African American Women and the Stigma Associated with Breastfeeding

African American Women and the Stigma Associated with Breastfeeding

August marks national breastfeeding awareness month, and although overall national breastfeeding rates are on the rise, breastfeeding rates for African American mothers are significantly lower than other racial groups. The benefits for both mother and baby are numerous, yet some new mothers are hesitant to do so, especially in the African American community. Why are African American women less likely to breastfeed compared to their white counterparts?

A persistent discrepancy exists between African American mothers and mothers of other races who breastfeed. African American mothers have been lagging behind their white counterparts for years when it comes to breastfeeding.  According to the Centers for Disease Control and Prevention (CDC), the initiation rate of breastfeeding among African Americans is 16% less than whites. Multiple factors in the African American community may play a role in these discrepancies.

Lower breastfeeding rates among African American women begin with education, or lack thereof. “You can never have too much education and information,” says Joycelyn Hunter-Scott, a mom of two young sons. When asked about a stigma in the African American community Hunter-Scott replies, “I don’t think it’s a stigma; I believe it may have something to do with the lack of education and information the mothers receive during and especially after pregnancy—especially the younger mothers.”

Hunter-Scott, who was a mother who extensively researched breastfeeding when she was pregnant, is correct regarding the lack of education during the perinatal period affecting overall breastfeeding rates. According to the CDC, some hospitals within African American communities are failing to fully support breastfeeding. In a CDC Morbidity and Mortality Weekly Report, ten indicators that show hospitals are supporting breastfeeding were evaluated showing that hospitals in zip codes with more than a 12.2% African American population were less likely to implement three specific indicators. These indicators include: helping mothers initiate breastfeeding early on, having infants “room in” with their mothers after birth, and limiting what infants eat or drink in the hospital to only breast milk.

Renee Bell-Eddings, MSN, RNC-OB, whose main job function is to educate staff nurses within the Women, Infant, and Children’s (WIC) department in a community-based hospital in Houston, Texas, also knows education is the key for new mothers, but also attributes a social component to breastfeeding. “I believe the reason there is a stigma is simply [because of] the lack of education and support from family and friends. Often times we see that she is the only woman in her family that has chosen to breastfeed. We also have to understand that the family plays a big role in the choices that a mother will make concerning breastfeeding—that’s where we see the cycle of breakdown because she doesn’t have the support she needs to continue.” A new mother needs support from those closest to her when taking on the challenges a breastfeeding mother may face.

A two-time mother, Hunter-Scott breastfed both of her sons—the eldest for one year and the youngest for seven months. She credits the support of her mother, sisters, and husband during that time. “This [support] made an enormous impact on my decision to breastfeed for the timeframe that I did,” she says.

Although Hunter-Scott had the support of her family (and nearly six months of maternity leave), she can see how a mother not having support or having a short maternity leave can negatively affect breastfeeding rates in the African American community. “I think it is important that the health care staff initiate breastfeeding after birth and make sure not to give pacifiers or artificial nipples to infants. I also believe many African American women don’t have the luxury of staying home after they have their baby. Some have to go back to work within a few weeks, some a few days, so it’s quicker and easier to send the baby off to childcare with formula.”

Negative cultural influences in the African American community about breastfeeding can also play a role in breastfeeding rates. Breastfeeding has been seen by some African American women as reverting to “slavery days” when feeding a child by breast was the only option. Baby formula as we know it was developed in the late 1800’s and soon gained popularity when feeding a baby with formula was seen as something only “elite and sophisticated” mothers do, regardless of race. These advertising campaigns led many women to believe breastfeeding was a choice only for lower income mothers.

Another issue that faces a breastfeeding mother is public breastfeeding and the potential shaming from others. Feeding a child in public from the breast is often seen as indecent and given a perverse sexual connotation. Being able to feed on demand is crucial for the continued production of breast milk in a lactating mother. The shaming some women endure is enough to discourage them from continuing to breastfeed even if they have chosen to do so initially. The indecency claims of public breastfeeding generalizations make it hard for any woman, let alone an African American woman, to nurture her child through breastfeeding. Negative portrayals by the media and in our own communities have a profound effect on the initiation and continuance of breastfeeding.

