Outnumbering physicians six to one, nurses spend more time with patients and in many ways they are the heart of American health care. And with medical insurance now expanded to cover millions of new patients, the pressure on nurses (as all of health care) is growing.
One concern is the long shifts (12- and 13-hour workdays are common), which among some nurses are popular, because it may mean fewer days per week. But the extended shifts are also associated with increased levels of burnout and patient dissatisfaction. And that's a real concern.
A shortage of available nursing personnel is projected to grow to hundreds of thousands within a decade. Some of this will result from a large cohort of nurses naturally reaching retirement age. But other nurses leave clinical practice citing an unfriendly workplace, emotional distress related to patient care, and sheer exhaustion.
This challenge to nursing is examined in depth in Resilient Nurses, a new Humankind public radio documentary currently airing on many local stations and now available online. We hear moving stories of nurses on the front lines.
Said Marion Tinsley, a nurse at the VA hospital in Boston's Jamaica Plain neighborhood: "If you're doing 10- or 12-hour shifts, you know, it's brutal on your legs. You go home, you hear the cardiac bells in your head. I would hear that for like two hours, you know, driving home... It took at least two hours for the dinging to stop in my head!"
In spite of these difficulties, most nurses report satisfaction with their careers -- an attitude attributable in part to who nurses are: typically very dedicated professionals drawn to a field where they can genuinely care for people.
But health care in America is projected to face rising demand. Baby-boomers are reaching the age when people tend to consume sharply more care. And a growing number of patients are battling chronic conditions from heart disease to cancer, diabetes to obesity. Many health care institutions are feeling stretched.
Karen Fink, a nurse at the world-famous Cleveland Clinic, told me: "The staff on my units is doing more with less staffing. They're definitely feeling the crunch of, you know, cost repositioning, and cost effectiveness. Oftentimes there's no one at the desk to answer the call lights, or the phones. There's a lot of stress between coworkers where, you know, 'That's not my job. This is your job.' And so the cohesiveness starts to break apart the more stress that they're under."
This prompted the American Nurses Association to issue a position statement in 2014 about the consequences of nurse fatigue. It cited risk for medical "errors and reduced job performance" as well as drowsy driving on the way home. Particularly worrisome are errors associated with over-tired nurses administering the wrong medications to patients.
"We're looking at patients that have easily 15 to 30 meds each, in a 12-hour period," said Ashley Weber, a nurse providing bedside care in the Center for Cancer and Blood Disorders at Children's Hospital Colorado. "When we're at home, and we see a phone call from work, we think, 'What did I do wrong? Who did I kill? What medication did I not give? What chemo, you know, didn't go in right?"
Part of the answer to this dilemma lies in a deep re-thinking of how American medical care is delivered -- not just the reforms incorporated in the Affordable Care Act -- a topic covered from many angles in a previous Humankind public radio documentary project, The Search for Well-Being.
And says nurse Janet Quinn, founder of HaelanWorks in Lyons, Colorado: "What is causing the suffering in nurses? Sometimes we want to reduce that to a phenomenon called compassion fatigue. But you know what? It's the opposite of that. It's that nurses are working in systems that keep them from having these moments with [patients] -- a caring occasion, a moment where two people see each other, and meet in a place that is beyond time and space."
But for nurses working in health care today, much benefit can be gained in self-care techniques. "You have to take time for yourself," notes nursing pioneer and former University of Colorado nursing dean Jean Watson. "You have to have some kind of practice; whether it's meditation, whether it's prayer, whether it's nature, whether it's journaling, whether it's poetry, art, literature. You have to learn to pause to reconnect with yourself and your source."
And says Rose Hosler, a Board-certified holistic nurse at Cleveland Clinic, "You get your schedule, and see how many patients you're going to see, and your day starts to get a little harried. And I'll just pause, and I'll think to myself, 'I am just grateful. I'm just grateful that I'm here, and in the presence of wonderful people.' Thinking of that throughout the day really helps me."