by Casey Horner/via Unsplash
My hairdresser made a comment that I hear from a lot of people who are not in health care.
“I don’t know how you do a full 12-hour shift when it’s life-and-death work. I mean, I have long days working too, but cutting and styling hair isn’t life and death. I just can’t understand how you do it.”
I smiled and shrugged, as I usually do.
“Thanks for recognizing that. I don’t know. We get used to it, and we have a certain flow at work, even when it gets crazy. Plus it cuts down on the number of days I have to commute to work since I get so many hours in in one day.”
I had so much more to say, but that wasn’t the place for it. This is.
It’s true that at our core, we nurses are just wired to do this kind of work and we can push through it beyond a standard eight-hour work day. It also works well for consistency in ICU patient care to only have one changeover of the patient’s nurse from one 12-hour day shift to the incoming 12-hour night shift. We have generally found ways to ride the waves of an especially high census mixed with especially sick patients, typically followed by at least a brief respite before the next wave.
All that having been said, I wrote a lot during pre-pandemic days about how hard the work was, and now it is curious and sobering to me to look back and feel that nursing was so much easier just two or three years ago.
Nursing at a tipping point.
At this current point in time, however, nursing and its role in our wild pandemic-stricken world seems to be reaching a tipping point that we’ve never quite found ourselves in before. A profession that was already facing a shortage is seeing a new exodus that appears to be only just beginning as nurses burnt-out from the pandemic are leaving the bedside all over the country.
Those of us who remain at the bedside are physically, emotionally, and mentally spent. We are deeply concerned about compromise in the quality of care we can provide when we as a profession are running on short (and shortening) staff and fumes. We are deeply concerned about our own well-being and longevity. We wrestle with a new kind of moral distress because of the barriers and politicization impeding progress in recovery from this COVID pandemic.
The immediate obvious solution would be to recruit more nurses to fill the gaps, but health care organizations and nursing schools have long known that this is much easier said than done. Now, as the work has become so much more difficult, with still more new waves of COVID patients, cracks in the system leading to larger fissures, and PTSD from the collective experience of it all, we teeter precariously at this tipping point and look with some trepidation at the cliff we hope to avoid toppling over.
What nurses need right now.
I would venture to say that what nurses need at this point includes at least the following:
- Concrete recognition of the work we do, beyond words of empathy or appreciation and beyond token gifts like pins and tote bags, which don’t actually make our work or lives more manageable (hello, extraordinary cost of living in Los Angeles). To put it bluntly, we want better compensation to recognize and reflect the highly specialized, intensely stressful, and irreplaceable work we do at the bedside.
- Management and administration on all levels showing us—again not only in word but in action and policy—that they truly respect our voices when we express what we need in order to do our work safely and sanely.
- Respect from the general public when we voice our expertise (and our despair) about health and preventable illness—particularly around COVID exposure risk and vaccine safety and effectiveness.
- Ultimately, a revamping of the health care system through the proactive move of governmental authorities to address deficiencies in the system highlighted by the pandemic.
What concerns me the most for myself and my colleagues nationwide is that our hope for the above feels shaky at best, but the need for it has never felt more urgent.
What nurses everywhere are saying and feeling.
This is not intended to be a criticism of my personal workplace, but rather a lament for what I see and hear from nurses everywhere. Additionally, this is not meant to be a doomsday post, but rather a plea and call to action from those who have power to change the above:
Administrators, policy makers, and you, the general public.
Please. We are so weary but we want to keep our heart for this profession. We want to keep our heart for you and your loved ones when you land in our hospitals. But we are hurting and we cannot continue this way. It simply is not sustainable, and the reasons it feels unsustainable go far beyond the fact that we do life-and-death work for 12-hour shifts at a time.
Please. Listen to us. Do your part.
(An earlier version of this post was originally published on the author’s blog, The Heart of Nursing.)
How about 8 hour shifts, but only 4 days a week and starting off with 4 weeks vacation. As I got older, twelve hours would have been too much. Nursing care has been shown to be critical. Nurses need to be given working conditions that promote their retention and ability to thrive as professions. ..
Start treating nursing as professionals. Stopped staffing with a skeleton crew and sending nurses home and then complaining there is a shortage of nurses. Working with a skeleton staff without reprieve causes burnout. Offer shorter shifts, like 4 hour-shifts. Twelve hour shifts are dangerous both to nurses and pts especially on short staffing. Policy and procedure should only be written by nurses who actually do on hands care not educated desk nursing. There is less teamwork now in nursing than ever before. Bring primary care doctors back into the hospital. I will stop as I don’t think things will change because healthcare is all about the profits. Most hospital are run by profit making companies. No one in hospital advocates for the pts. The hospital’s primary goal is to discharge you as fast as possible, stable or not, so many days allotted…if not able to leave, the pressure builds. I could go on and on.
We need to give nurses self care tools that are sustainable, in order to be able to meet the physical, mental, emotional demands that they are facing. The Transcendental Meditation technique, taught to nurses around the country, has been shown to statistically significantly reduce compassion fatigue, burnout, secondary traumatic stress and increase resilience. I learned the TM technique as a new nurse in the ICU and continue to do it every day (48 years!) http://www.tm-women.org/nurses educationdirector@tm-women.org.
Bring back eight-hour shifts. Research shows that after that, errors rise. We all know that errors are stressful, and that the workforce is aging, and that younger people aren’t interested in killing themselves once they see what it did to the rest of us. The current generation doesn’t remember how nice it was.
The work was just as hard but I don’t remember the tremendous upwelling of despair and fatigue leading to massive resignations in those years.
Insightful and well written article