The Pain Left Behind: Reflections on a Medical Mission and an Island’s Overwhelmed Nurses

“My family left after the volcanic eruption,” Sister said to me with a heavy heart. “But I asked myself, who will take care of my fellow Montserratians who stayed behind?”

These poignant words reflect the resilience and dedication of the nurses I encountered during my recent medical mission to Montserrat. During my time on the island, I collaborated with cardiologist Icilma Fergus Rowe of Mount Sinai Medical Center in New York City, who returns each year to provide much-needed cardiac care. The team serves over 100 patients in just five days, providing essential cardiac consultations, follow-up visits, and diagnostic echocardiograms, as well as referrals for further treatment or testing in Antigua or sometimes the United Kingdom (UK).

Local nurses under strain.

While many patients waited all year for consultation with our team and our presence was met with gratitude, local nurses who facilitated this care also revealed to me that our visit placed additional strain on the already overwhelmed nursing staff. Now, as I reflect on the benefits brought by medical missions like ours, I remain aware of the poignant reality that when you leave, you leave behind hurting colleagues whose pain stays with you.

The lasting effects of a devastating volcano eruption.

This small island in the Caribbean 25 miles southwest of Antigua, once a thriving community, has faced numerous […]

2025-01-08T10:20:14-05:00January 8th, 2025|COVID-19, disaster preparedness, Nursing, Public health, volunteering|0 Comments
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A Paradigm Shift in Obesity Care: Recommended Reading in AJN’s June Issue

The June issue of AJN is now live.

Obesity, which is depicted on the June cover, has steadily increased in prevalence in the United States over the past three decades. This month’s AJN Reports, “Weight Loss Medications: Stigma and Shortages,” takes a close look at the multifaceted implications of new medications to treat obesity. (Also see editor-in-chief Carl Kirton’s editorial, “A Paradigm Shift in Obesity Care.”)

“Nursing Care for Patients After Urostomy Surgery” details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care. (CE credit available)

Can physical activity help alleviate nurse burnout? This month’s Original Research article, “Addressing Nurse Burnout: The Relationship Between Burnout and Physical Activity” describes a cross-sectional study that sought to determine whether a correlation exists between self-reported physical activity levels and nurses’ perception of burnout in a sample of hospital RNs.

In “Improving Compliance with  a Nurse-Driven Protocol for Unfractionated Heparin Infusions in Patients with Venous Thromboembolism,” the authors discuss a QI initiative to reduce patient safety events related to unfractionated […]

2024-05-28T15:00:03-04:00May 28th, 2024|Nursing|0 Comments
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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 will be […]

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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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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