The Secret Society of Mayhem and Abuse
Submitted by Christine Cameron RN
At the risk of offense through the use of a cliche, I do recognize that I'm attempting to preach to the choir. However, I wonder if you'd just make yourself a cup of tea, relax and as you put your feet up, follow along with my thoughts.
I'm not going to go searching for boring stats or explore what professional standards have to say about any of this. I just want to speak some sensibility into your professional ears. Your “tired and fed up” professional ears.
No one can truly deny the current state of health systems around the globe, they all appear to be in desperate trouble. It is as if each one is at varying stages of a putrid infection. And those who assisted in this putrid infection, I believe, have celebrated the appearance of the Ovid pandemic. What better “patsy” to blame the flailing health systems on than the pandemic!?!?
If you secretly asked hospital managers about the pandemic, you'd probably find they celebrated it because it provided them with an excuse for the sad state we find our health care systems in. The pandemic took the focus off of management and gave them something tangible to blame. However, just ask most nurses and they will agree that the problems existed long before Covid.
Had the nursing profession been cared for appropriately prior to the pandemic, I think our health systems would have coped much better amid the chaos. Nurses were already under budgeted, under paid and under resourced. Nurses were already hanging on by the skin of their teeth! Hospitals and management have been putting constraints and unacceptable pressure on the nursing profession for far too long. This has led to nurses leaving the profession in vast numbers and patients are suffering even more.
I WAS a good nurse and I worked hard. I took good care of my patients. However, the profession has been in trouble for a long time. Let me provide a few basic examples:
16 years prior to the pandemic, I was required to provide 18 hours of patient care (by myself) during one single 8-hour shift.
13 years prior to the pandemic, I was unable to follow basic triage guidelines during most shifts as the triage nurse. I was regularly unable to get through the patients who required triage, let alone checking on those I had triaged, to ensure their condition had not deteriorated while they continued to wait to be seen.
12 years prior to the pandemic, I was expected to have a patient load of 14+ hours care AND act as the nurse in charge for the shift (during an 8-hour shift).
Just on a side note, 8-hour shifts DO NOT mean you should be working for the full 8 hours.... right!?!?!?!? Right! That SHOULD have meal times and breaks taken out. Perhaps shifts should have new names to better reflect that nurses require breaks.
Let's step away from health care to help bring home the concept of pay, breaks, etc. I am going to use a story reported in The Washington Post but I'll leave the company name and specifics out. They aren't needed.
A “successful” company had workers at a warehouse making $28,000/year. The company reportedly timed the bathroom breaks and harassed employees to return to the floor. The managers were paid $46,000/year, company execs $236,000/year and CEO $35.5M. The lowly hard workers are pushed, threatened, and drained of life so the top dogs can live off of their own greed.
The company would not survive for one second without the lowly worker. With no slight meant to these workers, all they are required to do is a basic job. There is no life or death outcome relying on their stressed work life. However, you can bet the lowly worker works much harder than the CEO.
If we look at the health system in the same way, the hardest workers in a hospital would be the nurse. Not only does the nurse work the hardest but they have the most stressful jobs and their work performed DOES have a bearing on life or death. That's the nature of the job.
A simple Google search can provide an idea of pay scales within most health systems. I can not imagine a nurse getting the same pay as a hospital administrator ($209,000-$574,000/year plus bonuses). Whether the pay disparity is as extreme in the health system as with the reported warehouse of employees, the issue of actual work vs amount paid remains stark. The vast number of nurses around the world keep our hospitals running. It's their sacrifice and hard work that saves lives and ensures patients are cared for.
Unit managers are probably pushed themselves by higher management into reducing hospital capacity, length of stay, adverse events, etc. That task will be performed by putting pressure on the nursing staff to work harder and quicker. However, even when they work harder there are no “bonuses” paid to nurses. And quite frankly, nor should there be for anyone in the health system. That is where a cancer of greed seeps in.
Unfortunately, money comes into play in the running of a hospital to the detriment of patient care. Hospital administrators are paid more or keep their jobs longer when they reduce hospital costs. And again, this allows money to be the driving force....not patient care or safety.
We really can not compare a business and a hospital. A business makes money and provides a service. A hospital provides a lifeline but management limit the ability to provide care when they look at cutting costs.
Thus, Nurses become an easy profession to manipulate. They work hard, they do extra work so their patients get adequate care and they just tend to keep going - no matter what. I can think of at least 3 meetings I attended (long before the pandemic) where management demanded we take on extra work load to handle the influx of patients. We were told in no uncertain terms that we would do what we were told, no matter what.
Word of these demands made it to the media and of course the hospital management denied the incidents, denied ever making such outlandish statements and firmly stated that they were all about patient safety.
