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Ripe for Exploitation

Nurses Article   (1,198 Views 18 Comments 1,423 Words)
by RobbiRN RobbiRN, RN (Member) Innovator

RobbiRN is a RN and works as a ER RN.

16 Articles; 9,929 Visitors; 170 Posts

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Nursing consistently tops the polls as the most trusted profession. In a cruel twist of irony, some of the same qualities that consistently win us first place on the most trusted chart also make us ripe for exploitation: We’re eighty-five percent female, programmed to please, and unlikely to fight back.

Ripe for Exploitation

The Most Trusted Profession

Nursing ranks as the most trusted profession in Gallup’s annual poll for the seventeenth year in a row with a score of 84. Doctors and pharmacists come in a distant second and third with scores of 67 and 66, and the list fades from there. Politicians are tied with car salesmen, continuing their grip on last place with a score of 8.

The honor of being part of the most trusted profession should not be taken lightly. Patients are keenly aware that we spend the most time with them, our motives are not tainted by financial gain, we usually care, and we’re positioned to share an honest, enlightened opinion. In theory, nurses are really cool people–great for relationships, good with confidences, least likely to inflict unnecessary pain, and excellent for decorating hospital marketing brochures with bright scrubs and big smiles. (And we usually pose for free, you know, because they asked.) We may be all these things. In a cruel twist of irony, some of the same qualities that consistently win us first place on the most trusted chart also make us ripe for exploitation: We’re eighty-five percent female, programmed to please, and unlikely to fight back.

Risk for Exploitation - Why??

85% Female Profession

First, just being an eighty-five percent female profession still makes us vulnerable to inequality. "On the Basis of Sex," a recent movie about Supreme Court Justice Ruth Bader Ginsburg, stages a brilliant moment. Felicity Jones, who plays Ginsburg, is arguing a sexual discrimination case before an all-male panel of judges. One of them looks down on her and declares in a voice laced with condescension, “The word 'woman' does not appear even once in the U.S. Constitution." She stares him down and quips, “Neither does the word ‘freedom,’ your honor.” It’s a moving moment of assertive confrontation on her pathway to becoming the first female Supreme Court Justice. It’s a reminder of how far we’ve come.

Women have made major strides. We just finished Women’s History Month. We even have a Women’s Equality Day. There’s a myriad of opportunities open to us, but we still glaringly lag male counterparts in easily measured areas like equal pay for equal work and representation in government office. A friend of mine in Spokane, WA, works at a major hospital where the nurses are threatening to strike. One item of contention is the $41 million in salary paid to the fourteen executives at the top while the workers are facing eroding benefits. A breakdown of the executives’ salaries posted on social media shows an equal number of men and women, but the women make half of what the men get. Statistics vary, but females employed in the U.S. make about twenty percent less than males. The discrepancy is still about five percent for doing the same work. The number of females elected to government office continues to increase, but women still only hold about one in five elected positions. If money and power are any indication, an essentially female profession is still inherently vulnerable.

A Desire to Fix Things

Second, our innate desire to rescue, fix things, and make people happy increases our risk of exploitation. There’s a profoundly odd inverse relationship between love (caring) and power in human relationships. As power increases, love decreases, or, as love increases, power decreases. Most of us learned this lesson the hard way during our early teen years when we first fell in love. After a few weeks or months of infatuated bliss, we were slammed with the devastating realization that the other person no longer cared. We may have found ourselves desperate to save the relationship, willing to do anything to try to please the one who had stopped caring, making us vulnerable to manipulation and various forms of abuse. The one who cares the least obviously has the most power.

Nurses are correctly described as caregivers. We don’t need a lot of concocted programs or checklists to push us to improve patient satisfaction. We’re usually programmed to please. It’s in our genes. Most often, it’s why we signed up. So, what happens when we’re short-staffed, equipment isn’t working, supplies are missing, and patients become demanding or even belligerent? Our first response is to skip breaks, work with full bladders, walk faster, and try harder, often postponing or neglecting our own needs to make sure others–patients, visitors, and our bosses–have what they need or even what they just want. Many of us work while sick or injured ourselves, giving for the sake of others. As sensitive people who care, we’re inherently vulnerable to “takers” who don’t care beyond their commitment to their own welfare.

Nurses - Not Fighters

Finally, nurses are generally not fighters. While this is an obvious corollary to our basic instinct to fix things, there are other constraints firmly entrenched. New nurses are increasingly entering the profession deeply in debt. The push for increasingly higher levels of education has a hidden benefit for employers–a submissive workforce. Student loan debt averaged about $33,000 in 2018. More than ever before, new RNs just need the job. A young, smart coworker was venting to me in the breakroom a few weeks ago about a new policy removing our ability to override several frequently used medications. Her observations were valid, and her rationale had merit. When I suggested that she send an email to management, she quickly backed down. “Are you kidding me? I can’t afford to rock the boat. I’m a single mom with $48,000 in student loans. My kids come first. I’m bought and paid for.” A lot of great ideas never get past venting in the breakroom.

