nursing – Sheila Dougal

From a hospital nurse: We need to treat the community like a hospital right now

woman in black coat and face standing on street — Photo by Gustavo Fring on Pexels.com

I don’t work in a Covid unit. I don’t have to wear an N-95 mask all day. But I do work in a hospital full of very sick people with rapidly increasing numbers of people with Covid 19.

This month a friend, and church member died from Covid 19.

At the hospital my nurse friends cry, take deep breaths, pray and go to work in a building full of men and women sick enough to be hospitalized with this virus. They perform high-risk treatments and provide personal care, putting themselves and their families at risk.

Nurses know how to minimize transmission of contagious disease. Preventing the spread of disease is a key pillar of our profession. We know that we don’t have to know exactly how coronavirus spreads and how long the incubation period is to enact practices for preventing the spread of this disease or any virus. Hospital nurses work in a world with contagious disease everywhere. And this hospital nurse has a message: Right now we all need to treat the world like a hospital.

In the hospital there are very sick people with Covid as well as people with strokes, heart attacks, injuries from trauma and more. Nurses, aides, housekeepers, doctors, respiratory therapists, imaging techs and all the above sick and injured people are in the same building. In the hospital we’re caring for patients, having meetings, making schedules, eating lunch, going to to the bathroom, etc. Life and death and the effort to push back death in the hospital carries on. How does it carry on?

We wash our hands, wear masks, distance ourselves, and then wash our hands again and again and again.

We do what we have to do to keep each other and our patients from getting sick with something we don’t see or feel but could be passing to someone else.

We were doing this before COVID and we’ll be doing it after.

This is how we must behave in the world right now. This is why we need to wear masks, and wash our hands frequently and keep our distance from others. When we go to Walmart or to church services. When we fill our cars with gas or visit a friend. This is how we must go about our business. This is how we must live in our communities with Covid 19.

It’s not easy, fun or fair. But it’s the best way we know to push back death and disease and care for one another.

Bedside nurse

(Image Credit)

It’s a small army I see
two or three days a week.

While it’s dark and cold
we march in uniform,
feet shod with shoes ready
to keep a steady
clip for the next thirteen hours.

The building we raid looms tall and overwhelming,
pregnant with arrhythmias
calls for help to the bathroom
bowel and bladder accidents
vomitting
fevers
complaints
pain
hope
joy
fears
laughter
tears.

But in we march
giving away our days to
the drug addict
the laboring woman
the feverish child
the suicidal man
the fractured old lady
the hemiparetic senior
the wounded, retired warrior.

Nursing : A ministry of dignity

(image credit)

I’m up late. Tomorrow I’ll start working night shifts at the hospital where I work as an Acute Rehabilitation nurse. It’s just temporary through the end of the year when I’ll complete my BSN… finally ( it only took 18 years).

I’m up late doing research for my Capstone project. It’s about how the nurses at my hospital can implement change to prevent our often elderly patients from acquiring pressure injuries (A.K.A. bedsores). And all this research has me thinking about what motivates nurses and how much healthcare in the U.S. depends on nurses.

Nursing is not a lesser version of practicing medicine. It’s a way of honoring the dignity and worth of another human being through giving wholistic care, instruction and resources for the person’s good. But so often, especially bedside nurses, loose sight of what it is they do, or rather they’re disillusioned by what they do.

The pressure on bedside nurses from hospital managers and administrators is to perform complex, fast-paced deliver of tasks and medications and education… endless requirements all documented to a T in 12 hours. The pressure from the bed (patients and family members) is often (not always- there are many thankful and inspiring people in those beds) to provide 5 star resort pampering. The pressure from our peers is often to act like we have it all together, like we don’t need help, like we can do anything. And all this pressure has many nurses loosing sight of what’s really important: human dignity. Our own, and our patients’.

This is where, for me, being a Christian nurse is so freeing. The yoke of hospital nursing in America is heavy, but Jesus’ yoke is light.

I don’t have to please the system, or please the patient even, I have to honor the Imago Dei in every one of my patients. When I make human dignity the aim of my nursing care, all the rules and regs and complaints fall like broken chains.

