By Shawn Kennedy, AJN interim editor-in-chief
Courtesy of the American Journal of Nursing archives
We all know that our nursing jobs expose us to various hazards—back and joint problems, needlesticks and other means of exposure to infectious diseases, traumatic injuries from encounters with violent patients or their family members, just to name some common ones. And as if that’s not enough, the psychological toll taken can result in burnout and even PTSD, which wreak havoc on retention. Heart disease and depression should probably also be on the list.
You may have seen news reports about a study with Danish nurses, published in the May issue of Occupational and Environmental Medicine. The researchers found that nurses younger than 51 years at baseline who perceived their workplaces as highly stressful were significantly more likely to have ischemic heart disease during the 15-year follow-up. Now, as the Journal of Clinical Psychiatry reports, a Finnish study has found that nurses and physicians who work in overcrowded acute care units have “twice the risk of sickness absence due to depressive disorders” compared with colleagues working in less crowded areas. And Health Policy reports on a study revealing that, among Canadian nurses, “Depression is a significant determinant of absenteeism for both RNs and LPNs.”
Is anyone surprised? Not nurses, for sure, and probably no one who’s worked at or been a patient in a hospital recently. With few exceptions, hospitals are generally terrible places to work. Yes, the Magnet Recognition Program and initiatives like Transforming Care at the Bedside (TCAB) and others are gradually improving this. (You can read more about TCAB in AJN’s special report and 12-part series.) But is it enough? Are nurses who experience job-related injury or illness the proverbial canaries in the coal mines, harbingers of an increasingly common and serious problem? What will it take for hospitals to revamp their environments to make them less stressful and more life-sustaining for nurses?
After 30 years of being a nurse, I hear the same complaints over and over. Working conditions and pay have gotten better, but the bottom line is that nursing is hard work. I use to love it, but became very burnt out and left bedside nursing after 20 years. The greatest thing that I learned to do for myself, was say “no.” It is o.k. for me to take a day off or to do something for myself. Being a nurse does not have to mean sacrificing your whole life caring for others. I didn’t join a nunnery. I am not Mother Theresa. Care for yourself!
Darien,
Thanks for that perspective. People acknowledge the stressful environments of nurses esp those working in critical care, for example, but I’ve heard little and read less on additional stress imposed by working with demented patients. Doing that day in and day out must indeed be one of the highest stress jobs. Seems that everyone is working harder than ever with fewer resources these days, and not just in nursing or health care industry. Is it our society in toto that has misplaced priorities -or just the US?
Sounds like you have outlets, which may be the key – need to have a source of joy in life and you seem to find it outside of work. Used to be many also found it in our work…. Thanks for your thoughtful comment!
I certainly agree hardily. I want to say also that these issues and feelings pertain also to a nurse in Long Term Care. Someone should really do a study on the effects of dementia and all its facets, annual state surveys, being responsible for everything, aggression of demented residents, a med pass which is heavy and has to be done in a two hour time frame, to documenting everything you did, said and delegated, wound care assessments, working autonomously. I have been assaulted by a residents husband and also by another resident who has significant psych issues. We are literally screamed and I mean screamed, shrilled at, cursed out, criticized by residents who are demented and their famiies, suppose to have all the answers and all this is done with a smile. I AM EXHAUSTED and want to find another job. I’ve been doing this for 21 yrs. I can’t take it anymore. The emotional toll if rapidly reaching the point of unpayable. Something needs to change. The structure is killing us. I can’t wait until Friday and dread Monday. I have lots of other things in my life. I do limited obstertical ultrasounds at my local pregnancy ctr, I go on medical missions trips, I visit my kid in college and play with my grandson. But something has to give. I can’t keep up this pace. I am also not alone. I have coworkers that feel the same way. So what is the answer??
Maria,
Great points – your litany of what nurses do and are responsible for really hits the mark! And you’re absolutely correct – without a collective voice, we won’t be heard. Most nurses will agree we need to join together but don’t do it – that’s why out of over 3 million RNs in this country there’s fewer than 200,000 ANA members. Imagine if we DID all unite!!
