Why I LOVE Nursing and feel we deserve....

Autonomy, Respect, and Standards in the work place to protect our license and the care we provide every patient.
I wrote this several years ago and part of it was published in the Florida Nurse, through the FNA:
It is still true today and some of the main reasons I am still at the bedside and as much as I may rant and rave at current situations, I TRULY Love what I do and always strive to excel:

Nursing and All of Its Possibilities and What the Future is Bringing

Nursing is many things to many people. It is often a profession, a career, a calling and to some, just a job. To love this job is to learn early on that when the rewards do not outweigh the negatives it may be time to re-evaluate. In the current nursing shortage/crisis, whatever some may call it, many are re-evaluating what this profession means to them. Every day they drive to work, often wondering, what the day may bring. Each day is often very different.

Will you have those few patients that make it all worthwhile, the 2-year-old that, once her fever has broken, follows you around holding your hand? She lets you know with her innocent trust, that you helped her feel better and that she has just made your shift a brighter piece of time, this is the one, that while you may not really have the time to play, you decide it’s a good time to make time. Is it the older woman with multiple organ disease and a loving family, who just wants her to be able to go gently into the night? Her family understands her desires and needs for a peaceful end; so, you soothe her with cool cloths and keep her as comfortable as possible, leaving the family the chance to share her final moments in time. While this may not be a physically busy patient, the emotional investments it generates, play a different havoc with your coping mechanisms on a busy shift. On the other hand, will it be that man, that, though seemingly sailing along on the road to recovery, the inexplicable occurrence happens. You find yourself and many others on the medical team, fighting to save this man from the circling four horsemen, whose dogs are nipping at his heels. When you pull him back from the breach, will you have the staff to cover his increased level of need? Will it have been another day of coming in only to find that there are not enough nurses on the floor and that the intensive care unit is currently full, but they are trying to find a bed? 

    Many nurses find themselves in this situation today. Patients are increasingly sicker when they come into the hospital, with greater demands in regards to their care and needs. Their potential to arrest or just begin the often agonizingly slow spiral towards the light is when they need nurses with the time to assess and re-assess their situation. Time that can make the difference with an experienced and astute nurse caring for this patient, this nurse can maybe delay or prevent a sentinel event from occurring. This nurse uses years of learning to know the signs that indicate a significant occurrence is heading towards this patient. Often it may just be a gut reaction, but the chance to head off disaster is in the hands of this nurse who knows the warning signs and what to do to keep the pending arrest at bay and turn the tide when provided the time to care for this patient in a safe and uncompromised manner. This is the time that many nurses rarely have in an age where staffing ratios have not changed for the better in well over a decade. Most facilities’ ratios are built on the budget and the decreasing number of nurses, not the increased acuity of the worsening patients’ health characteristics. Standards need to be set based on the patients’ level of illness and the increased workload that illness places on the nursing staff to give them the care they need and deserve.

    As noted above, nursing is one of the most compassionate, rewarding and enjoyable professions in this world. It is also demanding of knowledge, experience, and the ability to make life-altering rapid-fire decisions and all of the stress that that can entail. Nursing often requires more than adequate amounts of time, the time to assess patients’ thoroughly and accurately. In this way, nurses are more likely to note a deteriorating condition before it becomes life threatening as well as perhaps having the time to interview patients more carefully, thereby, determining issues that may present problems while they are caring for them.

