Abuse Culture in Nursing...How Far Does it Go?

[HoneyBeGood]

Time to open the can of worms...I am sure it has been opened several times...but maybe I am not seeing this topic addressed enough. Am I crazy or is the world of nursing crazy and I am just in the mix?

Why did no one tell me in nursing school? Why did I not listen to my mother who is a RN. But now my complaints are met with a common phrase "Welcome to nursing." W*T*H. This is it? The field of nursing nursing seems like a patchy grassland with some good here...nice and green...some barren dry areas...and many muddy waters (aka hospital nursing).

What are we going to do? Blame society, our polity, or the economy? Why am I so hallow on the floor?...when did I turn into a robot...who must finish her tasks and keep it moving. Little time for emotions or connections...even if a patient and family are tearful in the room because of a new life changing diagnosis. I see and hear their tears but my mind is focused on the meds I need to pass, my manager who is breathing down my neck, or whatever can of worms I must deal with in my other patient's rooms. The only reason I give a warm pat on the shoulder is because it seemed appropriate for the situation. The patient seemed to need it...and it works and the patient is reassured and more calm...but inside I feel nothing as I think of the other tasks at hand.

When I get home from work...I often reflect on my patients and how emotionally disconnected I was even when their lives were being turned upside down. I feel sympathy for them at home...disgust towards myself for my coldness on the floor...and loathing that I have to go back to that place. On the floor I have no time for sympathy. My goals are to keep my patients stable and safe and complete my tasks....so many tasks.

I knew nursing was going to be hard but I did not realize how much I would become cold. I give great customer service and give warm smiles to my patients and their families...but mostly inside I feel nothing for them. I just do my job and keep it moving. The fact I am this way brings self loathing. When did my smiles turn into a robotic tool to do my job rather than have genuine connection with an other being?

When the nursing school admissions council asked me 'why do you want to become a nurse?' My genuine answer was I want to help people and feel good about what I do. I do help people...but feeling good about helping my patients...that feeling has very much faded. I feel like a robot that must complete my tasks and keep it moving. I am even annoyed when they want to connect with me, in my mind "I have tasks to complete...I don't have time for this conversation, I don't want to get to know you better, I have tasks to complete.' And those are the nice ones. The unsavory patients, docs, and managers that leave a sour taste in my mouth, makes it all the more easier to be cold.

Weird...if I had known I would end up this way as a nurse inside...maybe I would have taken a different path.

The reason I say abuse culture...is because I have come to find in nursing that there is A LOT nurses will put up with at the expense of themselves. Stress, anxiety, depression, prescription medication, weight gain, insomnia, etc. Some realize it, some don't, and some just don't care. Any hospital nurse will lave a laundry list of the BS we have to put up with...but it is like there is a resolve that this is just nursing...it is what it is. Hospital nurses all know what's up.

This culture is so strong, that what is unreasonable in other professions...is not unreasonable in nursing. It is accepted. If a new nurse can't get with the program then she is told hospital nursing is not for you. Instead, maybe hospital nursing is not for nurses. How about that?

I hardly find people say this...nurses complain about how bad it is, how we are stretched so thin, how we don't get our breaks, how we never have a chance to eat or urinate, poor staffing, understaffing, the list goes on and on but people don't say...

Hey maybe it's not that this nurse is not fit to be a hospital nurse...forget about the 3-4 years she/he spent specifically training for nursing and proving herself/himself...but if she/he can't take crazy patient loads, poor staffing, etc...she is not a good fit? Why not the other way around?

I know it is not likely to change...these nursing conditions...but to accept it does not sit well with me. (by accept I mean: the vibe of hospital nursing is not for all nurses...no...it is...but not under the current conditions). I know there are unions and all that but very little is being done especially considering our numbers. Maybe it is not the new nurse who is struggling in the hospital...maybe it is the hospital that is dropping the ball. Maybe it is the culture of the hospital to abuse nurses and maybe it is nursing culture to accept it.

This abuse culture is so rampant you have nurses like me who are losing their souls at the expense of being good at my job. i can do my job and keep my patients safe but there is something so wrong. I am a med surg nurse. I am sure it may be waaaaaaaaaaaay better on other floors.

How far does it go that the abused don't even realize they are being abused? The ones who don't make it in the hospital are pushed to other fields of nursing. Fine...but I dare say it is not because the the nurse is not competent or can't manage patient care in the hospital conditions. Rather not every nurse can handle the hospital conditions that make it not condusive for success. Then people wonder 20% of nurses in their first year drop out of the profession completely. That is pretty high considering the time and money invested.

