Nightingale Nursing ... On its Deathbed

Sarina Day, ASN

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.

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Nightingale Nursing ... On its Deathbed

About Sarina Day, ASN

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