The problem with nursing today

By Shelly A. Fischer | 10/01/2015

Would I choose this profession if I had it to do over again?


I stopped in for a quick blood draw at one of the system hospitals where I consult. As a patient, I generally don’t mention I’m a nurse, let alone an employee of the system. I rather enjoy the anonymity and sense of being a “secret shopper” of sorts. Since my work is primarily with CNOs and nursing leadership rather than frontline staff, my presence usually goes undetected. Today was different, though. Today, my cover was busted. Why? Because of my need to talk about the profession I love, the profession I am most loyal to, the profession—as I have repeatedly heard myself say—"I would choose again, and again, and again!"

The person at the front desk directed me to a bench in the hallway and asked me to have a seat. As I waited for someone from the lab to appear, I looked up and down the hallway, noticing the pleasant artwork, natural lighting, and well-designed, healing landscape of the courtyard outside a window of the new facility. Returning from the lab, my helper asked if I might wait a few minutes for the phlebotomist to come, and I continued my assessment of the environment, making mental notes of items I would place in plus and minus columns.
Fisher_Shelly_ID_embed_SFWAfter about 15 minutes, I became aware of a growing sense of annoyance and began looking around for someone to ask when I might expect to see the phlebotomist. Right about then, “Neil” (name changed to protect the innocent) appeared in a crisp, white lab coat and, with a large, pearly grin, apologized for my wait. Making solid eye contact, he explained he had been on the patient care unit completing a few morning draws. His transparency and fresh-faced presence disarmed my annoyance and, as we entered the lab, I acknowledged I had perhaps made a mistake by not registering at the front desk for the usual 10 to 15 minutes of interrogation and paperwork. Neil explained that, no, he would just briefly check my insurance card and computer information to make sure no changes or updates were required. Huh. That’s a slick improvement.
Efficient? Check. Friendly? Check. Transparent? Check. Two patient identifiers? Check.
As he prepped the site, Neil asked what I did for a living. When I told him I was a nurse, he beamed and told me he was in his second year of the nursing program at a local university.
“How long have you been a nurse?” he asked. “Thirty-five years.” “How has nursing changed over the past 35 years?” Answering that took the rest of the time we had together. 
Nursing is harder now than ever before, as I see it. First, the complexity: Patients and their treatments are complex, and people are sicker. Drugs are ever-changing, and there are more medications than ever before in history, each with multiple names. The systems we work with are convoluted, filled with idiosyncrasies and nuances, all designed to make us work quicker, safer, and better—but, in effect, boggling our minds and inviting the ever-unsafe multitasking.
Next on the problem list, technology. It was supposed to help us, speed us up. Instead, it has hindered communication, interfered with effective time management, and reduced our ability to focus on the patient. It has slowed us down, BIG time.
My mind flashes back to the handwritten SOAP note on each patient in the med-surg unit I worked on as a new grad. On that 32-bed neurosurgery-neurotrauma unit, I worked with my roommate, the only other RN. Neither of us had fewer than 16 patients. Still, I was quicker and my documentation more individualized and complete back then. I’m certain of it.
And those good ol’ Kardexes! Despite umpteen pencil erasures that wore holes through the card stock on which they were printed, that documentation system shall go down in history as the single most effective communication tool in nursing. And the metal flippy presentation things in which they were held? I remember them as if they were in my hands yesterday.
Finally, and maybe most importantly, there was our focus—or lack of it—on money. Back in “my day,” it was dirty to talk about costs related to patient care. We did not ration supplies or work to decrease overtime and increase productivity. We worked like dogs because there was no one else to work in the midst of a significant RN shortage. We worked as a team because other RNs were not available. We had to backfill with NAs (no certification at that time!) and LPNs, and they worked to the max of the scope of their role (maybe beyond). We came home with little yellow charge stickies stuck to our shoes, crisp white uniforms, and stethoscopes—you name it. No one ever reprimanded us and spent meeting after meeting discussing lost charges.
I was shaken from my reminiscing with a “Well, that should be enough” from Neil. I had hardly noticed the stick. Looking me hard in the eye, he asked, ”If you were deciding now, would you choose to be a nurse?”
As my mind’s eye flashed through the many hospitals, units, colleagues, patients, and families with which and with whom I had worked over the years—the blood, sweat, and tears that were an essential part of being a nurse, every shift, every day—I felt a rush of familiar pride, the reward of going home exhausted, knowing you had made a difference in more than one person’s life that day, sometimes a really huge and indescribable difference. Now, in the face of complexity, technology, and focus on the dollar, I wrap up my days the same way—ever proud to be a nurse.
Absolutely. I would choose nursing as my profession again, and again, and again! RNL
Shelly A. Fischer, PhD, RN, NEA-BC, FACHE, is assistant professor at the University of Wyoming’s Fay W. Whitney School of Nursing in Laramie, Wyoming, USA.
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