pressured to work on critical patients Pauline C. Beecroft et al., “Outcomes of a One-Year Pilot Program,” The Journal of Nursing Administration (December 2001).
average nurse is forty-seven . . . See, for example, “Nursing Shortage,” American Association of Colleges of Nursing (updated April 24, 2014).
many nurses are delaying retirement David Auerbach, Peter Buerhaus, and Douglas Staiger, “Registered Nurses Are Delaying Retirement, a Shift That Has Contributed to Recent Growth in the Nurse Workforce,” Health Affairs, (August 2014).
“The younger nurses have good skills . . .” Interview.
“Today, baccalaureate degree nurses . . .” Author correspondence with Donna Yates-Adelman.
“New nurses are lumped . . .” Interview.
“older, diploma-prepared . . .” Linda Kay Matheson and Kathleen Bobay, citing I. Daiski, “Issues and Innovations in Nursing Practice: Changing Nurses’ Dis-empowering Relationship Patterns,” Journal of Advanced Nursing 48, no. 1 (2004). See also Judith Vessey.
“were those with university . . .” Cheryl Woelfle.
“I hate nursing students . . .” Interview.
just as psychologically damaging See, for example, “Workplace Violence: Assessing Occupational Hazards . . .”
Nurse victims can suffer See, for example, Brian G. McKenna, “Experience Before . . .”
shame See, for example, Dianne M. Felblinger, “Incivility and Bullying in the Workplace and Nurses ‘Shame’ Responses,” Journal of Obstetric, Gynecologic, and Neonatal Nursing 37 (2008) (A CE course on bullying); “Workplace Violence: Assessing Occupational Hazards . . .”
self-blame, guilt See, for example, “Workplace Violence: Assessing Occupational Hazards. . .”
post-traumatic stress disorder. Ibid.; Rebecca Catalanello, “Bullying at Work Can Make You Sick, but Remedies Are Few,” St. Petersburg Times, July 26, 2009.
eroded self-esteem. Michelle Rowe and H. Sherlock, “Stress and Verbal Abuse . . .” (2005); Janette Curtis et al.
substantial economic consequences See, for example, Mika Kivimaki et al.; Pauline C. Beecroft, Lucy Kunzman, and Charles Krozek, “Internship: Outcomes of a One-Year Pilot Program,” Journal of Nursing Administration (December 2001); Martha Griffin; Brian G. McKenna, “Experiences Before . . .”
higher rates of workplace . . . thousands of dollars. See, for example, Pauline C. Beecroftet et al., “Internship . . .”; Martha Griffin and Brian G. McKenna, “Horizontal violence . . .”
between $40,000 and $100,000 per nurse See Lois Berry and Paul Curry.
cause increased medical errors . . . See, for example, Michelle Rowe and H. Sherlock; G. A. Farrell, “Aggression in Clinical Settings: Nurses Views,” Journal of Advanced Nursing 25, no. 3, (1997); Cheryl Woelfle.
“lateral violence stops” . . . provide safe care. Martha Griffin.
“secret club” Interview.
advocates for patients . . . each other. Cheryl Woelfle,
their transition to practice. Penny Sauer.
“We may be fat, old . . .” Interview.
“are the foundation of hospital care . . .” Interview. One such description: “To explain congestive heart failure, she told us that the heart is like stretched-out underwear and, without the elasticity, cannot function properly and pump the blood throughout the body.”
“ . . . It’s just the way it is with nurses.” Interview.
Chapter 5
“The nurse owes the same . . .” The American Nurses Association, Code of Ethics For Nurses, http://nursingworld.org.
“I go home sometimes . . .” Interview.
“I love the free entertainment . . .” Interview.
Elena Uhls . . . . . . “it’s better that way.” Interview. This is not her real name.
nurses’ top health and safety concern . . . American Nurses Association, Nursing World 2011 Health and Safety Survey, LCWA Research Group, August 2011.
approximately 1.8 tons A. Nelson, A. Baptiste, “Evidence-Based Practices for Safe Patient Handling and Movement,” Online Journal of Issues in Nursing, September 30, 2004.
More nurses are concerned . . . “accident after a shift.” ANA Nursing World 2011 Health and Safety Survey.
The number of nurses reporting . . . “a frequent occurrence.” Ibid.
Other common nurse injuries . . . See, for example, Karyn Buxman, “Humor in the OR: A Stitch in Time,” AORN Journal (July 2008).