The ultimate restraints are the legitimate needs of the patients entrusted to our care. Even when the workload is grossly unrealistic because we had a couple of call-offs, we still imagine that the people in those rooms are like our own family. Some of them really need us, and we don’t want to fail the ones who do. In the ER, we have no control over how fast patients pour in. As EMS stretchers line up in the hallway and patients back up in the lobby, we’re forced into working dangerously–again, and we shift into a nearly frantic survival mode of putting out fires. We just try harder, work faster, and, yes, cut corners (putting ourselves at risk) when survival depends on it. At times our productivity is super-humanly-amazing, off the charts–and simultaneously enabling.

Those who profit from the accepted inequities in our system bank heavily on our dedication to our patients. If bus drivers, teachers, IT specialists, or professional athletes strike, it’s an irritation or an inconvenience. If we strike, even if enough temporary replacements are pulled in, patients could die. If enough of us went on strike at once, a lot of people would die. There are some significant pockets of resistance, and a few major battles have been won, but generally, our profession of non-fighters has demonstrated remarkable restraint. Those in power expect that we’ll continue the established path of pacifism.

Bargaining Power

Paradoxically, the greatest constriction of standing up for ourselves, the welfare of our patients, is also our best bargaining chip when we do take on the powers propagating the exploitative system. I sometimes think of our current nursing profession like a wife in an abusive relationship, fearing for our own safety and that of our children, those entrusted to our care. The battered wife knows there may be casualties if she resists, but at some point, she chooses to take the risk. As a profession, we cannot condone harm to innocent, needy people. At some point, honor demands we take a stand.

The core problems plaguing our profession run much deeper than staffing levels. This year, there are massive rumblings about fixing our national disgrace. The U.S. remains the only industrialized country on the planet that does not provide some form of universal access to healthcare. We are the only system enabling rampant profiteering at the cost of human lives, pretending that healthcare is a commodity like a new car or pearl necklace. Storm clouds are gathering, and two serious questions for the rest of our Nation are looming large on the horizon.

Who causes the greatest harm to our patients? And who will step up to rescue them?

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I'm an ER RN, traveler, dancer, and published author as Robbi Hartford.

16 Articles; 9,929 Visitors; 170 Posts

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I was speaking to a co-worker about all of things we are responsible for and how we are expected to just take it. She said to me, well such and such can man all of the units in this building on her own with next to nothing. I thought to myself, it isn't someting to brag about, working short staff, and running more units then you can safely keep control over. Once something goes wrong, guess what, you will face the music about how you dropped the ball that day. Management won't care about how you were able to "magically" pull it off, all of those other days. I get it though, we need a job to pay our bills and we need to put food on the table but at the same time, it is crazy how nurses deal with as much as they do to do it. I guess when one's voice has been silenced so long, all a person  can do is talk about how Sally the nurse is super woman  and how you should join her.

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TriciaJ has 37 years experience as a RN and works as a Retired.

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2 hours ago, Workitinurfava said:

 I guess when one's voice has been silenced so long, all a person  can do is talk about how Sally the nurse is super woman  and how you should join her.

This is why I never voiced admiration for those who went "above and beyond" by skipping breaks, working off the clock, etc.  They actually help erode working conditions for all of us.

At rare times I faced a big enough emergency at work that I did go above and beyond.  At those times, I made it abundantly clear that my heroic efforts would by no means become the norm and I expected recognition and accolades galore.  Of course there was no recognition or accolades, but it got the message across that crisis management would not become business as usual.

Throughout my career I advocated for staffing, breaks, etc and particularly collective bargaining.  Unions aren't the be-all, end-all, but a collectively-bargained contract is legally binding.  It provides rules for management.  Without such a contract, management can unilaterally provide rules for employees and employees have no voice.

 

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RobbiRN is a RN and works as a ER RN.

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1 hour ago, TriciaJ said:

This is why I never voiced admiration for those who went "above and beyond" by skipping breaks, working off the clock, etc.  They actually help erode working conditions for all of us.

I believe it was one of your comments in another thread that inspired the line about how super human productivity which is off the charts is simultaneously enabling. Your point is well taken. My generalized, impressionistic portrayal of nursing is intended to help sharpen the focus on the challenges we face and rally our collective resolve to demand a better system at every level. 