    More and more what a patient deserves is going to be in the manner that they are going to be lucky to get only what they need the most. Numbers show that in 10-20 years there will be a shortage of at least 800,000-1.2 million nurses in this country alone. Nurses continue to leave the profession or are moving into areas away from the bedside, sometimes through increasing education or taking jobs in other, often, less critical areas, or moving out of the profession altogether. Many facilities seem to be pinning their hopes on graduating nurses who have no experience or gut feelings that can prevent patient events. The fact of the matter is that without experienced and satisfied nurses the mortality and morbidity of patients will only escalate. Admittedly, more nurses graduating and getting experience will help with some of the increasing shortage, but working to keep and satisfy nurses who have been loyal and committed to a workplace should also be a high-level goal. Due to past business crises, many hospitals have decreased or eliminated the benefits that nurses received in the past and may be looking to decrease them further. This is the time to improve benefits and tuition reimbursement if these facilities want the better-educated nurses at the bedside. Better retirement packages should be implemented, whether on a hospital-to-hospital level or at the state and national levels. Increasing the salaries would also be of benefit. There should be no salary cap for nurses who continue to be educated. On not only a yearly basis but also many are back in college, obtaining higher levels of degrees and certification. Facilities should be just as concerned at rewarding their loyal and experienced nurses as well as encouraging new nurses. There should be no limit on how many years a nurse can earn a raise; they have only continued learning throughout their career. The fact that many new nurses are paid very close to the same salary as a nurse with 20 years of experience says a great deal about who hospitals and other facilities value.

    These are only a few of the pressing issues that need to be improved and examined to waylay the oncoming shortage and the danger this presents to the increasingly sick population coming into facilities around the country. Staffing is an issue unto itself and needs extreme measures and policies implemented to ensure patient safety, satisfaction and the care they deserve. Tied to this is nursing satisfaction. Patient safety and satisfaction decrease with decreased nursing satisfaction. Research has noted that patient mortality and morbidity, that is their deaths, increases with nurses unhappy in their situation. Safe staffing ratios can be found throughout nursing studies; many have shown that a nurse with more than two patients in a critical care area compromises patient safety and care, and the nurses on the floor should have no more than four patients to care for and ensure their safety. Some states have even mandated that hospital units advertise their staffing ratios so patients and families know what they are walking into.

    Attitudes are changing; hospitals across the nation are adopting more nurturing and less punitive demeanors. Nevertheless, they seem to have missed the realization that as the nursing shortage continues; the value of a skilled and professional nursing staff that feels appreciated is paramount to the stability of any facility. NURSES will continues to leave this wonderful profession for the same reasons that they have left for the last many decades. NEW NURSES will LEAVE for the same reasons because the issues are not being repaired; the problems with this profession are not being fixed. These newly educated nurses are walking into seriously compromised staffing situations and viewed with many of this younger generation’s work ethic, they will not stay as long as the nurses currently in place.

    More forums need to be in place to allow front-line nurses the chance to help make some changes. This gives the nurses at the bedside the opportunity to voice concerns and if they are wise, they will come with ideas for changes needed, not just the issues themselves but a way to make it better. In addition to the changing views that many facilities are embracing, there needs to be changing views among the nursing-at-the-bedside staff. With professionalism encouraged at every level in facilities, it should no longer be the directors versus those at the bedside; it should be us (being every one of us) for them (being the patients and families that come through the hospitals doors). Through increased education, taking pride in being autonomous, improving the collaborative way in which we practice, taking command of our professionalism, and working hand-in-hand everyday for the betterment of our nursing culture, will we be able to improve nursing satisfaction. With these measures, we can ensure patient safety and satisfaction and decrease patient mortality and morbidity.

    One other issue to be considered in the face of this looming crisis is that nurse’s work in alphabet soup. JCAHO, OSHA, and AHCA are just a few of the alphabets telling us how to do our job and often how wrong we are doing it at varying levels. Where is the alphabet that helps us not work in jeopardy, with unsafe staffing ratios? Where is the alphabet soup FOR nurses? Who ADVOCATES for Nurses?

    Many nurses want to work at facilities that offer all of this and more. Where one can find the time to play with a little girl who is feeling better, or comfort and soothe a dying woman and her family, and when the time comes, one can pull a man out of the claws of the four horsemen’s grasp. It may not be smooth sailing every day, but the face of nursing is changing and attitudes towards nurses need to evolve more. Every patient, family, and staff member should be able to walk into the halls of any facility and know that in this place, someone cares and that someone will be there when needed.