The societal and commercial pressures to not breastfeed or stop breastfeeding altogether before six months of age are evident through aggressive marketing campaigns of formula producers. Societal pressures include: not having a national maternity leave law, the shaming of breastfeeding in public, and not having enough dedicated breastfeeding areas in public establishments to encourage breastfeeding. Many mothers do not have the ability to stay home for extended periods of time after birth, further encouraging them to stop exclusive breastfeeding in exchange for formula. Working mothers in the United States need support to continue breastfeeding before their baby is even born by means of national legislation for established maternity leave, breastfeeding or pumping breaks when they return to work, and a willingness from their employer to provide a conducive environment to support a mother’s wish to continue to breastfeed.

With all racial and societal factors aside, breastfeeding offers both mother and baby numerous benefits—and this is why it’s vital that mothers attempt to breastfeed for at least six months. When formula was introduced it was touted as the “perfect food” for a growing baby, but nothing compares to a mother’s milk. Breast milk has everything needed to sustain an infant and promote lifelong health. Nurturing a newborn with a mother’s milk offers baby rich nutrients that have proven benefits for both mother and baby, not to mention the money saved from not purchasing formula.

Infant mortality rates are twice as high for African American babies than white babies, and breastfeeding is the key to saving infant lives. Health benefits of breastfeeding for baby include decreasing the risk of common childhood illnesses, such as upper respiratory infections, ear infections, and asthma. It also provides long-term benefits for obesity and future diabetes risk, high cholesterol, and high blood pressure. Mothers benefit from breastfeeding by helping get back to pre-pregnancy weight sooner (breastfeeding burns up to 500 calories per day!) as well as decreasing risk for diabetes and breast, uterine, and ovarian cancers.

Education, education, and more education is the key to increasing breastfeeding rates in the African American community. Education has to start during the prenatal period and continue through birth and thereafter. Bell-Eddings knows knowledge is power: “Education is a big key in changing the mindset of all and allowing mom to make an informed decision.”

Surviving Your First Year as a Nurse

Surviving Your First Year as a Nurse

Nursing school is difficult, no doubt, but it pales in comparison to the first year working as a nurse. New nurses face many obstacles they may not have even fathomed while in school. Whether you landed a position in your dream unit or had difficulty securing the first job, the first year out for any nurse is challenging.

Once out of school, many wonder if their first job will be anything like their professors taught. Unfortunately, it’s not, but there are ways to cope with learning the ropes of nursing. A nurse of just over one year, Kelsea Bice, BSN, RN, an emergency room staff nurse at MD Anderson Cancer Center in Houston, Texas, realized her first-year nurse training was much different than school. “Most came from preceptor roles. I found it extremely difficult to rationalize my book training with the experience of my preceptors and my own thoughts,” she recalls. “It was very overwhelming at times.” Although it can be overwhelming, here are some key points for newbie nurses to remember when transitioning from student nurse to nurse.

1. Remember that School and NCLEX Do Not Reflect the Real World

Many new graduates struggle with the sheltered environment of school and the hypothetical world of NCLEX when they are in their first job working with real patients. The ultimate goal of nursing school is to teach one how to pass NCLEX. A nurse’s first year on the job teaches the individual how to become a nurse. The two realms massively collide with the first job after school. “The most difficult part of the first year is taking critical thinking from a theoretical/hypothetical situation to a real person in a real bed in front of you,” states Bice.

As a student, the first-year nurse is not exposed to all of the internal policies and systems of a clinical facility. In a new environment, reports may be conducted differently from the ways one was previously exposed to, some common procedures may be completed in an unfamiliar manner, and, when a patient is crashing in a real-life setting, it isn’t always “textbook” like NCLEX. These nuances can be hard for new graduates to grasp without their own experiences to pull from. Once out of school, new nurses soon realize that patient ratios will often be higher than they were while in school. Nurses, especially new nurses, have to really work on honing their time-management skills. When asked how nursing schools can better prepare students, Arthandreale Nicholas, BSN, RN, a nurse at Harris Health Outpatient Medicine Clinic in Houston, Texas, says, “[M]ore clinical hours with realistic nurse-to-patient ratio staffing [are needed] so new nurses can be prepared to have more patients and develop time-management skills.” As any experienced nurse knows, time-management skills will improve with time.

