Nurses Living with the Guilt of Providing Mediocre Care

[Nurse Alexa, MSN, RN]

This is something that I feel like is important to talk about. It is difficult sometimes as a staff nurse to perform all tasks in the ways we wish too.

While tasks are performed in the best of our ability - we all get into nursing to make a difference.
 

With staffing shortages and increased demands on our jobs, I know many of us feel like there's only so much we can do during the day and families expect a lot from us, while we also expect a lot from ourselves. 
 

I think this does add to nursing burnout. I have grown to prioritize care and try to make time for those little personal touches that I got into nursing for. 
 

We all need to learn to give ourselves grace.

[RNperdiem, RN]

Too bad time is a zero-sum game. Sometimes there is just not enough time. When I think about how much time I spend charting, I wonder if I could take at least half that time back and put it towards patient care. 

Over almost 30 years in the business, charting to CYA and satisfy Joint Comission, has just become close to unmanagable. 

I left my first med-surg job because I was rarely able to give more than basic assessments, meds and some surface level care. Med-surg and LTC is designed with CNAs giving assistance with patient care. There are never enough good ones. If a CNA calls out or is pulled for sitter duty, the nurse has to manage somehow. 

[Tweety, BSN, RN]

I work with the idea that I'm going to give 100% effort to my job and do the best that I can do.  Different days that's different because sometimes I'm tired, distracted with personal problems, and just being a human.  But most of the time I'm on my A game.   I would only feel guilty if I were deliberately being lazy and slacking.  

Is my best good enough?  Sadly due to the demands mentioned above, no it's not. I sometimes feel regret that I had to make a patient wait to get discharged, that I'm behind passing a pain medication, that I noticed long after a lab draw that something needs addressed, etc..   I feel the patients deserve better.  I feel a lot of things.   Do I feel guilty?  Nope because I'm doing my best.

 

 

[JKL33]

Tweety said:

Do I feel guilty?  Nope because I'm doing my best.

Glad to hear that.

I would feel dissatisfied at the thing things you mention above, but I'm way over that dissatisfaction being about my performance...or anything "me" really, unless I reasonably and realistically could have done better.

[Tweety, BSN, RN]

JKL33 said:

Glad to hear that.

I would feel dissatisfied at the thing things you mention above, but I'm way over that dissatisfaction being about my performance...or anything "me" really, unless I reasonably and realistically could have done better.

"Dissatisfaction" is a good word.

 Last Wednesday I started with a 6:1 ratio.  Throughout the day I discharged 4 of them and got 2 post op admissions.  I had two cups of coffee on the run, worked from 7AM to 4:30 pm without a break, but I finally did take my 30 minute lunch and was starving, didn't drink any water throughout the day and stayed an hour late charting.  Did the patients get superior quality care?  Probably not but they got the best of me.  What do I have to feel guilty about?  My employer needs to feel guilty for putting me through this.

[No Stars In My Eyes]

Now that I am retired, I think back on all my places of work, and for the most part I was satisfied. But that was when nurses got to do the kind of nursing we would like to be able to do for our patients: Team Nursing, with good staffing and ratios. Those were the days.

But my last facility job, I should have walked out on early into the employment. I kept trying and kept trying to get everything done, but always had to stay several hours after shift end to finish charting. My last med pass was always a rush. I am ashamed to say there are times when I had to skip certain tasks to get the cart to the next shift in time. I still have never been able to figure out how the other nurses got EVERYTHING done in time, redundant charting and all, and sat around the nurse's station waiting to clock out. It just never seemed right to me; maybe they skipped some tasks too? Nobody would ever give me any 'help' or clues, except to say that I talked to the patients and should have just been pushing pills because that was my job. However there were multiple instances when I was torn away from one task to do something else "real quick"...but so many of those 'pull-aways' took more time than they should and the sheer number of those extra tasks kept piling up. It was not right at all; not fair to the patients, not fair to the nurses. 

I switched to private duty nursing for the last 5 or 6 years, because at least then I was able to do GOOD nursing care that satisfied my patient's needs and MINE!

[Tweety, BSN, RN]

No Stars In My Eyes said:

B I still have never been able to figure out how the other nurses got EVERYTHING done in time, redundant charting and all, and sat around the nurse's station waiting to clock out.

I have a coworker like that.  She's never clocked out late. Ever. I asked her about it and she just said "I'm very organized".   I wonder how that's possible to never get behind not even one day and wondered if it was me that was unorganized and slow.  The other day she confessed the manager called her because she didn't chart on two patients....at all.  She "forgot because she was too busy".  

The other day I had to address and re-collect a lab (nurses draw labs now) because I noticed a potassium that was low at 4pm the day before that wasn't followed up.  It was indeed still low.  The doc said "thanks, you always get shite done...".  So there is that.  LOL

[subee, MSN, CRNA]

Amy Wagoner said:

For as long as I can remember, I have always wanted to be a nurse.  Nursing is not for the faint of heart, and it is certainly not a glamorous job, but, for me, it is a very fulfilling career.  Nursing school was not easy.  It took an incredible amount of time and energy.  I survived nursing school while raising two small children and working a full-time job.  The hard work paid off, and I have a career I love that can lead me in many amazing directions.  Something very profound for me is that nursing isn't just a job; nursing is part of my identity.  When someone asks me what I do, I proudly respond:  I am a nurse.  I could simply say I work at a hospital or in healthcare, but that seems much less personal.