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Truth66 has 15 years experience.

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I've said for years that Nursing is one of the most abused, exploited and discriminated against than any other profession that is out there.  This is precisely why we are doing everything that we can to discourage our two young daughters from going into Nursing.

The thought of them being treated like we and our fellow co-workers are treated, frightens and disgusts us to no end. 

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SherPCCN has 30+ years experience.

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We have a history of priority setting to make it through some pretty scary scenarios! We sacrifice ourselves and any task or nicety to meet the essential and life and death needs of those in our care. We endure the wrath and disapproval of the others in our care when we have to focus on a crisis elsewhere.

For too long, it has been ok to let units run short staffed or with unmanageable acuity, simply because we do it.  We've grown used to thinking it won't change and to thinking we can't appear incapable. A potentially life threatening error woke administrators up a few years ago  to realizing we were dangerously staffed and we amazingly got an extra nurse in response.  

It's not just newer nurses that don't want to rock the boat.  Seasoned nurses are aware the hospital would love to replace them with new grads for less pay.

Great article!

 

 

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3.24.95 has 23 years experience as a LPN and works as a Nurse.

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I worked nights at a prison hospital's palliative care unit. Shift ended at 6:30 so I never saw the providers.

late Apr, 2018: I filled out a "note to Dr form" about a stage 1 on Mr Jone's sacrum. 

I changed the font to bold on the report sheet.

I filled out a "note to Dr form" about the stage one, that was now a 2.

I offered to assist CNAs in repositioning him. They refused.

I did it myself, even after we rotated carts.

I "voiced grave concern" to my supervisor, she suggested bringing it to day supervisor's attention. I did and she agreed...it was very concerning and something needed to be done. FINALLY!!

3 days off...stage 3! And day shift sup agreed with Dr..."it wasn't as bad as I was making it out to be" :(

After confronting a CNA in a slightly more aggressive (venomous) & louder (or as loud as you can be through clenched teeth) manner, than my usual, I was unofficially booted to another unit and the CNAs were "spoken to."

I filled in for a call-out on that unit, and called the ER -- despite the fact that "it's just something we don't do" -- begging for any provider to assess Mr Jones. They did, and they agreed. He said he'd do his best to catch Mr Jones Dr.

mid-July 2018: Mr Jones died from a toxic cesspool of MRSA, where his sacrum used to be.

It was the first time my persistence and tenacity failed me, and the most disheartening day of my nursing career. All I remember about the 45 minute drive home was the nearly unbearable & depressing, feeling of defeat.

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RobbiRN is a RN and works as a ER RN.

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2 hours ago, SherPCCN said:

It's not just newer nurses that don't want to rock the boat.  Seasoned nurses are aware the hospital would love to replace them with new grads for less pay

You're right. One of the pitfalls of sweeping generalizations, and there are several in my article, is that some fine points get missed. I've assertively voiced my opinion for years and had a few minor victories along the way, but I've never been so keenly aware of how convenient it would be for new management to trade me out for  a cheaper, more compliant replacement.

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5 hours ago, SherPCCN said:

We have a history of priority setting to make it through some pretty scary scenarios! We sacrifice ourselves and any task or nicety to meet the essential and life and death needs of those in our care. We endure the wrath and disapproval of the others in our care when we have to focus on a crisis elsewhere.

For too long, it has been ok to let units run short staffed or with unmanageable acuity, simply because we do it.  We've grown used to thinking it won't change and to thinking we can't appear incapable. A potentially life threatening error woke administrators up a few years ago  to realizing we were dangerously staffed and we amazingly got an extra nurse in response.  

It's not just newer nurses that don't want to rock the boat.  Seasoned nurses are aware the hospital would love to replace them with new grads for less pay.

Great article!

 

 

I worked on a very small pediatric floor, 7 beds but we expanded up to 12 if needed (I think that was the highest when I was there).   Before I got there a baby was given an overdose of adenosine while they were trying to get her out of SVT.  Luckily the baby did fine but evidently it was quite the Charlie Foxtrot.  Up until then they would staff with 1 RN and one tech, some of whom were great and at least one who was lazy and irresponsible.  After this sentinel event they decided there would be 2 licenses on the floor at all times but it still took about 6 months to fully implement.  Nurses told me of shifts with up to 5 or 6 admissions with as many discharges as well as outpatient blood draws (bill checks, which also includes weight and VS).  The point being, it didn't matter how bad it was until a baby came this close to dying, just like SherPPCN stated.  

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SherPCCN has 30+ years experience.