Prioritization also serves a vital role in a nurse’s first year on the job. Prioritization and time management go hand-in-hand; once one is mastered, the other will become easier and vice versa. Nicholas, a nurse of five years, recalls her most valuable lesson in her first year was prioritization of duties. “Make sure to see sickest patients first and get meds passed ASAP,” she suggests. New nurses may not realize how long 12-hour shifts really are—or that they may not get the desired shift they want to work directly out of school. Typical 12-hour shifts turn out to be longer when you factor in commute times, codes at shift change, or a lengthy report. In addition, nursing schools don’t prepare students for difficulty finding their first job in an oversaturated market. Nicholas experienced long days and an undesirable shift firsthand; her commute to her first job, a neuro step-down unit, was 60 miles each way and she worked a “swingshift,” meaning she alternated between night and day shifts. “I only stayed at my first job for four months. The schedule with the commute made me very discouraged, so I actually went months without working until a local hospital gave me a chance,” says Nicholas. New nurses are ill-prepared for these realities since the average nursing school does not typically have students complete a full 12-hour clinical day. In addition, the clinical sites are typically in close proximity to the school.

2. Respect Your Elders

We’ve all heard the phrase “Nurses Eat Their Young” (or “N.E.T.Y.”) when referring to the way some seasoned nurses communicate with newer nurses. Sometimes, there are personality conflicts between people, but most of the time seasoned nurses are just frustrated with the newer generation thinking they know more than they actually do directly out of school. As the saying goes, “You don’t know what you don’t know.” Seasoned nurses on the unit have a wealth of information to share with you—just be willing to listen.

Bice has her own take on the relationship between newer and more experienced nurses: “Older or ‘more experienced’ nurses say new nurses are coming out of school really cocky or with bad attitudes, but I truly think that’s just the generation gap in the workforce showing through.” Bice believes new nurses can thrive in their first year with more encouragement from seasoned nurses. “I think if new nurses are nurtured through their orientation and supported and offered a safe environment to ask questions, make mistakes, and figure it out, they could be successful on any unit,” she adds.

Newer nurses should also understand that there are multiple ways to carry out nursing duties. Their preceptors may have a different way of doing certain asks. Not all nursing tasks are textbook like they were in school, and this may be a hard concept to grasp when just starting out. Be willing to understand why particular individuals carry out their nursing responsibilities the way they do. And if you don’t like it, put your own spin on it later. Be open to others’ opinions when you first start out—you may realize you have learned something you may not have known otherwise. Take it all as a learning experience.

3. Don’t Cause Waves

One of the quickest ways to become the unpopular nurse on the unit is to act like a know-it-all. No one cares that you had a 3.9 GPA in school or that you passed the NCLEX with 75 questions. All anyone—including colleagues, patients, and family members—really cares about is how you can safely and effectively deliver care to patients. Remember, the first job is to learn how to become a real nurse.

Another way to cause waves during the first year of nursing is to actively complain about your chosen profession. The story plays out time and time again—a new grad comes into the unit and continuously vocalizes how much he or she hates bedside nursing and declares plans to be out of there in one year—on to NP or CRNA school. Doing this usually causes a deep divide between you and other seasoned nurses on the unit.  This may be where some of the N.E.T.Y. comes into play.

Newer nurses may feel isolated due to their inexperience, but it’s imperative to ask for help from others when needed. Nursing involves teamwork. In addition, starting a new job and attempting to be a martyr by making fellow coworkers look bad only actually makes you look bad in the long run. One day, you will be on the other end and won’t appreciate the lack of compassion. Everybody makes mistakes, and you don’t want to be thrown under the bus because of one. Learn to speak to your colleagues when a problem arises; it could uncover a learning experience for both of you.

4. Continue Your Education

Just because you have finished nursing school and passed your boards doesn’t mean your education should cease. The real education has actually just begun. Continuing education doesn’t mean you immediately go back to school for an advanced degree; it means continuing to learn in your new role. Jonanna Bryant, MSN, MS, RN, a veteran nurse of 24 years, who is currently working on her doctorate, wholeheartedly agrees. “Learning doesn’t stop after one leaves school, and you don’t have to return to school in order to learn,” she says. As a new nurse, you should be constantly looking up medications, medical terms, and diagnoses that you don’t know. It’s uncomfortable being asked a question for which you don’t know the answer. Not knowing the answers should bother you to the point that you want to seek additional knowledge.

It’s imperative that you continue to educate yourself in your chosen specialty—meaning that if you work in the ER, brush up on triage or work towards your trauma certification. Get your Basic Life Support and Advanced Cardiac Life Support certifications. Read nursing journals, re-read your nursing textbooks, and become involved in professional nursing organizations—anything that will enhance your knowledge base. The education of a nurse never stops.

