Wednesday, December 9, 2015

Nurses Voices: The Scrub Life

Kami could not wait to finally start working at the hospital.  Sure, she’d done nursing shifts as a nursing student, but she’d graduated and now she would get to stay in one place and be able to really make a difference in the lives of her patients.  A year passed by and Kami was already exhausted.  This is not the life and career she had dreamed of.  She spent 12 hours a day being ordered around by demeaning, demanding doctors, running around without having sufficient time for each of her patients.  As she spoke to the manager, he just nodded and then went on with his life.  “I cannot go on like this,” she thought, “Something needs to change.”   
Kami’s story is a nursing story among thousands of others, all with a similar message.  Nurses are not given sufficient voice in defending their rights and giving new ideas.  Isn’t it only fair that those who work the closest with the patients should at least be able to speak for themselves?  Although many improvements have been made over history in the field of nursing, the lack of voice that nurses hold in hospitals, physician’s offices, and other healthcare facilities has scarcely improved, and nurses should hold an equal say alongside with doctors, chief nurses, and hospital administrators.        

History of Nursing: What can we learn?

Nurses are trained individuals who care for the sick.  It is a practice that has existed for hundreds of years.  It’s been through all sorts of changes and developments, especially of the last couple of decades.  Earlier nurses were educated by locals, or family members, and would usually stay with a specific person in their home.  Some of the wealthier families would have a nurse who would stay in the home and really get to know the needs of the patient.  In the more recent years of history- specifically the 1800s until now, nursing has begun to really develop and become more of a specific profession that is highly sought after rather than just a partially educated helper.  

          As nursing started gaining momentum as a profession,.  At this time, women all around the world were generally expected to be stay-at-home mothers and care for the needs of the house and children.  At first, the field of nursing had difficulty expanding partially due to the intense “superiority” that men held in matters outside, and sometimes even inside, the home.  This gave nursing a rough start as women were usually the only ones to be in this field of practice.  It was often difficult for them to have a say in medical matters, even though they were often the ones most involved with the patients and the hospital facilities.  Some women, however, were able to make a stand for nursing rights and the voice of women in general; one in particular was the famous Florence Nightingale.
          Florence Nightingale is often known as one of the biggest contributors to “founding” the current nursing educational and training system (Crane).  I will spend a little bit more time on her because of her example of how nursing ought to be today.  There is much to be learned from her.  Florence Nightingale always felt her divine purpose was to help the poor and needy.  She worked in many hospitals in Europe, becoming a Superintendent for a part of the hospital, and then the leader of a group of nurses sent to help the military.  

At one of the institutions she helped run, she was told that she would only be allowed to help those of the Church of England.  After hearing this demand, she declared that she would leave her position if this were the case.  She was able to talk the hospital committee into allowing patients of all faiths into the hospital.  It was on rare occasion that the leaders would listen to such a case, and especially coming from a woman.  This stood as an example of the power a nurse and woman can have.  She gained respect and was able to bring a lot more improvements and success to hospitals, as well as military care facilities.  
          Nightingale helped advance the practice of and education in nursing.  At many of these schools, women were often treated very poorly.  They would have to do all the dirty work and were often taken advantage of, receiving little respect.  After graduating the course, these nurses continued elsewhere, working in facilities and hospitals, still receiving the same poor treatment; and sometimes even worse!  Years passed, and although many advances were made, some things never really changed; which brings us to now.

Right Here, Right Now

Recall Kami’s story at the beginning.  It’s easy to see the resemblance of how Kami feels with how the nurses over a hundred years ago felt.  What once was a problem over a century ago- is still a problem today!  The voice of a nurse is still not being heard.  The turnover rate for nurses is increasing at a rate higher than ever (Welton).  The turnover rate of 2015 ranges from 10% to 40% for Registered Nursing, about a 5% increase for bedside RNs since 2011 (2015 National Healthcare).  Imagine if that continued!  Nobody would want to be a nurse.  
It’s not to say that nursing is only getting worse, there have been many advances and improvements in nursing practice and education, and especially in technology; but it’s almost as if a nurse has been turned into another machine designed to help the patients heal, yet with no potential room for development or humanistic progress.    

