the patient isn’t the only one sick

Here’s a quote from an article entitled “The Depression Epidemic”, published in Christianity Today, March 2009.  I discovered this gem at http://erickouns.com/2013/04/09/i-worry-about-arthur/  where I read regularly.

“Our jobs are not secure, and due to specialization, many of us do not have the flexibility to move easily and quickly from one job to another. We work long hours… . We compare ourselves with other colleagues when comparisons are fruitless, or find ourselves being compared unfairly. When we come up short, we feel the burden of unrealistic expectations we have placed on ourselves or have received from others. We are given responsibilities with little authority and even fewer resources, and feel we have no control over job expectations or even how we use our work time. Many of us are subject to sometimes dehumanizing corporate or economic systems not of our own making and seemingly beyond our influence. We feel small, insignificant, and expendable.”

This paragraph is an apt description of the job situation for many professional nurses, myself included.

I am relatively insignificant in the corporate world of hospital systems.  Decisions which directly affect how patient care is done are made by persons who are specialized in profit-making and rule-making. If nurses and patients are lucky, some of those persons will remember when they themselves gave bed-side care.  More often, those long-reaching decisions are instigated by regulatory agencies who have been given a free ride to create their own importance, and handed down by corporate officers who answer only to the stakeholders.

Here’s a dirty little secret about nurses and our profession:  we are officially informed, on a regular and recurring basis that we aren’t good enough.  We are told that we aren’t accurate enough, nice enough, punctual enough, professional enough, loyal enough to our job; that we are not good enough at teaching our patients, we don’t anticipate the physicians enough of the time, we don’t make up for the physician’s mistakes as smoothly as we are supposed to, we fail to make up for the lack of functional equipment, and we are not good enough at compensating for antiquated systems on which administration refuses to spend any effort or money.  And if we protest that the staffing levels are inadequate to give the care that patients need, we are told that we just aren’t efficient enough.

Does anyone realize the amount of damage caused by this constant, unrelenting diet of “you aren’t good enough” ?   In what other profession or type of job, or educational system does anyone expect optimal outcomes with a steady diet of “You aren’t good enough”  being fed to the people?

CQI.  Constant Quality Improvement.  That’s what brought us better fit & finish on our new cars in the latter decades of the 20th century.  It worked well for all sorts of factories, but in regards to hospitals and nurses, the industrial results have not been replicated.  Instead, hospitals started tracking patient satisfaction scores as a marker for quality of care (that is a rant which I can’t afford to tackle in this post)  and we are finding both to be dismal in many facilities.  Particularly as ER volumes increase and wait times lengthen.

I know the goal of CQI is better nursing care and better patient outcomes.  But I think that nursing is one of the few professions where a steady diet of backward negatives is honestly expected to result in performance improvement.  Without going into a lengthy rant about the work conditions and daily expectations, suffice it to say that every bit of that quoted paragraph above comes into play on a regular basis for every hospital nurse I’ve known.  How many is that? I haven’t counted.  But it is not location-specific nor time specific. This isn’t about my current or previous contract jobs, not about any one particular job venue. No, as my career has traversed 20+ years, traveling me to active practice in 7 different states and at least 15 hospitals,  I have seen that paragraph play out every time.

Is it any wonder that nurses have high rates of dysfunctional relationships, abuse of tobacco and alcohol, professional burnout, and chronic health problems equal to those of their patients?    The actuality of life for most nurses is one of constant cognitive dissonance: we truly intended to take good care of our patients when we decided to enter the profession, but the design of the systems that pay us are inherently broken and/or destructive to the point of preventing us from doing our best.

I don’t have a systemic answer for this.  Personally, my answer to my self is to give compassionate presence to every patient and to engage respectful communications with those around me in the professional environment.  I don’t try to subvert the systems, but I do work around them when they obstruct good patient care.  I also embrace them when they provide needed safety and tools for good communication.

Further concerns in regards to sufficient nursing staff in the USA can be found here: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

Unless we staunch the damage within, and stop the hemorrhage of personnel from bedside care, we will not adequately address the nursing shortage that looms in the next 15 years.

I am one of those 50-something nurses who intends to discontinue giving institutional-based nursing care.  I personally extend a hearty welcome to every nursing student I meet.  I secretly wish that they weren’t subjecting themselves to such a life of receiving abuse, while at the same time I am glad someone will carry on the race in the place of those of us who have become weary.

young racers

 

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