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.