There is a healthcare crisis in the U.S. The fastest growing portion of the population are over 65 and many don’t have the resources or support to get the care needed to live and die with dignity. There is a shortage of nurses in the U.S. and many are part of that fast-growing retirement age. Chronic disease plagues half of our populous and many don’t get the treatments, medications, appointments and care they need. Center for Medicaid Services has lists and codes and rules that make navigating the healthcare system a daunting task. Amidst the dark maze of U.S. healthcare, nurses who value human dignity are respites of light.

Dear nurse, I know you feel overwhelmed. I do too. But stop and remind yourself, you’re a nurse. Not a doctor. Not a medication-technician. And you’re not a slave to the hospital or healthcare company you work for. You’re a nurse. A minister of help, hope and heart. You are a minister of dignity. Our healthcare system is a mess, but that person in that bed, no matter how nice or how cranky, how dependent on drugs or how debilitated with cancer, is a person made in the image of God. And like Daniel Darling wrote referencing his surprising response to Horton Hears a Who:

‘Yes,’ I thought, “every person really is a… person, no matter what their usefulness to society, no matter how seemingly insignificant they are, no matter what their stature.”
A person’s a person. What a thought for our strange and confused age. – Daniel Darling, The Dignity Revolution. p.14

I’m not a medication technician. I’m a nurse.

I met him at the time clock.

“How are you?”

“Great, now.” He smiled reaching for the barcode side of his badge to swipe out.

It was the end of our shifts. He worked the observation unit where patients stay in the hospital for less than 24 hours. He admitted 4, discharged 4, so had a total of 12 patients that shift. “Not that bad actually…” he reasoned. Usually it was more like 16 or 18 patients a shift with the rapid turnover, or thoroughput as the hospital administrators like to call it.

We walked into the elevator together lamenting the fact that we have degrees in nursing-which is a theory of practicing healthcare that is born out of service and caring for the whole person- but we are defacto medication technicians.

We pass meds, answer call lights, document idividualized plans of care, Braden scores, BMAT’s, NIH scales, head to toe physical assesments (that we’re basically filling in the blanks for cause we literally had 55 seconds in the room before being called out to talk to Dr. So and So), intake and output, vital signs (because we’re short on nursing assistants), Functional Independence Measurement scores (in perfect detail after noon and before the end of the shift because Medicare thinks we’re forecasting care if we capture it in a chart before noon. Newsflash Medicare: WE ARE FORECASTING. IT’S THE ONLY WAY THIS REQUIREMENT WILL GET DONE)… I could go on and on. But all the time we spend with our patients is mostly given to documentation and passing meds…. we barely get time to squeeze in a really good asessment, much less time to educate our patients, listen to them, and collaborate with others for their good.

We’re nurses, not medication aides. But at the end of a 12 hour shift of being interrupted every 55 seconds we cling to making sure our patients all got their medications and all the required charting is done as the evidence that we did something meaningful all day. And we hate it. We don’t want to just pass meds and chart. We want to nurse.

Nursing is not an assistant to practicing medicine. Nursing is a way of practicing healthcare. It’s wholistic. It listens. It touches. It serves. It cares. It instructs. It encourages. It finds resources. It researches. It collaborates. It leads. It values the image of God in people.

The healthcare delivery system in America, especially in hospitals, lays a heavy burden on nurses’ shoulders. But if we can see the value of what we’re doing and go to the person in that bed in need of a person to help them get better and go home, or die with dignity, we’ll drop the baggage of the U.S. healthcare system and become lightbearers.

At the end of a long day spent, I pray I can say my focus was the person, not the system.

I’m not a medication technician. I’m a nurse.

A PSA from a short-of-breath nurse: Don’t go to the hospital to get pampered.

(Image credit here)

Amidst the cacauphony of I.V. alarms, bed alarms, chair alarms, call bells, overhead pages for code blue, code purple, stroke alert, ringing phones and the chatter of nurses, nurse’s aids, doctors, therapists and social workers, a nephrologist walks up behind me at the nurse’s station where I’m trying to get a handle on my patients’ (all 6 of them) history, medications, lab results and scheduled tests for the day as well as doing my required log-on charting. (Deep breath… that was a long sentence and that’s usually how I feel about 5 minutes into my shift at work. Deep breath Sheila, deep breath).

