Nurses Week Takeaways from DC Part II: Spoken Words

Happy Nurses' Week. Here are some takeaways from my speech in order of appearance. Some of you might not like what I have to say, but I'm speaking my mind.

"I want you to go back to where you came from and convince at least one of your colleagues to get off their butt and do something about safe staffing- grow a pair, say something, step out of their comfort zone and take a risk."

I don't know about you, but one of things I find absolutely maddening and frustrating is the deferential nature of so many nurses when it comes to speaking up to management. For people who can be fierce advocates for their patients, and some of whom are willing to stick a knife in their own colleagues' backs, when it comes to speaking out about things in the workplace, they run and hide under a table and pee on the rug.

And then they sit behind the nurses station when the manager disappears and bitch about it among themselves in whispers. Pathetic.

"Then…I challenge each of you to have three conversations this year, out of your comfort zone. I want you to talk with that nurse colleague, and a physician, and with someone in administration, preferably an executive. I want you to find common ground with them as a human being and have a conversation. Break the ice by asking them, what is the most difficult part of your job… Let them know you’re interested in what they have to say. And then… creatively propose a way to start solving the problem of safe staffing. Together. Follow through. Commit."

We need to start talking with people, to get out of our everyday routine and realize that unless we start to take steps to change our situation, we won't ever make things better. Don't expect things to happen overnight. The point is, all of us, taking little steps as individuals, can create a powerful force. If you're too scared to have these conversations alone, find a teammate to go with you and back you up.

Don't be intimidated by executives. Just because they wear suits and make lots of money does not mean they have some kind of magic powers. Remember that inside that suit is a human being who could just as easily put on a pair of scrubs. Not that they would have a clue what to do next, but the point is, they are people. If you can relate to them as another human being and not some unapproachable authority figure, you'll have a much more relaxed conversation.

Sometimes physicians can be rushed, abrasive or unapproachable. They are always short on time because they are just as swamped with their patient load as we are. But by refusing to take time to interact within the greater community of healthcare, they are missing out too. They isolate themselves and this is not a good thing. I talk extensively about this in my book, Navigating the C. Physicians need to make themselves available and approachable by taking steps to take control of their own working conditions.

"When we have those conversations, there are a few points I want you to take away, remember, and use."

1. "There is a difference between safe staffing to avoid sentinel events and staffing that is adequate to improve a patient’s health after being hospitalized or being treated in a healthcare facility."

When you look at healthcare like any other business, the whole idea is to make money. But we're not just providing gadgets made on an assembly line. People and illnesses are unpredictable, they don't act in a linear, measured way. You can't set safety standards to cover all possible scenarios. There has to be some human judgement involved. It's not a factory setting.

Maybe with one nurse to 6 patients nobody dies on a given shift, but did every one of those 6 patients get their medicine on time? IV tubing changed? Dressings changed? Blood glucose checked on time? Call lights answered? Education completed with time to ask questions including on the day of discharge? Linens changed? Ambulation (walking) around the unit? Baths? Trips to the bathroom if an escort was needed? Did the nurse get all of the charting done and check all the orders within the limits of that 12 hour shift? Report given to oncoming shift without any omissions?

2. "Today’s nursing jobs are not the equivalent of a regular desk job. They shouldn’t be compensated like a desk job. Hour for hour, we put in a lot more work and have a lot more responsibility than your average paper pusher. It beats us up, physically, emotionally, spiritually. 36 ≠ 40! Think about that."

I know a lot of nurses (and laypeople too) think that working three 12 hour shifts a week is great because you get four days off, but you pay a price for that. How do you feel that first day off? Are you just as perky and productive, ready to jump out of bed and take on the day with full energy? Maybe if you're 23 and just out of school, but the longer you work and the older you get, the less resilient your body is going to be. It takes a day or two to recover your energy after working those back to back long shifts.

A 12 hour shift is never just 12 hours. Most nurses don't get paid breaks so they are scheduled for 12.5 hours- usually something like 7 am to 7:30 pm, or 7 pm to 7:30 am. Whether they took that break or not, and it's usually not. Add any time it takes to drive to and from work, find a place to park, walk into the building, get ready for report. For most nurses it's a good 14+ hour day. That leaves little time between shifts for basic self-care- like enough sleep, time to prepare and cook a healthy meal, spend time with your family, take care of pets, doing chores around the house that can't be put off, and so on.

Nurses might be considered full time at 36 hours a week, but they don't get paid any more for the hazards they endure, they don't always get ample vacation time, almost never get sick leave that isn't coming out of their vacation time, they never get compensated for missing lunch, they get in trouble for working unapproved overtime even though they can't finish all the documentation of their day within that 12 hour time frame because they were busy taking care of everything that came up around their patients' needs all day. Some nurses who are represented by unions might get some of these perks, but in most states, especially those deep red, "right-to-work" states, they don't get any extras.

