Unrealistic expectations of nurses.

  1. 33
    I just got home from a busy day of work on a critical care unit (CCU). I cried on my way home while driving in my car. Not because I am sad, but because I am angry. The expectation of a nurse is unrealistic. We are expected to give patients their medications on time. Some of these medications are anti-rejection medications in transplant patients, antihypertensive medications to reduce insult to one's heart and vascular system and medications to prevent seizures.

    We are expected to reposition patients at least every two hours to prevent skin breakdown and risk for infection. Mouth care every two hours for patients who are on a ventilator to prevent ventilator associated pneumonia (VAP). We need to document vitals and hemodynamic numbers every hour. We need to trouble shoot equipment and hang multiple drips and titrate these drips for hemodynamic stability in patients.

    We go to lunch knowing we gave report to a nurse on a CCU who has her/ his own patients and now ours for the 45 minutes we get to eat and regroup for the remainder of the day. These nurse's are also "caring" for our patients when we leave the unit to bring another critically ill patient to a test or procedure. We look at orders and clarify orders and question orders to understand a rational behind why we are doing what we are doing to keep our patients safe. This is all before we actually carry out an order by a physician. We implement nurse-based interventions in the care of patients and families.

    We are expected to and desperately desire to provide holistic care to patients and their families that include listening and being present in a room. To listen to the wife of a patient who has been married to her husband for 50 years. She sits by her husband confused and not understanding what is going on. She asks the nurse questions. Wants someone to reach out to touch her arm and listen to her fears and express that there is not a right or wrong answer in the decisions she is making in regard to her loved-one's medical interventions. I say, "Gather the information, talk to the rest of your family. Most importantly, listen to your heart."

    I care and will continue to care about the nursing profession. I will not stop caring or become immune to what I see to cope with the challenges that nurses face in all specialties in the nursing profession; ED, critical care, and medical-surgical nursing to name a few.

    I truly feel at a loss of words. I entered the nursing profession later in life. I feel an innate passion to contribute to healing the sick and comfort the dying. It is a task that at times, feels impossible. And, actually is impossible. My heart hurts when I leave work knowing that I did not provide the care to very sick patients and their family members that I would want provided to my loved ones.

    I care and will continue to care about the nursing profession. I will not stop caring or become immune to what I see to cope with the challenges that nurses face in all specialties in the nursing profession; ED, critical care, and medical-surgical nursing to name a few.

    Nurses leave the bedside. They move out of hospitals or into management positions within hospitals. The burn out may make these individuals feel as though, "These problems aren't my problems anymore". I understand the feeling. But, nurses need to ban together, support each other and get involved in professional organizations and legislation to put our profession in a place that we can do our job in the way we were taught through our education it should be done and how we know within our hearts it should be done. We can not leave the bedside and forget about those that are still there.
    I can not drag myself away from where the heart of nursing is. The bedside. I can not leave the trenches of down and dirty nursing... where nurses are not too good to do whatever it takes to get the job done. I can not leave my colleagues. Yes, there is bullying in the nursing profession. But, there are many nurses that support each other and are smart, perceptive, kind and supportive. These nurses know when another nurse is struggling. These nurses step away from their responsibilities to help another nurse get back on track.

    My day that I cried over was eased by one nurse. A nurse that stepped in and did not leave me alone until I said, "I am back on track."

    CCU nurses many times, take on three patients during their day and emergency department (ED) nurses take on six alternating patients during a shift. Medical-Surgical nurses can take up to eight patients. Medical-Surgical nurses are expected to identify decompasating patients. This is in the mists of giving lists of medications to each patient. By the time these nurses get to patient eight, it has been hours since they have seen patient one. Unrealistic expectation. I have worked in the ED and now in tical care. I have worked in education as a clinical instructor and have had clinicals on medical-surgical floors and in long-term care (LTC) facilities with student nurses.