The nephrologist asks a question aimed into the general vacinity of the nurse cluster.

“Who’s the nurse for room 22?”

Her question is nearly drowned out by the noise, but since I’m inches from her I stop what I’m doing, look at the nurse assignment in my hand, look up at the doctor and tell her the name of the nurse. No one knows where 22’s nurse is, so I call her on vocera. She answers. She’s in a patient’s room doing a dressing change, can I take a message, she asks. I turn to the nephrologist, who heard the radio conversation, and she says, “That’s fine, just tell her I started her patient on lasix and ordered some labs for the morning. Her blood pressure is ok, but she is very edematous. Please be sure to get an accurate weight on the chart.” And then she grabs her bag, and swiftly walks away, white coat flapping at her pace.

This little vignette, which took me a few minutes to write occurs non-stop for 12 hours on most hospital units. The fast-paced, noisy, environment that presents demands from signs, alarms, questions, comments, phone calls and call bells are all aimed at one person: the nurse.

I always say nurses are the filter for everything that reaches the patient in the hospital. And whatever the patient wants to reach in the hosptial, has to also go through the nurse. The fact that nurse’s are interrupted every 55 seconds by issues that require their attention, even if only for the time it takes to delegate that interruption to someone else, is nevertheless problematic where nurses are pushed to fetch high patient satisfaction scores.

I’ve been a nurse for almost 18 years and over the years the increasing demand to bring in these high patient satisfaction scores has largely been directed, you guessed it, at nurses. The reason is because the nurse is the filter. And there’s nothing wrong with being the filter. Nor is there anything wrong with wanting a patient to be satisfied with their experience at a hospital. But I take issue with the goal being patient satisfaction and not patient safety.

When nurse’s are pressured to be sure they deliver thorough assessments of their patients, detailed, accurate charting, and be the filter through which all things in the hosptial go to reach a patient, with the goal being a “happy costumer” and not a well-informed, well-cared for, safe patient, nursing becomes a juggling act with a fake clown smile. And it shouldn’t be.

Without fail, every shift I work I hear complaints from my patients, not about the poor assessment or education their nurse gave them. Not about the lack of kindness. But about the missing mayo on their lunch tray. That it’s noon and no one pulled the shades up. That they pushed their button 3 minutes ago and no one came to pick up their dinner tray. There’s an attitude of entitlement amongst many of the patients I work with and in part I think it’s due to a lack of understanding about what nurse’s do and what the hosptial and healthcare system is for. I think there’s a misconception perpetuated by hosptial advertisements that make people think when they go to the hospital they’re going to a 5 star resort. But it’s a hosptial, where people are really, really sick! And people, not robots, are taking care all those sick people.

Deep breath Sheila, deep breath.

I am a Christian. I believe deeply that loving my neighbor well, including my patients at work, is evidence that Christ is real and lives in me. I believe serving others opens the door for testimony of the good news of Christ. I’m all about loving people well. But catering to people’s desire to be pampered should in no way be part of what people expect when they seek healthcare or go to a hospital. There’s a distinct difference between love and pampering.

There’s a healthcare crisis in America. We are getting older, we are obese, have diabetes and are chronically ill. According to the CDC 1 in 4 adults in the U.S. has two or more chronic diseases. Heart disease, cancer, stroke, diabetes, chronic lung disease, alzhiemers, and chronic kidney disease are what many of us in the hospital have two or more of. And many of these are preventable. But there’s an attitude I’ve been sensing over the past couple years among my patients that concerns me. There’s an expectation to be pampered by the healthcare system and a lack of ownership for our choices. There’s a lack of willingness to learn or change. And there’s a lot of pressure on nurses to make us happy.

As a mom, I feel like this is antithetical to what it means to care for another person in love. Love does not rejoice in evil. It does not coddle. It does not pamper. It does not tell you what you want to hear when you have diabetes, heart disease, an infection and want the nurse to make you happy by bringing you extra ice cream.