In addition to learning job-specific skills, learn more about the roles of other health care professionals. Learn the role of a respiratory therapist, physical therapist, and radiation tech—these are all professionals you will work with on a daily basis. Education provides opportunities for you to grow not only as a nurse, but also as a person. Enhancing yourself through education makes you a better nurse and allows you to educate your patients, their family members, and your colleagues.

If you do eventually decide to go back to school for an advanced degree, make sure you master your role in your current position before doing so. Regardless of what some may say, an experienced nurse has an advantage when heading into graduate school. Concepts covered in grad school can be easily grasped with the experience one gains from working as a nurse.

5. Find a Mentor

Many nurses, if not all, may feel they were not adequately prepared for the real world even after finishing school and passing the NCLEX. The type of treatment new nurses receive in their first year can negatively or positively affect their overall career trajectory. This leaves a new nurse either loving the profession and wanting to stay in for the long haul or loathing the profession and trying to leave altogether.

“The first year was hard,” says Nicholas. “I honestly almost broke and thought about other career paths. I’m thankful for the good shifts and grateful patients who encouraged me to keep going.”

Potential challenges one may face in nursing should be discussed and support should be given to newer nurses, both in school before they graduate and on the job. Bice believes having more open, honest discussions with preceptors and other experienced nurses on the job would be beneficial. “Debriefing after incidents, like ‘what could I have done better?’ [and] ‘what will I do differently next time?’ This way, gaps in learning are realized and bridged,” she says.

New nurses should not only be oriented to their new career, but also mentored by seasoned nurses. A mentor serves as an experienced and trusted adviser. Mentorship should be a part of orientation for all nurses new to the profession. Bryant, a nurse consultant for the Centers for Medicare and Medicaid Services in Philadelphia, Pennsylvania, also believes in new nurses having a preceptor or mentor for the first year, “…someone who they will follow and be able to ask questions and talk to regarding concerns with their new job,” she says.

The first year of nursing is tough, but manageable with the right mindset. Bice advises the newer generation of nurses starting out to “chill out and listen,” which is in line with Bryant’s recommendations for the first year: “Pace yourself, be thorough, and communicate.” Nicholas wishes she could have told her first-year self to be “more confident” and to not be afraid to question orders she was unsure about. Use their advice to successfully integrate into your new role. Soon enough, you’ll be a seasoned nurse and will be able to give tips to the newbies on your unit.

Study Tips for the Nursing Student

Study Tips for the Nursing Student

School’s back in session and that means lots of studying to make the grade for your ultimate goal of becoming a nurse. Maybe you need to brush up on your studying skills since it’s been awhile since you’ve been in school or summer break was extremely long for you.

Here are some study tips to make the transition back to school easier.

  1. Read and then summarize. After reading your study materials (books, class notes, etc.) summarize them by highlighting the important points and then copying them in your own handwriting. It’s important to not only highlight, but to actually copy notes in your own handwriting- not typing them out. Why? Because when you write your notes your brain absorbs more of the information if you have to form the words instead of mindlessly typing them. I know this sounds time consuming, but you will remember so much more by writing your notes out.
  2. Write your notes out in an easy-to-read format. During my grad school years I used a combination of techniques to absorb the vast amount of material. One particular method that worked well for me was to make study questions out of my notes. I wrote the notes out on notebook paper and also on index cards. This, again, is a lot of work but well worth it considering. I used the index cards to study while I was at work.
  3. Take breaks. Pacing yourself when you are in study mode is important. I know some people like to pull all-nighters, but studies have shown you don’t retain as much information with long study sessions. Try to make it a point to alternate studying for 30 minutes and taking a break for 10 minutes. Use that break to walk, stretch, or grab a snack.
  4. Take care of yourself. It’s hard to take time out to care for yourself when you have to worry about work, family commitments, and school. Now that you’re in school you have to take time out for yourself now more than ever. You shouldn’t neglect yourself because if you don’t care for yourself, no one will! Make it a point to exercise regularly, eat healthy and get plenty of sleep each night.
  5. Get involved in study groups. Some people are solo studiers, but they may be missing out on benefits of group study. Meeting with a small group (3-4 people) at least once a week can boost your study progress simply by repetition and hearing the information out loud. Only meet with others to study after you have gone over your material on your own. When you meet, speaking to others will cement the information in your brain and others in the group may help you understand a concept you were struggling with or give you information you may have overlooked previously.