[LadyFree28, BSN, LPN, RN]

I think it's just nursing is full of a bunch of pansies expecting rainbows and unicorn farts.

Work is hard. If it wasn't, we wouldn't get paid.

If you go into a profession EXPECTING it to be tough, and it is, expectation met, no disappointment.

People go into nursing expecting it to be a never-ending wonderland of rewarding feelings from helping grateful people. Then it's tough, expectation not met, disappointment and complaints. It's not that nursing is a problem. (Don't get me wrong, we have problems. But not really more than other jobs of similar responsibility versus education levels.)

******It's the expectations people have going into nursing that are the problem.

Wooh I thoroughly enjoy your posts...this one I REALLY love

That's probably as far as hearts and unicorns, your gonna get out of me

But I digress...

I find what I think some people do is miss the mark of being informed at times, or they romanticize nursing like, say, Gone With the Wind, or any sappy movie of the decade, instead of knowing that

a) life is never about those riding in the sunset moments, most of the time;

b) life does not have a laugh track, cheers, or applause for you, and

c) that's not going to change just because you are a nurse...

Even though a laugh track, cheers or applause can e a comforting mental soundtrack as a nurse...

Nursing and managing patient care and our populations is about as loving as being underground like in the Planet of the Apes movies ...it's struggle, and just when you THINK you have won, THEN you find out the TRUTH....

You have to fight-er-CHOOSE a few more battles to win the war-even ones against your personal and better judgement-and you do that with critical thinking, nursing judgement and competency; and with one's own unique twist while doing it, and if you HAVE to, what my siggy line says-haven't steered me wrong YET!

[LadyFree28, BSN, LPN, RN]

Love your post OP, and you're absolutely right! Nurses do NOT try to change things, they all just have the mentality that it is what it is and that you're supposed to be miserable. Look at ANY other profession that requires a bachelor's degree and you will see a lot more professionalism and respect.[/quote']

I agree to disagree, I find that no profession has a corner on professionalism; the HUMAN condition is ride with people with all fiction and maladies; it's just were in the business of that-and we have a TON of gray in the approach of our clientele.

[HoneyBeGood]

I beg to differ wooh,

I think most all nurses new it was going to be hard…nursing school tends to whip you into to shape. The issue is

in the theoretical world of nursing school we are given ideals of how patient care should be. In the Hospital we are given policies that are theoretically based but the hospital has no intention of carrying it out. So nurses live in the real world of nursing where corners have to be cut to meet these ideals.

There is a strong disconnect with hospital management. What matters is the bottom dollar. I work in a Christian hospital and you best believe God is the last thing that matters to management. They paint that picture on their website about happy staff and appreciative patients and living in the faith…yeah right…but cash is king in the hospital. If you can't keep up…forget about God…you got to go. You can't stay here.

Pop a pill patient so you will stop wining in my hears. We don't have time or resources to manage your pain…so pop a pill and shut up…we will see you in 2 years when you are addicted to oxy…which eventually lead you to heroine…be admitted into our detox program…then in 3 days we will ship you out and likely see you again next year…because no one addressed your depression and anxiety issues while you were here…vicious cycle.

[LadyFree28, BSN, LPN, RN]

Pop a pill patient so you will stop wining in my hears. We don't have time or resources to manage your pain…so pop a pill and shut up…we will see you in 2 years when you are addicted to oxy…which eventually lead you to heroine…be admitted into our detox program…then in 3 days we will ship you out and likely see you again next year…because no one addressed your depression and anxiety issues while you were here…vicious cycle.

See....I don't see that as a vicious cycle and there are so many internal issues with this part of your post.

I'm a nurse who has learned the art of NOT chasing pain, knowing and learning WHAT not to do to have someone "chase" pain; there are many alternative medicines, as well alternative reasons as well.

Not everyone who get oxy is a drug addict or WILL be addicted.

Also utilizing resources is a prudent thing to do for your pt, case management, or if not, assess what the pt MAY need and investigate with a click of a button-the Internet. You also find what people need is an ear, schedule a time and give 5 minutes; if they need more, schedule another, if possible or for the next day, even if they move to another floor or another nurse-they may just ONLY need those five minutes. Keep in mind those mental health therapeutic techniques we learned in nursing school-they work WONDERS and made my first year as a fresh LPN; and they work throughout my career.

Get resources, practice practice hone and OWN your practice, because it DOES get better-and you NEED to if you have your sights on CC, where the pts (and sometimes the families) are sicker and SURLIER-just forewarning you.

