I went into nursing because I wanted to help people. I even went back to
school recently to upgrade my education so I would be more able to do that.
Lately though, I’m having second thoughts. Was my wanting to help people just an
unrealistic pipe dream? It seems the barriers to my being able to care in the
way I envisioned when I entered the profession are simply increasing. For one
thing, there are not sufficient resources available for me to provide care. Take
for example, the “simple” issue of incontinence. I would first of all like to
use best practices to promote continence, rather than dealing with the issue of
incontinence. Think about how that would promote the dignity of the patient,
let alone, cut down the workload after the fact! But in those instances in
which a patient has been incontinent, it takes adequate linens to change
bedding; it takes time and possibly additional personnel to wash and care for a
patient who’s soiled, uncomfortable, and probably embarrassed. All of those
things seem to be in short supply and yet when I see what the CEO makes, when I
see the fancy new equipment that there seems to be money for but that doesn’t
seem to improve patient care one bit, I wonder about whose needs come first. Who
determines the spending priorities? It’s certainly not the nurses on the floor!
The lack of resources often keeps me from being able to provide the care I
want. That makes me feel inadequate and dissatisfied; it also makes me legally
vulnerable. I’m so afraid that I will not be able to provide even the minimal
level of care required, that I will overlook something critical, that I will do
something that will cause someone harm. One day I floated to the newborn
nursery. I was supposed to be taking babies out to their mom’s at feeding time.
This hospital had no carts to transport the babies through busy corridors. We
had no time to stay with the breast-feeding moms to make sure the baby was
latching properly. We were running to get the babies out and back on time.
Meanwhile, the housekeeping staff were cleaning the corridors, there were
electrical cords all over the place—I was terrified I would come around the
corner and bump into someone and drop the baby! I don’t know how I’d be able to
live with myself, let alone recover from law suits and charges that might
result. I could even lose my license!
So, I generally feel pretty powerless to do my job and to advocate for my
patients. That feeling of not having control is even more dramatic when I see
who around me does have power. Mostly, the docs have a lot of power. Some are
okay and even collegial but others verge on being abusive. What makes it even
worse is that sometimes my nursing colleagues seem co-opted to the docs. Like
one night I had to phone an attending physician because her patient was in a lot
of pain and the analgesic just wasn’t holding him. She yelled at me, told me I
was an incompetent fool, that she was going to report me to the administration.
I did get a new order for a stronger analgesic, though. When I told the unit
manager the next morning, she just shrugged her shoulders and said, “Before you
wake up Dr. X, you need to be sure it’s important enough.” I had thought it was
important enough!
Somehow my skill in assessing the patient, my judgment in proposing a
solution, my ethical responsibilities to advocate are not valued and even seem
invisible to nursing and hospital administrators. But just when I think I’m
going to pack it in, I meet someone who says, “Hi, you probably don’t remember
me but you looked after me when I had surgery a couple of years ago. I was so
afraid; I had never been in hospital before, never had surgery before. You held
my hand and answered my questions and stayed with me until I fell asleep. I will
never be able to tell you what a difference you made!” And then I think, maybe
it is worth it, just for those people for whom I do make a difference.
