Nightingale Nursing ... On its Deathbed

Nursing practice used to follow the Florence Nightingale theory of compassion and empathy. The COVID Pandemic has been a detrimental and damaging change in how nurses care for their patients. As new nurses approach nursing care with wide eyes and bushy tails....will they be the fresh change we need to revive the Nightingale approach of compassion and empathy to nursing care?

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Nightingale Nursing ... On its Deathbed

Nursing practice has turned into a checklist of menial tasks. Is the model of compassion and empathy dying?

Compassion. Human touch. Healing. Genuine rapport. These were the principles that I wore on my sleeve just a few years ago before the COVID pandemic. I admittedly do not have the most ... ethical moral compass, generally speaking. But if there's one thing I can boast it's my genuine approach to holistic healing. I've been a registered nurse for just shy of ten years, working as a bedside nurse in a hospital setting. It took quite a few years for me to expertly learn and embrace the holistic approach to caring for my patients, wholly.

I'll get right to the point. The pandemic has changed healthcare in the most harmful way. The purpose of this opinion editorial is to openly dissect the abusive working conditions that nurses have since endured and, thus, the poor-quality care that patients are now generally receiving in the hospital setting.

When the pandemic hit the country in March 2020, I was working in an ICU in Richmond, Virginia. I remember the first COVID positive patient that I cared for, "Patient X,” on March 30, 2020. As I was receiving the handoff report in the morning, my hands were shaking as I donned my PPE (personal protective equipment). An N95 mask (which I would then reuse for five days in a row before receiving a refurbished mask), a flimsy plastic face shield, and paper-thin plasticky gown. "Be careful about donning and doffing your PPE today. There are 'secret shoppers' in the Emergency Room watching nurses don and doff, and they're threatening termination if they misstep the process,” warns the nightshift nurse giving me report. I respond with an agitated chuckle. So much for being a hero. The morning proves busy. Patient X becomes increasingly short of breath, and his respiratory distress worsens. We increase the support on his continuous BiPap machine. The intensivist provider and I look at each other. We both know it's time for invasive life support intervention. I carefully don my PPE and enter the room. With a shaky breath, I tell Patient X that he can no longer sustain his own breathing and it's time we place him on life support by means of the ventilator. Patient X looks more relieved than frightened, he's tired of fighting. I ask if I can call his wife and allow him to talk to her before we intubate him; he nods his head. I dial his wife in the room and explain the situation to her before handing the phone to Patient X. I feel intrusive listening to what I know may be the last conversation between Patient X and his wife. Little did I know, this was only the first of hundreds of intimate and tearful I love you's and goodbyes that I would uncomfortably and intrusively bear witness to over the next two years.

As I prepare the patient and equipment for intubation, I learn that Anesthesia will be intubating the patient in place of the intensivist, as is the typical standard. The Anesthesiologist arrives and dons what is practically a full space suit, secured and insulated from head to toe. I feel exposed and foolish standing next to him in my plastic Fisher-Price PPE. We intubate the patient without incident. He dies two weeks later on the ventilator, a full code with chest compressions and defibrillation shocks.

The meat of my story lies in the politics of how nursing crumbled at and beyond the height of COVID in April 2020. Hospitals were nervous about the prospect of losing money. They cut ancillary staff, physical therapy, occupational therapy, part-time nurses, and patient care techs. The extra responsibility had nowhere to land but on the shoulders of the bedside nurses. The bedside nursing shortage became critical, and as a result of the unsafe working conditions, the country saw a mass exodus of nurses leaving the bedside to pursue lucrative travel nursing.

Administration bullied nurses into clocking out "on time" despite having a staggering, unmanageable assignment. At the time, I was a contract nurse (therefore, not employed by said hospital), so I told Administration they could *** off (in so many words) if they expected me to work for free and without the malpractice that covers me while I'm on the clock. Nurses were placed on a "disciplinary action plan" should they clock out late by fifteen minutes or beyond. Termination was threatened should it occur a second time.

I've since left that hospital corporation and now work for a different company. I work as a float nurse, working among several different hospitals in a variety of units based on a daily need. No longer do I approach my patient assignment with the optimism of holistic healing, though I wish I could. I don't take the extra five minutes to hold my patient's hand as they are tearful about the uncertainty of their medical condition. I can't sit with a therapeutic ear and listen to the stories that my patients wish to share with me. How can I? I'm now responsible for answering call bells, obtaining blood draws, getting vital signs, and assisting in activities of daily living. Hospital policies and protocols become more demanding in terms of timeliness and extent of patient charting. When once the patient ratio for the stepdown units was one nurse to three or four patients, I now care for six patients who all deserve to be holistically cared for. But all I can deliver is ticking off the boxes for my daily checklist – vital signs, check; medication pass, check; updated whiteboard, check; help them to the bathroom when I have time – check; make sure they're still alive, check?

I intend to leave bedside nursing within the next few years, and I plan to leave the field of nursing entirely within the next ten years. Florence Nightingale's theory emphasizes that "the nurse must use her brain, heart, and hands to create healing environments to care for the patient's body, mind, and spirit.” Perhaps we will see the day that nurses can practice Nightingale's theory instead of ticking the tasky items off the never-ending to-do list. I would like to be clear that the purpose of this editorial is not to dissuade anyone from joining the nursing field. Frankly, the optimism and eagerness of the nurses fresh out of nursing school whom I meet within the hospital setting allow me to feel cautiously optimistic about the future of nursing. Perhaps, as I hang up my nursing shoes in the next few years and pass the baton to the fresh-faced, eager new nurses, the field of nursing will turn around, and the principles of Florence Nightingale will re-emerge and again become commonplace within the practice of nursing. In the meantime ... Nightingale nursing lies frail on its deathbed.