The majority of my career has been in Emergency Nursing, but I now serve in a position away from the bedside, where I continue work to optimize patient care.  Throughout my career, I have been witness to horrible injuries and situations, but I have also been blessed to witness a few miracles.  I have had very good days.  I have also had very bad days.  Every day I presented to work with the goal of providing safe and seamless care to every patient that I encountered.  I believe each patient (and their family) deserves adequate attention, which is determined by many factors.  The evolution of healthcare from a ministry to a business has made this increasingly difficult for nursing.  The expectation to carry an increased patient load has negatively affected the quality of care that can be provided.  When the ratio of nurses-to-patients increases, the allotted time and attention for each patient is typically reduced in order to accomplish all the required tasks in a shift.  When it becomes more important to complete tasks than to give quality care, it becomes a problem.

As demands increase, how do healthcare workers deal with the guilt of not giving their patients the attention they deserve?  At my graduation pinning ceremony, I took the Nightingale Pledge to "dedicate myself to devoted service for human welfare.”  As a new graduate nurse, I had zero insight into what that statement really meant, but I quickly learned the magnitude of being responsible for the needs of others, regardless of if they are sick or well.  As demands grew, I would leave my shift feeling defeated, knowing I wasn't able to provide the attention or quality of care that my patients deserved.  This guilt led to dissatisfaction, frustration, and, over time, caused me to seek a new role.  I needed the time to reassure the new mother who brought in a fussy baby that she is doing a good job.  I needed time to be present at the bedside with the family member who was grieving the loss of their loved one despite our best efforts.  I needed time to explain things to my anxious patient during an urgent situation.  I needed time to decompress between patients and the reassurance that I was doing good work.

Nurses bear the burden of making sure patients receive good care despite the circumstance.  When we are unable to meet those standards, how do we deal with the guilt?  When guilt tells us we aren't giving our best, how do we overcome the situation and protect our well-being?

With increasing healthcare demands and our recent pandemic, many nurses have begun to rethink their career choice.  I know many people have chosen to leave bedside care and pursue a different path.  How do you evaluate if you are ready for a change?  If we do not take care of ourselves, we can't take care of the patients adequately.  When the shift is long and guilt sets in, take a deep breath and assess your well-being.  You deserve that attention, and it will help you evaluate whether you can carry on or if it is time to take your nursing career in a new direction. 

We need to revolt against the paperwork...perhaps a cabinet position o the czar of redundancy.  Imagine if we could  cut our paperwork by75%, allow charting by exception, etc.  The physicians would be with us.  It has to happen.  

[uniteddemclub, BSN, RN]

I graduated during the pandemic and there was no ceremony. I didn't have to give any pledge. I sort of half-@as my way through nursing because I'm tired. Even if I'm a bad nurse, I dealt with bad nurses, bad cops, bad social workers, bad foster parents, bad teachers, and bad people in a list of other jobs. Every profession has their bad apples who show up for the paycheck and don't actually care about the people they're working for. At least I'm not stealing from my patients. There was a CNA at my job who took a patient's debit card and PIN to buy some groceries and actually went to an ATM and stole $1100 cash for herself. At least I didn't do that. I do good and bad things as a nurse and whether or not I'm a good nurse is just a matter of opinion. I had clinical instructors who hated me and others who liked me, or at least acted like they did. There's no rule book about what constitutes 'enough attention'. I get my work done and go home. That's all that matters. I refuse to set expectations for myself about how much time I give everyone. 

[No Stars In My Eyes]

Paperwork vs. Patient care. Maybe we could dictate as we work during patient care and there would be people who listen to our tapes ( like they do for doctors ), and type up the notes and info. VOILA!!

[subee, MSN, CRNA]

uniteddemclub said:

I graduated during the pandemic and there was no ceremony. I didn't have to give any pledge. I sort of half-@as my way through nursing because I'm tired. Even if I'm a bad nurse, I dealt with bad nurses, bad cops, bad social workers, bad foster parents, bad teachers, and bad people in a list of other jobs. Every profession has their bad apples who show up for the paycheck and don't actually care about the people they're working for. At least I'm not stealing from my patients. There was a CNA at my job who took a patient's debit card and PIN to buy some groceries and actually went to an ATM and stole $1100 cash for herself. At least I didn't do that. I do good and bad things as a nurse and whether or not I'm a good nurse is just a matter of opinion. I had clinical instructors who hated me and others who liked me, or at least acted like they did. There's no rule book about what constitutes 'enough attention'. I get my work done and go home. That's all that matters. I refuse to set expectations for myself about how much time I give everyone. 

I'm sorry for nurses that had to graduate during the pandemic.