[MatrixRn]

I blame a lack of effective nursing leadership. These people are responsible for creating and maintaining an environment that supports nursing practice. They are completely missing the mark. I wonder if they have any conscience twinges when they cash those executive bonuses??

I agree nursing leadership is the arena that needs dig in to help right this ship, but a few other items need to be considered.

One: Most nurse managers were once bedside nurses. And, at least initially, see the job from that vantage point. The two roles are vastly different in scope.

Two: Many are brought in with little management experience, except for being charge of the floor. In most cases that means a large learning curve.

Three: Once they are in the role the person may need to learn by the sink or swim method. This should not be a surprise to nurses, we do this for bedside work.

Given all of that, many nurse managers do well and thrive, but yes it can take some time for them to build the skill set needed. And no matter where they are in that learning curve they need the help of the floor staff. Things will not change unless items are brought forward....and then acted upon. Period.

My rule has always been, if you come with a complaint or problem, I want to hear a proposed solution. It may be the one acted upon but this kind of information helps the nurse manager get a feel for what the floor staff are thinking.

Yes, there will be those managers who do not thrive, it happens. These folks stand out as they manage floors that are chaotic at best. Frankly, if this was a long standing problem even after issue after issue was moved to her....I would look for another floor to work on.

[SubSippi]

Although I do agree that being a nurse is incredibly frustrating, and that making the transition from student to working RN can be disheartening, I don't agree with the idea of a nursing "abuse culture."

I think that a large part of the reason so many new grads feel they are being "bullied" is that this is their first experience in the real world, full of adults, and their first experience really being responsible for something other than themselves. What an experienced nurse views as pressure from management, a newbie might view as abuse, or bullying.

Yes, there are a million things that need to be changed, but I think that is more of a reflection on the state of our world, rather than the nursing profession.

What's funny to me is when all these VPs and managers and such are finding all kinds of ways to cut corners, but insist on special care for their family members when they're in the hospital. Nothing is ever going to get changed because the people in charge truly don't care...they can make people bend over backwards to give them what they want when they need it.

Anyway, I figure there's no point in being all sour about it all the time. If I have to be at work 3 or 4 nights a week, I'm going to be in a good mood. Having a bad attitude isn't going to do anything but ruin my day.

[MatrixRn]

There is a strong disconnect with hospital management. What matters is the bottom dollar. I work in a Christian hospital and you best believe God is the last thing that matters to management. They paint that picture on their website about happy staff and appreciative patients and living in the faith…yeah right…but cash is king in the hospital. If you can't keep up…forget about God…you got to go. You can't stay here.

Honeybegood,

I beg to differ. The upper leadership know exactly why they are in business....to Make Money. If the hospital does not make money they will have to close. This means they cannot continue to service the community or employ you.

I think nursing school did a great disservice to us. They said nursing was all about 'taking care' of patients in their hour of need, but they left off the part about a business -whether it is a non-profit or for-profit one- needs to make money or we have no job.

[futureeastcoastNP]

I have to say, Shilla brought up a very good point about nurse managers having no management experience, and that might be a huge issue. Nurse managers are battle hardened bedside nurses with years if experience - so that's the mentality they bring to being a manager. Leadership degrees require that people learn a lot about how to keep morale up, that complimenting when people do good is more effective than negative comments when people mess up for example. Nurse managers don't get that training, and it creates a dog eat dog culture on the floor as they approach their new role exactly as they approached their old one. The solution would be a requirement that all nurse managers take graduate leadership courses in order to take the role. I think it would REALLY help.

[SubSippi]

I have to say Shilla brought up a very good point about nurse managers having no management experience, and that might be a huge issue. Nurse managers are battle hardened bedside nurses with years if experience - so that's the mentality they bring to being a manager. Leadership degrees require that people learn a lot about how to keep morale up, that complimenting when people do good is more effective than negative comments when people mess up for example. Nurse managers don't get that training, and it creates a dog eat dog culture on the floor as they approach their new role exactly as they approached their old one. The solution would be a requirement that all nurse managers take graduate leadership courses in order to take the role. I think it would REALLY help.[/quote']

I have always thought it would be a good idea for there to be some kind of nurse executive master's degree. I think it would put more nurses in high up leadership positions.

And when I say always, I mean starting about six months ago.

[DosmoRN]

I agree with ladytfree. Her post is worth paying attention to, especially for young nurses who feel disillusioned, dissatisfied and guilty about not giving "emotional support" because the workload is impossibly heavy. It takes a while, sometimes quite a while to overcome this. Nursing educators place heavy emphasis on nurse-patient relationships. Most of us went into nursing because we wanted to "help" people. We assume that expressing empathy and concern is what "helps" people. But that is not our main function as nurses.

