AACN News—September 2000—Opinions

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Vol. 17, No. 9, MAY 2000


President's Note: Make Waves: Support Our New Nurses

By Denise Thornby, RN, MS

President, AACN Board of Directors

Although I love the ocean, I have always had a healthy respect for the power of its fury—especially after having been chased off the Outer Banks in North Carolina by a hurricane or two. I was naturally drawn to the movie “The Perfect Storm,” because my father had been in the U.S. Coast Guard and, of course, because of its star, George Clooney.

This saga about the crew of a small fishing boat battling a once-in-a-century storm, which was created when three separate storm fronts converged, reminded me of what is going on in some of our ICUs. I am concerned that recent graduates and nurses who are new to critical care practice will be left adrift, threatened by the swirling forces of dangerous fronts converging upon them.

These troublesome fronts jeopardize our ability to fully support and develop new nurses. I see three contributing factors:

• The work and the workload that we must manage to be able to care for all the patients in our ICUs are intense. The facts that patients are sicker than ever; that technology has increased; that support services are scarcer; that medical interventions are more complicated; and that there is a shortage of nursing staff are all overwhelming. One medical ICU nurse commented that letting the preceptor and new nurse pick their patient assignments first is no longer adequate because, unlike in the past when a greater number of patients were stable, all the assignments now are complicated.

• ICU staff members are weary, causing a “tropical” depression that further contributes to the storm. They have given too much and have too little left to provide a supportive, nurturing environment that can foster the growth and development of new staff. With this exhaustion comes frustration, anger and a lack of patience. Nurses are overwhelmed by trying to care for and give to patients and their families. As a result, they have little energy left to support their team members, which is a serious issue for new staff members who need a great deal of support to make the transition into fully competent and confident coworkers.

• Much of the safety net that assisted staff in successfully navigating storm conditions has been lost. The loss of clinical nurse specialists, staff development departments and unit-based clinicians makes it increasingly difficult to support and guide novice critical care nurses as they learn how to care for critically ill patients. At the same time, the practice of assigning nurse managers to more than one unit affects their availability to assist their staff members.

Despite these issues, we must bring novice nurses into our units and provide them with adequate support to become fully competent critical care nurses. Because hiring only experienced critical care nurses in the face of the ever-growing nursing shortage is now a luxury, each new hire into our units is a gift and should be treated as such.

Each new staff member hired should be greeted with open arms of encouragement. We have a professional obligation to coach, mentor and pass on our expertise to others.

In my experience, most critical care nurses want to support new graduates and other staff and cannot understand the few who manifest their “high standards and expectations” in a hurtful and destructive manner. There is no excuse for this type of abusive behavior, and I believe all of us are accountable to confront it when we see it. Our legacy of “eating our young” or “putting them through their paces” must stop with us. If we do not put an end to this, it will destroy us.

I echo the eloquent request issued by Aurora Hernandez, president of the National Student Nurses Association, to the American Nurses Association House of Delegates in June 2000: “Remember what it was like to be a new graduate … we need you to create an atmosphere of caring for and about us as we begin our professional careers.” Personally, I will never forget what it was like when I began my critical care nursing career as a new graduate in the cardiac surgery ICU at the Medical College of Virginia Hospitals. As I stood there my first day, I was overwhelmed by the mere sight of the patients, let alone the thought that I would be caring for them. Although I can laugh now as I tell tales of my first year in nursing, it was a sobering experience at the time. I cannot recall how many times I cried, as my husband drove me to work for the night shift, because I was anxious. However, I was fortunate, because I had wonderful, caring, expert nurses who worked very hard to help me gain the skills and confidence I
needed. They:
• Never laughed, smirked or groaned at my questions.
• Encouraged me to take care of myself.
• Helped me to see how much I was learning and gaining in skills.
• Told stories of “dumb” things they had done as new nurses.
• Stood beside me when one of the surgeons was less than happy with me.
• Gave me articles and books to read.
• Pushed me to accept more challenging patients.
• Relieved me when I looked like I might drown.
• Teased me so that I knew I was part of the team.
• Challenged me to study and to set a goal to become certified in critical care.

New graduates or novice nurses need care, acknowledgement and support. They need you to show them how to be highly effective critical care nurses. Although you will be challenged to give and support these new “gifts” to your team, what you will receive in return will be immeasurable. Please help them, help us all to create a legacy of positive influence. Make waves that will empower not engulf your new coworkers. Our patients and our profession will be better for it.

My Turn: Who Will Care When the Nurses Are Gone?

By Joanne Musgrave, RN, BS, CCRN

What will happen when the nurses are gone? The average age of the bedside nurse is now 45, and fewer young people are entering the profession. Fewer still are staying at the bedside for more than a couple of years.

Increasing numbers of older nurses are beginning to leave the profession, because they cannot bear to provide a lesser standard of care on a regular basis. Doing more with less can be tolerated only to a certain point. Choosing not to be a part of the problem when fighting for a reasonable solution is no longer an option. Show us a way to provide decent care on a regular basis without killing ourselves and we will stay.

The reality is that 120-pound nurses cannot continually lift 250-pound semiconscious or uncooperative patients in and out of bed two or three times per shift without suffering back strain or worse. Although help is needed to turn and bathe larger patients, there is often not enough staff. Having only the minimum staff or the mindset to handle only the crises does not provide patient or family satisfaction.

I have been a bedside nurse for 30 years and thought I would never be able to leave, because of my love of the work and an abiding moral obligation to my profession. I am less certain of this each day.

Good, young nurses come to our institution and stay for about two years before leaving to attend anesthesia or physician assistant school or to take an office or desk job. Most of them have no desire to practice bedside nursing on a long-term basis. Although I cannot blame them, I will miss them—and so will the sick who need them.

The “bottom line” is the only constant I see in healthcare today. The goal is that patients come and go in a timely fashion, without complications that would cause the cost of their care to escalate. I wonder who will care for me when I need help? Will they be competent, and will they care? Will they have good intentions, but work in a system that prevents them from meeting my needs?

What can I say to young men and women who hesitate to choose nursing as a profession or, if they do, leave the bedside in a few years? I can say that I am sorry that their education has failed to show them the realities of delivering care in today’s world. I am sorry that they are not valued more openly by hospital administrators, physicians and the public.

I can tell them that they will make a difference to those with whom they come in contact. They will save lives and ease suffering by seeing or foreseeing complications that require intervention. They will be the ones to keep care coordinated and patient-focused. Although they will care for cranky patients and family members, most will be grateful and know that they are their lifeline. They will feel good much of the time.

They will work shifts, weekends and holidays. However, they can also work part time for a good salary. Flexible and off-shift hours can provide them with greater opportunities to be with their children and avoid the high cost of daycare. They will have ample chances to use their intelligence and show compassion. They will never be bored.

We will all use the healthcare system at some point in our lives. Many parts of it need fixing. Many obstacles and challenges are found in a hospital setting. However, those who are willing and able to provide skilled, quality care to the sick and dying will find enormous satisfaction in doing a job that really matters.

Joanne Musgrave is employed by Pinnacle Health as a nurse in the cardiovascular medical-surgical ICU at Polyclinic Hospital, Harrisburg, Pa.