Diary of a Nurse Who is Not 'Exceptional'

Description/personal accounts of the trend in health care to place less emphasis on meaningful care.

Diary of a Nurse Who is Not 'Exceptional'

It is clear that the Nursing profession has evolved in so many ways.  Our evolution into well-educated, clinical care providers has absolutely had positive impacts on the quality of care provided to our patients.  This evolution has taken nurses into advanced clinical practice, administration, education, and informatics. But have institutions become more focused on the committees, projects,  posters, research, surveys, and accreditations, that are intended to improve the quality of care, than ACTUALLY providing that care? 

In a perfect world, the time and effort put forth in these essential collaborations would result in the changes needed to improve direct patient care, the circumstances and environments in which this care is given. Unfortunately, in reality, the bedside nurse rarely sees the changes that improve workflow, that provide the tools needed to complete the work most efficiently and safely, or the support of peripheral systems that are essential pieces to the care puzzle.  This has been my personal experience after 25 years of nursing.

I love the idea that our profession is elevated, but I question if we have overlooked our primary role and purpose … direct care.   As a result, and in order to feel empowered to achieve my professional satisfaction, I have chosen to practice in a way where my focus is on providing the best quality direct care, demonstrating leadership for a milieu team by modeling best practices, advocacy, and going above and beyond for my patients, often their families, and my co-workers.  These often physically and emotionally exhausting efforts are clearly not valued as much as accreditations, project participation, and professional organization affiliation, so it begs the question:

Does taking and passing a test to measure knowledge translate into that knowledge being used to benefit patients in practice?

Again, in ideal practice that could be the case.  Or, an accredited nurse may sit in the nursing station delegating tasks, making few caring connections with the patients, not ensuring that patient care needs are met. 

Have we lost sight of the contributions that a seasoned nurse brings to any milieu? One who after a quarter of a century of work still holds dear ethical and professional principles, an old idealist, who executes their job in a fashion consistent with these principles and expects the same of those around them.  An advocate, challenging and questioning systems, providers, and practices at times, motivated by the needs of patients and the betterment of the milieu, often ... no almost always ... at the expense of being perceived as difficult(at the very least).  And certainly, this is not viewed as exceptional. 

Magnet designation is sought after as a moniker for excellence in nursing care.  A great amount of the focus is on the same ideology regarding the advancement and elevation of nurses.  But does it take into consideration the way an organization treats or values its nurses? Is there a respect for work-life balance? When asked to call or come in for committee meetings on off days or do work for those committees on your own time, I am inclined to answer … NO.  When asked to write Magnet stories, I have always written about the extraordinary efforts made by staff members which positively impact patients. This does not often represent the organization’s support, rather the choice of an individual employee to go above and beyond. Not exceptional. 

In the pursuit of a Magnet designation an institution should ideally have: 

  • A higher percentage of satisfied Registered Nurses 
  • Lower RN turnover and vacancies
  • Greater nurse autonomy
  • Improved patient satisfaction

In participating in the initial Magnet designation process I saw the push for RNs, for example, to become ANCC accredited in our specialty, with a pay increase as an incentive to do so.  But it took 22 months; almost 2 years of requests to get only 5 rolling bedside tables for our patients (18-22 patients on the unit) after the changes in social distancing and COVID precautions prevented our patients from sitting in close proximity in a dining room at tables.  I watched as they ate with trays barely balanced and often spilling on their laps, some hunched over an end table, others seated on the floor eating with their meal tray on their bed. Our patients are mostly homeless, living each day often without the basic dignity of sitting at a table while they eat (if they eat); a simple dignity that most so clearly take for granted. Basic dignities and consideration of the population we treat can’t be overlooked while the focus on designations and accreditations is greater.

Shouldn’t the latter be seen just as, if not more, valuable than the ANCC accreditation?

This is patient care. This, too, has value, giving our patients an environment that offers them comfort dignity and respect. But this priority is not deemed exceptional.

I was assaulted this year. My nose was broken and I incurred permanent nerve damage in my lip as a result of the strength of force in the punch to my face. Three other staff members were assaulted as well. During this event, once reoriented, while bleeding profusely, I coordinated the emergency and directed all the staff in securing the patient in restraints and medicating him. I returned to work on my next scheduled day of work, 43 hours later.  The professional work ethic and dedication to the safe control of the situation, putting my well-being needs last, during (and after) this psychiatric emergency, is also seemingly of lesser value, nor is it seen as exceptional. 

Each year for more years than I can count, I have purchased gifts for our patients for the holidays. Again the population I work with often has little to nothing. I spend my personal time purchasing practical useful items, as well as some candy and seasonal treats, gift bagging them for each patient, and making sure that on the holiday they are gifted these items. Most don’t have visits or families who are involved let alone receive a gift. The holidays are often the most stressful times for our patients. Small but meaningful gestures make an impact on the inpatient experience. But this, too, is not exceptional. 

FACT: Should I require care in my future, as I most certainly will, I hope that the nurses caring for me are not 'exceptional' by the standards health care organizations seem to set.

Rather, I hope they are skilled and knowledgeable, with a strength of professional character, an outstanding work ethic, and a dedication to compassion, empathy, and kindness in their clinical practice.

They will be exceptional to me.