During those long shifts nurses get progressively more tired, they get hungry, they aren't quite as focused and sharp at the end of a shift as they were at the beginning, or at the end of a run of 3 long days. They have to be on the lookout for physical hazards to patients, signs of a patient's conditioning worsening or deteriorating, making sure medication doses they give are correct, checking over the doctor's list of orders to make sure those are correct, tracking down physicians and ancillary staff, taking phone calls, interacting with family members, and things that happen without regard for a nurse's physical needs for food, bathroom, having a moment to clear their mind and think, or even getting off their feet to sit down for a moment.

And did I mention, responsible for the patient's life?

I think nurses should get paid a full-time, fully benefitted comfortable living wage for doing something on the order of three 8-10 hour shifts per week, so they have time to rest and recharge without burning out, so they can come to work able to fully focus on their patients' care. Yes I know this is a utopian dream, but I'm saying it because I mean it. Seriously.

3. "Nurses need to be able to do our jobs without sacrificing our physical or mental well-being. We need to see that we’re not stuck forever with only lateral options for career moves. We need to know that by advancing ourselves, we don’t have to sacrifice our integrity."

Nurses are subject to all of the emotions that any human being has. And we are working around some of the most vulnerable people in the population, as well as the stresses they bring in with them, that likely landed them in the hospital in the first place. Along with their family members and any other dysfunctional behaviors that they harbor in their everyday lives. And we often are on the emotional receiving end of those dysfunctions, when they are paired with fear and misunderstandings in regard to the patient's condition. We are subject to verbal and physical violence from stressed out patients and family members, as well as the internal, lateral and vertical workplace dysfunctional behaviors like bullying.

Nursing is a profession with a wide range of options for work, but within big healthcare organizations, the pyramidal nature of the hierarchy means there are few options for advancement. And more often than not, those with aggressive and less cooperative tendencies tend to move up the ladder, regardless of their leadership and people skills. Once they leave the bedside, managers are bound to serving the aims of the administration and no longer can prioritize their staff's needs.

Management is bound to keep administrative secrets and respond to staff concerns with carefully scripted messages dictated by the highest ranking administrators. Honesty is not always possible if a manager wants to keep the trust of the higher-ups.

4. "Keep your intellectual curiosity alive- don’t rely on dumbed-down, pharmaceutical and hospital industry-funded continuing education for all your career needs. They won’t help you go above and beyond. Strive to grow personally, strive to grow beyond the scripted, measured, limited status quo that keeps us stuck."

Attend any professional nursing conference and you'll see the vendor booths stocked with glossy, full color literature and trinkets from pharmaceutical companies, attractive marketing materials from healthcare organizations looking to recruit employees, and sponsorship logos and banners from industry leaders on every visible surface, screen, and object.

Continuing education is offered as part of the deal for listening to pharmaceutical companies tout their latest drug, so nurses only hear the industry side of things. They might get a nice dinner and a glass of wine too. They tell nurses the message they want them to hear, without any opposing viewpoints, critical questioning, or an explanation of the results of randomized trials that might lead one to question whether the thing they're selling is really as good as the profits they'll make.

Ever since I left the hospital setting, I've had much more energy and curiosity because I'm not so fried, and I read journals and medical and nursing newsletters, the latest research findings, I can seek out good continuing education on my own instead of having it fed to me passively. I've encountered a brick wall with my local chapter of my professional organization- I've offered on multiple occasions to talk with them about the work I've been doing, cancer survivorship topics, social media usage by nurses, and other ideas, and have been either ignored or told we can't afford to do that. Why? Because I'm not a pharmaceutical company with a budget to pay for a catered dinner and wine for a couple of dozen nurses.

Fuurthermore, speaking of professional organizations, nurse entrepreneurs with small businesses simply cannot afford to have vendor booths at these big conferences. The price per vendor booth is something like $3000. A small business cannot recoup that.

"We hear a lot about VALUE-based care these days, it’s one of those favorite buzzwords that the scripted bots of the healthcare industry love to hear rolling off their tongues. But healthcare won’t be successful unless those who deliver the care have human qualities to care. And exhausted, burned out, chronically understaffed nurses can’t care. Let’s start using value and care as verbs instead of nouns. How about if we VALUE nurses so we can CARE?"

I think this is self-explanatory.

"But most important of all- let's get back to value- each of us should think about what we value. We’re here for patient safety. We can’t live our values if we’re not authentic. When we know who we are, what we value, and why, we are grounded, and are less likely to be swept away by the strongest gust."

Hopefully this, above and below, is self-explanatory, too.

"If you take nothing else away from this rally, resolve to define your values around your work. Why did you become a nurse in the first place? What’s your number one priority as a nurse? Live and work in accordance with those values. Encourage your fellow nurses to do the same. Moral distress is not good for your health, or your patients’!"

"Patients and nurses alike, each of us only gets one life for sure. Let’s make sure each of us can live it fully."

Take it away, nurses...