I am not saying we should be rude nurse crachets to our patients. I’m saying we need to enter the healthcare system as patients being our own best advocates. We need to want to make changes in our lives so that we can be healthier. We need to want to know what medications we’re taking and ask questions. We need to learn about our diseases and how best to control them.

So in summary, as a PSA, from a nurse who very much wants you to be happy, in the long run, and healthy as you can be, please take ownership of your health. And if you enter the hospital, please go there to get better and get home. Don’t go there to get pampered.

*P.S. This post is not talking to people who can’t even access healthcare. That’s a whole other PSA aimed at Christian doctors and nurses and people in positions of power and it goes something like this: Taking basic care of our neighbor’s human body is the right and dignified thing to do. Stay tuned…

Will Christian nurses lead the way in providing healthcare for the marginalized?

In the days of the Norwegian awakening in 1850, the revival of faith in Christ among Christians sparked a birth of an order of service to the sick and poor. The Kaiserswerth deaconesses began serving their communities as trained nurses out of a renewed joy of their salvation in Jesus. Their renewed fervor for Christ effected their involvement in their meeting the needs of those on the margins in their society (Shelley and Miller. 2006). That’s what happens when your heart is ablaze with hope and love from the Spirit of Christ. It’s always been that way for Christians.

Paul, in the Bible, was urged by the apostles, when he was new to the faith to, “remember the poor,” and be generous in helping meet their needs.

Tertullian spoke of the reputation of early Christians when he said, “It is our care of the helpless, our practice of loving-kindness that brands us in the eyes of many of our opponents. “Only look,” they say, “how they love one another! Look how they are prepared to die for one another.” (Shelley and Miller, 2006)

Ancient historian Eusebius of Caesarea wrote, “The Christians were the only people who amid such terrible ills, showed their fellow-feelings and humanity by their actions. Day by day some would busy themselves by attending to the dead and burying them; others gathered in one spot all who were afﬂicted by hunger throughout the whole city and give them bread.” (Shelley and Miller, 2006)

As Shelley and Miller point out in their book, there’s a distinct way nursing, apart from other healthcare professions, displays Christlikeness. That distinct characteristic is hands-on service of others. Not that doctors, PA’s, therapists and assistants don’t give hands-on service, but nursing, of all those professions is an army of people who provide hands-on, bedside service 24 hours a day, 7 days a week to the ill and injured.

It being national nurse’s week, I thought it a good time to think out loud (post a blog) about what I am asking God might be the role of nurses in the U.S. burdened healthcare system. And I’m thinking from a Christian perspective.

I know the push nationally and politically is for nurses to become the primary providers of healthcare in the U.S. It’s less expensive and there are more of us to meet the needs of our aging population. But as a Christian, I see those the healthcare system, even if driven by nurses, won’t care for. Like the deaconesses of the 1850’s I see the marginalized in our society and I wonder, “What’s my role? How can I just ignore this need?” And it’s an enormous need!

The elderly, disabled, orphaned, medically fragile, mentally ill, homeless, poor and ethnic minority population in our country is no small margin of folks. The elderly alone make up the greatest and fastest growing portion of our population. The U.S. healthcare system can’t and won’t be able to meet the needs of so many of these people. People, made in the image of God.

I wonder if God would raise up an American army of nursing deaconesses in his church who would give freely in our communities the provision of hands-on service to those who will never be able to pay for our services. I wonder if we would cleansing wounds, change diapers, give medications, assist in ambulation, relieve pain, provide resources, and speak the gospel into the lives of those our healthcare system will never be able to care for.

Jesus calls those who follow him to serve and love like he does. In fact, it is he who works in us Christians to will and act the way he does. Christian nurses have a great opportunity ahead of us in the U.S. If we will follow Jesus, surely we will be driven by our Servant-King’s love to give to those who can’t give back and to lay our lives down for those Jesus would redeem.

But whoever would be great among you must be your servant, and whoever would be first among you must be your slave, even as the Son of Man came not to be served but to serve, and to give his life as a ransom for many.

