In the front line

A recent nurse graduate in my facility approached me the other day, confiding her worries regarding nightmares she was having about work. The dreams mostly centered on bad outcomes for her patients or emergencies she couldn’t handle. She would always wake up with the sense that she forgot to do something in her previous shift or inadvertently made some fatal error.

I told her not to worry, that such dreams were fairly common for new nurses and would pop up time and again throughout her career. Then I had to think about that.

Why do nurses shoulder so much of the blame for the failures of our healthcare system? When anything goes wrong, where do fingers get pointed at first? We are in the front line — the easy targets — for patient and family frustrations. While terribly unfair, that is almost understandable because —  who else is accessible?

Who else is accessible?

Not the CEOs, CFOs, COOs and CNOs who make the money decisions that lead to staffing shortages without reasonable accommodations and appropriate supports; not the insurance companies who deny care and charge co-pays, co-insurance, deductibles, premiums and out-of-pocket fees; not Big Pharma that raises drug prices beyond the stratosphere. So who’s left to bear the brunt of questions, worries, complaints and confusion? Us.

What is NOT excusable is the blame visited upon nurses in a system prone to negative outcomes.

In reality, we nurses are our own worst critics when we make mistakes! But, instead of getting support, sympathy and analytic feedback, we face ever more punitive action. No wonder we have nightmares.

Nurses blame one another as well. Inter-shift, inter-unit, inter-title and inter-facility conflicts are common, and are often filled with resentment and innuendo. We never really know what that other shift or unit did or didn’t do; we just feel like we are the ones who got the short end of the stick. Many of us feel that it is our unit that serves as the hospital’s “dumping ground.”

When people work hard, yet find little satisfaction; when the vision we had for our profession or for our lives seems unreachable; when we sense that we are exploited and that the system is stacked against us — we feel helpless, depressed and angry.

Wouldn’t it make better sense for nurses, instead of being angry, to try and address the root causes of these conditions and develop solutions that can change them?

Identify the root cause

In our hospitals, the top executives are those ultimately and directly responsible for staffing, financial decisions and work practices, yet we never really deal with them directly. Instead, they hand over the work to Human Resources, Nursing Administration and a variety of other administrative personnel. Our testimony, grievances, complaints and issues often fall on deaf ears. Why? Because those who are assigned to sit with us have little or no power to substantively respond or fix the problems.

More and more often, the only time we make headway is when we engage in protracted campaigns, often culminating in strike votes and public exposure projects.

Advocating for quality care

Nurses aren’t apathetic — we are frustrated and demoralized when we see our practice being eviscerated by decision-makers who have no connection to our patients. All the more reason to take pride in every victory we win through concerted union activity. Whether it’s more blood pressure cuffs, working thermometers, mold removal, an extra nurse, removal of a bullying manager, a fair contract with concrete gains — these things really matter on a day to day basis. And imagine what life would be without them...

We need to take ownership of our successes — these give us the strength to continue. We also need to recognize that the real battles, the bigger things, require an even higher level of internal education and organization in each facility and on each unit. This will be crucial as we enter a potentially unprecedented era of anti-union activity.

No one nurse can move the mountain of healthcare chaos that exists around us. But together, armed with knowledge, capacity and a unified vision, nurses can change the world, and transform our nightmares into the realization of our dreams.