Are we experiencing mass burnout in healthcare? - page 6

by SheaTab 10,281 Views | 70 Comments

This was written in response to a thread where a nurse experienced lateral violence at the hands of her preceptor. I thought it would be an appropriate discussion to start in this area. Thoughts? And so it goes in the world of... Read More


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    I think there are so many things wrong with nursing that I don't know where to start. I think unfortunately many people see nursing as a stable entity and enter the profession for the wrong reasons. It is not an easy career and one must absolutlely LOVE it for to be successful. Those that enter for the wrong reasons are the ones who are LAZY and yes, there are many of them. I bust my butt every shift, doing extra, taking care of the patients to the best of my abiility. I work overtime to finish everything and try not to leave things for the next shift to do. I also find lateral violence in my workplace. Its so tiring to have nurses attack each other. There seem to be those that are never happy, that are always attacking others and I for one am downright sick of it. I think we all work hard and need to bond as a group rather than to implode from within.
    I also agree the problem is bigger than nursing. I know the mandates come down from management, but I for one signed onto this career to take care of my patients, to be a patient advocate and nobody will take that from me. I am a nurse who cares for her patients and for her coworkers. I think there are more of us than not and we need to start becoming advocates for ourselves just as much as we are advocates for our patients.
    I also say, if you dont love the profession and you are not in it for ALL the RIGHT reasons then, step aside and let those of us who want to care for patients do just that.
    lindarn likes this.
  2. 0
    Quote from SheaTab
    Hi NurseMike,

    This is an insightful post. I am right there with you on health insurance reform. It isn't a republican, democrat, liberal, conservative, or socialist issue; in my estimation, it's a human rights issue.

    I agree also that according to their scope and practice, nurses of all educational preparation bring infinite value to the profession. I have wondered on occasion if "the powers that be" will further dilute the role of the RN by assigning what used to be RN roles out to LPNs and CNAs. I am hoping that this is not the wave of the future or else we all may be looking for jobs. In this respect, I do advocate for keeping RN roles, RN roles or else we may be challenged to justify our continued existence in certain practice areas. Take dialysis for example. There are many clinics that use dialysis techs for the most part and provide minimal nursing oversight. Dialysis is not a benign procedure and it certainly requires vigilance on the part of the nurse to interpret lab values and make nursing decisions based upon assessment of the patient. This is one small example of how RNs are being replaced by unlicensed assistive personnel. Don't be surprised to see licensing/certification programs crop up in the near future for all sorts of nursing related duties. Another example is the practice of CNAs delivering medications in some LTC environments. We have to protect the scope and practice of an RN because it is the right thing to do for the patient.

    Would you mind elaborating on the duties that were added to your load as a result of union intervention? I am interested in hearing more about your experiences.

    Profit or Not-for-Profit, the motivation appears to be the same and that is, PROFIT! The revenues are just distributed differently.

    Medical insurance providers are definitely earning a pretty penny and our patients are paying the price! The same is true of medical malpractice insurance companies. What a mess! They are price-gouging docs who have no choice but to participate in the monopolies. What about tort-reform? Mercy! While many lawsuits are frivolous, tort reform has resulted in the inability to receive any justice with regard to acts of harm committed against them. Take Texas for example. Doctors are flocking there in droves to set up shop as a result of the extensive tort reform in the state. It has become unprofitable for attorneys to take on most med malpractice cases and as such, the patients are left without a legal advocate when they are harmed.

    Thanks for your thoughts!

    Tabitha
    As far as scope of practice, two things have really surprised me since I've been a nurse. One, not a huge surprise, is how good many LPNs are. In school, we were taught the differences between professional nurses and practical nurses, and it all sounded very logical. I was not surprised that experienced LPNs knew more than I did as a brand new RN, but I soon noticed that many could teach things to experienced RNs. For example, our "wound care champion" is an LPN, and RNs go to her with questions about dressing changes. But, in retrospect, I shouldn't really be so shocked, nor should I attribute it to a more "boot camp" mentality in LPN school. Rather, with our work loads, the simple fact is that we're all doing practical nursing, with precious little time to do a lot of deep thinking.
    My other surprise, and it still amazes me, is that even very smart, very dedicated aides are often severely lacking in critical thinking. One example I've sited elsewhere is a patient with exaccerbated CHF and +3 edema in both legs, so we've got to get those legs elevated to get the swelling down. Well, that's a knowledge deficit, and when you explain why it isn't a good idea, most get it. But there have been other instances when I've had to butt heads a little bit over something that seemed to me like simple common sense, but maybe wasn't so simple before I went to nursing school. One example comes to mind was a walkie-talkie pt with serious psych issues whose family had complained because he hadn't had a bath in three days. I wasn't out of school, yet, but I was assigned as a sitter when an aide came in and laid down the law that he was getting a bath, or else. He did not get the bath, and I was still calming him down an hour after the aide had moved on. I don't guess that's a great example, because I wasn't yet a nurse, but I had covered therapeutic communication, so I was using nursing skills the aide evidently lacked and thinking about our priorities. There have been enough other examples that don't come to mind at the moment to persuade me that an aide is not a nurse, so I'm right with you on not delegating tasks that really need a nurse. And as much as I will always respect LPNs, as I get better at some of the practical tasks of bedside nursing, I do sometimes get to use some of that professional training. Just not always as much as I'd like to.

