Nursing as a Calling: Aspirations and Realities

Let’s take a few minutes to consider the profession of nursing and working conditions that face nurses in today’s healthcare system.

Christoffer Grundmann, writing in The Cresset (a journal published at my undergraduate alma mater, Valparaiso University), traces the historical evolution of nursing as a profession.  His article starts by observing that:

The advent of professional nursing is a fairly recent phenomenon in history. This is a remarkable achieve­­ment in human civilization, since the profession of nursing defies natural instinct. It is perfectly natural to care for one’s own kin in times of sickness or when they have become too frail to care for themselves due to age or physi­cal or mental challenges. It is anything but natural to do so for those outside one’s very own family and clan. What is natural instead is to instinc­tively shun suffering and wailing. It is also only natural to dissociate oneself from failing life, from dying, and death….

It’s an interesting and informative piece.  If you’ve never thought of how the nursing profession originated and developed, I’d suggest taking a look at it.

Realities

Though Grundmann’s article conveys the remarkable advancement of nursing as a healing profession, the contemporary practice of nursing is fraught with challenges, not the least of which are stressful working conditions.

Several years ago, I was co-convenor of two New Workplace Institute roundtable sessions about workplace bullying and violence confronting nurses, held with members of the Massachusetts Nurses Association (MNA), and it was an eye-opening discussion.  Too many nurses are on the receiving ends of aggressive behaviors from all angles — they get it from patients, physicians, and fellow nurses. 

I heard stories of bullying from supervisors, peers, and physicians, and of physical violence committed by patients.  In addition, I learned about how economic pressures facing the healthcare system often fall on the shoulders of nurses, who are asked to care for more patients under stressful working conditions.

Workplace bullying

There is growing recognition of workplace bullying in the nursing profession.  Cheryl Painter’s article about bullying and turnover among nurses captures the problem (some citations omitted):

Destructive workplace behaviors contribute to the inability to retain nurses in the healthcare environment because of the stress associated with these behaviors. Briles (2003) defined the problem of destructive workplace behavior as “working manners, habits, and styles that can directly and negatively affect the bottom line of a unit, department, and the entire organization”…

These destructive workplace behaviors cause targeted employees to experience serious physical and psychological damage…, resulting in negative aspects of the EVLN model, which consists of exit – leaving employment, voice – verbal threats of retaliation, loyalty – entrapment by the organization, and neglect – willful negligence to work duties.  The resulting organizational decline costs the healthcare organization both time in retraining new employees and money to mitigate the effects of EVLN.

Considering the nursing shortage and the increasing demand for healthcare services, strategies need implemented to improve satisfaction, increase motivation, augment productivity, and improve retention to ensure safe and quality healthcare.

Staffing levels

In many hospitals, nurses are being asked to care for a greater number of patients.  Concerns about overwork and increased risk of patient errors have led MNA and other unions to support legislation that will set nurse-patient ratios.  Here’s a summary from the MNA’s legislative agenda:

We have a disturbing crisis in Massachusetts hospitals. Registered nurses are being forced to care for too many patients at once, and patients are suffering the consequences in the form of preventable errors, avoidable complications, increased lengths of stay and readmissions. The Patient Safety Act calls upon DPH to set a safe limit on the number of hospital patients a nurse is assigned at one time. In addition, the bill calls for staffing limits to be adjusted based on patient needs. It also bans mandatory overtime and includes initiatives to increase nursing faculty and nurse recruitment.

For all of us

The future of the nursing profession matters to all of us.  As we struggle to keep healthcare costs under control, and as our population ages and requires more assistance from healthcare providers, nurses will play an increasingly important role in keeping us well.  For example, the New York Times ran a piece yesterday reporting how one health insurer is paying for more nursing care to assist doctors treating patients with chronic diseases:

As an insurer, Geisinger now pays the salaries of extra nurses in doctors’ offices, whose full-time job is to help patients with chronic diseases stay on top of their conditions and, ideally, out of the hospital. The doctors, including Dr. Kilduff, help hire the nurses, who work closely with the doctors to oversee the patients’ care.

The nurses make sure patients who need quick appointments are squeezed in, and they alert the doctors to any early indications of trouble by keeping in close contact with the patients and looking out for the results of patients’ lab tests.

In sum, we should take seriously the working conditions for nurses.  It’s both the right thing to do and in our own self-interest.

***

Additional info

Nurse Beth Boynton writes and consults on nurses and emotional health.  You can subscribe to her e-newsletter, Confident Voices for Nurses, for free.  Current issues of the newsletter are highlighting the topic of disruptive interpersonal behaviors.

If you’re on Facebook, you might look up Alaka McConnell, who has been posting extensively about bullying and violence facing nurses, with links to articles and studies.

Earlier this year, I wrote a series of posts on workplace bullying in the healthcare professions, including nursing.

2 responses

  1. Pingback: Nurse writes about bullying by doctors, and other doctors respond « Minding the Workplace

  2. I have been a nurse since 2003. My experiences with bullying have been so intense and ongoing that I have not worked in over 16 months. I made mistakes, but none life threatening or that with appropriate support from management I would not have been able to overcome. I worked for a major health care system and have been banned from employment as they hold a monopoly on jobs. I am fearful of not being able to work in a hospital again in this area. Help. Is there a way to get your name cleared after such targeting?

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