EP 104: Five Challenges in Nursing
Nurses face constant challenges. Nursing can feel like a never-ending struggle. Not many people understand what a nurse does, and nursing school brushes the surface of the reality of what it means to be a nurse. Nurses commonly deal with five struggles: the reversal of DNR orders, job satisfaction, inconsistent workflow, service sector mentality, and hospital politics.
- Reversal of a DNR order
- Dealing with non-compliance
- Job satisfaction
- Inadequate staffing
- Heavy workloads
- Stress doesn’t equate to pay
- Night shift and holidays
- Inconsistent workflow
- You never know what is going to happen
- The pressure to know everything
- Service sector mentality
- The customer is always right
- Lack of respect from families and physicians
- Hospital politics
1. Reversal of DNR orders
One of the many challenges in nursing to deal with in the hospital, especially in the ICU or as a new grad, is when a family decides to reverse the patient’s DNR orders. When this happens, the family goes against the patient’s wishes, and as nurses, we are patient advocates.
We try to stand up for our patients, but the majority of the time, it is of no use. The family decides to change their loved one’s code status; this is usually when the patient cannot vouch for their decision. This usually happens when a patient is brought to the hospital in an unstable condition or during a patient’s decline at a hospital.
Dealing with non-compliance
To a certain extent reversing a DNR order for someone who established it is, in a way, noncompliance. But what is one of the challenges in nursing is patients coming to the hospital and then refusing everything.
They don’t want their medication, don’t want any procedures, and want to go home. If you don’t want anything, why did you come to the hospital?
Some patients are compliant when in the hospital, but when they leave, it all drops off. We call those frequent fliers, they build up their hospital miles, and you build up your frustration.
They come in in a very critical state, we literally save their lives, and they go back to what they were doing and not adhering to their medical plan. It makes you feel worthless and useless as a nurse. Your role almost seems pointless.
2. Job Satisfaction
As nurses, we go into nursing hoping to have a meaningful and impactful career. As new grads, we still haven’t been beaten down, and you can tell when someone still has that new grad face and mentality. Over time the job satisfaction we felt in our early years starts to dwindle and slowly disappear.
Staffing is an ongoing issue in nursing. You can feel the drastic difference between having adequate staff and being short. It’s night and day. You feel it even harder when you work at night and especially when your outside-of-work life is not where it needs to be. This is the main reason nurses leave the bedside and sometimes nursing altogether.
You feel this the most when you’re short-staffed. A heavy workload can be anything from having a really sick patient with a lack of support to having a 400lb patient that just breaks your back from the physical labor you have to do. Even when there are set ratios, the workload gets heavy.
Ratios, unfortunately, don’t always account for acuity, and there’s a discrepancy between having 4 patients that are decently stable vs. having 4 patients and 3 of them struggling to breathe.
This goes for all units. The ICU may seem simple enough to handle two patients, but there have been a handful of times when the workload was so much that you’re still sitting at work an hour after your shift to catch up on charting.
Stress doesn’t equate to the pay
Nurses are undervalued in the financial aspect. Most careers and jobs get rewarded with higher pay or some financial bonus. Do you know what nurses get? Food, we get fed as our bonus. That should just show you how unwilling hospitals and other places are to increase nursing pay.
There is a different kind of stress that comes with working with people. Many times we carry life and death decisions, we aren’t managing someone’s finances or getting someone’s internet up and running. Nurses deal with lives.
When you are a nurse for a few years, you truly start to recognize this. I wouldn’t be surprised if nursing was the number 1 most underpaid career, but no one will come to that conclusion because that would mean raising wages.
Night shift and holidays
The healthcare field is a unique field in which work does not stop. It is a 24-hour job which means the night shift; someone has to work the night shift. No matter what kind of a nurse you are or how long you’ve been nursing, there have been many times that the night shift has negatively impacted your life. As humans, we are not made to work nights, our circadian rhythm makes us most functional during the day.
Many people enjoy every holiday with their families; nursing is one of those fields that doesn’t adhere to those guidelines. The nurse is required to work certain holidays, usually 50% of them. If you work nights, there are some holidays, even though you’re off, you can’t really enjoy because you’re coming off a shift.
