Unwritten Social Contract: Your Needs Come First!

The unwritten social contract, which implies that individuals must meet their own needs before attending to other issues, is lost on too many nurses and other healthcare workers. We cannot effectively care for patients unless we care for ourselves first. The moral of the story is to take care of your most basic needs first, for this is the only body you will ever have. Your needs come first! Nurses Announcements Archive Article

Unwritten Social Contract: Your Needs Come First!

According the the unwritten social contract, "each individual in a society has an underlying obligation, to the best of his ability, and before all else, to take care of his own basic needs, both immediate and for the foreseeable future, before attending to the needs of others" (Bell, 2008). The social contract has no specific person or author to which I can attribute credit because, after all, it is unwritten and unspoken.

Nurses and nursing students are well-schooled in theories surrounding basic needs. We all learn about Abraham Maslow's hierarchy of needs fairly early in our educations, and the idea is drilled into our heads that every person will experience consequences if basic needs are not being addressed.

A person's most basic needs can be easily remembered by using the acronym OWN-A-SEX, which stands for oxygen, water, nutrition, activity, sleep, elimination, and sex.

Even though nurses know all about the importance of basic needs, too many healthcare workers neglect their own most essential needs during the course of their work shifts. Countless nurses arrive to the workplace with insufficient rest, run around with full bladders, care for patients while hungry, fail to hydrate adequately, and otherwise shove their most basic physiological needs to the wayside while drifting along during the shift.

The principles surrounding the unwritten social contract seem to be lost on way too many nurses who place the needs of patients, families, physicians, coworkers, and management above their own. Other nurses view their entry into the nursing profession as some type of altruistic higher calling that involves devoting their lives to helping others first.

Anyhow, the culture of inpatient bedside nursing at many facilities seems to produce excuses for the fact that staff nurses and other healthcare workers regularly fail to meet their needs for food, water, sleep, and timely elimination.

Many years down the line, these same nurses are suffering from various ailments, taking multiple medications, and feeling used and abused by the healthcare system that employs them. Numerous patients have come and gone during the years through admissions, discharges, transfers, and demise, while the bedside nurse deals with the same body for the rest of his or her life. If we do not take care of the one body we have, it will slowly fall apart.

Some would say that the most caring, unselfish nurses will always ensure the safety and address the needs of their patients above all else. However, the most effective healthcare worker is the one who has rested, refueled, rehydrated, and relieved himself when the urge comes. We cannot effectively care for patients unless we care for ourselves first. The moral of the story is to take care of your most basic needs first, for this is the only body you will ever have.

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TheCommuter

About TheCommuter, BSN, RN

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Specializes in Oncology; medical specialty website.

How can this be done, if, as you noted in your previous thread/article, nurses are not being given the opportunity to void, let alone eat? I'm honestly asking this.

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How can this be done, if, as you noted in your previous thread/article, nurses are not being given the opportunity to void, let alone eat? I'm honestly asking this.
Yeah, this also made me think of the article about nurses not taking their potty/meal breaks. I know I ruffled a few feathers when I commented that any nurse who doesn't take two minutes to pee during a 12 hour shift is *choosing* not to. I stand by that. I totally get others' point that nurses have insane ratios and workloads. But once nurses start implying that they are *literally* unable to set aside charting for a couple minutes to go pee, they are venturing from "legitimate complaint" territory to "playing the victim card" territory. (hey, that's another article!)
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Great article, and could not agree more!

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Specializes in CVICU, ER.
Yeah, this also made me think of the article about nurses not taking their potty/meal breaks. I know I ruffled a few feathers when I commented that any nurse who doesn't take two minutes to pee during a 12 hour shift is *choosing* not to. I stand by that. I totally get others' point that nurses have insane ratios and workloads. But once nurses start implying that they are *literally* unable to set aside charting for a couple minutes to go pee, they are venturing from "legitimate complaint" territory to "playing the victim card" territory. (hey, that's another article!)
This sort of angers me, mainly because I've "played the victim card" myself. I've postponed bathroom breaks to chart because I worry if I postponed charting I would be distracted later and forget, or it wouldn't be an accurate time. But I really think we're set up to be this way sometimes, when we're expected to perform what sometimes is a very difficult and demanding job, but are told there isn't another nurse available who can cover us for a lunch break. Not even a charge nurse. I've tried to negotiate breaks with neighbors, but hours pass, and neither of us can seem to find the time. Don't get me wrong, I'll step away for 2 minutes to empty my bladder, and I drink water frequently. But 12 hours is a long time to go without a real break away from alarms, demands, responsibilities. Sometimes I think bedside nursing puts you in a delusional state.
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Sometimes I think bedside nursing puts you in a delusional state.