Hallelujah and amen to this article. Two words: legislative activism. Nurses are powerful and we can change the way things are done! (First, I need a new grad job, but of course that’s another story). The economy has long underestimated the value of good nursing care and how to create properly healthy working conditions. The thing that always got me, as I observed nurses at work during my time as a ward clerk, is that they are supposed to be harbingers of health, yet they are often not realistically allowed any breaks during the work day, AND they’re prohibited by the Joint Commission and Infection Control to have EVEN a SIP of WATER at the nursing station during this break-less shift. And this is in California, where conditions are supposedly better than in other states. Excuse my language, but WTF!? I believe we can make conditions SOOOOO much better if we continue to unite and demand change.
Furthermore, I believe the general public does not truly realize that RNs in hospitals are often responsible for almost everything that happens to the patient while they’re in the hospital. Even if an MD orders a wrong dose, wrong med, etc., the RN is seen as the last check before it gets to the patient and if they mess up then people say, “Why didn’t you double check it?!? (While you’re in the middle of 800 other tasks and interrupted 20 times in the middle of administration). Nurses are also seen as responsible for the spiritual and mental well-being of the patient AND family, for the complete safety of the patient medically and socially (i.e. abusive, intrusive visitors, even for preventing certain written correspondence from certain individuals, etc.), for the cleanliness of the room, removing food trays, making sure the TV works and the room isn’t too hot, or too cold, for making sure all paperwork is always completely finished and immune to liabilities, making sure a patient eats before the kitchen closes and you can multiply this by 4 or 8 depending on ratio laws. And this is ON TOP of all the technical nursing tasks such as making sure hydration for chemo starts on time – perhaps for three different patients, while giving blood to another patient and making sure that no one’s having any life threatening allergies to the chemo or the blood…One might say, “Oh but don’t you have an assistant? Don’t you have housekeeping? Don’t you have a charge nurse to help you?” – This is only if you’re lucky, and even then, you’re the primary nurse. YOU are responsible for everything that does or doesn’t get done. And people wonder why nurses eat their young? It’s called incredible amounts of stress folks! This is why it happens. Oh, and don’t forget the whole death and dying aspect, whereby you might have 3 patients getting chemo, plus one who is dying and who’s family needs support and plenty of attention. It’s no wonder. It is no wonder at all that nurses are being pushed toward burnout.
I’d say right now, most nurses are too tired, too busy or possibly to depressed and burned out to even read or respond to articles like this. But the bottom line is nurses need a voice. Nurses need to be active in politics which affect healthcare and nursing. This is how we achieve change. This is how we achieve patient safety. This is how we retain nurses.
On a final note, I went to nursing school without really understanding just all the many ways nursing is challenging. I had no idea. And I think the majority of the public has absolutely no idea, or else they would be more supportive of ratio laws in every state, for example, and other kinds of supportive legislation. Obviously, we need nurses in the near future.
I’m not whining. I am aware that if I don’t like nursing, then I don’t have to be a nurse. I’m just explaining some reality that, if heard, might make the whole system a little or a lot better. Why live with this junk if we really don’t HAVE to?
I haven’t read it, but I do own it and I’ve heard it’s very good – It’s a book called “From Silence to Voice,” by Buresh and Gordon. It’s about nurses talking to the media and having a voice. This is really essential folks! In the words of the great Cesar Chavez, “Si, se puede!” Yes, we can.
I am not surprised by these findings but it is great to see it presented/born out through research. I have not looked at these studies; hopefully this is research that is well done. I have worked in nursing since 1986. I have seen both psychologically healthy and unhealthy RNs. I doubt it is different than many other professions. Nursing demands a selflessness that can at times border on martyrdom. Of course any issues like these are multifactorial and complicated. Other studies have added that night shift work contribute to stress and depression. My spouse is a firefighter and subject to many of the same psychological and physical stressors that nurses endure. The International Association of Firefighters has occupational research that documents the increased incidence of heart and lung disease. That is the first step. Designing programs to decrease the impact of stressor variables and unhealthy work practices is the next step. Measuring the impact of these programs is also of primary importance. It is nice to know that we might be at the beginning of a new journey.