3. Inconsistent Workflow
Nursing and the medical field breed unpredictability. You really never know how your shift is going to go, that’s even if you are working 3 shifts in a row. A patient’s condition can drastically change daily, even hour to hour.
Sometimes you work three shifts in a row, and you have different patients each time. Not only are the patients’ statuses inconsistent you’re not even sure you’ll have enough staff.
Sometimes you can’t even plan out your shift with patients transferring or trying to open beds for other patients. The only thing consistent is the inconsistency.
The pressure to know everything
As inconsistent as a nursing shift and a nursing career is, there is this expectation to know everything. “Why is my father’s blood pressure keep going down”? “We’re trying to fix it right now. He’s on 20 mcg of Levo. We’re thinking about adding another pressor”. “Ok, well, why isn’t the first one working? Why isn’t he improving? He was doing much better yesterday. Do you even know what you’re doing”?
Nurses are very knowledgeable and understand what the situation is; the thing is that there is not always a solution for every problem; a lot of the time, we are just managing to buy ourselves, our doctors, and our families sometimes. The pressure being put on us makes challenges in nursing even harder.
Inconsistent workflow eventually leads to exhaustion, and many nurses leave the bedside and nursing altogether. There is only so much you can take at work, not to mention the stress we still undergo at home and in our social lives. Nurses get burnt out and tired; sometimes, it’s hard to recognize. Relaxing, taking time for yourself, and enjoying life are essential.
4. Service Sector Mentality
As much knowledge as nurses have, nursing almost feels like a service sector. The customer is always right and gets turned into the patient is always right. “Yes, Mr. Trout, I’ll get that for you right away, ohh you need something else, and another thing, now another pillow, ohh you don’t like the air mattress, you want to go for a walk right now, yes, right away.”
There are shifts where you’re just being bossed around, and many nurses don’t know how to handle a needy patient. It takes a toll because you have more than one patient to worry about, and some patients feel it’s a privilege that you’re their nurse.
Lack of Respect
Nurses are always at the bedside, so they’re usually the first to get questioned and yelled at. Most families don’t understand what is happening and are usually ignorant of what you explain. Families can talk down to you for no apparent reason; this is felt when they say you’re just a nurse. Let me talk to a real doctor.
Many nurses also experience a lack of respect from physicians, which is a challenge they face. They often talk down to nurses, especially the new residents, when they think they know more than you because their years of schooling trump all your experience. We’re supposed to work together, but this situation makes it to the list of challenges in nursing.
Nurses fear speaking to doctors.
One of our biggest challenges as nurses is talking to doctors, which worsens when an MD belittles a nurse. As nurses, feel that we should know what to do in each situation and the unrealistic expectations nurses put on themselves.
Usually, when a nurse calls a doctor, it’s for two things; an update or the patient is deteriorating. This is one barrier many nurses struggle with, and it takes time to get past it.
5. Hospital Politics
You’d think the hospital and the medical field wouldn’t have as much office politics, but boy, you are wrong. There always seems to be a day vs. night mentality and a staff vs. management mindset. It’s more pronounced in some places than others, but it exists.
Instead of everyone working as a cohesive team, they talk and stir up drama amongst themselves which is why it’s one of the biggest challenges in nursing. This makes a challenging career such as ours that much harder to work in.
Learn what are the biggest challenges in nursing by watching the full episode here 👇👇
01:22 Topic introduction
02:32 Mental toughness prepares us
03:21 What is DNR?
07:00 Nurses suffer with their patients too
11:28 Job satisfaction
12:55 You can’t always put money first
16:23 The Grid
18:16 Beyond money is life
19:08 We get food
21:07 Night shift and Holidays
24:52 Inconsistent workflow
32:33 We tend to think of our patients
34:15 You need boundaries
35:48 Service sector mentality
39:36 Lack of respect
42:40 Hospital politics
46:44 Why are they teaching Nursing Care Plans?
49:44 End of show