Matthew 20:26-28

Nursing service has to be driven by love or it’ll burnout

(Image from Nursing Times)

There’s a tension between the idea of nurses being professionals who are above the tasks of caring for a person and the idea of nurses, from their Christian roots, being called to serve the poor and most in need. As I’m reading Called to Care- A Christian Worldview for Nursing, I’m faced with this tension. I do believe as a Christian nurse, my calling to serve my patients is born out of Christ’s example. I’m compelled by Christ’s servant-leadership to lay down my life for my patients. That may mean taking a minute or two to rub lotion on old, cracked feet. It may mean singing Amazing Grace with a confused elderly woman to help her relax. It may mean bringing coffee and a magazine to a man grieving the loss of his wife and his own recent stroke. None of these things require a nursing degree. But as a Christian, these things are the evidences of my love for God and people born out of Christ’s love for me.

In reading Called to Care, my thinking is starting to clear about what’s been troubling me so much about nursing this last year or two. It’s the tension between the call to be professional from the world’s perspective, and the called to be a servant from Jesus’ perspective.

I do believe that the demand for nurses to be highly educated professionals who fetch high patient satisfaction scores for their facilities, are customer obsessed, highly skilled in the complex care of their patients, who document to the satisfaction of CMS and the Joint Commission stands as sort of a siren’s call to detour nurses from their calling and only ends in burned-out nurses who quit or move to less patient-care roles in nursing. If our goal as nurses is to meet the demands of all the powers that be we’ll loose sight of the calling of nursing to care for people. That doesn’t mean we wouldn’t or shouldn’t get degrees, or serve our patients in a respectful, winsome manner, or be highly skilled. It just means we don’t put the cart before the horse. The service oriented nature of the calling of nursing has to be driven by the powerful motivator of Christ’s love which serves others for their own good and God’s glory. If it’s driven by demands of various other authorities it will avoid patient care or burn out doing patient care.

The unique aspect of nursing in healthcare is the hands-on, bedside care of a person in need. Nurses cannot eliminate the care of people from what they do in nursing. Nurses are concerned with the whole person, not just the part of the person that is sick or injured. Sitting with a man who lost his wife and had a stroke in the same week to listen to his memory of playing basketball in college is just as much a part of nursing as pushing IV antibiotics. It doesn’t require a nursing degree to sit with the man, but sitting with the man is a degree of delivering true nursing care.

This kind of attentiveness to the whole person when you’re caring for 5-7 patients with complex medical conditions and multiple interventions in the hospital setting is a rare soothing balm on the sore of rushed professional nurses. Without a heart motivated to attend wholly to a person’s needs based on love the nurse who seeks to deliver such rare treatments of attentiveness will feel the crushing weight of seeking to please administration and customers and give up.

As a Christian I am compelled by the love of Christ to minister to the needs of people around me in his name. And it’s that love, the love of Christ, that keeps my flame burning and me from burning out.

Nurses, we are our patients

Friday the 13th I became a patient at the hospital where I work. I had a robotic total hysterectomy with salpingectomy and cystoscopy. After years of battling endometriosis, and recently bleeding, pain and fibroid issues I decided it was time for the worn out organ to go.

Being on the other side of the patient/nurse relationship is strange. I joked on social media that I felt like a spy. I did, but not with intentions of busting anyone. Just more like an undercover agent gathering intel. I noticed some things I’ll take with me with when I go back to work. The main thing I noticed was the obvious: I was the patient, someone else was my nurse. I bring this up because when you’re the nurse, it’s easy to distance yourself from the patient and when you have to be the patient you get a reminder of how human we all are. Nurses, we are our patients. Our bodies get diseases and we have surgeries, we need medical care. We don’t seek out medical care as much as non-nurses. We tend to care for our own needs and avoid being the patient.

There are many problems in healthcare and nurses feel the weight of those problems. But what motivates us to do the difficult work we do is a genuine care and concern for the health and well-being of people. And those people include us. Nurses, we need to take care of our bodies, because our bodies are the ones caring for other bodies. And we need to embrace, encourage, guide and teach new nurses, because they are taking care of us!

