDF that I got away from bedside d/t my education plan. I picked a specialty that allows a little bit of both–dressing changing and other bedside tasks along with working in my specialty (informatics).

    My shift is more reliable and not so crazy, but I still work with my partners on the floor. I have to in order to make things work in my job.

    Some people say I’m not really an RN anymore, but I tell them, “Once a Marine, always a Marine, so once an RN, always an RN.” I love my patients and I will do whatever needs to be done, whether I sit at a desk or at their side. I’m still their advocate.

    • #4 by torontoemerg on Saturday 04 February 2012 - 2100

      Hmmmm… do you think the same could be said of all nurses who have left the bedside? Judging from the contempt I have heard in the voices of my betters toward the front line nurse, I wonder.

  4. #5 by Gregmercer601@gmail.com on Saturday 18 February 2012 - 2205

    I can understand your frustration. I think the solution must involve improving conditions at the bedside, building power and prestige. One group of nurses attacking another has always been our main response to outside oppression, and it only keeps us divided and weak. Forcing Nurse to the bedside would do more to demean its status than anything to date: what better way to reinforce low status than to feel a need for everyone to do their time? Nursing professors aren’t Nurses? I wonder what Dr Peplau would say to the idea that writing important books about Nursing made her no longer a Nurse, unless she put in a token shift here and there? You cannot mandate status and respect: it fails. Improved status comes with struggle to take it: look at the civil rights movements, slow and hard and frustrating, but the only way forward.

  5. #6 by Tomlinson on Sunday 25 March 2012 - 2342

    Nurses do not really want to be business entrepreneurs, unless they have no other choice. They want to be nurses. I find this very amusing. I don’t think they can be business entrepreneurs…Most people become nurse because they want to help people while making a living…that’s how I see it.

  6. #7 by JaneDoe on Saturday 26 April 2014 - 0634

    I agree with everything you have said in this post. The disrespect is the worst thing about this job.

  1. A entry prompted by a post on These Emergency Blues « Speeding Through Nursing School

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