Monday, April 02, 2007

How to End the Nursing Shortage

Within the past week, I've heard two nurses deliver impassioned tirades about why the field's so difficult (and understaffed). I know these nurses in different contexts: one at the hospital, one in the classroom. They're different ages and have different backgrounds, and between the two of them, they've done just about every kind of nursing. While two people isn't a statistically reliable sample, these factors suggest that their complaints are largely true across the board.

Both of them report that nurses get abused by everybody: by patients, other nurses, and doctors. The abuse ranges from the verbal (being called stupid or cursed at) to the physical (having excrement thrown at you). Add that to the sheer physical demands of the job, especially in trauma/ED, and you have a surefire recipe for burnout. One of the nurses said, "You go into this because you want to make a difference in people's lives, but most of the time, you don't -- or you don't feel like you do. You just get put down."

Both of these nurses are extremely kind, articulate, intelligent people, and I was shocked to hear how consistently they'd felt belittled. In my two and a half years volunteering in the ED, I've certainly seen bad patient behavior, but I've heard more patients praising their nurses, and I've never seen a doctor insult a nurse. One of the nurses delivered this tirade in front of the nursing station and next to a doctor, which suggests that she was comfortable with at least that set of colleagues. Still, the bitterness in her voice was unmistakable.

“So why do you do it?” I asked her. “Why stay in the field?” (The other nurse has left the field.)

To explain why she stays, she told me two stories. One was about helping to resuscitate a toddler: the child had been brought in blue after having drowned, and left the hospital pink and yelling, to everyone’s joy. “That’s the best feeling in the world.” A few days later, the mother brought the child back to the hospital to thank the medical team, and they all cried.

The second story was about helping the family of a dying patient: respecting their wishes and telling them they were doing the right thing; caring for several of them in the patient’s room when they became ill themselves, so they wouldn’t have to leave the patient’s side; allowing them to stay in the room as long as they needed to after the patient died. “I didn’t do anything special; I just did what I’d do for anyone, what I’d want myself in that situation.” But the family wrote a letter to the hospital praising the nurse’s care, saying how wonderful she’d been. “Whenever I have a bad day at work, I go home and reread that letter, and think, ‘Okay, this is why I do this.’”

I’ve always made a point of thanking the nurses who’ve cared for me, and when I hear a patient praise a particular nurse, I try to tell the nurse about it. To me, these actions are routine common courtesy; until last night, I didn’t realize just how important they are.

If you want to help end the nursing shortage, say “thank you” to a nurse. Better yet, write a letter your nurse can read after a tough day.

And whatever you do, don’t throw excrement.


  1. Granted, I've only been an ED nurse for just over a year, but it seems to me there are two types of ED nurses; those that burn out, and those that thrive on the environment.

    I hope to be one of the latter. We have a few nurses with 10+ years of ED Nursing, one with 20+, and they keep on getting better.

    There are rough days, but that's when your friends come in handy...

  2. My beloved, a nurse of some 30 years, would offer two other reasons - management (which she's done and doesn't want to do now because she is a nurse - she doesn't work as a nurse, she is one, it is her vocation) and money.

    I fear for the life of any doctor who abused her. Picture Nurse Ratched with a smile.

    As for abusive patients...

  3. LOLOL - I wholeheartedly agree with that last sentence!

  4. I spent ten days in the hospital in '03, going from trying-hard-not-to-die, to, on my way back from a severe and steroids-refractory Crohn's flare. I'd been there long enough to start to get to know some of the staff, and I promised one of my favorite nurses that I would come back to visit. She surprised me by answering, bitterly, "The patients always say that, but they never do. They forget us as soon as they go home."

    I took that as a challenge. Went home. Knitted for fourteen doctors and nurses and nursing assistants, lace shawls and scarves, hats and, in one male nurse's case, handknit socks to thank him for walking in his patients' shoes with such great compassion. I wanted to not only say thank you, but to do so visibly and tangibly in as permanent a way as I could think of. And yes, I visited: but I got to see, the first time I went back in those doors on my own two feet, that the greatest joy I could have imagined was the look on their faces, simply seeing me. Alive. And whole again. Affirming the value of every moment of every day on their jobs. And taking the time to let them see.

    Patients who don't return to visit have no idea what they're missing out on.

  5. That's a great story, Alison! Thanks so much for sharing it!

  6. I work in the ER for two reasons 1. It makes my heart sing when I care for my patients (I take care of soldiers) and 2. for the excitement. I agree saying thankful would help, but accepting the thanks and letting go of things we can not control would help too.

  7. EXACTLY! Thank you goes a long way.

    And thank you for recognizing it!


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