When I was admitted to pre-op on Friday a PCA, new to pre-op checked me in, gave me a warm, anti-microbial sponge bath, and then she realized I didn’t have an armband on. She ran to the desk to print one, verified my name and date of birth and put it on… inside out. She apologized, I assured her it was no big deal. She fixed it and we went on to verifying what I was having done, applying my SCD’s (which by the way I love, and want to own… it’s like a leg massage while you sleep!). Then the overhead announcement came that the hospital is in “downtime”, which means the computers don’t work and you’ll have to document everything on paper. The nurse and PCA bemoaned the fact that this was going to mess their day up, and rushed to print labels so they could draw my blood before the printer stopped working.

In the midst of the nurse and PCA discussing the trouble with their downtime situation, the anesthesiologist popped his head in from behind the curtain, said he’d be doing my anesthesia, had to go to another case first but would be back. He’s the one I was praying for. If the anesthesiologist doesn’t get it right, things go bad fast.

Once the IV was in and the labels were printed and the circulating nurse for the operating room spoke with me, verifying all my important information, the gynecologist doing my hysterectomy came in and sat down on my bed, put her hand on my leg and assured me of what was going to happen and how long and such. My husband left my side with a kiss on the forehead and versed being pushed into my veins. I remember the O.R. Getting on the table, a mask on my face, hearing the voice of my doctor and nurse telling me to go to the beach for awhile. And the next thing I knew I was shivering, moaning and hurting in the recovery room.

In the recovery room for 4 hours, waiting for a bed to open up in the hospital for me, I was in and out of shivering episodes, and drugged sleep. Somewhere in there my doctor talked to me about the surgery… I vaguely remember images on a paper and the word endometriosis.

When I got to my room on the postpartum unit, the pain, shivering and nausea had taken over. Between dry heaves, my nurse asked me the admission profile questions, the lab came in to draw my blood, the CNA took my vital signs, two nurses came to check out my skin and look at my incision sites and noticed that my left hand was very swollen- my IV had infiltrated. And then I had to pee. That didn’t go so good. In fact it didn’t go at all. The nurse called my physician, attempted to drain my bladder with a straight cath (attempted, is the key word here… 3 times to be exact). For the next two hours I tried to breath, reposition myself in some tollerable position in that bed with those flat, plastic pillows and text family members and friends who were wondering how I was. The nurse tried a couple times to start an IV with no success, so the house supervisor came to my rescue with one swift poke to my left bicep. By 9 pm, I was throwing up, still couldn’t pee, three more attempts later, a congregant of nurses had a successfully placed a foley catheter so my bladder could empty. The last time I had that many nurse looking at that part of my body I was having a baby. Humbled, medicated, poked everywhere I could be, I hunkered in the fetal position and prayed for gas to pass, urine to flow and my pain to back off enough that I could sleep a few hours. I got two.

At 6 am, when the Foley catheter came out and the male student nurse came in with his preceptor, the countdown began: When I could pee, eat without puking and walk down the hall I could go home. By noon I had accomplished all three. The discharging nurse reviewed my medications, discharge instructions and precautions with me and my husband wheeled me to the car.

Things have improved tremendously in the past 24 hours. And I’ve been thinking a lot about how nursing is caring for other people. People like me. I’ve run across patients in the hospital who seem to forget their doctor’s and nurse’s are people just like them. They get sick, have headaches, fight diabetes, high blood pressure, endometriosis, cancer, have surgery. They don’t know all the answers. But they are in the position of doctor and nurse to help the person in the bed get to a place where they can go home and feel better. Nurse’s we need to remember our patients are people just like us. Patient’s your nurse is a person just like you. We all have needs at times that require the help of others. The nurses and doctors who cared for me weren’t perfect, but they were caring and did what they could to help me. And I’m so thankful! I needed their help.

When I go back to work in a few weeks I’ll be the nurse not the patient, but being the patient this past week has given me a more relaxed view of what I do. In all the pressure to perform it’s so important to give each other the grace, forgiveness and accountability imperfect people need. Patient’s need our help. And nurses are not perfect. But what we do for our fellow man to help them gain strength, function, dignity… it’s very God honoring. We nurses care for people made in the image of God. And sometimes we’re the people being cared for.

