Nursing Malaise

Not Nurse Ratched has written compellingly on her blog about the seemingly chronic and unfixable malaise in nursing:

I maintain that currently registered nurses work in an environment perfectly engineered to create and perpetuate anxiety, hostility, and eventually depression. Why do we eat our young? Because we are anxious, hostile, and depressed. Healthcare today is a society of witch-hunting, and someone has to be burned. In all likelihood it will be “the primary nurse.” The primary nurse currently has responsibility for nearly everything, including ensuring physicians are correctly entering computing orders and ensuring that all the electronic pieces of the chart are present and correctly uploading to the main system. We now must double-check ourselves, our aides, our secretaries, and our physicians. If any part of the system goes down, you’re the one responsible. This is in addition to heavy patient loads. Speaking of which: you’re assigned too many patients for safety? Complain, and you’re written up for being a bad team player. Don’t complain and make an error, and you run a real risk of losing your job and/or your license.

She then adds:

I don’t know what can be done about that part of the job. It’s a hard job, we choose it, and we figure out how to cope or we quit and find something else. This other stuff…I can’t give up believing that this bureaucratic terrorism is not a necessary part of the profession. I feebly cry out to my nursing brothers and sisters: what can we do? Is there a solution? Can we not stop the environment of fear?

What’s appallingly obvious about this present malaise NNR describes so vividly that it is nearly always the result of nurses abusing other nurses. This, I think, is the elephant in the room. We can talk at great length about hospital policies, regulatory requirements, the exercise of power in hierarchies, horizontal violence, corporate culture and all the rest and how they negatively affect the quality of nursing work-life. But strip away all that, and you’re left with nurses formulating policy, making decisions and giving direction which adversely and sometimes abusively impact other nurses. In short, we do it to each other, and then we blame some impersonal force, like “the hospital;” for some unfathomable reason, we think that is A-OK.

I’ve argued on this blog before that there is a spurious belief out there that once a nurse becomes management he is somehow exempt from the professional duties and responsibilities which bind all nurses, and hospital policy or the demands of human resources takes precedence over these obligations. This pretense needs to stop: it’s damaging to the profession and it harms patients. Nurse managers who create an unsafe or hostile working environments are responsible in turn for increased patient mortality and morbidity. The evidence is pretty strong for the link between quality of nursing work-life and patient outcomes. By the nursing standards of practice here in Ontario — like most places — abusive behaviour and  harming patients is surely a matter for professional discipline. Do we need to start reporting a manager’s “bureaucratic terrorism” to our respective colleges/state boards of nursing? Maybe it’s time we called them on it. There is clear sense among frontline nurses that we need managerial accountability for poor practice, and evidently hospitals aren’t providing it.

But ultimately (and I speak from personal experience here) the best answer is to speak truth to power, take care of ourselves and our profession, and walk away. Toxic workplaces are beyond the ability of any single nurse to fix, and the clearest (and most financially damaging, for it costs big money to fill a nursing vacancy) message we can send to abusive employers is to vote with our feet.

Nursing is a hard job, physically, intellectually and emotionally challenging. But no nurse signed up for working in an environment of fear and hostility. Coming home from every shift emotionally drained and numb for anxiety is not sustainable, not for patients, not for nurses personally, nor for the profession as a whole.


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  1. #1 by Jenn Jilks on Thursday 16 December 2010 - 1205

    You are so right, hitting the nurse on the head!

    Talk about man’s inhumanity to man!
    The way women in power treat other women not in power shocks me.

  2. #2 by Raquel on Friday 17 December 2010 - 0837

    You are right. And unfortunately in this rough economy jobs are not as plentiful as they once were. We can’t so easily jump from one hospital to another (maybe even with a nice sign on bonus, remember those?) Often we are just stuck.
    It sometimes feels as if we are set up to fail. Subsequently, there is backbiting and throwing other nurses under the bus, however If we don’t support each other, we are really, truly screwed.

  3. #3 by The Nerdy Nurse on Sunday 19 December 2010 - 0402

    I started writing my blog out of frustration and as a form of therapy. The daily bludgeoning I was receiving from my fellow nurses was beating me down and taking a toll on my sanity and my patients safety. I had heard that nurses eat their young, but never thought I, with my outspoken nature, would ever be a victim of a bully, yet alone a group of them.
    My boss blamed me. Said I was too sensative, shouldn’t take it personally, and overreacted. Ulitimately I was forced to change days of the week, some shift diffs, and had to work nights, which was something I had feared and avoided since becoming a nurse. I was wronged, and legally, was harassed.
    For some reason there are some nurses, some people in general, who revel in making others look bad. Perhaps somehow they feel that this makes them look better. They are the more competent nurse, and they need to let everyone know it.
    These nurses not only destroy our pursuit of professionalism and hold back nurses from getting the respect and recognition deserved for the excellent care provided by so many, but are dangerous because of their downright arrogance. Alas, they can see every flaw in another’s performance but fail to acknowledge and accept change, even with evidence based practice, and feel that their way is always the best.
    Medicine is constantly evolving. As nurses, members of the healthcare team, that means evolving with it. This also means growing, learning, changing, educating, and helping your fellow nurse, rather than throwing them under the bus.
    I wish this was something I give give a pill or an injection to fix, because there would surely be some laced lattes and frappachinos up in here, for the good of mankind!

  1. Response to “Dark times” | Not Nurse Ratched
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