“Most women’s health nurses . . .” Interview.
“not only for the patient . . .” Interviews.
“If you can’t deal with it, you leave.” Interview.
nurses may be more susceptible . . . See, for example, Patrick Meadors, “Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children,” Journal of Pediatric Healthcare (January 2008); D. Boyle, “Countering Compassion Fatigue: A Requisite Nursing Agenda,” Online Journal of Issues in Nursing, January 31, 2011.
“Nurses are not only ‘first responders’. . . . ” D. Boyle.
“The patients become part . . .” Interview.
87 percent of nurses . . . Meredith Mealer et al., “The Prevalence and Impact of Post-Traumatic Stress Disorder and Burnout Syndrome in Nurses,” Journal of Depression and Anxiety 26, no. 12 (2009).
high rates of suicide . . . See, for example, Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, “Exposure to Stress: Occupational Hazards in Hospitals,” July 2008.
35 percent of nurses . . . 12 percent of emergency medicine residents. Darlene Welsh, “Predictors of Depressive Symptoms in Female Medical-Surgical Hospital Nurses,” Issues in Mental Health Nursing 30 (2009).
Occupational reasons for this depression Ibid.
Patient care can be taxing . . . people who aren’t nurses. Interviews.
“People don’t know . . .” Interview.
Workplace stressors . . . These are just a few of many examples.
In Quebec Brian Daly, “Rash of Suicides at a Quebec City Hospital,” QMI Agency, Torontosun.com, August 12, 2010.
At least one . . . “won’t be the last.” Marianne White, “Union Worried About Rash of Nurse Suicides,” Postmedia News, August 14, 2010.
82 percent of nurses . . . nurses to become ill. Charlie Cooper, “Stressed Nurses Are ‘Forced to Choose Between Health of Patients and Their Own.’” The Independent, September 30, 2013.
South African nurses . . . Tanya Jonker-Bryce, “‘Fatigued’ Nurses Threat to Patients,” WeekendPost (South Africa), June 11, 2011.
30 percent of nurses are burnt out See, for example, “Self-Care of Physicians: Strategies for Care,” Hospice Management Advisor, August 1, 2009.
defined as a “loss of caring.” M. McCreaddie and S. Wiggins, “The Purpose and Function of Humour in Health, Heath Care, and Nursing: A Narrative Review,” Journal of Advanced Nursing (March 2008).
irritability, difficulty concentrating See, for example, B. Lombardo and C. Eyre, “Compassion Fatigue: A Nurse’s Primer,” Online Journal of Issues in Nursing, January 31, 2011.
low energy, and thoughts of quitting. See, for example, Debra Wood, “How to Manage Compassion Fatigue in Oncology Nurses,” Oncology Nursing News, March 26, 2009.
related but lesser known condition See, for example, Laura Landro, “Informed Patient: Helping Nurses Cope with Compassion Fatigue,” The Wall Street Journal, January 3, 2012; Caitlin Crawshaw, “Caring Workers Pay the Price; Mind and Body Compassion Fatigue Flies Under the Radar.” The Telegraph-Journal (New Brunswick), June 20, 2009. Little research has been done on the emotional impact of patient care on nurses. See, for example, M. Bloomer, W. Cross, and C. Moss, “The Impact of Death and Dying on Critical Care Nurses,” Australian Nursing Journal (September 2010).
secondary traumatic stress disorder See, for example, M. McCreaddie.
empathetic nurses unconsciously absorb See, for example, D. Boyle.
experience the traumas emotionally . . .“spiritual depletion” See, for example, B. Lombardo, C. Eyre, and D. Boyle; Patricia Potter et al., “Compassion Fatigue and Burnout: Prevalence Among Oncology Nurses,” Clinical Journal of Oncology Nursing (October 2010).
“a state of psychic exhaustion.” D. Boyle.
“‘What is to give light” “Compassion Fatigue Program Gives Staff Skills to Be Resilient Against the Cost of Caring.” States News Service, January 3, 2012. Indeed, Tulane Traumatology Institute director Charles R. Figley has said, “There is a cost to caring. Professionals who listen to clients’ stories of fear, pain, and suffering may feel similar fear, pain, and suffering because they care. Sometimes we feel we are losing our own sense of self to the clients we serve.” See “Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized,” Routledge Psychosocial Stress Series, 1995.
anxiety, depression . . . loss of objectivity B. Lombardo and C. Eyre.
less able to feel empathy . . . with certain patients See, for example, Laura Landro, “When Nurses Catch Compassion Fatigue, Patients Suffer,” The Wall Street Journal, January 3, 2012.
