CUP OF NURSES PODCAST

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5 challenges in nursing

Nurses face constant challenges. Nursing can feel like a never-ending struggle. Not many people understand what a nurse actually does and nursing school just brushes the surface of the true reality of what it means to be a nurse. The 5 struggles that nurses commonly deal with are the reversal of DNR orders, job satisfaction, inconsistent workflow, service sector mentality, and hospital politics. 

  1. Reversal of a DNR order
    1. Dealing with noncompliance
  2. Job satisfaction
    1. Inadequate staffing
    2. Heavy workloads
    3. Stress doesn’t equate to pay
    4. Night shift and holidays
  3. Inconsistent workflow
    1. You never know what is going to happen
    2. The pressure to know everything
    3. exhaustion
  4. Service sector mentality
    1. The customer is always right
    2. Lack of respect from families and physicians
  5. Hospital politics

Reversal of DNR orders

One of the hardest things to deal with in the hospital, especially in the ICU and especially as a new grad, is when a family decides to reverse the patient’s DNR orders. When this happens the family is going 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 during the time that the patient themselves is not able to 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 noncompliance

To a certain extent reversing a DNR order for someone who established it is in a way noncompliance. But what is hard to deal with in nursing is patients coming to the hospital and then refusing everything. They don’t want their medication, don’t want any procedures, and they just want to go home. If you don’t want anything why did you come to the hospital? 

There are also those patients that 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. 

Job satisfaction

As nurses, we go into nursing with the hope of having 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. 

Inadequate staffing

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. 

Heavy workload

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 are struggling to breathe. This goes for all units. The ICU may seem simple enough to handle 2 patients but there have been a handful of times where 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 sort of 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 in increasing 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 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 for there have been many times that 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 get to 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. 

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 from day to day even hour to hour. There are times where you work 3 shifts in a row and you have different patients each time. Not only are the patients’ statuses inconsistent you’re not even sure if you’ll have enough staff. Sometimes you can’t even plan out your shift with patients transferring, 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 a lot 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, doctors, and families sometimes. 

Exhaustion

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 our social lives. Nurses get burnt out and get tired, sometimes it’s hard to recognize. It’s really important to be able to relax and take time for yourself and enjoy life.

Service sector mentality

As much knowledge as nurses has, nursing almost feel s like a service sector. The customer is always right 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 really needy patient. It takes a toll because you have more than one patient to worry about and some patients feel that it’s a privilege that you’re their nurse. 

Lack of respect

Nurses are always at the bedside so they’re usually the first ones to get questioned and yelled at. Most families don’t understand what is going on and are usually ignorant to what you explain. Families can talk down to you for no apparent reason, this is really 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. Lots of times they talk down to nurses, especially the new residents when they think they know more than you because their years of schooling trump all your years of experience. 

Nurses fear speaking to doctors

One of our biggest challenges as nurses is talking to doctors and it’s worsened when an MD belittles a nurse. As nurses, we feel like we should know what to do in each situation, and unrealistic expectations nurses put on themselves. Usually, when a nurse calls a doctor it’s for 2 things; an update or the patient is deteriorating. This is one barrier a lot of nurses struggle with and it takes time to get past.

Hospital politics

You’d think the hospital and the medical field wouldn’t have as much office politics, boy you are wrong. There always seems to be a day vs night mentality and 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. This makes a challenging career such as nursing that much harder to work in. 

 

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