For years, polls have shown that Americans view nurses as having the
highest honesty and ethical standards of all professions—not only among
healthcare professions, such as doctors, pharmacists, and dentists—but all
major professions. Given this overwhelming admiration for nurses, why
don’t more people gravitate toward the calling? Why do we continue to
see nurses leaving the profession in growing numbers?
F
ive years from now, according to the American
Nursing Association (Sullivan, 2014), the U.S. will
require an estimated one million additional nurses to
care for a growing elderly population and to replace
retiring nurses. Hospitals will be especially affected by
this shortage as nurses leave the inpatient setting for
the lighter demands of outpatient care.
While conventional wisdom regarding a shortage of
nurses might tell us to explore educational requirements,
compensation issues, or the scheduling demands of shift
work, darker issues lurk just beyond public awareness.
We need look no further than reports about nurses
leaving the profession over high stress and burnout,
bullying and incivility, and workplace violence.
Healthcare workers in general are at risk for illnesses,
injuries, and fatalities because of long hours, changing
shifts, physically demanding tasks, violence, and exposure
to infectious diseases and hazardous chemicals, according
to the Bureau of Labor Statistics (Dressner, 2017). These
same statistics reveal that a worker in healthcare and
social assistance is nearly five times more likely to be the
victim of a nonfatal assault or violent act than the average
worker across all industries combined.
While these facts may not have a statistically proven
correlation with the projected shortage of nurses,
they require a closer look.
High Stress and Burnout
Kronos Inc. recently conducted a survey of 257 nurses,
finding that 98% of nurses in the U.S. say their work is
physically and mentally exhausting, and 90% have
considered leaving their jobs to find something offering
better work-life balance (Safety+Health, 2017). The
leading causes mentioned were excessive workloads,
the inability to take breaks, even for meals, and a lack
of sleep between shifts. Just over a quarter of nurses
said they have called in sick just so they could stay
home and sleep.
A seasoned ER nurse recalls working 7/7 many years ago:
“You needed to be superhuman to work those hours,
and it took a full 24 hours to recover mentally and
physically. I really messed up my brain rhythms. My
personality changed, and I became depressed. Now
I’m exhausted after working four 12-hour shifts. ER
work requires you to brainwash yourself to stay
immune to exhaustion.”
Exhaustion is just one part of the problem. Frustration
with the number of job requirements that are not
patient-facing is another stressor for nurses. A nurse
interviewed for this article describes it this way:
“The amount of charting a nurse has to do outweighs
the face-to-face interaction with patients. If a patient
complains of pain, for example, the nurse not only has to
go into the charting system to chart the pain, but open
the MAR to check on medications, then chart on those
meds in both the MAR and in the computer system, then
in the chart. I understand that correct documentation
needs to be completed to ensure appropriate use of
narcotics. However, the mass confusion and repeated
charting in multiple and redundant systems takes up time.
Charting in general is redundant, repetitive, and takes
away from [direct] patient care,” she says.
In her view, the reasons for the amount of paperwork
are “legal or political.” She recalls staying after the end
of shifts to complete paperwork to ensure her duties
did not fall to the next shift and to avoid write-ups
from her supervisors.
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