Nursing: a vocation for exploitation?

By Dr Pushpa Chandra

May 01

As we ​approach Nurses Week 201​9, in Canada, we discover that working conditions are far from ideal within the profession. Widespread fatigue, poor health and fear of making mistakes prompt the question: who is taking care of the caregivers?

Nurse fatigue: who is taking care of the caregivers?

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The situation, throughout North America, is critical. Susan Reese, director of the healthcare practice group Kronos Incorporated, summed up the urgent need to improve conditions in a recent press release: “A workforce that is so inspired by their work is hard to find in other industries, and hospitals and health systems need to invest in nurturing and supporting their nurses”.

Nurses – at the heart of the medical system

Nurses are the backbone and the heartbeat of our medical system, but do they get the support and status that they deserve? As a pediatric nurse in intensive care at BC Children’s Hospital for 27 years, Dr Pushpa Chandra says, “I had the enormous and privileged opportunity to heal the body, mind and the spirit of many children and their families.” But, she added, “nursing is so much more than a competent execution of clinical skills. It’s true to say that ‘caring based discipline’ is the fundamental element that makes this profession effective and even possible”. Compassion, she says, is the quality consistently required to fulfill a nurse’s duty to care; treating patients in a dignified manner in a warm, sensitive and safe environment routinely, day after day after day.

Compassion is the quality consistently required to fulfill a nurse’s duty to care

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However, nurses are not machines. They have feelings and physical needs that are often at odds with physical and emotional stresses and scheduling that are part of the job. As professionals they have to put sleep ‘debt’, their own sick children at home or any other personal life issues on hold as they show up for a 12.5-hour shift. They have the duty of competency, accountability and must exercise mental strength to confront any situation (pressure of work, conflicts, distress etc.) they may encounter.

Blame the nurses, give them pills to get over it

Night shifts, when the body is ‘expecting’ to be resting and restoring, are a time when sensibilities are particularly vulnerable. Mistakes and errors are four times more likely to happen. Drug errors are most common and, because of chronic circadian rhythm disruption, the accompanying feelings of failure and diminished autonomy as nurses are required to fill out incident reports that inevitably cascade through to the higher levels of management.

Ironically, bearing in mind their role of promoting health in others, in many ways nurses have below average health. They are more likely to be overweight, have higher levels of stress and be sleep deprived. Additionally, they may experience workplace violence and injuries. According to the US Occupational Safety and Health Administration, nurses and health care workers experience the highest rate of non-fatal occupational injuries and illnesses of any sectors, including construction.

Occupational illnesses and injuries, by sector

Hospitals: 157.5
Construction: 147.4
Manufacturing: 111.8
Private industry: 105.2
Professional/business services: 54.5

Cases per 10,000 full-time employees.

Source: US Bureau of Labour Statistics

A 2015 Canadian study also noted the prevalence of major depression in Canadian nurses is double the national average of working women. As a matter of fact, in BC last year, with the introduction of British Columbia's Nurses Union's (BCNU) new contract, there was an increase in pharmaceutical coverage for depressed nurses who, remarkably, are given antidepressants rather than having their deeper issues addressed. If this is the attitude of the medical institutions to their own, what hope is there for the rest of us!?

Major depression in Canadian nurses is double the national average of working women

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Despite all this, Dr Chandra has fond memories of working as a senior nurse with children—but also some memories that have scarred her. “Senior nurses handle more complex assignments and these have a higher patient mortality. I remember spending hours with parents and their dying children. As a nurse, you are part of the most tragic times when, as happened on one shift, your patient dies in the middle of a night shift at 3am. You would think that you would be offered a choice to go home to recover from such a trauma, with an opportunity to heal and return later. No, that doesn’t happen. You just have to carry on.”

45% of nurses choose to leave the profession early

“The truth,” Dr Chandra continued, “is nurses can quickly burn out—physically and emotionally—and the only option they have is to leave this nurturing profession that leaves them so empty! In the USA, a recent survey showed that 45% of nurses will leave the profession within a few years of qualifying.”

Indeed, a study in the Policy, Politics & Nursing Practice reveals that an estimated 17.5% of newly-licensed nurses leave their first nursing job within the first year, and one in three leave within two years. Even though a survey in the USA recently revealed that 93% of nurses think they made the right career choice, fatigue is a pervasive problem. This, according to Susan Reese, confirms what anyone who has spent time in a hospital already knows—that nurses are compassionate, hardworking professionals, and it’s time to take care of the caregivers. Otherwise, it is clear that nurses are being exploited for the very qualities that make them the best people to work in the profession.

Running the numbers on nurses

93 % say they are mentally/physically tired at the end of a typical day
98 % say their job is both physically and mentally demanding
85 % say their work causes them to suffer from fatigue, which has consequences
70 % who work night shift admit they drive home from work drowsy
23 % who work night shift have pulled their vehicle off the road to rest
44 % worry their patient care will suffer as a result of fatigue
37 % worry about making a mistake
11 % admit to making a mistake as a result of fatigue
28 % have called in sick to catch up on sleep
63 % say their job has caused burn out
80 % find it hard to balance mind, body and spirit
44 % say their managers don’t know how fatigued they are

The top causes of fatigue

60 % excessive workloads
42 % not being able to take lunch and dinner breaks during a shift
41 % not being able to take any breaks during a shift
25 % not being able to get enough sleep between shifts
25 % doing 12-hour shifts (as opposed to 8-hour shifts)

Susan Reese says, “A fatigued employee at risk of burnout is not an engaged employee. Combating fatigue can be achieved by giving nurses more control over their work schedules, ensuring they have regular breaks, along with offering adequate rest periods between shifts and access to health and wellness programs. These benefits will ultimately help nurses, patients, and hospitals and health systems".

A fatigued employee at risk of burnout is not an engaged employee

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What do you think?

Are you a nurse? Have you ever been a patient in a hospital? How do you think these issues can be resolved so that the people who dedicate their lives to caring for others can also lead a happy and healthy life? Please leave your comments below.


About the Author

Dr. Pushpa Chandra is a Vancouver-based Naturopathic Physician. She worked for over 27 years as a registered nurse and 22 years at BC's Children's Hospital, working in critical care with the province's sickest children. Her interests include research in circadian rhythm disruption, sports medicine and pediatrics. A competitive sports enthusiast, she has completed ultramarathons and marathons in all 7 continents. As a shift worker she has been using the ingredients of AWAKE and ASLEEP to boost her performance, endurance and overall health.