Hospitals, at times, will open up beds that have been closed due to staff shortage, even though there are not adequate staff to provide care. Then you have the hospitals that use specifically designed and public funded palliative rooms as storage closets. Or, hospital wards are taken up by management offices instead of utilizing them for patient care.
Then you have hospitals with fleets of vehicles. I can not fathom paying for vehicles (upkeep, insurance, registrations, etc) and spending less on patient care. Any why would a hospital need vehicles?
In my personal opinion, nurses should never regularly work a double shift, let alone be given more work than their shift hours allow. Rest and recuperation are needed to provide the professional level of care that nursing demands.
Perhaps if management want more nursing hours they should work on the floor instead of in their offices working on charts and graphs showing wait times, length of stay and what could have been done to get patients out sooner. Where are the charts that acknowledge nurses require adequate time to provide the professional care they have been trained to do?
At the end of my time in the emergency department I remember a particular trauma patient. Prior to her arrival I had 2 high care patients crammed in the single bay trauma room. Both high care patients had to be moved out for the trauma patient and of course they were “cared for” in the hallway....not! As the trauma patient entered the trauma room, the Nurse manager and educator both raced into the trauma room to assist. They more gave directions and orders as to what was required to be done – it appeared too much work for them to just assist with their own hands. After a few terse words from me, they got the message and left me to the task at hand. I mention this because it speaks partly to how management behaves. Their paperwork was much more important prior to the trauma patient than dropping their tasks and assisting the nurses in the overcrowded department.
The time has long past to find a better solution than to kill off nurses one by one. We have lost too many prior to, during and since the pandemic. Without nurses, the health care systems will not work. Worse yet, we are at risk of becoming an endangered species!
Hospital managers look at ways to save money, which generally ends up forcing larger workloads on nurses. Instead, they need to be looking at the money used to feed the greed of elitism. Hospitals do not need cars. If visiting professionals need a vehicle, they should be renting one themselves. Perks don't belong in health care. Are large executive offices needed when patient beds are needed more?
Meetings should be limited-they waste time that is not available. Statistics may shed light on how patients progress, but paperwork (other than patient files) should be limited.
A plan needs to be thought out, put together and utilized by health care worldwide. And who better to put that plan together than nurses who actually do the work? However, that plan can only be made by nurses who stand true to the profession. The first priority of nursing is...patient advocacy. Everything in nursing works to that. I will forever harp on that until my dying day. Nursing does not work if it is not centered on patient advocacy. To veer away from the priority will only lead to the type of health system we currently find ourselves drowning in.
True patient advocacy will demand you make choices as a nurse, choices you may not like. However, to take the easy road will ensure you continue to feed the putrid infection within our health systems.
True patient advocacy means reporting issues whenever you see them occur, without considering the ramifications upon your career.
True patient advocacy means supporting patients to make their own choices, whether medical staff see them as the right or wrong choice. We can provide them with education, but if they do not want a certain kind of treatment or lifestyle, that is their right and it is the responsibility of the nurse to support this.
True patient advocacy means you take your time and perform your tasks in a professional manner instead of as quickly as possible. If you have too much work to perform and not enough time, it is your responsibility as a professional to advise management that things need to change. Unfortunately, nurses just try to get through tasks quicker, for the most part, so patients do not suffer. What makes us think that patients don't suffer if a task for their care is performed quickly instead of in a professional manner? How many nurses have pushed an IV medication too quickly while busy?
One of my favorite tasks was to give an IV antibiotic as a push.....longer than the required time. I kept a watch near the syringe and spent the time talking to the patient, getting to know them, letting them know that someone cared. It felt like the best way to do two tasks at once, with the added benefit of my sitting for a few minutes, and resting while we talked.
A true patient advocate does not presume to know the patient, they listen to what the patient says. As nurses we should listen to our patients. I've seen those who require specific classes of drug be refused because staff just “knew” they were a druggie. Well firstly, if they are in fact a “druggie” perhaps an answer can be given as to why that might matter? If a patient has a drug prescribed for them, they have a right to that medication. Who are we as the advocate to judge? The advocate does not judge.
A true patient advocate will ensure that some form of discharge planning is made instead of pushing the patient to the hospital curb as soon as the order is given. Hospital ward supervisors are always asking “who can be discharged today?”. Hospitals are overloaded and there are not enough beds. However, that is no reason to push patients out earlier than required or if discharge planning was not addressed. I truly understand overcrowded hospitals and pressures on staff to push patients through. However, a true patient advocate would not push a patient out the door without knowing they have a clear and concise discharge plan so they are confident regarding any required continuing care.