*Regarding the attached photo: This is me on March 30, 2020, after placing Patient X on invasive life support. He is pictured behind me on the ventilator – no patient identifiers are pictured.

Sarina_COVID.jpg.ecb56d08dddef63bab755f8ef6202c17.jpg

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Sarina Day

About Sarina Day, ASN

My name is Sarina and I have been a nurse for nearly ten years. The COVID pandemic has destroyed the Florence Nightingale founding philosophy and ethics in healthcare, specifically nursing. I’m currently in school to obtain my Bachelor’s in Nursing and I’m working on a project to “tell the world” about my story and experience as a nurse. The following essay is my truth.

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Specializes in Clinical Research, Outpt Women's Health.

Hate seeing good nurses leave the bedside. Can't blame you though.

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Specializes in Tele, ICU, Staff Development.

Thank you for sharing. I am moved by your story.

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Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

It is a hard thing, but where we are. Kudos to you for looking out for yourself. 

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Specializes in Private Duty Pediatrics.

I worked in a hospital for 1 1/2 years - back in the 70s. I switched to private duty home care and have been very happy. I don't make as much, but I don't care. All our bills are paid, we own our house, and we have adequate savings. 

I do provide Nightengale nursing.  Can you switch to part time hospital and part time private duty? Or part time something else and part time private duty?

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Specializes in Critical Care; Float Pool.
On 10/19/2022 at 7:38 AM, Sarina Day said:

I currently work part-time in a hospital bedside setting. I'm working on my BSN right now - I will graduate in May. I plan to leave bedside in the next year or two, but frankly I make too much money to leave my current position. It's worth the grievances...for now.

 

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Specializes in Physical Medicine & Rehabilitation.

You're story definitely resonates within me as well as former colleagues of mine. I provided Nightingale nursing even after COVID slowed down significantly this past year not because I had the time or because I/we had gotten used to COVID patients, but because it's a part of my lifestyle and how I treat people in general. I finally decided to leave bedside (and very quickly) once I passed my AANP this past August and I hope I will continue to bring my Nightingale nursing to the future palliative and hospice patients I will be seeing very soon as an NP. Thanks for sharing and hope all ends well with you.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I retired five years ago and never stop feeling grateful that I was gone before covid.  Your story makes my heart hurt.  It's not supposed to be this way.  You have not lost your compassion; they burned it out of you.  Six patients on stepdown?  How far are hospitals willing to push this envelope?

Making people reuse PPE and threatening termination if not donned just right?  Who are these "secret shoppers" and why aren't they busier looking after sick people?

Something's got to give at some point.  Meanwhile, I applaud your willingness to speak out and your efforts to save yourself.  Wishing you the best.

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Imagine a nurse being told by the Nurse Director that "You spend too much time with the patients."

!!!!

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Specializes in Nurse Educator.

I see this struggle in so many nurses when I bring my students to their clinical rotation. When I meet with each of my students for their mid and final evaluations, I spend time talking with all of them about the importance of showing compassion and empathy towards their patients and taking the time to listen to the patients story and get to know e while they are completing their tasks with their patients. Nursing is SO much more than the skills you learn in school. These patients are trusting their lives in our hands. The least we can do is show them we truly do care about them as a person. 

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

No compassion for the caregiver.

 

That's what has happened to nursing.

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18 hours ago, Rmooney said:

I see this struggle in so many nurses when I bring my students to their clinical rotation. When I meet with each of my students for their mid and final evaluations, I spend time talking with all of them about the importance of showing compassion and empathy towards their patients and taking the time to listen to the patients story and get to know e while they are completing their tasks with their patients. Nursing is SO much more than the skills you learn in school. These patients are trusting their lives in our hands. The least we can do is show them we truly do care about them as a person. 

It's sad, but necessary, in my view, that the above is said.  That it even has to be said is such a statement about the situation today.

Some people say:  "There's no problem with going into nursing for the money as long as you can do your job well."  This is correct, logically speaking, from the nurses' point of view, but the problem arises that when nurses don't actually care about their patients or their families or are unable to show empathy and kindness towards them in the course of providing care, patients and their families suffer.  

While Covid has brought about a lot of stressors for nurses and other health care members, I see these problems of indifference and uncaring attitudes towards patients and family members as being related to more than just the difficulties brought about by Covid.  Over twenty five years ago, when there was a largely older nursing workforce than today, I didn't see these problems to such a degree, and nurses then routinely had 12 patients or more on med-surg units.  The nurses I remember back then were professional, kind, and had enough life experience and maturity to extend kindness and patience towards patients and family members.

Today, young people are attracted into the profession with sentiments of taking charge of their careers and empowering themselves, not having the opportunity to extend compassion and kindness towards patients/family members while providing them with excellent nursing care.  The nursing profession is glamorized in the media.  I don't believe this is in the interests of patients/family members.  Nurses are extolled as "heroes" for doing their job.  

In some media for professional nursing, nurses are seen doing what to me appears to be dancing/miming.  I find this incongruous with the seriousness of a nurse's duties.

Florence Nightingale's primary concern was the wellbeing of her patients.  She understood the value of using statistics. She was a serious practitioner and a teacher.  Florence Nightingale promoted her work and the wellbeing of her patients, not herself.

Today, there seems to be more focus on self-promotion and career advancement than on caring for patients and their family members with empathy and kindness.  In contrast, my State Board of Nursing speaks of the nurse's duties to  patients and their family members.  It doesn't talk about nurse empowerment or nurse dissatisfaction in providing care to patients/family members.    

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