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PsychRN4e

About PsychRN4e

Psychiatric RN- Associates Degree in Nursing. Bachelors of Arts Degree in Psychology. Employed by one of the top 8 ranked hospital networks in the nation and a Magnet designated facility for 25 years.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
12 hours ago, PsychRN4e said:

The professional work ethic and dedication to the safe control of the situation, putting my well-being needs last, during (and after) this psychiatric emergency, is also seemingly of lesser value, nor is it seen as exceptional. 

Maybe not viewed as exceptional by those in leadership at your particular place of employment, but exceptional in my view. Then again, I'm another nurse who did not exceed expectations, so it might not count for much. 

Your patients are better off because you're there for them. As you point out, the value of excellent patient care is often overlooked these days, except by the patients that are counting on you. Thank you for all that you do!

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Specializes in school nurse.

I think that perhaps you have bought too much into Magnet propaganda.

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Specializes in Psych, Addictions, SOL (Student of Life).
On 2/16/2022 at 7:34 AM, PsychRN4e said:
 but I question if we have overlooked our primary role and purpose … direct care.   As a result, and in order to feel empowered to achieve my professional satisfaction, I have chosen to practice in a way where my focus is on providing the best quality direct care, demonstrating leadership for a milieu team by modeling best practices, advocacy, and going above and beyond for my patients, often their families, and my co-workers.  These often physically and emotionally exhausting efforts are clearly not valued as much as accreditations, project participation, and professional organization affiliation, so it begs the question:

Have we lost sight of the contributions that a seasoned nurse brings to any milieu?

In the pursuit of a Magnet designation an institution should ideally have: 

  • A higher percentage of satisfied Registered Nurses 
  • Lower RN turnover and vacancies
  • Greater nurse autonomy
  • Improved patient satisfaction

Shouldn’t the latter be seen just as, if not more, valuable than the ANCC accreditation?

This is patient care. This, too, has value, giving our patients an environment that offers them comfort dignity and respect. But this priority is not deemed exceptional.

I was assaulted this year. My nose was broken and I incurred permanent nerve damage in my lip as a result of the strength of force in the punch to my face. Three other staff members were assaulted as well. During this event, once reoriented, while bleeding profusely, I coordinated the emergency and directed all the staff in securing the patient in restraints and medicating him. I returned to work on my next scheduled day of work, 43 hours later.  The professional work ethic and dedication to the safe control of the situation, putting my well-being needs last, during (and after) this psychiatric emergency, is also seemingly of lesser value, nor is it seen as exceptional. 

Everything you describe here makes you an exceptional nurse so don't cut yourself short!?

 

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

I agree direct patient care is very often ignored as a priority value in nursing today.  Not every nurse will want to give gifts, but considering the population you work with, it is very commendable.  It can't be easy to work with people of extremely limited resources every day and not be able to give them everything they obviously need.

On 2/16/2022 at 4:34 AM, PsychRN4e said:

once reoriented, while bleeding profusely, I coordinated the emergency and directed all the staff in securing the patient in restraints and medicating him. I returned to work on my next scheduled day of work, 43 hours later.  The professional work ethic and dedication to the safe control of the situation, putting my well-being needs last, during (and after) this psychiatric emergency, is also seemingly of lesser value, nor is it seen as exceptional. 

That's pretty exceptional!  You should probably receive some sort of award for that!

Thanks for your article, PsychRN4e.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I worked for a place that pushed ANCC certification. Unlike your place, we received nothing for the certification. It just gave the hospital something to brag about, at our expense (literally). I didn't renew it after the initial certification period.

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Very beautifully written!

"In a perfect world, the time and effort put forth in these essential collaborations would result in the changes needed to improve direct patient care, the circumstances and environments in which this care is given. Unfortunately, in reality, the bedside nurse rarely sees the changes that improve workflow, that provide the tools needed to complete the work most efficiently and safely, or the support of peripheral systems that are essential pieces to the care puzzle." 

Well said.

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Specializes in Geriatrics, Dialysis.

I can't agree more. Excellence on paper does not always translate to excellence of care. The push for more accreditations, more committees, more  focus groups, etc.  either takes time away from providing the care we are there to provide or adds more  personal time devoted to work related activities away from work and therefor likely unpaid. 

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Specializes in Psychiatric.

This resonated with me. I also work with many homeless patients on a psychiatric crisis unit. Many of my co-workers and myself have donated clothing and purchased articles such as reading glasses and an occasional pair of shoes to wear when patients are discharged back to a shelter. So many stories...last week I brought in two new pairs of socks and gave them to a patient...he keeps them in his pocket as revered property and won't wear them because they're "new."  We have had many staff injuries also, even with security on our floor 24/7.  I am still passionate about my work, even though there is occasional derision from other nursing areas regarding psychiatric nursing. What we do for our patients comes from compassion, not from initials after our signature.  Meanwhile, our hospital is working on Magnet status. And yes, there is a goal to have a percentage of nurses get their BSN degrees and specialty certifications. I am the only RN with a certification in psychiatric mental health nursing, so I was delegated to be the Magnet Champion for our department. We have seasoned nurses with 20-30 years of psychiatric nursing experience. What motivation do I give them to spend their time off studying to get further education and certification?  Though there is tuition reimbursement for college credits, there is no extra pay for BSN nurses or for obtaining certification.  Our organization has spent thousands of dollars for a consultant to guide us through the Magnet recognition process to make sure we pass.  It is astounding to me that this is where time, energy, and money is focused, in an era where there is a nursing shortage. But then, I became a nurse to care for patients, not to run a business. And sadly, that is what healthcare has become...businesses that are run by MBAs...a far cry from Florence Nightingale's vision.

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