Burning out nurses are a seismographic reading of the coming tsunami in healthcare

It’s a buzz I hear every shift I work, “The hospital is short nurses and aides…” The tension on the unit is thick. Will there be enough nurses? Will I have to take more than 6 patients? Will I only have 1 CNA for my unit of 25 patients? Will I be asked to check my email, fix a missing code status, remove equipment from the hallways, be reminded to not violate HIPPA by leaving my notes at the nurse’s station face up? Will I be asked to be the team lead with a full load of patients, do an inservice on the unit, not leave the patient’s in the bathroom alone, make sure all my patients are happy, document the fall risk score in two different places now because the IT people changed the process again? I really could go on and on here. The tension and dissatisfaction of nurses who are working in stressful conditions already in burnout mode is at a fever pitch.

Currently working on my BSN, taking my evidence based practice class I’ve been asked to identify a practice problem in nursing and research for evidence that could help in changing practice for better patient outcomes. As I’m trying to narrow down my research, I feel like I’ve been asked to pick one problem out of a tumultuous, angry sea of problems. The problems in nursing are many. They point to greater problems in healthcare in general in the U.S. Like a seismograph is predicts earthquakes, the sense of impending doom amongst nurses in the U.S. is telling us that a tsunami of trouble is coming in healthcare. In fact we are already seeing it’s threatening waves.

With the mass of baby boomers in the U.S. who are elderly, have chronic disease and need ongoing healthcare, the health system in the U.S. doesn’t have enough nurses to provide the care this 50 million and growing population needs. Complications related to diabetes, heart disease, stroke and fall-related injuries lead to our hospitals being filled with elderly patients who often end up with hospital acquired infections and injuries . These infections and injuries are often traced to the lack of nurses.

Caring for our aging population in the hospital are nurses under the pressures of healthcare administration to fetch high patient satisfaction scores, prevent adverse patient outcomes, document every single interaction, intervention, assessment, plan, education (and more) of every patient he/she cares for, be highly educated, engaged, enthusiastic and all without the adequate staff, technology and resources they need in a busy 12 hour shift. We’re tired.

I know for me, I go to work every day praying that God will give me the wisdom and strength to care for my patients. I keep that my priority my entire shift. But throughout my shift, while my eyes are fixed on the prize of helping my patients heal and get out of the hospital better than when they came in, or die with dignity while they’re there, I’m being bombarded with complaints from patients who got oatmeal instead of cream of wheat and motions from family members who see me walking at a fast clip down the hall to retrieve a warm blanket for a cold patient and want me to come into their dad’s room cause he wants to go to the bathroom. I’m constantly being bombarded with a cacophony of call lights, vocera messages that there’s a doctor on the phone who wants to speak with me, written reminders at my computer from my manager to fix charting that was omitted from the previous shift, emails from IT, administrators, food services, the wound nurse, the fall prevention team, the engagement team, the joint leadership team… all wanting a piece of my attention and time.

If you’re a patient in the U.S. healthcare system, do as much as you can to advocate for yourself and your loved ones. Care for people around you- neighbors, friends. And if you’re in the hospital, pray for your nurse.

Nurses, we have to keep our focus on the what’s important. The system is in turmoil. A tsunami of patients with acute on chronic needs is coming our way, yes is already here. Let’s see the image of God in them, care for them with dignity and let all the attempts to put bandaids on the hemorrhage in our healthcare system not sway us from standing for what’s best for our health and the health of our patients. Sometimes that’s going to mean going to work praying, listening to an old lady tell you about her deceased husband, teaching a bilateral amputee how to slide on a board from his bed to his wheelchair, helping your fellow nurses and aides to help your incontinent, immobile patients get repositioned in bed so they don’t get a new pressure sore, and then after 13 long hours of a 12 hour shift walking back to your car praying for wisdom and strength to do it all over again the next day.