    My own unlicensed position was a notch down the pay scale from an aide. I usually say "orderly," but it was a bit more complicated. When I started, we did patient transports, but also passed meal trays and did the housekeeping in the patient rooms. Daily cleans--dusting, mopping, stocking supplies--and terminal cleans after the patient was discharged. It was hard work, but you spent a lot of time with patients, and that had a lot to do with my becoming a nurse. We were under nursing services and assigned to particular units, so you got to know the patients and the nurses pretty well. We were CPR certified, but I never had to use it. Still, sense I was in each room several times a shift, there were times when I did see something that needed a nurse's immediate attention and get help that avoided a more serious problem.

    Over time, some of these tasks got removed. The job got easier, but seemed less meaningful. Now it's strictly transport. Housekeepers clean the rooms--but now nurses or aides have to remove all the linens and hazardous wastes after a discharge, because, you know, we have so much extra time on our hands. Dietary workers pass trays, but they don't take time to open containers for patients who can't, so food sits until an aide or nurse notices it's there. Transporters pick people up and drop them off, but have no idea who's been puking his guts out all morning and needs a gentle ride. And it just doesn't look to me that a lot of them feel like they have anything to take pride in. However, the union was run by housekeepers who didn't like that we made a quarter an hour more than they did, and after ten years they managed to get that job classification changed. And, to me, that's one of the risks of any union, that decisions are made by union officers and any members militant enough to show up to all the meetings and scream about their personal peeves. As much as my fellow nurses hate coming in for mandatory, paid staff meeting, I just don't think many are going to make it to optional, unpaid union meetings.

    But we need to do something. I just wish my critical-thinking skills were up to figuring out what.

    ETA: I do notice that I can usually manage five patients better than six. I even have time to stop and chat with them a bit.
    Last edit by nursemike on Nov 26, '09
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    What I am really good at is assessing the patient, listening to them, interpreting the S&S they describe and putting it into "doctorese" so they can obtain apropriate treatment. I am also a good caregiver in that I can make someone feel better with a footbath while they talk, for instance: things that make up the magic of nursing, in short. I like to research their disease and find nursing interventions that address the discomfort they are having. This is good for chronic diseases as well as acute. Once I had care of a person who had Gastroparesis, among other things. This person started spewing Tube feed out of his mouth.The LVN who came on gave him an injection of Ondansetron. However I had managed the problem before by checking the residual (350ml!) and turning off the pump as necessary to tolerate the feed, assessing for constipation, etc, and recommending a lower rate, or just actually informing the DR of the findings. The LVN was "more efficient" according to the powers that be, and was a more desirable employee as the LVN finished the paperwork and task faster, problem solved. This is a terrible risk for aspiration, and misery. It kind of demonstrates the value of an RN. How many times have we seen a DR who says "Oh, you have nausea, take this..." when the problem is something like aversion to pureed chicken, as an example. This type of nursing takes time and thought but pushing meds seems to be the priority all too often. I don't know what this has to do with activism exactly but I think I am talking about the kind of slapdash nursing that is in vogue now in some places. I suspect Florence did a lot with just observation and caring. I wish we had the gift of time.
    SheaTab and herring_RN like this.
  4. 2
    Quote from Onekidneynurse
    Medicare rejects just about every bill that is submitted. We submitt scripts for meds every three months and Medicare rejects them in January, April, July, and Oct every time. Same med, same chronic illness, same patient.
    Kidney:

