Wednesday, April 25, 2007

*smack* *munch* nurses.

That's a joke, people.

John (for whom I have immense respect and liking) has a post up on "lateral violence", aka "nurses eat their young with sprouts and bleu cheese." He posts some sobering stats on how many new nurses (defined here as nurses within the first couple of years of licensure) leave the profession entirely or change jobs.

Not to disagree entirely with John's point, but I have a thought on a couple of other issues that face new nurses. I thought I'd expound. Of course I did.

Issue Number One: Nobody Really Knows What The Hell It Is We Do.

We dare to care, yes. We dare to cry. We dare to work out BSA and dosages for neonates in a code. We dare to keep up with changes in legislation. We dare to influence that legislation. We dare to advocate for abused patients. We dare to work in a profession that is historically undervalued. We dare to protect our patients from doctors' errors. We dare to report our own.

In short, we do a whole lot more than caring and crying.

Yet, when I started nursing school, I was the only person in a class of forty who said something other than "I want to help people."

Nursing students are no less clueless than the rest of society. I would estimate that ninety percent of the folks I went to school with thought that a person's warm-fuzzosity was the primary determinant of how they'd do as a nurse. And all of those people got whacked upside the head with the reality of how tricky the job is--not just from the standpoint of interacting with sick people, but from the standpoint of having to be a scientist.

Aside from the one woman who went into school "to meet doctors" and the other who wanted her husband to stop bugging her about getting a job, *all* of the people who wanted to "help others" have left the profession.

All of them. That's fifteen nurses (of the ones that finished school) who have gone back to accounting, or bank tellering, or whatever they were doing before. I am one of six (SIX!) students from my graduating class who is still a nurse. Nobody, apparently, knew that it would be as hard and as intellectually demanding as it is.

At the same time, I'm watching smart young feminists of my acquaintance not enter nursing because of the helpmeet stereotype. Frankly, what this profession needs more of is smart young feminists. Yet we're not attracting them, because nursing is still seen as a pink-collar, nearly-service-industry, "helping" profession. When I talk to women who are working toward their premed degrees about what I do for a living, they're gobsmacked to discover that modern nursing is a hell of a lot more like their concept of being a doctor than they thought.

Solution? We need to be realistic about what we do. We need to tell people, every chance we get, that we are intelligent, trained, scientific professionals who are also able to steer a family through a health crisis or advocate for a rape victim. I am eternally grateful for Pal Angie, who will be getting a newly-minted RN this summer (hooray, Angie!) and who is one of the smartest, toughest, feminist, most realistic people I know. If more people could see nurses like her, we'd have no problem with a shortage.

And if more nurse-wanna-bes understood that it ain't all hugs, we'd have fewer people who ought to be somewhere else.

Harsh, but true.

Issue Number Two: It's About The Stupid Management

Sometimes I feel like a cross between Joe Hill and Emma Goldman, with the Pinkertons about to bust down my door, but it's true: Hospital management is hostile to nurses. Period.

A friend of mine who's also an RN got offered a fantastic bonus for signing on with a particular hospital which shall remain nameless. She showed up on the floor the first day after two weeks of orientation to find herself in charge of one practical nurse and twelve patients. Twelve. All of whom were in varying states of circling the drain because of nursing shortages at that hospital. She walked out after that first day and came to our facility, which (at the time) still cared about staffing rather than the latest technological widget.

We as nurses need to do two things to fix this problem: First, we need to stop signing up for extra work. When I see a nurse who's working ten days in a row without a day off, I don't see a dedicated professional. I see a person with serious issues about saying "No."

Quite frankly, the world will not end if we all start saying "No." The hospital will hire agency nurses or more full-timers, or start paying attention, at least, to staffing levels. Management might actually have to come in and work--and that, my friends, is a truly marvelous feeling, to watch your manager wipe ass for twelve hours because he hasn't had the huevos to hire new people.

Second, and more importantly, we need to agitate for safe staffing levels. When I say "agitate", I mean everything from my own technique (which involves yelling if necessary) to the technique of calmer colleagues (who speak in front of the state legislature). Every nurse can make a difference at some level in this fight. If you're crazy about writing letters and emailing representatives, you can do that. If you're nuts for making middle management uncomfortable, you can do that. And if you get a warm, fuzzy glow from saying "No" to extra shifts, you can do that.

We as nurses do need to shut the hell up and stop putting new nurses through a gauntlet. Nobody's going to be tougher, or faster, or smarter for being abused. There are, however, *systemic problems* that I think are a larger threat to the profession as a whole. We need to spend the breath we'd use debating how, exactly, we eat our young fixing those.


The Frog said...

As someone who is graduating nursing school and finally starting work, I wish there were more people like you in the field, just from what I've seen in clinicals and in my nursing instructors.

I wish nursing were full of scientists. I wish that "Disturbed Energy Field" wasn't an official nursing diagnosis. I wish that people didn't use the term "murse" to refer to male colleagues.

But I'm also very happy that nursing is ever so slowly becoming more of a field that will stick up for itself, that nurses are being trained to advocate for themselves, and that we will slowly become scientists--real scientists, who have evidence to back up their interventions and can provide excellent service to their patients and the other team members with whom they collaborate.

Jo said...

"Disturbed Energy Field" is one of my favorite ass-chappers as well.

Gotta say, though, that this is the first time I've heard "murse". "Murse". Oh, lovely.

Sometimes there are not enough desks in the world to hold all the dents my head wants to put in them.

Miss Two said...


Just wanted to finally de-lurk and say that the person who's been spending hours in your archives isn't crazy- just a potential nurse.
THANK YOU for this post.

People look at me like I'm nuts when I say that I'm headed for nursing school because I'd do a whole lot of the work of the doctors including the calculations, admin medicine, etc. but also get the patient contact and care that I'm good at and enjoy. I consider the position equal to doctors... just different. So it's good to know that someone who's already 'inside' is saying what you are.

Now, I'm looking for scholarships etc. because though I feel nursing is my vocation (and I've been an EMT so I've done some work on it) it's still damned EXPENSIVE!!!


LIM said...

simply put ...a brilliant blog

Anonymous said...

I recently interviewed for an acclerated BSN program and when the interviewers asked me why I thought I'd make a good nurse I answered: "I'm smart, and I'm assertive." They were shocked. They told me everyone usually starts out with "I'm nice". Not that nurses shouldn't be "nice", but I think you're absolutely right that nursing attracts many people who don't really understand what it takes to be a nurse, and deters a lot of smart, competent folks who think they don't want to stand around all day waiting for a doctor to tell them what to do. This was, I'm slightly ashamed to admit, one of my reasons for not going into nursing back in the day, before I got my head out of my ass, and before I started reading blogs like yours.
Anyway, thanks for another great post Jo, you continue to be a big inspiration.
p.s. "Disturbed Energy Field"? Really?

UnsinkableMB said...

I think you're right about the fact that there needs to be something beyond than the desire to help people when choosing nursing. I am grateful for my non-fuzzy years in Corporate America, getting kicked around in the Advertising and Technical Consulting industries. That experience gave me the edge needed to survive life as a nurse --- especially in the operating room!!!

I recently returned to my nursing alma mater to give a Reality Check talk to graduating seniors. By the looks on their faces after my presentation, maybe it would be more helpful if they heard it BEFORE they entered the program!

Anonymous said...

You make a very important point, Jo. I surely didn't mean to say that lateral violence is the sole cause of nurses leaving the profession...

One of the trends I am seeing that really scares me is people entering nursing school without having ever seen the inside of a hospital or nursing home... The culture shock alone has to knock some people out...