    The ratio and acuity of patients makes it impossible to provide best care to patients in any setting. We do not always give medications on time or provide the holistic care that is essential to patient and family care. We miss things. Not because we are incompetent, but because we are over-worked and understaffed on our units.
    Today was a day I left work angry and appalled about what the nursing profession is reduced to in regard to skilled nurses and patient care. I worked a twelve-hour shift and spent another hour and a half giving report to the night shift nurse. This nurse was taking on a heavy load with three patients in the CCU that included what I did not finish during the day.

    Nursing is a nobel profession. I am not about to take these challenges passively. But, the only way to make change is collectively. We need to stick together, read the research on evidenced-based practice, share this knowledge and insist on change based on this research.

    My fellow nurses, I support you even if I don't know you. I know we have all had the feeling, "Why am I doing this? What did I get myself into?" Most of us know why we entered this profession. We always need to come back to that... even on the worst of days.
    FLhopeful86, PrismRN, Archerlpvn, and 30 others like this.
  2. 27 Comments so far...

  3. 2
    This is great! Thanks for sharing a realistic yet still hopeful slice of nursing reality.
    merrywhiterose and shybb like this.
  4. 13
    I agree.

    There are over 740,000 allnurses.com members.
    Nursing is the largest health care "profession" in the USA.
    Just think what we could do if we ALL stood together?!
    Amazing things.


    Yes, still an optimist.
    Archerlpvn, xoemmylouox, mclennan, and 10 others like this.
  5. 5
    I'm a realist...and that makes me an optimist.


    I maximize my practice; I am able to advocate how to MAXIMIZE in a given time period.

    I've been in the trenches for over 10 years, started as a CNA, to LPN, to RN.

    What we do is not for the weak or faint of heart; I enjoy what I do, and I have been able into it well without running away burnt out....

    WHY, one may ask? Or...HOW???

    I am real about our business...it's 24 hrs/7days/365...I MUST leave it because, at the end of the shift, I have done my best to maximize. I may stay over, but not often; I don't answer the phone, nor will I; my mistake and errors are not life threatening; I will fix them the next day or he next shift; whichever comes FIRST.

    I leave my business of the bedside at the bedside. I meditate, I breathe, I go home and live my life as LadyFree.

    One of the things I have is only expectations for ME, and NO ONE ELSE...it keeps me sane, and happy. I am ultimately responsible of ME as a nurse; not what is "expected" but what, why and HOW I DO.

    Optimists may wait for things to be better; realists ask "what can be done?" "what can I do NOW?"

    One foot in front of the other...

    Be the change you seek in the world and in his business; make sure understand what you can do in your time period; then understand your system, then get involved, contribute and provide CHANGES....this evolution of a nurse practice does NOT occur overnight; it takes time; try not to be hard on yourself; be REALISTIC...with a plan.

    Nursing has evolved...make sure your are looking at it realistically to help keep evolving our business.
    0.adamantite, herring_RN, Psychcns, and 2 others like this.
  6. 7
    thats why nursing in a hospital is such a conflict of the heart. we know what we should do, what we want to do, etc,but we CAN'T do because of improper staffing. No wonder people run away from this profession. Can you say liability??
    xoemmylouox, TriciaJ, spiderslap, and 4 others like this.
  7. 4
    Quote from jrwest
    thats why nursing in a hospital is such a conflict of the heart. we know what we should do, what we want to do, etc,but we CAN'T do because of improper staffing. No wonder people run away from this profession. Can you say liability??
    Improper staffing has been a thorn in nursing's side FOREVER, heck for many jobs....when one slacks off or is constantly calling out, or is late, that happens.

    Nurses run the show for our patients...the ONLY liability is the ones who's responsibility is to staff correctly and adequately...and may not be able to because of higher administration and executive issues...that is NOT the beside nurses fault. and that is one that I will utilize the "what can be done?" attitude during my time there...buddy up with a nurse, check in each other...all while recording trends of chronically unsafe staffing. The process which I describe is where there are several states where nurses are actively preparing and pushing for required ratios; I live in one of those states...however, knowing that change is like watching pain dry on the wall of China, I will utilize what I can do for the BEST with in the NOW, and I choose to be satisfied with what is available at the time, realistically and logically.

