Having moral courage- my soap box speech

[anon456, BSN, RN]

Fellow nurses, I was very moved by the "Hospitals Firing Seasoned Nurses" thread. It was timely for me. I have been struggling with my own moral issue and wanted to share that process with you.

Unlike the author of the thread cited above, I have not been fired (yet) and I'm not being aged out. Some of the issues in it didn't apply to me, but what struck a chord was how many facilities talk out of both sides of their mouths: they value their nurses, but too bad, they will have to be short-staffed, carry heavy loads, and/or be blamed when they drop all the balls they are trying to juggle. We try so hard at this job because we care about our patients, and our love for them causes us to put up with a lot that other professions would not put up with.

The thread was timely because I have had to show moral courage at work very recently, and it's been difficult. Each time I do it it becomes easier. Even if the consequence may eventually be that I resign or lose my job.

It's hard to fight the system to the same degree as some of you since I am not in a union state. I work at a pretty good place that seems better than a lot of places that others here described and I love my job for the most part. I love caring for my patients and they are why I keep coming back. Mostly I work with very good people who are under a great deal of stress due to the nature of the job, but also because things are not run exactly smoothly all the time.

I can't go into a lot of details about my situation but let's just say I had to draw a line and stand firm a few times. This was very difficult for me to to. I have been brought up very traditionally to respect my elders and not question authority. Even when I see the authority is wrong or mistaken, I was brought up to hold it in, keep my head low, and stay quiet.

We often forget, in the cogs of the big machine, that we as nurses have legal autonomy to make judgements about our patients and advocate for their behalf. It's our duty even when we might get fired for it or have to walk away and not support unsafe or wrong practices.

I know that we need our jobs to pay the bills. We worked hard to get where we are. New grads are often hired into facilities that already have a culture of things that may not be ideal, and they normalize that culture because they don't know any better. They may feel a bothersome twinge in their hearts at first but dismiss it because they don't have the experience to be sure of their feelings. Especially if it's their first job, they don't want to give it up and I don't blame them.

What are experienced nurses teaching the new grads in regards to moral courage? Are we experiencing a kind of compassion fatigue where we are numb to the things we feel powerless to change, so we just shake our heads and try not to think about it too much? Are we endorsing the status quo by continuing to do it?

I can't fix the system, especially in a non-union state. What I can do is speak up so that my co-workers hear me, and it validates what they also know to be true. It changes the culture and plants seeds.

After much thought on my situation I decided I would follow proper channels to implement change within my facility. If I am faced with a direct situation I will calmly dig my heels in and advocate for the patient, even if those above me are pressuring me to do otherwise. I have done this already a few times and not only did I not get fired, I was patted on the back by my co-workers, and supported by my manager. It may get old after awhile but right now I'm still employed.

I plan to try to approach people in higher positions in my facility in the coming weeks, as is appropriate, and at least let my voice be known in a constructive way. If even half my co-workers did the same, people might start to listen. Especially if they back up those words with actions: reminding people of their autonomy as Registered Nurses.

If I have to leave I will, but I would rather stay and change the culture one person at a time. I have a back-up employment plan in place if it comes to that. It was a scary think to contemplate these past few days and weeks as I turned it over and over in my head and heart. Once I made that decision, however, I felt a release of tension, a release of my fear, and a sense of peace wash over me. I can go to sleep in peace, and wake up in the morning, and walk with my head held high with a clear conscience in my heart.

Yes, I have a family to feed and bills to pay like many of you. I also have higher obligations than to my place of employment. First to my God and my own peace of mind. Second, to be an example for my children to always do the right thing, even if it takes courage and is hard to do. And finally, I have an obligation to the title of R.N. and all that it means.

It starts with each one of us.

[jadelpn, LPN, EMT-B]

Best wishes to you in your process.

Remember, the higher ups get paid handsomely to use any means necessary to make money. It is a nurse's legal and ethical obligation to do what is right for patients. So if the means necessary can be blamed on the nurse, so be it.

It is a dysfunctional, soul sucking situation. But please remember, you are NOT crazy, you are not just "being paranoid" you are not a poor practicing nurse. You are, however, a financial obligation that can be replaced regardless of your practice.

Let us know how it goes.

[anon456, BSN, RN]

Best wishes to you in your process.

Remember, the higher ups get paid handsomely to use any means necessary to make money. It is a nurse's legal and ethical obligation to do what is right for patients. So if the means necessary can be blamed on the nurse, so be it.

It is a dysfunctional, soul sucking situation. But please remember, you are NOT crazy, you are not just "being paranoid" you are not a poor practicing nurse. You are, however, a financial obligation that can be replaced regardless of your practice.

Let us know how it goes.

I am all too aware of that. :-( And prepared that if that's the case, so be it. I don't always have to work hospital nursing and I have worked other nursing in the past that's more patient-centered. I'll let you know if things go down.

[roser13, ASN, RN]

Kudos to you. You are in the trenches, trying to make a difference. I so admire that. I am of an age where I "need" my position & benefits in order to retire on time.

I like to think that in my younger years (and before my husband's disability declared itself), I too would be taking a stand.

[inshallamiami]

my heart goes out to you.

[nursel56]

Thanks for this post. What I see in it is something that formal education can't teach you, and it's a wisdom that comes with experience. I think that gets lost in the shuffle sometimes. It's not all about the mechanics, it's a sense of knowing when to go to the mat and when to let it go. That is leadership to me.

[LadyFree28, BSN, LPN, RN]

Well said.

Once one has exercised moral courage, the empowerment that flows through is unbelievable; you don't fear losing a job, because then you realize that your practice transcends the place of employment; it only solidifies one's nursing practice.

I learned very early in my healthcare career and my nursing career to speak up and question; I've been in this business for almost 15 years and it hasn't left me to speak up; I've honed how to question, but the advocacy is MUCH stronger.

Welcome to the fold!

[vintagemother, BSN, CNA, LVN, RN]

Beautifully said, anon. Thank you for putting into words what I feel in my heart.

[middleagednurse]

Good for you. I hope you have considered the consequences. I often feel that nursing is akin to the factories that young women worked in at the turn of the century. One wrong move and they were out of a job. Not much has changed. One of my biggest challenges as a nurse has been learning to keep my mouth shut, but someone needs to lead the revolution.

[missfreda]

Wonderful words to live by. I believe in standing up for yourself and speaking out. The position I take is "if i cant stand up for myself, how can i stand up for my patients?" We are suppose to be advocates and sometimes others in higher positions will try to shut you down. Don't let em run you off. Most often I find that most are simply incompetent in the position they hold and is fearful that someone who knows more, (especially the law) can be a threat to them. Don't compromise your morals/values, treat ppl like you would like to be treated. Show compassion to others in all that you do. Because what happens to others, could happen to you.

[kbrn2002, ADN, RN]

Great post and good for you for taking a stand! There are a lot of reasons why others may not be willing, or able to join you in the good fight. Some of it may be a type of compassion fatigue, years of doing the right thing and fighting for the right things to be done wears thin when there is never any positive outcome. Management agreeing with suggestions from staff and actually implementing those changes are two very different things.

I suspect more of the reason for not joining the fight though is fear with a healthy dose of realism. Like it or not, in most places the economy still stinks and good jobs are hard to come by. Moving is not an easy option for most people, especially if there is a family involved .

My personal circumstances; If I lose my job over a hopeless battle I probably wouldn't be able to just walk into a new one right away. The job market, my age and level of experience are all factors that realistically limit my options somewhat. Moving is not a good option as my husband and I both have parents that are aging and we are the only adult children in the area. Besides my house is finally paid off, so who wants start over somewhere new at this point in life.