Hopefully these tips will make the transition back to school easier. What other study tips do you have for the new school year?


Are You Prepared for a Disaster?

Are You Prepared for a Disaster?


Nurses are usually prepared for the common disasters they see at work- a code blue, code red or maybe even a code black, but have you ever thought about what you would do if an emergency occurred at home?

I recently lost electricity in my home for a period of about 9 hours. Luckily it was overnight, but nonetheless, I was in the dark without electricity and wasn’t prepared. You never know when an emergency situation may occur. Mother nature doesn’t let us know when she decides to bless us with a tornado, flash flood or hurricane.

Being without necessities such as water, electricity and food for any period of time is an inconvenience at best and downright dangerous in some situations, especially if you have medical problems. Being adequately prepared for disasters can help you get through and minimize your stress at the same time.

A list of potential items you may want to have on hand include:

-Copies of your important documents in a waterproof and portable container (insurance cards, birth certificates, deeds, photo IDs, proof of address, etc.)

-Extra set of car and house keys

-Credit/debit cards and cash, especially in small denominations. I recommend you keep at least $50-$100 on hand.

– 3 days worth of bottled water and nonperishable food, such as energy or granola bars

-Flashlight: Note: Traditional flashlight bulbs have limited lifespans. If you’re going to use one of these then make sure you have extra batteries. Light Emitting Diode (LED) flashlights, however, are more durable and last longer than traditional bulbs.

-Battery-operated AM/FM radio (and extra batteries)

-Keep a list of the medications each member of your household takes, why they take them, and their dosages. Keep at least a weeks’ worth of meds on hand if you can. If you store extra medication in your emergency kit, be sure to refill it before it expires.

-First aid kit

-Contact and meeting place information for your household, and a small regional map

-Childcare supplies or other special care items

-Lightweight raingear and Mylar blanket

This list isn’t all-inclusive but will get you started with a good emergency kit if needed. Place the items in a duffle bag in an easily accessible area. The items you include will vary with the region you live in and what natural disaster(s) your area is prone to. The bottom line is to be prepared for the unexpected.

Do you have a home emergency kit? If so, what’s in it?

Why Good Nurses Leave the Profession

Why Good Nurses Leave the Profession

It’s 8:00 a.m. and Christa Thompson, BSN, RN,* is travelling to a local Houston hospital to educate nursing staff on the latest medical device. A typical day is anywhere from two hours up to 12 hours for her, but she’s not unusually tired or stressed by the end of the day. A nurse for over five and a half years, Thompson is a RN by trade and works part-time as an independent clinical consultant training other people on the use of medical devices. She credits her nursing education and curiosity at an international nursing conference for getting her this job.

“I went up to a medical device booth at the conference and asked the representative if they hired nurses, simply out of curiosity,” says Thompson. “I was pretty much hired on the spot.” She loves her consultant job and knows her new career is a dream job for most nurses, but nursing is not where her true passion lies.

Thompson plans on leaving nursing to become a doctor. Nursing has been a rewarding career for her, but she realizes she can’t do nursing forever, even if her intentions weren’t to continue on to medical school. She is not alone in the sentiment that nursing at the bedside is not something that most nurses can do for their entire career. Her path to transition from the bedside is unique but not uncommon to many nurses in the profession.

Of the 3,514,679 nurses in the United States, nearly 63.2% of RNs and 29.3% of LPNs work in a hospital setting. The RN Work Project reports an average of 33.5% of new RNs leave the bedside within the first two years. Leaving the bedside to pursue other nursing positions does not necessarily mean nurses leave the profession, but it is a catalyst to do so. Why do some nurses leave the bedside and eventually the profession? Ask any nurse and the answers are varied, but common themes seem to ring true for most.

Why Nurses Leave the Bedside (and, Ultimately, the Profession)

Poor Management. One of the greatest complaints nurses have is the lack of support from their management team. What makes a poor manager? Some nurses may say it’s one who doesn’t value open-communication and feedback from his or her staff. Some say it’s the management team that plays favorites amongst staff or a particular shift. Yet, other nurses say it’s the manager who is not supportive of a nurse advancing her career. The list could go on forever, but one common frustration among nurses is the overall lack of support for those at the bedside. It seems to some that once nurses become managers, they “forget where they come from” and are oblivious to the struggles a bedside nurse faces on a daily basis.

