I came upon this post on KevinMD.com, written by a nurse. I am pleased that a physician has provided a vehicle for nurses to tell their stories and, in this case, share the heavy toll that working in a hospital setting can have on nurses.
Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.
Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time. As a living organism, we know that the body can only sustain so much stress before it starts to break down. These ailments can be physical and/or mental. Sometimes they happen over a period of time, however often times we do not even realize the symptoms until they have forced us to take notice. As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest.
Bedside nursing is hard and very stressful. The bedside nurse is responsible for caring for multiple people every minute of every shift. That is, multiple sick and potentially dying people. The nurse is responsible for monitoring the patient’s response to treatment, the patient’s condition, the patient’s mental health, the doctor’s orders, assisting the patient with activities of daily living, and being there for the family.
Bedside nurses are the coordinators of care. We are the ones who make sure that all parts of the care plan are being carried out and that the system is working the best it can. We are the ones who comfort the patients when they need us the most.
We do not mind doing all of this. In fact, this is what we signed up for when we graduated from nursing school. We can handle these tasks if we have a partnership with the hospitals that we work for. This partnership all starts with the nursing grid. Each unit in a hospital has one. It is basically a chart that states how many patients each nurse should have. It is a chart that is supposed to indicate the safe number of patients that each nurse should be assigned every shift. It is a topic of heated discussion in the nursing world.
Normal patient-to-nurse ratios depend on the unit and the acuity of the patients. For instance, most nurses agree that in the intensive care unit (ICU) nurses should not be assigned more than two patients each. If a patient needs continuous dialysis or another procedure that needs to be monitored, then this ratio goes to 1:1. This is a common theme. If a nurse is assigned to a critical care unit or cardiac unit, then the patient to nurse ratio is acceptable and safe at 3:1. This means that each nurse on the unit should only have three patients. Acceptable medical-surgical unit ratios are usually either 4:1. This means that for every four patients, there should be a nurse. Another rule of safety is that there should never be only one nurse on a unit. Too many things can change quickly, and safety comes in numbers. Remember we are talking about human life.
When these basic rules are followed, then nurses and patients have better outcomes. Nurses stay at the bedside longer and patients do better overall. The problem that nurses are having is these basic safety numbers are not being followed, and we are burning out as a result. This has to change if we are going to keep our valuable nurses at the bedside. It has to change if people are going to receive the care they deserve when they are in the hospital.
Nursing salaries also need to be increased. Most nurses have their bachelors in nursing degree (BSN). Many hospitals require it as a condition of employment. A bachelor of nursing degree takes about five years, and the cost of the education starts at $50,000. Many nurses have to take out loans to pay for school. If we look at a 10-year repayment plan that does not include interest — a $50,000 loan means a monthly payment of $417.00.
I work in the Midwest. Our new nurses start at $22.00/hour. Some nurses earn a differential for working nights and weekends, too, although those shifts come with health and family costs. If we multiply $22.00/hour by the average 160 hours that most full-time people work each month, we end up with a gross monthly salary of $3,520. Most accountants say that taxes and benefits equal at least 30% of our pay. This means that on average, a new nurse can expect to bring home $2,464 a month. If we subtract the student loan payment, this means a new nurse will need to live off of a little over $2,000 a month. Trying to pay for housing, food, transportation, and utilities each month, forces many nurses to choose to work overtime.
Working 12-hour shifts are rough. In fact, 12-hour shifts often are 13-hour shifts, and many times, nurses do not get breaks. We want breaks, we do! They just become impossible with the increased patient loads and the increase in patient illness that we see. If a nurse somehow gets to leave to go on break, the relieving nurse needs to assume the responsibility for double the patients for the period of time. If that nurse is already having a hard time staying afloat of the assigned tasks at hand, then giving this nurse more responsibility doesn’t make sense. Bedside nurses are tired.
We also are often asked to float to other areas of the hospital — without training. Yes, I learned about basic orthopedics in nursing school; however as a neurology nurse, my knowledge of repairing bones is limited. Nurses should never be asked to float to another unit of a hospital unless they receive adequate training. This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. A salesperson would never be asked to work as an architect. A cardiologist would not be asked to fill in for a neurologist. It just isn’t done. Why do nurses have to risk their licenses to do this? It is not safe patient practice.
We get scared.
When nurses have all of these stressors constantly, they may not even realize that they are having symptoms of chronic stress that can lead to PTSD. It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as “another part of the job.” We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again.
Nurses need support from our hospitals, our government officials and our communities. We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves, and we need to take advantage of employee-assistance programs that offer free, confidential counseling. We need hospital-provided exercise rooms. We need to learn coping skills. We need to be able to process all of the emotions that we feel that have always been discarded as, “part of the job.” We need to talk about our issues, and we need to feel like we are being heard. We need to heal.
Anne Naulty is a nurse.