This idea of the “robotic nurse” can be demonstrated throughout all aspects of nursing.  The communication between nurses and doctors is crucial and must be delivered quickly and precisely.  A doctor hears what he needs to hear and continues working.  The communication with the patient is similar.  The nurse asks what he or she is supposed to ask, then reports only what is necessary- no more, no less.  This interaction between the patients and the nurses has so much more potential than it currently is achieving.  A nurse has the possibility of really helping a patient and experiencing real communication; if only they were given the opportunity to present their ideas and speak up for the patient.  
Many nurses complain about poor management.  Some say that managers do not allow open communication or feedback from the staff (Welton).  Many do not feel valued as part of the health care team, just docile staff members who follow orders without question (Minority Nurse).  If given the opportunity in medical board meetings or open, nurses could advocate for themselves as well as for the patient to improve conditions and healing.    

As a student entering the nursing program at BYU, I realize how difficult and vigorous it is to get into the program.  It is imperative for all the students admitted into the program have top notch grades.  But that is not all, they must also have a very well balanced life, participating regularly in service projects in the community, at church, and at school.  These are not just your average people, they are over achievers.  Why is it then that these brilliant minds are being treated as robots and forced to work like machines rather than people?  There is power in freely sharing ideas and being heard, especially when it comes to healing humans.  The medical field has its hands full of these sharp minds; they need not let them go to waste.    


Not all people feel that nurses should have more say.  Many feel like nurses already do have a voice and are very much active participants of the medical team.  Nurses have about eight less years of education than a doctor, and often a lot less experience.  For many it makes sense that doctors are the ones who make the decisions, their job is to just tell nurses what to do and focus only on matters at hand and medical communication; it makes the hospitals and workplaces run more smoothly with such order.  Isabel Hampton Robb, an early leader in the development of American nursing education, stressed the role of obedience for nurses.  Robb stated, “Above all, let [the nurse] remember to do what she is told to do, and no more; the sooner she learns this lesson, the easier her work will be for her, and the less likely she will be to fall under severe criticism. Implicit, unquestioning obedience is one of the first lessons a probationer must learn, for this is a quality that will be expected from her in her professional capacity for all future time…” (Nightingale).     
          While respect and authority does exist in the USA today, this country has functioned well and progressed because of the weight the voices of the people hold.  “While Nightingale expected obedience in following the rules and medical direction, her intent was to allow nurses the autonomy of purpose to advocate for patients and the profession (Nightingale, 1893).”  Just as people may not be seen as intelligent or as experienced as some of the politicians, nurses have the opportunity to see things first hand, to converse one-on-one with the patients, and to bring new ideas to the table that ought to be just as valued.  In many some states like California, the voice of nurses was heard and they now have Mandated Nurse-Patient Ratios to pair less patients with each nurse, allowing the nurse to give more attention to the patients (California).  As a patient, one can only imagine how beneficial it would be to have a nurse who is able to focus more completely them.  

Learning from the mistakes and successes of the past has always been and should always be one of America’s defining attributes.  Florence Nightingale was an exemplar in leading the way for advocacy in nursing; however, the much needed changes to nursing rights and voices have yet to take flight.  As the hospitals and healthcare centers follow the lead of people like Nightingale and California’s medical teams, doctors and nurses will have more respect for one another’s thoughts and opinions, managers will be attentive to nurses concerns, and nurses will be able to share their ideas and be more fulfilled, ultimately giving the best opportunity for recovery of patients. 

Works Cited

"2015 National Healthcare Retention & RN Staffing Report." NSI Nursing Solutions, Inc. Web. 9 Dec. 2015. A&E Networks Television. Web. 5 Dec. 2015.

"California RN Staffing Ratio Law." California RN Staffing Ratio Law. Web. 5 Dec. 2015.  

Crane, Patrick C., and Louise C. Selanders. "The Voice of Florence Nightingale on Advocacy." The Voice of Florence Nightingale on Advocacy. Web. 5 Dec. 2015.

Nightingale, F. (1893/1949). Sick nursing and health nursing. In I. Hampton (Ed.),Nursing the Sick – 1893 (pp. 24-43). New York: McGraw-Hill.

"Why Good Nurses Leave the Profession." Minority Nurse. 6 May 2015. Web. 5 Dec. 2015.

Welton, John M. "Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach." Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. Web. 5 Dec. 2015. 

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