Before I start I have to disclaim (that is now a verb): I'm not writing as a representative or critic of any particular institution. I'm doing that weird bloggy thing where I write about myself while conglomerating experiences of my own and other nurses from various working environments. I love nursing, as I've repeatedly stated, but there are dark sides to it, and I'm stuck in some. I am in a horrible funk, some of which is my baseline personality, some of which is attributable to personal factors (DIVORCE), and some of which is career related. I did not say "work" related, because I do not think it is my job in particular. I love my job. I literally cannot think of an area of nursing I think I would love any more. I enjoy my coworkers, I think we are lucky at my hospital compared with many others I've seen, and beyond that everyone hates something about their jobs. I know all that. I am pointing fingers at systemic problems in nursing, and I can't be the only one beaten down by them. People leave the profession in droves, and there are good reasons for it. It's not even recession proof anymore. I maintain that currently registered nurses work in an environment perfectly engineered to create and perpetuate anxiety, hostility, and eventually depression. Why do we eat our young? Because we are anxious, hostile, and depressed. Healthcare today is a society of witch-hunting, and someone has to be burned. In all likelihood it will be "the primary nurse." The primary nurse currently has responsibility for nearly everything, including ensuring physicians are correctly entering computing orders and ensuring that all the electronic pieces of the chart are present and correctly uploading to the main system. We now must double-check ourselves, our aides, our secretaries, and our physicians. If any part of the system goes down, you're the one responsible. This is in addition to heavy patient loads. Speaking of which: you're assigned too many patients for safety? Complain, and you're written up for being a bad team player. Don't complain and make an error, and you run a real risk of losing your job and/or your license. I know one nurse who appropriately followed the chain of command for a too-heavy patient load; her supervisor told her if she was unable to do her job she should leave. Believing she'd been fired, she left. She was then charged with patient abandonment and lost her license.
The list of things for which I can be fired lengthens daily. If I were less daunted I would make a list. There have to be a hundred miscellaneous things. They come out in e-mails, piecemeal. It begins to feel as if everything is a fireable offense. You can see how this happens: I'm sure our administrators have fires under their butts too, and to appease the firestarters they have to Do Something. So they e-mail everyone and say, "you're all going to get canned if you do this again." Problem solved. They've Done Something. But there is zero possibility of this tactic NOT resulting in paralyzing anxiety for staff. I am NOT the only nurse who sometimes feels terrified to do ANYTHING at work. I feel like a rat at the end of the maze some days. I've run and run, working as hard as I can, and there's no cheese, and even though there's no cheese I'm likely to get fired for not finding it. It's a silly metaphor, but I'm tired. But even this situation is better than the opposite, which I've also seen in nursing, in which you're never even told you can be fired for something until you've done it. I've worked in places where I never knew when I would get in trouble because management was widely known to save things up, let you have it, and fire you when you thought no news had been good news. Again: it is not possible to work in such an environment without acute anxiety.
Management aside, I hate to be the bearer of bad news, but the economy stinks. Nurses have to treat more patients with fewer resources, which means we have to work harder. Hard work isn't the end of the world, but it still stinks to not sit down for 12+ hours and THEN be rewarded with (a) a list of things you did wrong and/or (b) additions to Things You Can Be Fired For. Flexibility is vital, but I can't bend far enough to maintain a good attitude all the time with these things going on. Most of the time I can---or perhaps I am kidding myself and now I've just totally crashed and burned after a lot of denial.
Nurses have some bad statistics regarding suicide, alcoholism, and other isms. Since this is my blog and I can be lazy, I'm not going to take the time to find them. I've seen them, though, and I am now unsurprised. There are many shifts when I am physically exhausted; I've been physically or psychologically harassed by my patients, coworkers, physicians, or all three; I've been present for a death or other traumatic event; and I haven't eaten or sat down except to chart for 12 hours. This can happen repeatedly, shift after shift. What do you do with that? Lots of nurses drink a lot. I don't drink or smoke (I eat a lot of M&M's, which is a boring vice), but I see the temptation. I isolate, because most of my erstwhile friends are not in healthcare and I have nothing to discuss with them. Them: "CATASTROPHE. My new carpet doesn't match the curtains!" Me, thinking: "Catastrophe is when your entire family has been killed. Who gives a crap about your curtains." Or similar. I've heard that nurses can suffer from secondary trauma, and I really wonder how many of us walk around with a kind of subclinical PTSD from the stuff we see at work. Maybe it isn't even subclinical.
I don't know what can be done about that part of the job. It's a hard job, we choose it, and we figure out how to cope or we quit and find something else. This other stuff...I can't give up believing that this bureaucratic terrorism is not a necessary part of the profession. I feebly cry out to my nursing brothers and sisters: what can we do? Is there a solution? Can we not stop the environment of fear?
Maybe it's just me. I strongly consider that it may be, that perhaps I am not suited to this profession. Maybe I am too anxious, too high-strung, too predisposed to codependent enmeshment with other people's tragedies. Unfortunately those same traits make me a wicked good nurse. I am anxious, so I am extremely conscientious. I'm high-strung, so I stay current in my field and go around like a crazed Energizer bunny trying to get everything done quickly. I get enmeshed with patient tragedy because I care. This is not just a job for me. I've wanted to be an ER nurse for 30 years; it's a calling. I hope I can find a way to live healthy and happy so I can keep doing it...and that I don't get fired for x, where x is in the set of all possible things.