NPR had an interesting article on how job stress and burnout affects the quality of care provided by caregivers.  Nursing has long been considered one of the most stressful professions, according to a review of research by the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention in 2012. A major reason is cuts in staffing; some California nurses struck last month for a week over low staffing and wages.  A 2007 study in the American Journal of Respiratory and Critical Care Medicine found that 24 percent of ICU nurses and 14 percent of general nurses tested positive for symptoms of post-traumatic stress disorder.

Theresa Brown is a clinical nurse in Pittsburgh who has written two books about what it’s like to be a nurse. She says nurses are often stretched to the limit.  “A friend said when she started working as a nurse, when she would drive, she would vomit on the way in to work just because of the incredible level of stress,” Brown says.  “One of the senior nurses said there is no place we can go to just be alone and be in a quiet room for five or 10 minutes, except for the bathroom … you could have a patient get really really sick, you could have a patient die, and there’s no break,” she says.

 

Linda Aiken says she’s worried that hospitals think of nurses as a cost to be cut and not as a revenue stream. Cynda Rushton, a professor of nursing and bioethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, agrees. “There is a mindset among some administrators that nurses are easily replaceable commodities — a nurse is a nurse is a nurse,” she says.

Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren’t investing enough in their nursing staff.

Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can’t act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.

If the nurse sees that the medicine isn’t working, she could say that she’s assessed the patient’s pain, it’s a 10 out of 10, Rushton says. She could say she’s concerned about the treatment because “in my role as a nurse, one of my primary goals is to relieve my patient’s suffering and I’m not able to do that, so I’d like to talk about how we can figure out a way to more fully address this patient’s pain and their suffering.”

The goal is to help nurses better communicate with other staff members, Rushton says, as well as take care of themselves through mindfulness, reflection and other practices.

Nurses around the world are struggling with how to fulfill their ethical obligations, Rushton says. “In one sense, it could be considered a public health crisis, because if we don’t have sufficient nurses to meet the needs of people in need of health care,” the entire health care system could crumble. “I think that it’s time that nurses are recognized as a scarce resource that needs to be invested in, supported and respected.”

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