    Yikes, this just compounds an already overwhelming problem. This adds to the paperwork to the desks of Ambulatory Care nurses and causes the patient to have to wait, and wait, and wait! I know this to be true because I worked in Outpatient Cardiology. I can tell you that making a call to an insurance company about a prior authorization was my least favorite task. It was terribly unproductive and frustrating! I can recall times where I nearly cried! This is a great example of how paperwork imposed upon us unnecessarily by insurance companies keeps us from doing what we should, taking care of patients. Thanks for bringing this issue to light. Best! Tabitha
    GCTMT and herring_RN like this.
  5. 4
    Quote from SheaTab
    Hi NurseMike,

    This is an insightful post. I am right there with you on health insurance reform. It isn't a republican, democrat, liberal, conservative, or socialist issue; in my estimation, it's a human rights issue.

    I agree also that according to their scope and practice, nurses of all educational preparation bring infinite value to the profession. I have wondered on occasion if "the powers that be" will further dilute the role of the RN by assigning what used to be RN roles out to LPNs and CNAs. I am hoping that this is not the wave of the future or else we all may be looking for jobs. In this respect, I do advocate for keeping RN roles, RN roles or else we may be challenged to justify our continued existence in certain practice areas. Take dialysis for example. There are many clinics that use dialysis techs for the most part and provide minimal nursing oversight. Dialysis is not a benign procedure and it certainly requires vigilance on the part of the nurse to interpret lab values and make nursing decisions based upon assessment of the patient. This is one small example of how RNs are being replaced by unlicensed assistive personnel. Don't be surprised to see licensing/certification programs crop up in the near future for all sorts of nursing related duties. Another example is the practice of CNAs delivering medications in some LTC environments. We have to protect the scope and practice of an RN because it is the right thing to do for the patient.

    Would you mind elaborating on the duties that were added to your load as a result of union intervention? I am interested in hearing more about your experiences.

    Profit or Not-for-Profit, the motivation appears to be the same and that is, PROFIT! The revenues are just distributed differently.

    Medical insurance providers are definitely earning a pretty penny and our patients are paying the price! The same is true of medical malpractice insurance companies. What a mess! They are price-gouging docs who have no choice but to participate in the monopolies. What about tort-reform? Mercy! While many lawsuits are frivolous, tort reform has resulted in the inability to receive any justice with regard to acts of harm committed against them. Take Texas for example. Doctors are flocking there in droves to set up shop as a result of the extensive tort reform in the state. It has become unprofitable for attorneys to take on most med malpractice cases and as such, the patients are left without a legal advocate when they are harmed.

    Thanks for your thoughts!

    Tabitha
    I expressed these very same sentiments several years ago on this listserve. Hospitals and health care providers replacing RNs with yet another "flavor", of unlicensed, assistive, personnel, with the goals being, to run an health care organization with as few, or no, RNs. And this was before "medication aides" became all the rage in nursing homes and assisted living facillities.

    All of this de-skilling came about with the assistance (blessing) of our State Boards of Nursing, and State Nursing Associations. They are selling out the nursing profession, and ultimately, our patients. You don't see the State Board of Education advocating for the replacement of teachers with unlicensed teaching assistants, or HS dropouts hired off of the street. Why is that? Because teachers are unified nationally, and carry carry alot of clout and power.We can learn alot from them. I could be mistken,but no one ever died because they could not do long division, or diagram a sentence, but almot 100, 000 people die of medical errors every year.

    And make no mistake, our low level of education are contributing to our demise.We are only one educational level away from the unlicensed assistive personnel who are replacing us in the workplace. All other health care professions have increased their entry into practice, but nursing ads scream about on line nursing degrees at the drop of a hat. No one is replacing teachers, pharmacists, PTs OTs etc ,with HS dropouts. Folks, this does affect our credibility in the workplace.

    All of you nurses who refuse to unionize or support a National Nurses Organization, are also selling out your patients. You cannot advocate for yourself with the same power and effect that a national, powerful organization can. You are kidding your self if you think that you can.