Sleep deprivation plus dehydration plus alarm fatigue? Definitely!

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This sort of angers me, mainly because I've "played the victim card" myself. I've postponed bathroom breaks to chart because I worry if I postponed charting I would be distracted later and forget, or it wouldn't be an accurate time. But I really think we're set up to be this way sometimes, when we're expected to perform what sometimes is a very difficult and demanding job, but are told there isn't another nurse available who can cover us for a lunch break. Not even a charge nurse. I've tried to negotiate breaks with neighbors, but hours pass, and neither of us can seem to find the time. Don't get me wrong, I'll step away for 2 minutes to empty my bladder, and I drink water frequently. But 12 hours is a long time to go without a real break away from alarms, demands, responsibilities. Sometimes I think bedside nursing puts you in a delusional state.
I think I must not be explaining myself clearly, because people keep misinterpreting me re: the whole "can't stop to pee all shift" thing. I worked at a horrible LTC facility for a few months and was so overworked that I never took a single 15 minute break, let alone a lunch. And I'd stay over an hour every night to chart. It was an unacceptable work environment. But I still would stop passing meds or charting or whatever to pee once or twice. My point was that no matter how busy you are, there's always a chance to sneak in a BR break at SOME point during a shift. Not even the ICU has solid code blues for twelve straight hours. People implying that they literally had no chance to pee for their ENTIRE shift just struck me as silly. That's all. Trust me, I 100% agree with this article that EVERY nurse has a fundamental right to keep himself hydrated, fed and rested. I'll leave the whole "pee break" thing alone from now on, as i'm really just splitting hairs.
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Now that I am on the job, and have been in two different facilities, at both places the nurses I shadowed told me that 30 minutes is deducted from their pay whether or not they take a lunch break. And, all of these same nurses have told me that they skip their lunch break. It almost feels like peer pressure that we are supposed to skip our lunch break. I have no intention of doing this. I notice that my attention to details on the job starts to fade if I don't refuel. Eating something for lunch will make me a better nurse and help me provide safer care for my patients. As for taking a pee break...after having had five kids, I can assure you that one way or another, I will be taking a pee break...I just prefer for it to be in the restroom! lol

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Specializes in being a Credible Source.
nurses are not being given the opportunity to void
I don't need to be "given" the opportunity to void; when the time comes, I walk to the nearest restroom and attend to my business.

I get as harried as anyone but I'm not dependent on somebody else to provide permission for such things.

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Specializes in CVICU, ER.
I think I must not be explaining myself clearly, because people keep misinterpreting me re: the whole "can't stop to pee all shift" thing. I worked at a horrible LTC facility for a few months and was so overworked that I never took a single 15 minute break, let alone a lunch. And I'd stay over an hour every night to chart. It was an unacceptable work environment. But I still would stop passing meds or charting or whatever to pee once or twice. My point was that no matter how busy you are, there's always a chance to sneak in a BR break at SOME point during a shift. Not even the ICU has solid code blues for twelve straight hours. People implying that they literally had no chance to pee for their ENTIRE shift just struck me as silly. That's all. Trust me, I 100% agree with this article that EVERY nurse has a fundamental right to keep himself hydrated, fed and rested. I'll leave the whole "pee break" thing alone from now on, as i'm really just splitting hairs.
I get what you're saying now, that is an exaggeration to not be able to void for 12 hours. I'm just bitter I guess. :)
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Unfortunately the management mentality of "what have you done for me lately" has forced many nurses to take on lot of pressure. Just remember that regardless of how well you are performing, your manager will never be totally pleased. Managers are always demanding more...

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Specializes in critical care, Med-Surg.
I think I must not be explaining myself clearly, because people keep misinterpreting me re: the whole "can't stop to pee all shift" thing. I worked at a horrible LTC facility for a few months and was so overworked that I never took a single 15 minute break, let alone a lunch. And I'd stay over an hour every night to chart. It was an unacceptable work environment. But I still would stop passing meds or charting or whatever to pee once or twice. My point was that no matter how busy you are, there's always a chance to sneak in a BR break at SOME point during a shift. Not even the ICU has solid code blues for twelve straight hours. People implying that they literally had no chance to pee for their ENTIRE shift just struck me as silly. That's all. Trust me, I 100% agree with this article that EVERY nurse has a fundamental right to keep himself hydrated, fed and rested. I'll leave the whole "pee break" thing alone from now on, as i'm really just splitting hairs.

Perhaps you are simply being too literal.

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