In Nursing, Some Things Never Change: Shift Report, 1985

Several days ago, we published “A Day in the Emergency Room for a Nurse Who Loves Her Job.” It gave an engaging, sometimes moving account of one nurse’s experience of a normal/stressful day in the ER. As it happens, colleague Theresa Stephany recently sent me the bare bones report we’re sharing today—an actual shift report from 1985. She received the copy many years ago from a friend who worked the night shift at a local hospital, and who had typed and sent it to her manager at the end of the shift. Stephany wrote to me that she “kept it all these years because it’s so horrible that it’s poignant.”

I’m sure that poor nurse was exhausted. Anyone have a shift story to tell, nightmare or otherwise?

SHIFT REPORT, 1985

TO: DIRECTOR OF NURSES
FROM: HEAD NURSE 2ND MAIN
SUBJECT: ACTIVITY RECORD, 11-7 SHIFT, 9/8/85                

Memorandum:

  1. 12 patients in restraints, 2 in leathers, acquired during the night.
  2. 3 Foley catheters pulled out
  3. 1 chest tube inserted with 1300 cc’s pus out
  4. 2 temperatures over 103°
  5. 3 Temperatures over 102°
  6. 7 Temperatures over 101°
  7. 3 patients having DT’s
  8. 3 Patients having chest pain
  9. 3 patients having respiratory distress
  10. Approximately 50 “now” or “stat” orders during the shift
  11. Several chest x-rays done (staff to deliver to x-ray and return)
  12. 2 beds had to be moved to make room for a sitter patient
  13. […]
2018-08-23T10:49:13-04:00August 23rd, 2018|Nursing, nursing perspective|2 Comments
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Integrating Strong Emotions as a Developing Nurse

Most people, I would venture to say, start off in their profession with a fair degree of idealism, and this certainly holds true for nurses. When I talk with nursing students or new grad nurses and ask their story about why they chose nursing, the most common response runs along the lines of wanting to help others in meaningful ways.

Preparing new nurse grads for nursing realities.

In fact, I will meet with such a group of students this afternoon as I speak on a panel in the ethics class at my nursing alma mater. I, and other colleagues on this panel, want to encourage and inspire. But we will also be telling the students about the challenges we have encountered in situations involving moral distress, ethical dilemmas, and personal burnout. We will present situations when we felt that what we were doing at the bedside was not meaningful because we were only prolonging suffering—or, in other cases, so full of emotion and significance that it felt overwhelming to process.

We want to present the reality of nursing to these students, not to shatter their idealism, but to push them towards meaningful self-awareness from the start of their nursing career so that they are not caught off-guard by the degree to which they […]

2018-01-18T10:04:09-05:00December 8th, 2017|Nursing|2 Comments
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Moral Distress: An Increasing Problem Among Nurses

moral distress

An ICU nurse struggles to reconcile repeated surgeries and transfusions for a comatose patient who has little chance of recovery. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she’s not giving needed care to patients because of poor staffing.

Situations such as these are all too common and can give rise to moral distress. Moral distress occurs when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

As explained in “Moral Distress: A Catalyst in Building Moral Resilience,” one of the CE articles in our July issue, this “inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole.” […]

2016-11-21T13:01:03-05:00July 18th, 2016|Ethics, Nursing, patient safety|0 Comments
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More Evidence: Should We Get Rid of 12-Hour Nursing Shifts, Despite Their Popularity?

By Shawn Kennedy, AJN editor-in-chief

A new study in Health Affairs provides yet more support that reliance on 12-hour nursing shifts (or longer—we all know that shifts often extend a bit longer than scheduled) should be reconsidered. The study supports previous findings of increased burnout among nurses who work shifts longer than eight hours, but finds as well that longer shifts (13 hours or more) are associated with increased levels of patient dissatisfaction.

Despite these negatives for both nurses and patients, 80% of nurses surveyed across four states said they were happy with their hospitals’ scheduling practices.

I imagine that, with all the recent emphasis on patient satisfaction scores, this study will make nurse executives and hospital administrators take notice—especially as consumers become more aware of the research through coverage like this story at the U.S News & World Report site.

We’ve had evidence for a while that the 12-hour shift is not a best practice. For example, in 2004, Anne Rogers and colleagues also published research in Health Affairs. In their national survey of over 1,000 nurses, they found that most nurses generally worked longer than their actual shifts; nearly 40% of shifts were longer than 12 hours, and 14% of respondents had worked “16 or more consecutive hours at least once during the four-week period.” More importantly, they found that “the likelihood of making an error increased with longer work hours and was three times higher when nurses worked […]

2016-11-21T13:08:51-05:00November 27th, 2012|nursing perspective|19 Comments
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What’s New on the Nursing Blogs?

By Jacob Molyneux, AJN senior editor/blog editor

Matthew Bowden/Wikimedia Commons

So what’s new on the nursing blogs. I’ve been checking around today, and here are a few good things I’ve found so far. Please let me know if there are any really new and lively nursing blogs we should add to our nursing blogs page. We need some new voices, and I’m sure they’re out there.

Burnout. At Nursing in Hawaii (this blog changes its name periodically to reflect the current location of its peripatetic owner), we find a pretty interesting and roundabout kind of post, “Nurse Burnout, Reality Shock, Marlene Kramer,” that addresses the stages of nurse burnout in a really useful and practical way (after discussing an early seminal book on the topic, what this has to do with the development of the Magnet program, and a few other items). Here’s an excerpt, but I’d suggest reading the whole thing for a look at this seemingly universal issue for nurses.

the honeymoon. This is where the new nurse is still being oriented and everything is wonderful. The preceptor is so smart! The staff is amazing! The paycheck is HUGE! we all love to be around such a person and delight in the innocence of youth.

crash and burn. the onset of this is hard to predict, but usually about the six-month mark. Takes place when the nurse starts getting feedback from every direction, not […]

2016-11-21T13:09:27-05:00August 22nd, 2012|nursing perspective|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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