A Plea for Help in Making Nursing Sustainable

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 […]

2021-08-19T16:46:41-04:00July 29th, 2021|health care policy, Nursing, nursing career, Public health, safe staffing|5 Comments
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What Do Nurses Need?

“Covid-19 Is ‘Probably Going to End My Career’” is the title of my recent column in the New York Times. The nurse who made that statement spoke to me on the condition of anonymity because her hospital doesn’t like having nurses speak out. So—nurses are afraid to publicly complain about their difficulties on the job, struggle with a lack of PPE and short-staffing, and are overwhelmed by the number of deaths they are seeing. All this has led to the nursing profession being in crisis.

The six ideas below could help nurses drowning in difficulties imposed by Covid find their way back to solid ground.

  1. Staffing legislation. This could mean ratios, or some other way to insure that nurses are not expected to work short. The legislation should also require robust nursing float pools and keep secretarial and nursing assistant support at their usual levels. Units have to be staffed in a way that maximally benefits patients, not just to help balance a hospital’s bottom line.
  2. Mental health support. Nurses as a group are not always open to counseling, but during Covid nurses have spoken out about the emotional toll of the work and their ongoing PTSD. They have recognized their need for mental health support. Hospitals must give nurses health insurance that covers individual counseling, and have mental health resources available on the job for nurses. “Covid broke me” is being said by too many nurses, too often.

    3. […]

2021-03-05T09:52:27-05:00March 5th, 2021|COVID-19, Nursing|1 Comment
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Can We Ever Overcome Burnout in Nursing?

Reality shock redux.

Flickr / Harshit Sekhon

It seems to me that we’ve been talking about burnout about as long as I’ve been in nursing, and that’s over 40 years. In 1974, Marlene Kramer’s book Reality Shock: Why Nurses Leave Nursing reported on how nurses’ dissatisfaction with their inability to practice as they were taught was a major factor in their leaving the profession. (Here’s AJN’s 1975 review of the book.) In the 1980s, it was the downsizing of staff that caused many to leave (see the February editorial for my own experience). In the last decade, as health system changes and staffing (again) engendered moral distress and burnout among members, nursing organizations sought ways to mitigate distress among nurses.

Burnout’s persistence as an issue.

But the issue persists and arguably has gotten worse, with increasingly alarming reports of high levels of burnout—between 34% and 54% physicians and nurses report symptoms—and suicides.

To address the problem, the National Academies of Science, Engineering, and Medicine (NAM) established a 17-member committee to review the research on the […]

2020-02-18T11:56:44-05:00February 18th, 2020|Nursing|1 Comment
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Understaffing: A Policy Oblivious to the Unforeseen Swerves of Life and Nursing Shifts

The Roads of Life and Nursing 2019 by Julianna Paradisi

Neither life nor nursing shifts develop in a linear fashion. Both roads are full of unforeseen swerves. I was reminded of this over the weekend while sitting with a relative in an emergency department. Our weekend plans had been put on hold to accommodate this unforeseen swerve in health.

An ED staff under stress.

I couldn’t help but notice the emergency department staff were experiencing their own set of unforeseen curves this particular shift. Although it was early in the evening, to my experienced nurse’s eye they were already exhausted.

When we arrived, the triage nurse was being verbally accosted by two people who’d walked in off of the street, ranting and high, until a trio of security officers intervened. Another nurse hustled between triage and the bay area. A photograph of her young daughter on the reverse side of her ID badge dangled from the lanyard around her neck. Everyone looked tired.

The tricky ambiguities around nurses calling in sick.

Once my relative was confirmed as stable, I revealed to the other nurses that I was a nurse and said I’d noticed how busy they were that shift. The nurses […]

2020-01-09T10:53:17-05:00January 9th, 2020|Nursing, nursing career, wellness|2 Comments
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Supporting Systems to Address Clinician Burnout

National Academy of Medicine calls for action to address a crisis among clinicians.

As a nurse and researcher who has worked in the area of clinician burnout for many years, I was pleased to see attention to this issue by the National Academy of Medicine (NAM) in a recent consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Burnout, a syndrome of “emotional exhaustion, depersonalization, and lack of personal accomplishment” (Maslach et al. 2001. Job Burnout. Annu Rev Psychol. 52: 397-422), has far-reaching and troubling consequences for health care clinicians. The problem has grown to crisis levels: estimates indicate that 35%-45% of the nearly 4 million nurses in the U.S. are experiencing symptoms of burnout, and up to 54% of our physician colleagues experience it as well.

A ‘chronic imbalance’ of job demands with available resources.

Prominent among the factors contributing to burnout are the systemic patterns that erode professional fulfillment and well-being, many of which are beyond the control of individual clinicians.  Burnout represents a chronic imbalance of job demands with resources needed to meet them.

The National Academies of Science, Engineering and Medicine (NASEM), of which NAM is a part, convened a committee to examine the scientific evidence towards understanding the scope and consequences of burnout on the health […]

2019-11-04T09:34:15-05:00November 4th, 2019|Nursing|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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