I just got home from a busy day of work on a critical care unit (CCU). I cried on my way home while driving in my car. Not because I am sad, but because I am angry. The expectation of a nurse is unrealistic. We are expected to give patients their medications on time. Some of these medications are anti-rejection medications in transplant patients, antihypertensive medications to reduce insult to one's heart and vascular system and medications to prevent seizures.
We are expected to reposition patients at least every two hours to prevent skin breakdown and risk for infection. Mouth care every two hours for patients who are on a ventilator to prevent ventilator associated pneumonia (VAP). We need to document vitals and hemodynamic numbers every hour. We need to trouble shoot equipment and hang multiple drips and titrate these drips for hemodynamic stability in patients.
We go to lunch knowing we gave report to a nurse on a CCU who has her/ his own patients and now ours for the 45 minutes we get to eat and regroup for the remainder of the day. These nurse's are also "caring" for our patients when we leave the unit to bring another critically ill patient to a test or procedure. We look at orders and clarify orders and question orders to understand a rational behind why we are doing what we are doing to keep our patients safe. This is all before we actually carry out an order by a physician. We implement nurse-based interventions in the care of patients and families.
We are expected to and desperately desire to provide holistic care to patients and their families that include listening and being present in a room. To listen to the wife of a patient who has been married to her husband for 50 years. She sits by her husband confused and not understanding what is going on. She asks the nurse questions. Wants someone to reach out to touch her arm and listen to her fears and express that there is not a right or wrong answer in the decisions she is making in regard to her loved-one's medical interventions. I say, "Gather the information, talk to the rest of your family. Most importantly, listen to your heart."
I care and will continue to care about the nursing profession. I will not stop caring or become immune to what I see to cope with the challenges that nurses face in all specialties in the nursing profession; ED, critical care, and medical-surgical nursing to name a few.
I truly feel at a loss of words. I entered the nursing profession later in life. I feel an innate passion to contribute to healing the sick and comfort the dying. It is a task that at times, feels impossible. And, actually is impossible. My heart hurts when I leave work knowing that I did not provide the care to very sick patients and their family members that I would want provided to my loved ones.
I care and will continue to care about the nursing profession. I will not stop caring or become immune to what I see to cope with the challenges that nurses face in all specialties in the nursing profession; ED, critical care, and medical-surgical nursing to name a few.
Nurses leave the bedside. They move out of hospitals or into management positions within hospitals. The burn out may make these individuals feel as though, "These problems aren't my problems anymore". I understand the feeling. But, nurses need to ban together, support each other and get involved in professional organizations and legislation to put our profession in a place that we can do our job in the way we were taught through our education it should be done and how we know within our hearts it should be done. We can not leave the bedside and forget about those that are still there.
I can not drag myself away from where the heart of nursing is. The bedside. I can not leave the trenches of down and dirty nursing... where nurses are not too good to do whatever it takes to get the job done. I can not leave my colleagues. Yes, there is bullying in the nursing profession. But, there are many nurses that support each other and are smart, perceptive, kind and supportive. These nurses know when another nurse is struggling. These nurses step away from their responsibilities to help another nurse get back on track.
My day that I cried over was eased by one nurse. A nurse that stepped in and did not leave me alone until I said, "I am back on track."
CCU nurses many times, take on three patients during their day and emergency department (ED) nurses take on six alternating patients during a shift. Medical-Surgical nurses can take up to eight patients. Medical-Surgical nurses are expected to identify decompasating patients. This is in the mists of giving lists of medications to each patient. By the time these nurses get to patient eight, it has been hours since they have seen patient one. Unrealistic expectation. I have worked in the ED and now in tical care. I have worked in education as a clinical instructor and have had clinicals on medical-surgical floors and in long-term care (LTC) facilities with student nurses.
The ratio and acuity of patients makes it impossible to provide best care to patients in any setting. We do not always give medications on time or provide the holistic care that is essential to patient and family care. We miss things. Not because we are incompetent, but because we are over-worked and understaffed on our units.
Today was a day I left work angry and appalled about what the nursing profession is reduced to in regard to skilled nurses and patient care. I worked a twelve-hour shift and spent another hour and a half giving report to the night shift nurse. This nurse was taking on a heavy load with three patients in the CCU that included what I did not finish during the day.
Nursing is a nobel profession. I am not about to take these challenges passively. But, the only way to make change is collectively. We need to stick together, read the research on evidenced-based practice, share this knowledge and insist on change based on this research.
My fellow nurses, I support you even if I don't know you. I know we have all had the feeling, "Why am I doing this? What did I get myself into?" Most of us know why we entered this profession. We always need to come back to that... even on the worst of days.
