What’s the one thing you need to survive in nursing? It’s actually something that’s not taught in nursing school, yet it’s the most basic of all human instincts: self-preservation.
Instinctively, we do things that protect our bodies, minds, and spirits. Newborns need to be cared for and nurtured but, as we mature, we instinctively act to preserve our safety and our well-being. Eating, sleeping, loving are all actions required for human survival, and when we are overloaded or we are deprived, we engage in behaviors that may not be healthy, but those behaviors get us through difficult times. We deny, we compartmentalize, we endure. We find ways to cope in order to preserve ourselves and our well-being.
But what happens to nurses? Often, the iron instinct for self-preservation bends. We learn to work long hours on aching feet, long hours without sustenance, and long hours without bathroom breaks.
Some nurses endure bullying from nursing colleagues, physicians, and in some cases, patients’ families. They endure an overload of phone calls from managers, patients’ family members, laboratories, radiology, dietary, etc.; they endure call bells, an often steady barrage of alarms, and in some cases, work-related texts; and they fill out numerous forms, in print or in electronic charts and records. All of this, frequently in one eight-hour or twelve-hour shift.
Years ago, a police officer pulled over my mother, a now-retired nurse, who after working the night-shift, exited a gas station in the wrong direction and was driving into on-coming traffic. When I worked twelve-hour shifts there were mornings when, even after arriving home, I was too tired to get out of the car and napped before going inside. How many friends and nursing colleagues have talked about driving home in such tired states they could feel themselves nodding off at the wheel? How many nurses can’t sleep once they’re home, take diphenhydramine or something stronger to get to sleep, only to find that within a few hours they’re wide a wake but not fully rested? How many nurses have work-related chronic back or shoulder pain, painful varicosities, consume poor diets, suffer from obesity, and suffer from depression, anxiety, and stress?
What happens during that first job that dismisses our natural instincts to eat, to relieve our bladders, to clear our heads so that we can do better for our patients, for nursing, and for our own well-being? We tell patients they cannot do for others without first taking care of themselves. Why do so many of us fail to work by the same advice we give to our patients?
What price do we pay when we are so drained and exhausted that time away from work is spent recuperating from two- or three-twelve hour shifts in a row instead of enjoying quality time with family, having fun, and playing. The payback for investing ourselves in these unhealthy behaviors is diminished concentration while delivering care, physical and emotional burnout, and most damaging for professional nursing, attrition from the profession. Consider the knowledge and skill nursing loses when one nurse decides to forego delivering direct patient care and opts to leave professional nursing entirely. These are losses the profession cannot afford.
We often discuss safety in delivering care to patients, but within the past decade, the topic of safety in the nursing work environment specifically violence toward nurses, compassion fatigue, moral distress, depression, and diminished well-being have garnered some discussion and research but not enough action.
Nurse leaders, administrators, and healthcare organizations should work to promote environments of safety—physical, psychological, and emotional—for nurses, and nurses must maintain self-preservation in order to have long, healthy, and productive careers.