Nursing: a degree that honors the profession is not the evidence of competence

(A Red Cross nurse in France)

Today is the last day of my second week in the BSN online program at GCU. Tonight after 14 hours at work I submitted the first collegiate paper I’ve written in 17 years. The assignment: A formal 750-1000 word paper discussing the difference in competency between the associates prepared nurse and the baccalaureate prepared nurse, as well as identifying a patient care situation where approaches to nursing care or decision making might differ in having a BSN versus a diploma or associates degree in nursing. In my initial attempt I wrote 500 words without thinking twice and found all I had was an impassioned argument for why the RN, BSN isn’t any more competent than the RN, ADN. It hit a nerve. But what developed I think was a pretty well thought out paper which addressed the subject matter the instructor wanted while pointing out that the perspective taken in writing this paper all depends on how you view competency. The main difference in competency is not clinical skills for bedside nursing. The main difference is competency in being seen as a professional amongst other health care professionals, and in honoring the leading role nursing is in health care with a degree which is fitting. Nurses with BSN degrees can move into leadership positions and be seen by their cohorts as professionals. Nurses with BSN degrees raise the bar for how nursing is viewed.

Nursing has evolved over it history from a job seen only fitting for, “an ignorant woman, who was not fit for anything else,” (Draper, 1893/1949) where nurses blindly obeyed doctors orders without questions. Nurses in American history strove to get nursing to be seen as a profession with a unique perspective on health care. And they weren’t wrong to strive for that. Nursing is a profession. It isn’t mindless task work. Nurses today have to manage the health care of acutely complexly ill patients while collaborating with doctors, therapists, and other health care professionals. The truth is nurses are professional health care providers. But that truth is being pushed to light in a system that is still trying to work in the dark with nurses as medicine delivery technicians. Nurse’s are expected to have the knowledge of their professional cohorts while working in environments that continue to expect timed tasked work. Other health care professionals in the health care system aren’t expected to answer call-lights, take patent’s trays, empty trays, pass medications, take vital signs, answer phones, call referrals, enter orders into computer system, clean their own equipment, file repair reports, make beds, move beds, order patent’s meals, draw labs, draw blood, communicate with pharmacy, IT, management, CNA’s, family members, case managers, cafeteria staff, PPS coordinators, doctors, nurse practitioners, PA’s, patients, maintenance, housekeeping, central supply, linen services, etc. Nurse’s are expected to do all that, plus do extensive documentation and assess, plan, coordinate and carryout a plan of care for their patients as well as educate their patients and the families all in a 12 hour shift.

If the system is going to push nursing to be seen as the profession it is, as equals among health care professionals, the system has to stop treating nurses like waitresses.

The truth is nursing is a service-oriented profession. Good nurse’s will always do the “dirty work”of lowering themselves to help someone else. That is not beneath the profession of nursing. But the pressure to do more tasks in a 12 hour period as well as the pressure to be seen as a professional by getting a higher degree are pressing hard on nurses so that the ones who do get higher degrees are moving away from bedside nursing beyond their first year as nurses.

The work of a nurse historically is honorable, no matter what society thought of them. Whether doctor’s respected nurse’s or bullied them, nurses have been advocates of health and people in need of health care for centuries. The work of practical nursing does not require a bachelor’s degree. And that does not mean nursing is a job vs. a profession. But nurses do have a unique way of approaching health care that is distinct from doctors. Doctors treat disease. Nurses approach people wholistically for their health and well being. Nurses should be seen as health care professionals. And I’m glad to honor the profession of nursing with a fitting degree. I just wish the system would honor the profession of nursing not just with pressure to attain a higher degree, but with a role in health care (I’m especially thinking of acute health care, a.k.a. the hospital) that honors the profession.

At work today I parked a patient with severe brain injury next to me at the nurse’s station for his safety and my convenience. I had about four hours of charting to do and he couldn’t communicate or control his body safely with attached tubes and lines. As I assessed his needs through facial expressions, the way he held a pencil and the tears welling up in his eyes while he squeezed my arm and pointed to the coffee cup he couldn’t drink out of, I decided he was communicating his despair. I put my hand on his back and gently scratched while assuring him he was in a good place and we were going to do all we could to help him get better. He arched his back and made an expression of relief, enjoying the back rub. A lot of problems get solved with a back rub (and a cup of coffee if the patient can have it). It doesn’t take a BSN to make an aphasic man feel comforted. But it does take the kind of compassion that rubs a back to make a professional nurse.