An experienced charge nurse reviews staffing for the next shift. She notes that two out of the three nurses coming on have less than a year experience and she is concerned. In addition, the intoxicated patient in 54 is requiring hourly medications and frequent monitoring to avert DT’s (delirium tremors). The charge decides that in order to safely staff the floor she needs four nurses - but the staffing office says they are very sorry (sick call or staffing grid), and she can only have three.
A surgical nurse helps her patient to the bathroom and the patient is weak and unsteady on post op day three from a hip replacement. She foresees the likelihood of this patient falling at home and reports her observations to the physician, recommending that the patient stay another day to gain strength and more physical therapy - but the physician discharges the patient home anyway. He’s being dinged for his length of stay and can’t afford to look like an outlier.
Another nurse notices on the fourth post op day that the patient has not had a bowel movement for four days; but she can’t give Maalox or even a suppository without calling the doctor first. The nurse knows the surgeon is in the operating room and doesn’t want to interrupt. She also knows that the same over the-counter laxative that the doctor would order is currently ten feet away in the medication room.
An undertow is more powerful than a wave. An un-articulated conflict is much more damaging to our esteem than an obvious one. I could just as easily list scenarios where the nurses’ high level critical thinking, skill, autonomy and experience improved patient care. But the reason for discussing these situations is to raise awareness of their presence so that the effect can be mitigated. What effect?
Ambiguity increases self-doubt which in turn decreases self esteem; reinforcing nurses’ feelings of powerlessness. Raising awareness of these internal role conflicts however, allows us to intervene and change course. Many nurses take the above situations as ‘part of the job’, and fail to see how these daily conundrums insidiously chip away at their sense of self. But if we can identify and talk about the undertow that pulls us down, we can chart a different course.
To read the full article, click here The Undertow of Nursing: Charting a New Course.
Juice has partnered with Kathleen Bartholomew to create a two-part CD/DVD series that addresses the problem of nurse-to-nurse hostility and aims to provide the tools to end it. www.juicehealthcare.com.
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