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Our sentinel event was when a heart flight transporter helped a patient to the bathroom when nurses were too busy to come.  They accidentally opened a lidocaine drip wide open, which caused the patient to seizure and code, but he eventually recovered. 

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On 4/12/2019 at 1:54 PM, RobbiRN said:
Ripe for Exploitation

The Most Trusted Profession

Nursing ranks as the most trusted profession in Gallup’s annual poll for the seventeenth year in a row with a score of 84. Doctors and pharmacists come in a distant second and third with scores of 67 and 66, and the list fades from there. Politicians are tied with car salesmen, continuing their grip on last place with a score of 8.

The honor of being part of the most trusted profession should not be taken lightly. Patients are keenly aware that we spend the most time with them, our motives are not tainted by financial gain, we usually care, and we’re positioned to share an honest, enlightened opinion. In theory, nurses are really cool people–great for relationships, good with confidences, least likely to inflict unnecessary pain, and excellent for decorating hospital marketing brochures with bright scrubs and big smiles. (And we usually pose for free, you know, because they asked.) We may be all these things. In a cruel twist of irony, some of the same qualities that consistently win us first place on the most trusted chart also make us ripe for exploitation: We’re eighty-five percent female, programmed to please, and unlikely to fight back.

Risk for Exploitation - Why??

85% Female Profession

First, just being an eighty-five percent female profession still makes us vulnerable to inequality. "On the Basis of Sex," a recent movie about Supreme Court Justice Ruth Bader Ginsburg, stages a brilliant moment. Felicity Jones, who plays Ginsburg, is arguing a sexual discrimination case before an all-male panel of judges. One of them looks down on her and declares in a voice laced with condescension, “The word 'woman' does not appear even once in the U.S. Constitution." She stares him down and quips, “Neither does the word ‘freedom,’ your honor.” It’s a moving moment of assertive confrontation on her pathway to becoming the first female Supreme Court Justice. It’s a reminder of how far we’ve come.

Women have made major strides. We just finished Women’s History Month. We even have a Women’s Equality Day. There’s a myriad of opportunities open to us, but we still glaringly lag male counterparts in easily measured areas like equal pay for equal work and representation in government office. A friend of mine in Spokane, WA, works at a major hospital where the nurses are threatening to strike. One item of contention is the $41 million in salary paid to the fourteen executives at the top while the workers are facing eroding benefits. A breakdown of the executives’ salaries posted on social media shows an equal number of men and women, but the women make half of what the men get. Statistics vary, but females employed in the U.S. make about twenty percent less than males. The discrepancy is still about five percent for doing the same work. The number of females elected to government office continues to increase, but women still only hold about one in five elected positions. If money and power are any indication, an essentially female profession is still inherently vulnerable.

A Desire to Fix Things

Second, our innate desire to rescue, fix things, and make people happy increases our risk of exploitation. There’s a profoundly odd inverse relationship between love (caring) and power in human relationships. As power increases, love decreases, or, as love increases, power decreases. Most of us learned this lesson the hard way during our early teen years when we first fell in love. After a few weeks or months of infatuated bliss, we were slammed with the devastating realization that the other person no longer cared. We may have found ourselves desperate to save the relationship, willing to do anything to try to please the one who had stopped caring, making us vulnerable to manipulation and various forms of abuse. The one who cares the least obviously has the most power.

Nurses are correctly described as caregivers. We don’t need a lot of concocted programs or checklists to push us to improve patient satisfaction. We’re usually programmed to please. It’s in our genes. Most often, it’s why we signed up. So, what happens when we’re short-staffed, equipment isn’t working, supplies are missing, and patients become demanding or even belligerent? Our first response is to skip breaks, work with full bladders, walk faster, and try harder, often postponing or neglecting our own needs to make sure others–patients, visitors, and our bosses–have what they need or even what they just want. Many of us work while sick or injured ourselves, giving for the sake of others. As sensitive people who care, we’re inherently vulnerable to “takers” who don’t care beyond their commitment to their own welfare.

Nurses - Not Fighters

Finally, nurses are generally not fighters. While this is an obvious corollary to our basic instinct to fix things, there are other constraints firmly entrenched. New nurses are increasingly entering the profession deeply in debt. The push for increasingly higher levels of education has a hidden benefit for employers–a submissive workforce. Student loan debt averaged about $33,000 in 2018. More than ever before, new RNs just need the job. A young, smart coworker was venting to me in the breakroom a few weeks ago about a new policy removing our ability to override several frequently used medications. Her observations were valid, and her rationale had merit. When I suggested that she send an email to management, she quickly backed down. “Are you kidding me? I can’t afford to rock the boat. I’m a single mom with $48,000 in student loans. My kids come first. I’m bought and paid for.” A lot of great ideas never get past venting in the breakroom.

