Sunday, July 31, 2016

Give A Nurse A Break

If you've been a nurse for a while, it's likely no surprise that many nurses fail to eat, drink, go to the bathroom, or otherwise take care of themselves while at work (especially in acute care settings). In fact, you may yourself be one of those nurses who's suffered a UTI or other negative sequela as a consequence of poor self care.

So, in light of the fact that we focus so much on patient satisfaction these days, what would it take to focus just a little bit on nurse and employee satisfaction? What would it take to (literally) give nurses a break?


Legal Action Is Pending


In an article published on the Advance For Nurses Healthcare Network website on July 29th, 2016, it was reported that a Texas nurse has filed a lawsuit against her employer due to the fact that the hospital in question docks every nurse for 30 minutes of pay per shift for a meal break, even though nurses on break are required to be "on alert" throughout their breaks, and those nurses rarely enjoy an uninterrupted break.

The lawsuit, which is filed in hopes of class action status on behalf of 4,000 nurses, complains of "phantom" lunch breaks. There are apparently similar suits erupting around the country, and hospitals can rest assured that this issue is likely not going away any time soon.

A study in the UK showed that a significant number of clinicians may experience cognitive deficits while on the job due to dehydration. Ian Miller over on The Nurse Path wrote in 2013 that he had cause to believe that some nurses may be voluntarily dehydrating themselves while on shift in order to decrease the need to go to the bathroom. 

Patient Satisfaction Trumps Nurse Satisfaction

We're all aware how 21st-century healthcare has seen an enormous focus on patient satisfaction, so much so that Medicare reimbursement is now tied to HCAHPS scores, for better or worse. Despite the fact that patient satisfaction surveys may not always reflect patients' actual experiences in all cases, such surveys are now a bottom line driver for hospital administrators and bean counters.

What healthcare employers seem to forget is that there is more than one bottom line; the ubiquitous financial bottom line is the one that so many maintain in crystal clear focus, yet the bottom line related to people (namely employees) is one that is summarily ignored by the majority.

While Magnet status is indeed earned through adherence to a limited number of positive employment practices related to nurses, nurse satisfaction has no bearing whatsoever on a hospital earning Magnet status, nor does it have an impact on Medicare reimbursement.

In my view, satisfied nurses will almost always deliver better care, which will naturally lead to overall improvements in patient satisfaction; however, nurse satisfaction seems but an afterthought for most healthcare employers focused single-mindedly on a balance sheet.

Self-Care as the New Normal

For better or worse, nurses likely need to take matters into their own hands when it comes to their own satisfaction. Since employers appear to give short shrift to the notion of nurse satisfaction, nurses may find themselves in the position of creating their own nurse satisfaction working groups within their workplaces. Whether a nurse manager or leader supports these efforts or not, I challenge nurses on a specific unit to band together to create a system wherein nurses are encouraged to take breaks and are rewarded for doing so. As a group effort, nurses can encourage and empower one another to take care of themselves, creating a new form of peer pressure wherein nurses take the reins of their own wellness, making sure that positive self-care becomes the new normal.

Whereas nurses may indeed internalize a certain martyrdom for which there is some positive feedback both internally and externally, there's no true need to be a martyr. Just because many nurses have succumbed to the "norm" of not taking a break, not eating, not drinking, and not using the rest room while on shift, there's no saying that the new normal couldn't be one where nurses actually support one another in assiduously practicing positive self-care.

The Nurse Wellness Challenge

So nurses, pending lawsuits aside, I challenge you to consider this:
  1. Band together with nurses on your unit and collectively decide that self-care is worth your attention and energy.
  2. Subvert the dominant paradigm, and make self-care what the cool nurses do.
  3. Create an incentive program for how nurses will be publicly rewarded for taking breaks, eating lunch, etc. Make this incentive program a form of friendly competition.
  4. Invite administrators and managers to get involved; if management demurs, move forward without them.
  5. Make self-care an intrinsic part of nurse orientation and onboarding.
  6. Consider contacting the local media and making a public statement about what nurses are subjected to on the job and how you're working positively to change the paradigm
  7. Be accountability partners for your colleagues and help one another practice better on-the-job self-care.
It may not be easy to accomplish even one part of what I've suggested above. Nurses have learned that there is positive reinforcement for their martyrdom, and some nurses may be loathe to let go of the old story that suffering and martyrdom are part of the nurse job description. This type of paradigm shift may undermine a self-image that has hardened into a mask that is too painful to remove; other nurses may laugh in your face, arguing that it's just not possible to take care of yourself while being a nurse.

No matter the obstacles, I urge you to forge ahead with subverting the dominant paradigm of nurses living as martyrs. Create a new story; create a new dialogue. And when certain employers or workplaces push back against such efforts, it may simply be time to say goodbye and move on to an environment that is more nurse-friendly.

Taking a lunch break, staying hydrated, or using the bathroom during your shift shouldn't be such an effort, yet we've created an atmosphere where it is almost seen as a weakness. Your silence is complicity in this case, nurses, so get out there and convince others that a little self-care can be a radical departure from unhealthy practices that simply need to end.

Give a nurse a break.

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(Did you know there's a companion podcast episode to this blog post?)

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known blog, Digital Doorway.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses. Keith is also the resident nursing career expert at Nurse.com.

A widely published nurse writer, Keith is the author of "Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century." He has also contributed chapters to a number of books related to the nursing profession, and currently writes for MultiViews News Service, LPNtoBSNOnline.com, StaffGarden, and Working Nurse Magazine.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.
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