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What Keeps Nurses Up at Night?


Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

A National Nursing Ethics Summit was recently convened by the Johns Hopkins University School of Nursing to focus on the ethical foundations of the nursing profession and the contemporary ethical issues faced by nurses.

Today, nurses experience complex ethical dilemmas due to a changing healthcare environment: the desires of the family don't match the desires of the healthcare staff, inadequate communication about end-of-life care, a lack of resources, a shortage of nurses, maintaining privacy, recruitment and sustainability of the nursing workforce, justice and access to care, quality and safety, and more.

As part of the summit, a series of videos was produced with nurses describing ethical issues and challenges. The first of the series is "What Keeps Nurses Up at Night"

What keeps you up at night??????

To read more about the summit, please go to Ethics Summit Envisions Road Map for America's Nurses

uRNmyway, ASN, RN

Specializes in Med-Surg.

Ok, I'll bite. What keeps me up at night is feeling like what I do is completely useless. I entered nursing to make a difference, and there are so many patients, or so many shifts, that make you feel you just spent 12 hours just running in place. You try to teach until you are blue in the face, only to have patients keep making horrible choices. You bust your butt getting someone better, so they can go back home, and they come right back in with the same issues over and over again because they don't care half as much about their health as you do.


Specializes in PACU, presurgical testing. Has 4 years experience.

The patients for whom I have done everything possible and done it all correctly, and yet I worry that it wasn't enough.


Oh, I have situations that concern me, family who doesn't understand a problem with a patient, doctors who won't listen to RN opinions, etc. But I have learned by this point in my career to not take all that home with me! In the beginning, yes....I think that's natural. But letting what's happening with other people outside your family affect the quality of your family life (sleep being part of that)? No, thanks.


Specializes in ICU, PCU. Has 8 years experience.

Patience is more becoming of a nurse than it is of a patient, strangely enough. As uRNmyway says you could bend over backwards for some patience to get them right, educate them, and send them home.. only to see them again because they just don't care enough about staying healthy. Noncompliance with various treatments leads to an enormous number of admissions where I work. If I can't be patient that's it. Same thing goes for drug seekers who won't leave the call bell alone until you OD them. After a while it's easier to look at my 12 hour shift as a period of time where I have to struggle for a paycheck, not to make a difference. Without patience though (or commitment, or dedication I suppose) you will be up at night with anxiety.

Well, what kept me up at night (literally) more than anything else was being mandated to cover an overnight shift where the reason being was that the staff just didn't want to come in.

Well, what kept me up at night (literally) more than anything else was being mandated to cover an overnight shift where the reason being was that the staff just didn't want to come in.

hmmm....I imagine they'd love it if you decided to stay in bed and have THEM still be there at 11am because you didn't want to come in? ;)

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

What kept me up at night was futile care issues. One patient in particular used to make me want to cry, because her family insisted that we keep her alive at all costs. She was 95. Of course, it was something to do with money, which was to go to charity once she passed away. In the meantime, the family was burning through it keeping her in Jevity and Depends. She was like a political football---she was tube-fed, immobile, non-verbal, incontinent, and she aspirated formula routinely, causing pneumonia and making it necessary to send her to the hospital, which sent her right back to us with antibiotics and instructions on preventing aspiration. (Duh.) NOBODY wanted her to die on their watch, because we knew we'd be sued.....the family was very clear about that.

In the meantime, we fed, bathed, changed, and repositioned her Q 2 hrs. She aspirated and got pneumonia over and over again, and she bounced back and forth between the nursing home and the hospital. I remember one night when I was in the room opening a can of formula for her bolus feeding, she looked up at me and very deliberately shook her head. Of course, I couldn't stop giving her the feeding, but that night I didn't sleep well.

A year or so later, I was working in the hospital when she was brought in, again with pneumonia. Fortunately for her, she defied her family and slipped away peacefully during the night in between turns and changes. The family was naturally very upset and threatened to sue the hospital, the hospitalist, and the nurses taking care of her, but nothing ever came of it. After that experience, I made an advanced directive and had my PCP sign a DNR order for me. (Thankfully, I have no money for my family to fight over.) I won't allow that sort of thing to happen to me if I can help it.


Specializes in ICU, PCU. Has 8 years experience.

Yeah and night shift. Forgot about that. Night shift definitely keeps me up at night.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

The old ones. The ones who look at me with eyes without hope. The ones who just want to die, and we won't let them.

That Guy, BSN, RN, EMT-B

Specializes in Emergency/Cath Lab. Has 6 years experience.

I agree nothing does. I leave work and it stays there ready to be picked back up again. I see/do/hear way too much to bring that home with me.

whichone'spink, BSN, RN

Has 3 years experience.

-Seeing CABG/Valve patients that should not have been operated on, and unsurprisingly, sending the patients back to the CCU where they get worse. One patient really comes to mind, and makes me silently cry at times.

-Wondering how I will get screwed over when I go to work the next day.

-What did I forget to do or chart before I came home.

-Should I apply for nursing graduate school or start taking pre-requisites for pre-PA/pre-med.

Mostly what keeps me up at night is browsing YouTube.

hmmm....I imagine they'd love it if you decided to stay in bed and have THEM still be there at 11am because you didn't want to come in? ;)

Hey I guess we'll never know now, will we? LOL

proud nurse, BSN, RN

Specializes in Medical Oncology, Alzheimer/dementia. Has 15 years experience.

Nothing keeps me up at night, but I do have occasional nagging thoughts about how I just finished a 12 hour shift and felt like I still didn't have enough time to get everything done. I also think about how wasn't able to give each patient equal attention.


Specializes in PACU, pre/postoperative, ortho. Has 10 years experience.

Not much keeps me up, but some pts will stick with me & I wonder how they're doing after I leave. I often think of the more frail elderly hip fx pts who were going to be having surgery & hope they did ok. They surprise me more often then not!

More recently, I admitted a pt late in my shift & I had a nagging suspicion she was abused based on her injury, despite her denial. I passed on my thoughts in report to the oncoming nurse & charge. This pt was on my mind until I fell asleep & when I woke up. I was relieved (& saddened) to see officers on the floor to speak with her when I returned that evening.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

I have to agree with the cardiac surgery nurse in the video -- flogging a patient to keep them alive for the family or because the surgeon cannot bear to lose a patient, when the patient has expressed that they've had enough. That keeps me awake.