The ultimate restraints are the legitimate needs of the patients entrusted to our care. Even when the workload is grossly unrealistic because we had a couple of call-offs, we still imagine that the people in those rooms are like our own family. Some of them really need us, and we don’t want to fail the ones who do. In the ER, we have no control over how fast patients pour in. As EMS stretchers line up in the hallway and patients back up in the lobby, we’re forced into working dangerously–again, and we shift into a nearly frantic survival mode of putting out fires. We just try harder, work faster, and, yes, cut corners (putting ourselves at risk) when survival depends on it. At times our productivity is super-humanly-amazing, off the charts–and simultaneously enabling.

Those who profit from the accepted inequities in our system bank heavily on our dedication to our patients. If bus drivers, teachers, IT specialists, or professional athletes strike, it’s an irritation or an inconvenience. If we strike, even if enough temporary replacements are pulled in, patients could die. If enough of us went on strike at once, a lot of people would die. There are some significant pockets of resistance, and a few major battles have been won, but generally, our profession of non-fighters has demonstrated remarkable restraint. Those in power expect that we’ll continue the established path of pacifism.

Bargaining Power

Paradoxically, the greatest constriction of standing up for ourselves, the welfare of our patients, is also our best bargaining chip when we do take on the powers propagating the exploitative system. I sometimes think of our current nursing profession like a wife in an abusive relationship, fearing for our own safety and that of our children, those entrusted to our care. The battered wife knows there may be casualties if she resists, but at some point, she chooses to take the risk. As a profession, we cannot condone harm to innocent, needy people. At some point, honor demands we take a stand.

The core problems plaguing our profession run much deeper than staffing levels. This year, there are massive rumblings about fixing our national disgrace. The U.S. remains the only industrialized country on the planet that does not provide some form of universal access to healthcare. We are the only system enabling rampant profiteering at the cost of human lives, pretending that healthcare is a commodity like a new car or pearl necklace. Storm clouds are gathering, and two serious questions for the rest of our Nation are looming large on the horizon.

Who causes the greatest harm to our patients? And who will step up to rescue them?

Thank you for such a well written and well thought out article.  These are all things that know but in our frustration, often find it hard to put into words without using....venom.  Lol, well I can say that for myself only.

These problems were a big reason that I finally accepted management positions...I thought I could help my fellow nurses as I never had a nurse manager seem to 'help' us.  And often I did, but in the doing so, burnt myself up to a 'crackly crisp'! 

I am a fighter.  Or was.  But fighting alone wore me down.  I used to think that ANA or INA would be our 'group voice' helping us to make the changes in healthcare that most of us agree needs to be done.  But I see that I was wrong.  Seems they are bought and paid for as well.  What they agree to and vote on are more often than not, contrary to what I believe.  Contrary to what I saw as a nurse everyday. 

Now, well I work for myself.  I advocate for my patients whether it is popular or not.  And it isn't always welcome, but I continue to give the best care that I can and push others for the same.  As for working in a hospital or other healthcare setting again?  I just don't know that I can...especially with my big mouth lol.  

We had a HHN come to see a patient yesterday (I only see 2 x'x a month) and is frustrated and worried if the care is being given.  I suggested she call the family in for a meeting and tell them.  To give them care reports directly, but she fears for her job.  Sad.  She is young with a new and growing family with LARGE student loans to pay.  You may be right about what the CEO's/HCF plan was with forcing higher and higher educational standards on the nursing profession...if you owe so so much money, the ability to pay depends on you keeping your job or hurt your family and risk your ability to even work at the profession you love when your license gets suspended for nonpayment.

Ok, 'nough talking for me.  But thank you again!  I hope you keep up the writing as you did a wonderful job!

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RobbiRN is a RN and works as a ER RN.

16 Articles; 9,929 Visitors; 170 Posts

10 hours ago, LockportRN said:

I am a fighter.  Or was.  But fighting alone wore me down.  I used to think that ANA or INA would be our 'group voice' helping us to make the changes in healthcare that most of us agree needs to be done.  But I see that I was wrong.  Seems they are bought and paid for as well.  What they agree to and vote on are more often than not, contrary to what I believe.  Contrary to what I saw as a nurse everyday. 

Thank you for a noble effort and your kind affirmation. As you found, I believe strong individual efforts leave us vulnerable. I know several doctors who were punished severely as well for individual efforts to practice reasonable medicine. Our best chance to rein in the lunacy is resistance on a large scale, like the apparent union victory in NYC this month. As a profession, the mere threat of a massive strike should bring the Nation to its knees.  After all, we do have their lives in our hands.

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