When I first became a nurse, I worked in the ED of a big city hospital. It was a historic institution that was proud of its reputation for emergency care. Yes, it was fast paced and often understaffed, but there was a sense of team camaraderie and accomplishment. As a municipal hospital, no one was ever turned away and we often had stretchers in the hallways. On cold nights, we would allow homeless people to sit in the back hallway to stay warm, regardless of policies prohibiting the treatment of those who weren't official patients. (This was our nod to prevention: we could either keep people warm or send them out in the cold and admit them later for hypothermia.) These were our patients too, and I felt that all of us—nurses, medical residents, aides, and clerks alike—felt a sense of caring for everyone who walked through our doors.
I loved the work and working alongside colleagues who were competent, encouraging, and enjoyable to be with. I loved it until I didn't—until there were too many patients to care for and hiring was frozen; until budget cuts meant we had to take on other departments' duties to get things done expeditiously (like setting up oxygen tanks or cleaning beds after discharges); until experienced colleagues left and weren't replaced; until rotating for a month on the night shift became every two months instead of every three or four; until we needed to work double shifts too many times to cover for insufficient staff; until we began bickering with each other over scheduling, restocking supplies, or who we were paired to work with; until I stopped treating patients as real people and saw them as assignments to get through on a shift. It was time for me to leave.
My story is not unlike those of many other nurses who experience unrelieved work stress, who believe things will not get better, and who end up leaving jobs because they no longer feel good about their work. And while my colleagues and I might have found ways to deal with the stress individually—yoga was a popular choice back then—it was only a temporary fix in the face of a broken system.
In December 1997, Judith Shindul-Rothschild, a nursing researcher speaking at a health care rally in Boston that was protesting the corporatization of health care, said, “We don't need any more commissions, research institutions, or trend analyses to tell us something is terribly wrong with the U.S. health care system. When Rosa Parks refused to sit in the back of the bus, she didn't need any microanalyses of inequality in American society; she knew that what she was experiencing was racism, plain and simple, and she was not going to take it anymore. Well, nurses and doctors know just as clearly that the greed of corporate health care is squeezing humanity out of our health care system, and we're not going to take any more either.”
She was speaking out against a trend toward what many felt was an extreme downsizing of staff and services that placed profits over patients. Cost-efficiencies were the priority as large for-profit health care systems grew, and in many instances patient care suffered when staff were cut and nurses were hard pressed to provide the care and teaching their patients needed.
I don't think we've fully recovered from those days. Yes, we need to be fiscally responsible, but nurses' main priority shouldn't be patient throughput or implementing changes that save money while compromising care and patient outcomes. Nurses must be enabled to nurse. Research by Christine Kovner and Linda Aiken and others has shown that nurse staffing is crucial to quality outcomes and that nurses will leave workplaces that don't let them do the work they should be doing.
The National Academy of Medicine recently released a report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, focused on recommendations to address burnout (see a summary in this month's AJN Reports). AJN will also host a webinar on February 25 on this topic—watch for details on www.ajnonline.com. I was happy to see that most of the recommendations were system focused and didn't put the onus on nurses to deal with it as individuals. To paraphrase a Clinton-era phrase about the economy, “It's the system, stupid.”