Burnout can lead to . . . heavy-heartedness. See, for example, Meredith Mealer et al.
“Compassion fatigue does not” Debra Wood, “The Personal Cost of Caring Can Be High,” Oncology Nursing News, October 6, 2009.
“are associated with a sense . . .” D. Boyle.
“Doctors are demanding . . .” Interview. Experts say that if a nurse doesn’t treat compassion fatigue early, the condition can permanently affect the way she/he cares for patients (see D. Boyle). Yet compassion fatigue, arguably a major occupational health and safety hazard, is still relatively little known among healthcare providers.
social workers, counselors . . . See, for example, Caitlin Crawshaw, “Caring Workers Pay the Price; Mind and Body Compassion Fatigue Flies Under the Radar,” The Telegraph-Journal (New Brunswick), June 20, 2009.
“They often enter the lives . . .” D. Boyle.
Simpson calculated that . . . D. Wood, “The Personal Cost . . .”
some types of personalities . . . See, for example, G. C. Keide, “Burnout and Compassion Fatigue Among Hospice Caregivers,” American Journal of Hospice and Palliative Care (May–June 2002).
Also note, according to a 2014 study, nurses who are motivated primarily to help other people may be the most likely to burn out. Jeanette Dill, Rebecca Erickson, and Jim Diefendorff, “Motivation and Care Dimensions in Caring Labor: Implications for Nurses’ Well-Being and Employment Outcomes,” unpublished paper in progress, provided to the author in August 2014.
already highly empathizing people Author correspondence with Oakland University School of Nursing professor Barbara Penprase regarding a study in progress.
“We are programmed to . . .” Interview.
demands of managed care . . . Nadine Najjar et al, “A Review of the Research to Date and Relevance to Cancer-Care Providers,” Journal of Health Psychology (March 2009).
eight to ten percent . . . terminally ill patients. See Meredith Mealer et al. “The Prevalence and Impact . . .”
Other events that could lead . . . Meredith Mealer et al., “Prevalence of Post-traumatic Stress Disorder Symptoms in Critical Care Nurses,” American Journal of Respiratory and Critical Care Medicine, 175, no. 7 (2007).
similar to female Vietnam veterans. Interestingly, the ICU nurses most likely to exhibit these symptoms were night-shift nurses who were not the charge nurse. See Meredith Mealer et al., “Prevalence of Post-traumatic Stress . . .”
Twenty-four to 29 percent . . . general nurses. Ibid.
Outpatient nurses Meredith Mealer et al., “The Prevalence and Impact . . .”
“intense fear, helplessness” See Darlene Welsh, “Predictors of Depressive Symptoms in Female Medical-Surgical Hospital Nurses,” Issues in Mental Health Nursing 30 (2009).
“Often, I feel it’s an impossible job” Interview.
In 2010, Kimberly Hiatt . . . 140-milligram dose. JoNel Aleccia, “Nurse’s Suicide Highlights Twin Tragedies of Medical Errors,” msnbc.com, June 27, 2011.
A ten-fold overdose . . . not necessarily be fatal. Interview with a neonatologist at another hospital.
hospital personnel escorted Hiatt See, for example, JoNel Aleccia. “Nurse’s Suicide Highlights . . .”
(who had heart problems) See, for example, Theresa Brown, “High Price of Mistakes Sits Heavily on Nurses,” The New York Times, The Virginian-Pilot Edition, July 17, 2011.
Hiatt, who told staff . . . careful in the future.” Ibid.
Hiatt was stunned . . . her entire career. JoNel Aleccia, “Nurse’s Suicide Highlights . . .”
Administrators had given her . . .“leading performer.” Ibid.
The state nursing board required . . . See, for example, “Too Many Abandon the ‘Second Victims’ of Medical Errors,” ISMP Medication Safety Alert, July 14, 2011.
Hiatt had difficulty finding . . . committed suicide. Ibid; Carol M. Ostrom, “Nurse’s Suicide Follows Tragedy,” Seattle Times, April 20, 2011.
Hiatt reportedly suffered . . . often be neglected.” See “Too Many Abandon . . .”
surgeons who thought they made . . . See, for example, JoNel Aleccia, “Nurse’s Suicide Highlights. . . .”