Management may not even be aware of the stressors their staff encounters working the bedside. It could be that they are so wrapped up with their own job that they can’t focus on what would make life better for their staff. Or it could be that they just don’t care. Whatever the case, nurses do feel strongly about poor management.

Thompson agrees that management sometimes shows little consideration for those working at the bedside: “I feel like the night shift is ignored by management, like they have no voice.” The same sentiment echoes true for many other nurses. They feel as if management does not value them as part of the health care team—just as a docile staff that follows orders without question.
The best form of leadership follows a diplomatic approach; meaning, higher-ups actively engage their employees for input on situations that may arise. The diplomacy allows for everyone to have a voice. This type of management style encourages active participation among all employees and may dissipate some of the negative feelings some nurses feel towards their management team.

Lack of Upward Mobility. Many nurses unhappy with their chosen profession find that job mobility from the bedside is difficult without an additional degree. A nursing degree overqualifies many from other jobs outside of nursing and may not pay the equivalent of a nurse’s current salary. In order to get a job that pays as much or more than the average RN makes, additional years of school are typically required. This is a sacrifice that some may not be able to make, given that going back to school requires time away from work.

For those willing to go the extra mile and complete a higher degree in nursing, many career opportunities abound. Going back for an advanced nursing degree is the way some nurses find personal satisfaction in their career. Although not in a graduate program yet, Brittany Green, BSN, RN, a relatively new nurse of three years, plans on becoming a family nurse practitioner to influence patients in an outpatient setting and prevent some of the morbidity and mortality she sees in her current job as a cardiovascular recovery room nurse.

Green believes nurses leave because they experience burnout. “It’s not a career for everyone. It takes a special type of person to handle the emotional and physical stress that comes along with nursing,” she says. “I know I won’t be able to do bedside nursing forever; the long hours and stress will start to wear more on me.”

Underpayment. A nurse’s job can be physically and emotionally draining. Many nurses feel like they are severely underpaid for the work they do. Twelve-hour shifts can feel more like 16 when you are working the job of four people, but only getting paid for one. Nurses also sacrifice holidays, weekends, and family events because of their long and ever-changing schedule.

On the other hand, one may say a nurse’s schedule is ideal; a three-day work week schedule and having the ability to take long vacations using minimal vacation time sounds appealing to many.
But at what cost?

Nurses are notorious for picking up extra shifts on their day off because they feel like they are being paid not nearly enough for the work they do. Based on the most recent Minority Nurse annual survey results, the average RN salary in the United States is $67,980 per year. This may be considered a solid middle class income for most Americans, but nurses work very hard and feel as though it is not enough most days.

Too Many Tasks. Today’s nurse does it all; you name it, nurses do it. Administer meds? Check. Assist patients with dressing, bathing, and mobility? Check. Perform bedside procedures once done by physicians? Check. Coordinate care between all disciplines of the hospital? Check. The list is endless—and that’s the problem. Nurses are responsible for so many aspects of a patient’s care that it can become overwhelming for one person to manage during a shift.

A typical nurse works a 12-hour shift that translates into much more when the nurse is doing the job of multiple people day in and day out. Sometimes a nurse is so involved in completing everything it becomes difficult to take a much needed and deserved break during her shift. This makes for a very long day. Although the typical nurse’s schedule consists of three 12-hour shifts per week, when the days are packed with multiple tasks and responsibilities each and every day, burnout is inevitable. Studies conducted to rate nurse turnover clearly show that as a nurse’s workload increases, nurse burnout and job dissatisfaction—both precursors of voluntary turnover—also increase.

Nurses performing too many tasks typically boils down to staffing, specifically understaffing, which is also known as short staffing. When nursing units are short-staffed, nurses take on a majority of tasks done by others simply because they know how to do many other people’s jobs, but those people cannot do the job of the nurse. How many nurses have had to cover the front desk because there is not a unit secretary on duty? Or how about the nurse who is behind on her nursing duties just because she is trying to complete activities of daily living for a patient that is usually carried out by a nurse’s aide? Nurses wear the hat of many, but no one can take on the role of the nurse.

Short Staffing. A resounding number of nurses blame short staffing as the most common reason nurses leave the profession. According to a recent poll on, more than one third of 1,500 nurses polled say that continuous short staffing drives nurses from the bedside and, ultimately, the profession. One of the reasons for short staffing is management cutting costs as much as possible—and what better way to do that than cut staff and work on less than is needed? Nurses are notoriously known to multitask, wearing many hats on a day-to-day basis. Management knows this and may not think it’s a problem to go without a unit secretary or nurse aide on the unit because nurses will pick up the slack. Unfortunately, this unequal distribution of work leads to many unhappy nurses who burn out quickly when doing the job of many people.