Anybody can give emotional support. But nurses have a combination of facts and skills that usually no one else, family or friends, can provide. The best gift we can give our patients is often OBJECTIVITY. Ladyfree was spot on when she says *being objective and being a detective when "managing" my patients, I listen objectively, I think objectively, I intervene objectively for that individual patient and family. That's the "nursing business" that I take care of;*

​Of course a little pat on the arm conveys warmth, that's good. But sometimes what a patient needs more is a sensible, dispassionate evaluation of their situation, someone who can see the big picture and then act on their behalf.

[LadyFree28, BSN, LPN, RN]

I think nursing school did a great disservice to us. They said nursing was all about 'taking care' of patients in their hour of need, but they left off the part about a business -whether it is a non-profit or for-profit one- needs to make money or we have no job.

I will say, I have reconciled this was a business a long time ago-since 2000, when I started as a unit secretary/tech in a ED in a community hospital.

There are nursing schools that do have a course on economic healthcare...THIS needs to be a rule, not the exception, though. It was refreshing to discuss hospital economics as a competent in nursing school, something that wasn't a part of my practical nursing education; by then though, I learned about economics and CMS when I became a chart reviewer as a contractor for a Medicare program.

These issues should be an important part of our education, but the information is our there too; forewarned is forearmed...

[HoneyBeGood]

New grads disillusioned..? Of course but the reality was not what they were selling when they were applying. They were sold on those billboards the old smiling lady who appreciatively looks into her nurse's eyes. The nurse is beautiful, clean cut (like a halo was about to shoot out of her butt) returns her smile with a bucket of sunshine. They gladly took our checks and free labor as we were given the idealist view of nursing.

If in nursing school were given a course on the reality of nursing, the business aspect…which basically is the main controlling factor, the legal risks, the industry of health care. I dare say we would not be having this conversation. Nursing we are taught about looking at the patient as a whole and that should guide our care. But in reality deadlines, tasks, and CYA is most important. The only reason patient outcomes is an issue to big investors is because it effects their profit in the long run…not necessarily helping the community.

Instead of nurses in the hospital…that are actually on the floor…working with patients to be able to focus on what's wrong with patient care, there is a tug and pull between nursing staff and management and management is winning. Nurses are taking whatever we can get. Wow we got 70 cent pay increase…but I still hate coming into work in the morning. Dangling carrots seem to be working for a lot. But not that 20%, lol. They dipped and never looked back. But the rest of us stayed.

Some posters have actually proved my point. Every one sees the BS and all they can say is well new grads are disillusioned. What is wrong with wanting to go to work and actually be able to do what you were paid and trained for….I am disillusioned. Thank God for pointing out that it was all an illusion, what we were sold. I think some people are delusional. It's like there is a wall…they just don't get what is so wrong about this situation.

A nurse going on the floor should ALWAYS be entitled to his/her breaks, safe working conditions, hospitals should ALWAYS have adequate staffing to meet the needs of the patients on the floor. If they don't, then they should hold off on admitting patients onto the floor without adequate staffing. Not enough staffing….how about they hire enough nurses…everyone knows new grads are a dime a dozen in this field.

When sh*t goes down the first person they want to treat like a criminal is the nurse. Forget all the sacrifices this nurse made on the floor for patients and management. CYA people. That is what it has come down to. Because at the end of the day no one has got out backs.

Oh what about about the cost of training a new nurse and turn over rates?…the time and money invested….the MONEY:devil: invested?!

How about management looks at the big picture…the long run. Invest now save later, save more lives, save more money, improve quality of care. Lower the nurse patient ratio depending on level of care. Lower health care costs. But hospitals are big business. How about more resource nurses on the floor? How about actually giving sh*t about nurses' concerns…instead of justing lying and saying you do.

It is not absurd for nurses to expect adequate staffing, safe working conditions, adequate resources. All nurses know this…but for reason people still want you to drink the cool aide. New grads have too much expectations?! W*T*F? If that is too much to ask…then let me stay forever in my ideals. Something is not right in the waters and everyone knows it. Even in the top notch hospitals.

As for bullying…nah I feel there are a lot of bizniches in management but not bullies. You have a lot of bizniches in every job. I just think that money is the bottom line and they will not hesitate to throw you away if you don't get with the program. If you are meeting the deadlines and don't complain hey love you. They don't care how you do it, just get it done…but don't whine about missing your breaks or being over loaded with patients. Bullying…No.