Wednesday, 11 March 2009


I have had many people ask me why nurses don't explain the staffing situation to the patients.

I have never told a patient that I am short staffed and I never ever will. It is the last thing that vulnerable, sensitive, suffering, people need to hear. It is not their problem. It has nothing to do with them. It is 100% the fault of greedy managers and poor working conditions.

That doesn't mean that I haven't been tempted to open my mouth. Sometimes when patients and relatives become very angry and abusive and have unrealistic expectations that I cannot deliver I do want to tell them what is happening. But in all reality it would only make a bad situation worse. There are times when I have to be extremely firm without breaching the confidentialty of other patients. The anger and abuse from the patients/families is mostly a result of fear, anxiety and loss of control. The majority of people who act out like this when dealing with ill health are not bad people. Telling them that I am overwhelmed only exacerbates the problem. It creates more fear, anxiety and anger. Anger is really only an extension of frustration, hurt and fear anyway.

Nurses know this and we do allow ourselves to be used as kicking bags. Management also knows this as well and uses it against us in many ways.

I will not tell you that I have more patients than I can handle and I will not tell you that I cannot come right now because the man in the next bay is dying. I won't do it. Nurses who do this really piss me off. The patient doesn't need to hear about our problems. I will just say "as soon as I can". Scaring my patients and their families on top of their illness stressors is just wrong. My managers know that many of us think like this. Isn't it obvious?

When I was back in nursing school we were given lectures about body language, attitude, and "vibes". No matter how bad things get you can never let the patients see it. If they are stressed they will not heal. If you look angry and rushed they will react to it in a negative way. They might think that you don't want to care for them. Some patients may even think that they are "disliked" by the nursing staff or that they have done something wrong. Patients are very very in tune with the body language of their care givers. More so than even they realise. The last thing any decent nurse wants is for the little old man in the corner to not tell anyone when he is having pain because "those poor girls look so busy".

So I always pace myself and try to be incredibly positive even when I want to lock myself in a room and sob. I often feel really manic and also a bit panicked at work so I make an effort to slow down and smile.

I learned the hard way when I was a young stupid nurse about how important this is. During a particularly gruelling shift I forgot myself and must have had a face like thunder. I was not upset at the patients, nor did I think they were a "nuisance". I had witnessed a horrific death of a "regular" patient of ours and was positively broken hearted. I was also in a rage because we were supremely short staffed that day and my other patients were getting nothing in the way of nursing input.

After about 45 minutes or so of CPR and everything else the resus efforts were stopped for our regular. He was more like a friend than a patient. I then went out of the room and over to the nurses station. I had to call the family in. I felt sick. It was an inevitable death and they were told that this would very likely be the outcome. But they were also in extreme denial regarding the deterioration and ultimate prognosis of their loved one. Even at this early point in my career I had seen relatives of dead patients screaming with grief, pulling their hair out, losing control of their bladder (yeah) and collapsing. At 24 years old I could not handle it at all. Now I don't miss a beat and keep going.

I am giving a lot of background here because a few minutes after the death of my patient I acted like a complete dick. I can't justify it but I'll try anyway :)

On my way to the nurses station all I could think about was the dreaded phone call. Just as I was turning the corner out of the bay of hell another patient shouted me and asked for pain killers. My shoulders were slumped, my footfall was heavy, and I must have had a really horrible look on my face. I grunted and pivoted around to get the pain killers. I came back into the room and barely said a word. I wasn't thinking about the lady in front of me with the osteoarthritis from hell. My mind was still on the dead guy and his family. I handed her the tablets and grunted again and walked out. I know now that my body language was positively vicious. Some patients would just think "that nurse is just a cow" and they would give me the 2 finger salute as I walked away and forget about it or complain. But this lady reacted the way most patients would. She was extremely hurt by my behaviour.

It didn't hit me until about an hour later. I made my way back to the lady's room where she was sitting on her bed crying her eyes out. I apologised for being so out of it when I gave her the pain meds and explained that I had just seen something very bad and was still thinking about that when I walked into her room earlier. She let out a sigh of relief and said "I am so glad you told me that, I thought that you were angry with me for asking for pain killers again, I hate being a nuisance". I apologised and grovelled. I explained that I would never ever think that anyone is a nuisance for requesting pain medication! I told her that it is never ever good to sit there in pain, suffering in silence and that she should always ask for pain killers, just as she did. I am lucky that she was a very nice woman and very understanding.

From then on I made it a number one priority to watch the body language and the attitude. I sometimes slip and I think most nurses do forget this at times. I think it leads to a lot of complaints about gruff sour faced nurses. When patients pick up on negative vibes and energy of nurses they often take it personally. They should never be made to feel that way. Maintaining a good working environment for care givers is paramount to good patient care. Abused people who are being constantly stripped of their dignity are not going to come off as "caring" people. Would you beat the crap out of a dog day after day and then leave it alone with a child? We abuse the hell out of our nurses then we want them to be as caring as a saint with no human needs or feelings. Most (not all, there is always a bad apple) nurses do not try and upset patients intentionally. Most nurses just leave.

Any health care professional will tell you that you never forget a lesson learned the hard way. I certainly learned the importance of pulling myself together and keeping my emotions in check that day. It's not something I will ever forget even if it means that others don't quite understand the pressure I am under.


paulsc said...

I understand everything you have written about how important it is that you do not let your problems show but surely this just allows management to advantage?

Nurse Anne said...


paulsc said...

Why can I not edit my own posts? Now everyone can see that I omitted to type 'take' as the penultimate word.
Also, whi does the time of my previous post say 06:04 when I posted it at approx. 13.04?

Nurse Anne said...

The times on this blog are all screwed up. I'll look into it.

I have never been able to edit posts on blogger comments. I have made a lot of goofy typos on Crippen's blog comments section and haven't been able to fix them.

Nikki said...

Thank you for this, I do very often look busy/rushed. I have difficulty in walking slowly or at normal pace, I'm a fast walker naturally and even super speed when I'm busy.

I think often patients know when we are short staffed, especially our regulars, who know how many staff should be on each shift. They will often ask if we are short.

juli said...

paulsc has a very valid point when he says that behaving in this way just gives management the advantage. It's a regular conversation we have in my OT dept, how we constantly make such an effort to smile, reassure the patients, do twice the workload in one day that we should, and then just grumble about it to each other. When we're desperately short-staffed, for whatever reason, we just 'manage'.

The problem is, that while we all, whether we're nurses, OTs, doctors, physios, paramedics or whatever, can see that of we continue to just 'manage' in this way, we're playing into the management's hands, any of us who care about our jobs just can't do anything else, because if we react as we should, and don't stay behind to get all the non-essential jobs done because it's taken us all day just to get enough done to keep our registration intact, the ones that suffer are our patients. Essentially we're our own worst enemies because we care too much!

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