Several weeks ago, I got a call from one of the first new-to-practice nurses I ever trained. She did very well then, and experienced meteoric success in the years that followed. She often attributes (blames!) her success to me but, it’s her talent, drive and compassion that make her who she is! She’s now a clinical director of nursing with responsibilities that include three ICUs and the Emergency Department. The critical care units were placed under her charge a year and a half ago; she’s been the ED director for three years.
We “talk” often, primarily by social media, but catch up on bigger things via phone. The purpose of her call — advice. This isn’t unusual; she often taps into my past experience as a nurse manager and corporate director. Now, though, she’s looking for my current front line experience at the bedside. Specifically, am I satisfied being a bedside nurse? What keeps me coming back to work? What is my relationship like with peers, patients, physicians, bosses etc.?
I say to her, “It sounds like you’ve just gone through a nursing satisfaction survey” and, indeed, she has. She is now left holding the distinction of managing the most dissatisfied nurses amongst her peer group. Her only consolation is that general satisfaction is significantly worse throughout her hospital when compared to the last survey three years ago. As she tells me more, the story sounds familiar; it echoes some of the themes of my post, Why God? — Burnout, Vicarious Trauma and Moral Distress
One thing that confirms my suspicions comes when I ask her about nursing salaries. She says, “That’s the crazy thing! Satisfaction with pay reached an all-time high. It completely contradicts the rest of the survey!” I guess, and she confirms that many of the newer nurses ( <5 years experience) show greater satisfaction than more seasoned nurses. Nurses beyond five years, but less than 12 years experience, are dropping like flies; turnover and sick-time utilization is highest in this group. The mix is 50/50 with those at the upper levels of experience. She approximates that 50% feel the “golden handcuffs” of being stuck in their job — the negatives of starting over at this point is personally too great; they include loss of salary, seniority, influence, etc.. The other half of senior staff remain engaged, interact well with others, take on practice issues and orient new staff.
I respond to her, “You’ve got yourself some cardiac problems. Your nurses have lost their love for nursing!”
“Let’s start with your biggest group”, I say as I “diagnose” her mid-career nurses — they’re like patients with hypertrophic cardiomyopathy — all muscle, no squeeze! Knowledge, experience and time inflow to produce great potential with this group — just like the stretching of the right heart during diastole (preload). The cardiomyopathic heart fails to give to its potential which leads to compromised oxygen delivery, ensuing ischemia and resultant shock. Similarly, failure of nurses to engage in the work at hand (the delivery of effective nursing care) results in professional dissatisfaction, bad patient outcomes and career collapse. Without intervention, whether we’re talking nurses or patients, the end result is death.
I continue with my heart analogy. Her “golden handcuff” group is the one with an outflow problem – they have nothing to give — Diagnosis: dilated cardiomyopathy. They’ve grown larger but not stronger. They’re just kind of blobbing around waiting for the end to come. There’s little to give, not a lot of action and they’re killing everything connected to them.
Her newer to practice nurses also possess potential “cardiac” risk factors despite their seeming good health. I save this group for last because the other two “diseased” groups may be this one’s biggest threat. Why? Because cardiac disease is progressive. Strong, healthy relationships build bonds that create effective teamwork. Likewise with the heart, it is the coordination of electrical and muscular properties that lead to effective cardiovascular function. Atrioventricular dissociation is its opposite — the atria become isolated from the ventricles, which works for a bit, but is ultimately doomed to fail. Nurses “growing up” in hostile work environments don’t fair any better.
My friend likes my take on this but then asks, “What’s the cure”. I, like any good consultant, respond, “That’s the million dollar question!” The problem to a solution is threefold!
- These problems take time to develop and thus, time to fix
- There are options (think medical vs. surgical) to try but sequelae to each.
- Failure to intervene results in greater illness.
So we assessed some of the problems and now planning is the next step in the nursing process! I’ve given her food for thought and make a deal with her to follow-up on next steps. She wants to digest this a bit and agrees to call me back.
And this is where I turn to you, help me help her. I’m a good emergency nurse which means I’m good at figuring out problems — problems I identify thensend out the door for others to fix! Let’s get a dialogue going in the comments section. Please identify your area of practice and years of experience in answering the following questions:
- What are your top three satisfiers/disastisfiers in bedside nursing?
- When it comes to the future of bedside nursing, is the glass half-empty or half-full? Why?
- What relationship would improve your satisfaction if it was most improved? Peer, Patient, Physicians, Boss (or one not listed)?
Answer any or all, I’d love to hear from you!
As always, thanks for reading A Patient Nurse! See you soon in your local Emergency Department!