Employers can ease the burden on nurses by mandating nurse-patient ratios. Since 2004, California has mandated patient ratios of 1:5 for nurses working in hospital settings. Studies have shown the benefit of such staffing ratios. The Aiken study demonstrated that nurses with California-mandated ratios have less burnout and job dissatisfaction, and the nurses reported consistently better quality of care, leading to decreased turnover.

Decreasing patient-nurse ratios has more benefits than disadvantages that could benefit US hospital systems. The Aiken study followed nurses in three states: Pennsylvania, New Jersey, and California—with California being the only state with mandated nurse-to-patient ratios. Over 22,000 RNs were surveyed, and researchers found:

• RNs in California have more time to spend with patients, and more California hospitals have enough nurses to provide quality patient care;
• In California hospitals with better compliance with the ratios, RNs cite fewer complaints from patients and families;
• Fewer RNs in California miss changes in patient conditions because of their decreased workload than RNs in New Jersey or Pennsylvania;
• If California’s 1:5 ratios on surgical units were matched, New Jersey hospitals would have 14% fewer patient deaths and Pennsylvania hospitals would have 11% fewer deaths;
• Nurses in California are far more likely to stay at the bedside and less likely to report burnout than nurses in New Jersey or Pennsylvania.

Maybe other states should follow California’s lead and mandate nurse-patient staffing ratios. What will it take to get the message across to industry leaders and make a change in how staffing levels are managed across the United States?

To Stay or Go?
The nursing profession isn’t completely lost on Thompson. She still works occasionally at the bedside on an intermediate care unit simply because of the one-on-one interaction she has with her patients. Many nurses reflect that they love nursing and enjoy spending time with their patients—something that is becoming more and more difficult with everything nurses are expected to do in this day and age.

The decision to leave the bedside affects not only the nurse contemplating such a transition but also the facility and patients who may be taken care of in a facility that is short-staffed. Replacing a nurse is costly. The RN Work Project cites the average cost to replace an RN who leaves the bedside ranges from $10,098 to $88,000 per nurse. What’s more astonishing is total RN turnover costs range from approximately $5.9 million to $6.4 million per year at an acute care hospital with more than 600 beds.

There are nurses who love their career and wouldn’t ever think of leaving. Kim Hatter, MSN, RN, is one of them. Drawn to the profession because of her mother, she was inspired by her compassion at an early age: “[My mother] was actually one of the first African Americans to graduate from Southern Arkansas University as a registered nurse.”

When questioned whether or not she had plans on leaving the profession, Hatter says no. “I’ve never thought of leaving the nursing profession, but I have sought a higher level of education in nursing recently.” Like Green, Hatter is completing her goal of becoming a nurse practitioner. She recently graduated from an adult–gerontology program and will soon leave the bedside to work at an outpatient clinic.
Because the bedside can be brutal on the body, many nurses like Green and Hatter choose to pursue nursing higher education to move from the bedside instead of leaving the profession completely. “I’ve heard of a lot of nurses with back and knee injuries,” says Hatter. “Nursing is a physically taxing job and does take a toll on your body.”

What is the Answer?
Nurses face a variety of challenges in the workplace that makes their job difficult. Based on the most prevalent and distressing issues identified by nurses, what is the overall answer to keep nurses at the bedside and, ultimately, in the profession? The RN Work Project reported when RNs leave their job, most go to another health care job not necessarily in a hospital. This is great for the general community, but it leaves a gap in coverage in hospitals where most acutely ill patients go. Where does that leave patients who need care in a hospital setting?

Green doesn’t think there is any one solution to the problem. “Burnout will always be an issue in the nursing profession,” she explains. “I think one of the most important things is for nurses to feel appreciated—by employers, coworkers, physicians, and hopefully patients.”

Hatter has a different prospective on potential solutions to this monumental problem: “I think paying nurses a higher rate of pay is always an incentive to stay. I also think nurses should receive more recognition for the valuable role they play in society.” The common denominator between Hatter and Green is that they both believe the nursing profession deserves more credit than it currently receives—and maybe this is the first step in keeping nurses happy and in the profession for the long haul.