And since we are speaking of the patient, why don't we look at life from their eyes for a moment. As nurses we are aware that some patients and their families are afraid to complain, but not all. However, when we hear a complaint the initial reaction is to take it personally. As the patient advocate, the first reaction is to take our emotions out of the equation and just listen. And even if the complaint is about us, we do need to stop and pay attention. Put yourself in the patient's shoes for a moment and think about how they are feeling. Their complaint may be legitimate. For example, they might ask why it took so long for someone to answer their call for help. You might love to say there are so many emergencies being handled, greater needs than theirs, etc, etc. However, why is our extremely busy shift their fault? It's not. It would be the ongoing fault of nurses not standing up to management, who are responsible for placing these tremendous pressures on them.
Perhaps it is a preconceived idea of the patient's “issues”. Recently I was in an emergency department with a family member. In the next bay, an elderly man had been wheeled in and straight away he was yelling, crying and unable to be consoled. He had been trapped in a confined area when he was a young child and suffered from a severe case of claustrophobia. To have been put in the last bed of a closed off ward with no windows was horrific for him. The nurses' response was “they didn't tell us”. As she left to work out what to do, I could see that things were going to get out of hand a lot quicker than she realized. I suffer from claustrophobia myself, although not as severe. I walked to his bed and asked if I could sit beside him and I put my arm around him and started talking. I introduced myself and said that I suffered from claustrophobia also and that if others do not have it, they just don't fully understand the absolute fear. He agreed. That in itself was the first best move. I attempted to ask him what he did to help and what his home looked like, hoping for some small distraction to ease his intense crying. Eventually his nurse returned and they took him away in a wheelchair to another area. He stopped crying long enough to take my hand and kiss it and say “thank you”.
I have seen nurses handle a similar type of situation with anger, telling the patient that they are free to leave. Perhaps that is a response you may have had at one time or another. If so, are you able to understand which is the best advocate response? Again, you may be run off your feet with numerous emergencies but that is not the fault of your patient.
We can look at patients whom we might want to think are at fault of overloading hospitals. (obesity, suicidal, smoker, alcoholic, etc) We all have a right to make our own choices in life. I can guarantee that not one of us has always made the right choice, but we have made choices. It does not matter if the choices are good or bad, we make them. When patients arrive with problems as a result of their choices, they deserve no less care, attention or advocacy as other patients. Any bias is a hindrance to patient advocacy.
Perhaps I'll get quite a few with this example....how about a pedophile prisoner who was attacked at a nearby prison and he requires urgent care. Does he deserve less patient advocacy than any other? No. And perhaps the real secret to patient advocacy is empathy.
What about a drunk driver who is brought in by ambulance, along with numerous children who were in intensive care due to him running them over? We all might be angry at the driver's choice to drink and drive but again, that driver does deserve appropriate care. Having an empathetic response instead of an angry response will ensure we remain a patient advocate, professional in all we do.
We have no idea as nurses what people live with in their day to day lives. And, patients have no idea what we live with either. However, the nursing profession is all about being the patient advocate. That means we provide professional care no matter our deeper feelings. Advocacy takes precedence over our feelings if we are professional. And at times, this takes work. However, when it takes the greatest effort on our part - perhaps we should stop and identify some of the stressors that make it difficult. Is it workload? If so, where was the professional patient advocate who complained in advance of the workload? Is it a lack of staff? Where was the professional patient advocate who complained in advance about a lack of staff?
Somehow this message needs to get through: if nurses do not start to stand up and ensure their patients are advocated for.....nurses become as much of the problem as anyone else.
I know all too well what happens when a nurse fights. I had plenty of nurse friends warn me off of standing up for what was right. However, I saw clearly that I was as bad as the dishonest and abusive management staff if I didn't stand up for my patients.
If we just take a quick glance at any oppressed people in history, to look very closely at the oppression, it would have been overcome if all the oppressed people (and those who knew the oppression was wrong) had stood as one against the evil.
We hear the world fighting for so many who are oppressed, or want equal rights. But where are the nurses fighting as the patient advocate? They certainly are not fighting as a group. Some might fight, but most chose the protection of their career. What is it going to take to help nurses see that they are oppressed and that they can very easily win, if they just fight as a group?
Let me finish with a few observations. Before Covid, there were no troubles in nursing. And we can all be thankful for management who themselves single-handedly got us through Covid, even though Covid caused so many problems within the health system. At least management have everything under control now and deserve their bonuses for their hard work. Just blindly follow, blindly follow. Nothing needs to change. Don't rock the boat. And certainly don't consider taking on your first responsibility as a nurse, being the patient advocate. That would just ruin the secret society of mayhem and abuse.
Christine Cameron, RN
Bachelor of Health (Nursing)
Bachelor of Science (Education)
Graduate Certificate (Emergency Nursing)
Master of Advanced Practice (Emergency Nursing)