    While you sit and fiddle while Rome burns, hospitals and nursing homes have been busy stealing away our professional practice. There will be a point of no return, when they can say, "we have been able to function just dandy without RNs, or LPNs, why continue to support a groups that we have proven that we can do without?" And at the rate we are going, we are a generation away from that day. Think outside the box. JMHO and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    Last edit by lindarn on Nov 27, '09
    CaLLaCoDe, GCTMT, SheaTab, and 1 other like this.
  6. 2
    Hi Lindarn:

    What a powerful and thought-provoking message you bring to the table. I am most invigorated by your idea that we "think outside the box." You are spot-on with this sentiment. If we keep doing the same old thing we've done, we will keep on getting the same old thing we've gotten (paraphrasing Einstein here). It is going to be difficult to effect monumental global changes within the nursing profession without a national voice who is willing to make decisions that might be unpopular with the administrative masterminds. I am reluctant to say with definitive conviction that the ANA is not the national voice we need; however, these isn't a whole lot of evidence to support their ability or willingness to effect the changes that are so desperately needed in healthcare. We can post position statements all day on staffing acuity models, safe ratios, and quality nursing care, but until we collectively demand legislation that would guarantee the above, nothing will change and our patients will continue to suffer needlessly. I'd be interested in anyone who can provide evidence contrary to what is most assuredly my humble yet researched opinion. I would like nothing more than to have my faith restored that the MY major professional advocate is working hard to enact legislation that would allow me to safely perform the job that I love so much. Why is it that this one healthcare political hot-button is so dangerous for the ANA to actively pursue? Clearly, nurse-to-patient ratios is one of the most important issues on the table in our present practice environment.

    Thanks for your insight, Lindarn. What's happening in Washington with regard to nursing advocacy? What are your ratios like there?

    Best!

    Tabitha
    herring_RN and lindarn like this.
  7. 2
    Quote from goodneighbor
    What I am really good at is assessing the patient, listening to them, interpreting the S&S they describe and putting it into "doctorese" so they can obtain apropriate treatment. I am also a good caregiver in that I can make someone feel better with a footbath while they talk, for instance: things that make up the magic of nursing, in short. I like to research their disease and find nursing interventions that address the discomfort they are having. This is good for chronic diseases as well as acute. Once I had care of a person who had Gastroparesis, among other things. This person started spewing Tube feed out of his mouth.The LVN who came on gave him an injection of Ondansetron. However I had managed the problem before by checking the residual (350ml!) and turning off the pump as necessary to tolerate the feed, assessing for constipation, etc, and recommending a lower rate, or just actually informing the DR of the findings. The LVN was "more efficient" according to the powers that be, and was a more desirable employee as the LVN finished the paperwork and task faster, problem solved. This is a terrible risk for aspiration, and misery. It kind of demonstrates the value of an RN. How many times have we seen a DR who says "Oh, you have nausea, take this..." when the problem is something like aversion to pureed chicken, as an example. This type of nursing takes time and thought but pushing meds seems to be the priority all too often. I don't know what this has to do with activism exactly but I think I am talking about the kind of slapdash nursing that is in vogue now in some places. I suspect Florence did a lot with just observation and caring. I wish we had the gift of time.
    I love this! You have hit the nail on the head! We must use our ears to listen to our patients and their bowel, lung, and heart sounds, our eyes to inspect, our hands to palpate, our arms to hug, and our hearts to care about doing the right thing each and every time for our patients. There is no way to measure or quantify many of the interventions we perform as nurses and commonsense will tell you that rushing through nursing care will result in increased errors. Come'on!

    Nobody has ever measured, not even poets, how much the heart can hold.
    — Zelda Fitzgerald
    herring_RN and lindarn like this.
  8. 2
    NurseMike:

    I really enjoyed your posting, especially the part about how we as RNs seem to do a lot more Practical Nursing than that which makes our profession unique. What is it that makes our profession unique anymore? I'd like to hear more of your thoughts around this since I think you made an excellent point that there doesn't seem to be enough time in a given shift to do much in the way of critical thinking. Have you noticed RNs doing less assessing than what we were taught was necessary in school? I know that the nursing process is hammered into our heads in school, but I think the principles are still quite valid and result in quality patient care when utilized appropriately.

    Thanks again,

    Tabitha
    herring_RN and lindarn like this.
  9. 3
    Ok, Miss Tabitha, you appear to be the new Sister Simone Roach! And the internet is the new "book" that you should write. Ok so we all agree that something is wrong, and like politicians we can go on stating the problems that we find and we all will nod our head and say..YES! But let's do this...we must come up with a catchy phrase that will get people's attention and that will epitomize our ideals. Then we will have to find ONE THING to will ask for and then go on to find other things little by little. Brainstorm, guys...any ideas for a good movement slogan? Can we get together on this? Ideas anyone?
    herring_RN, lindarn, and SheaTab like this.
  10. 0
    Quote from nursemike
    Wow. That's a side of Medicare abuse you don't hear much about.
    How is it Medicare abuse?


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