    (Many hospitals have been fined for unsafe staffing...just FYI...but it doesn't stop there...)


    That's what kept me and plenty of nurses sane for many years.
    Last edit by LadyFree28 on Sep 20, '13
    herring_RN, Psychcns, Wise Woman RN, and 1 other like this.
  8. 2
    Quote from LadyFree28
    I'm a realist...and that makes me an optimist.

    I maximize my practice; I am able to advocate how to MAXIMIZE in a given time period.

    I've been in the trenches for over 10 years, started as a CNA, to LPN, to RN.

    What we do is not for the weak or faint of heart; I enjoy what I do, and I have been able into it well without running away burnt out....

    WHY, one may ask? Or...HOW???

    I am real about our business...it's 24 hrs/7days/365...I MUST leave it because, at the end of the shift, I have done my best to maximize. I may stay over, but not often; I don't answer the phone, nor will I; my mistake and errors are not life threatening; I will fix them the next day or he next shift; whichever comes FIRST.

    I leave my business of the bedside at the bedside. I meditate, I breathe, I go home and live my life as LadyFree.

    One of the things I have is only expectations for ME, and NO ONE ELSE...it keeps me sane, and happy. I am ultimately responsible of ME as a nurse; not what is "expected" but what, why and HOW I DO.

    Optimists may wait for things to be better; realists ask "what can be done?" "what can I do NOW?"

    One foot in front of the other...

    Be the change you seek in the world and in his business; make sure understand what you can do in your time period; then understand your system, then get involved, contribute and provide CHANGES....this evolution of a nurse practice does NOT occur overnight; it takes time; try not to be hard on yourself; be REALISTIC...with a plan.

    Nursing has evolved...make sure your are looking at it realistically to help keep evolving our business.
    I feel that your right to a certain point. But I also believe that there should have a balance
    elprup and lindarn like this.
  9. 6
    I hear your call to unite and fight for nursing. In this respect, I find a pity that only about 5% of nurses are ANA members. After I passed the NCLEX, it was the first thing I did. And I consider my ANA membership my most important contribution to nursing. ANA is not a perfect entity, but it is our only credible national organization. If all 3.5 million nurses in this country were members, we would be unstoppable. With such a membership, ANA could lobby and push for federal legislation on staff ratios and better working conditions. No representative or senator would dare stand in the way of 3.5 million nurses. As it is now, we have no strong voice in Washington or at the state levels. The membership at the state nurses association is also pitiful. We have no one to blame but ourselves and out lack of unity for failing to advance our interests. There is strength in numbers!
    plumbtrician, lindarn, bsn2b09RN, and 3 others like this.
  10. 12
    The ANA wastes it time on BSN and DNP and not on improving or advocating for nurses at the bedside. Only in a few states does the state ANA such as NY, MN I believe actually get involved in negotiating better staffing and working conditions. I'm not going to waste my hard earned money for an organization that doesn't have my back. I want practical things like a patient ratio mandate like CA has a and a "no lift" work environment that has the necessary lifts including ceiling lifts to protect my back. This is so very important considering the growing obesity in America from 200 to 300 to even 400-500+ pound patients that we are expected to move and clean and care for. We are being put in impossible situations, and I will only support an organization that actually helps us in the trenches! Now give me the National Nurses United! That is a wonderful union that I would gladly pay my dues for. A real union that is proactive and actually helps the nurses improve working conditions, not the many weak unions that exist now!
    mclennan, TriciaJ, spiderslap, and 9 others like this.
  11. 7
    I would buy a ticket to attend a 1,000,000 nurse march!
    xoemmylouox, mclennan, TriciaJ, and 4 others like this.


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