92 percent of doctors surveyed . . .” Ibid.
“If we fire every person . . .” F. Norman Hamilton, “Suicide of Nurse after Tragic Event,” Letters to the Editor, Seattle Times, April 22, 2011.
second victims usually require . . . “time of greatest need.” “Too Many Abandon . . .”
“Of course, we will also . . .” Tom Hansen, “Children’s Hospital CEO Responds to Infant Overdose,” kirotv.com, September 28, 2010.
half of nurse respondents believed . . . Thank you to Judy Huntington, the executive director of the Washington State Nursing Association, for providing the author with survey data.
After terminating Hiatt . . . “Patient Safety Day Strengthens Seattle Children’s Efforts to Improve Medication Safety,” Seattlechildrens.org, October 30, 2010.
In 2003 and 2009 . . . See, for example, “Death Was Third Fatal Medication Error At Children’s,” kirotv.com, September 28, 2010.
“This was not the fault . . .” See, for example, Q13 FOX News Web Reporter, on chicagotribune.com, October 1, 2009.
“If my mom got an insulin . . .” JoNel Aleccia, “Nurse’s Suicide Highlights. . .”
Ohio nurse Beth Jasper CNN Wire, “Lawsuit: Nurse Who Died in Car Wreck was ‘Worked to Death,’” KVDR.com, November 13, 2013.
The case was dismissed . . . Dismissal order, James Jasper vs. Jewish Hospital, Court of Common Pleas, Hamilton County, Ohio, entered April 10, 2014.
In Massachusetts, after a newborn . . . Scott Allen, “The ‘Second Victims’ of Medical Tragedies,” Boston Globe, November 30, 2004.
“have a little cry.” Interview.
even when their hospitals . . . Interviews.
if an average hospital RN salary . . . T. M. Dall, “The Economic Value of Professional Nursing,” Medical Care 47, no. 1 (2009).
staffing for hospitals is not . . . Interview, Peter McMenamin. The author is grateful to McMenamin for spending a significant amount of time explaining the economics of nursing.
A strong nursing staff . . . P. Miller, “Nurses Drive Hospital Revenue Too,” HCPRO, Inc. (March 2009).
nurses could do a better . . . Interviews; also see, for example, B. Lombardo and C. Eyre, “Care for Caregiver to Avoid Low Morale and Burnout,” Hospice Management Advisor, August 1, 2009.
“People will just about kill . . .” Donna Gr
ay, “Care Providers Get Compassion Fatigue: Burnout Common Among Healthcare Professionals,” Calgary Herald (Alberta), February 2, 2006.
nurses take self-care measures . . . their feelings. See, for example, Patrick Meadors, “Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children,” Journal of Pediatric Healthcare (January 2008); “Self-Care of Physicians: Strategies for Care,” Hospice Management Advisor, August 1, 2009; “Female Nurses Reduce Burnout in ICU Teams,” Nursing Times, August 30, 2011.
“permitting ourselves to seek support” Interview.
Some hospitals do have programs . . . Interviews.
Barnes-Jewish Hospital in St. Louis recently . . . staff retreats. Interview, Patricia Potter, director of research for patient-care services. See also Laura Landro, “When Nurses Catch . . .”
with experience . . . prepare themselves accordingly. Interview.
registered nurses younger than thirty . . . the profession’s demands. R. Erickson and W. Grove, “Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses,” Online Journal of Issues in Nursing, October 29, 2007.
“The greatest common risk” Tara Parker-Pope, “A Doctor’s View of Medical Mistakes,” nytimes.com, March 26, 2008.
Burnout and compassion fatigue have been linked . . . See, for example, B. Lombardo and C. Eyre; Nadine Najjar et al.
correlated with higher patient mortality rates . . . See, for example, Lara Landro, “Informed Patient: Helping Nurses Cope . . .”; Patricia Potter et al.; D. Boyle.
prone to make mistakes. See, for example, Brittany Hoover, “Compassion Fatigue May Cripple Health Workers, Expert Says,” Lubbock Avalanche-Journal, March 30, 2012.
fatigue alone can cause . . . ISMP Medication Safety Alert, “Nurse Advise–ERR,” December 2005.
nurse burnout is linked to . . . $69 million a year. Jeannie P. Cimiotti et al., “Nurse Staffing, Burnout, and Healthcare Associated Infection.” American Journal of Infection Control (September 2012).
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 44