Kyana Brathwaite, founder and CEO of KB CALS- Caring Advocacy & Liaison Services, worked as a critical care nurse when she hurt her shoulder during a patient transfer.
“Our patient population is getting heavier [and] it is not always realistic to pull colleagues from different areas/departments to help. My true issue was not with the injury—although unfortunate, they do happen—my issue was with how my particular situation was handled after the injury by both management and the entity I worked for,” she explains.
For these reasons, the pain of her injury and the lack of support by management, Brathwaite chose not to stay at the bedside. Would she have stayed had circumstances been different?“Prior to the injury, I was considering staying at the bedside for at least five more years to give me time to plan the direction in which I wanted to take my nursing career.”Although she did plan to continue her career eventually, she would have given solid years to suffering bedside nursing specialties.
In fact, many nurses run from the bedside as soon as possible because conditions are so deplorable. They look for jobs in advanced practice, teaching, and other non-bedside related areas of nursing, while the number of nurses taking care of the most critical patients continues to dwindle.
Here are four reasons nurses leave the bedside and some ideas as to how to make them stay.
1. New Grad Education
New grads can go into a bedside job and not know exactly what they are in for. In nursing school, clinicals usually don’t go beyond two to three patients per student so they are not exactly exposed to the real-life rigors and stresses that come with the life of a bedside life—and cultural shock is a very real phenomenon.
“Nursing students are constantly told by faculty, peers, mentors, and experienced nurses what bedside nursing is ‘really like,’ says Greg Eagerton, DNP, RN, an associate professor at the University of Alabama at Birmingham School of Nursing. “However, it is like the first time we ride the bike by ourselves…The same is true for new nurses; their hands are held throughout their training and then the day comes when they are ‘alone’ and it’s a little frightening. They now have the sole responsibility for their patient’s care, their patient’s life—and that can be daunting. It’s also the reason we always encourage team support from their mentors, their more experienced peers, and from all members of the health care team, including physicians, therapists, support staff, etc.”
Although this is true, new grads often express intense dislike of their new role as a bedside nurse, and they immediately want to move to another branch of the profession. Is it that the nurse is not prepared or that the job is simply too difficult? It certainly sounds like management is trying to accommodate new nurses, but a quick search of internet nurse boards will reveal new nurses in despair. Perhaps more intensive job shadowing will allow new grads to see what bedside nurses do. Perhaps more realistic teaching would also go a long way toward helping them. Whatever the answer, new grads are a special population that needs attention—though it already gets quite a bit—to keep them safe and happy at the bedside.
2. Staffing Ratios
Another issue that chases nurses from the bedside is poor staffing ratios. It can be overwhelming for one nurse to have eight to ten patients to themselves. Not only is it unsafe, it is also stressful, and many nurses would rather find a new job than to put their licenses and their mental health on the line like that. For this reason, staffing ratios are important to consider when examining the loss of bedside nurses.
“I do not feel staffing ratios is the main driving factor,” argues Ken Shanahan, MSN, RN, CCRN-K, clinical nursing director at Tufts Medical Center. “One of the main reasons I feel this way is because the only state with staffing ratios is California and yet they have the most nurse strikes. These strikes are actually increasing dramatically and are something we will need to address as a profession. The work environment is the most important factor and number of nurses or ratios is only a component of the working environment. There are many other components that we are not hitting the mark on that would help create a healthy work environment.”
Although a large portion of nurses would disagree with Shanahan’s opinion on the importance of staffing ratios, he does have a point: they are not all that is involved here. Getting the floors better staffed is only one part of the puzzle, but addressing pressing issues such as horizontal violence is needed, too. Everyone knows about staffing ratios, but few realize they are only one prop to hold up a very large house meant to keep nurses at the bedside.
3. Compassion Fatigue and Burnout
Compassion fatigue and burnout are the psychological components that keep nurses from staying at the bedside. The two are closely related but are not the same. Burnout, in short, is frustration with the situation and is typified by anger. Compassion fatigue is an exhaustion of the ability to extend oneself emotionally anymore and is typified by depression. Please note, these are very simple definitions and they are not exhaustive. Both of these conditions can occur together, and neither is pleasant. Nurses have had their lives broken over these issues, and no one wants to go through that. How, then, do we solve this problem?
“Burnout and compassion fatigue are concerns for direct care providers in all professions,” explains Eagerton. He suggests the following measures to help support staff:
- Leaders should be visible and approachable.
- Work schedules should allow adequate time off between shifts.
- Adequate breaks should be provided during the work shift so that staff have down time.
- Schedule time for staff to have discussions about what stressors they are experiencing that may lead to burnout and fatigue.
- Create opportunities for staff to be involved in activities that allow them to do things that are not direct patient care but have meaning to them, such as committee membership, attending professional conferences, and so on.
- Have resources available for nursing staff in addition to their managers to discuss their stressors, such as chaplains, mental health professionals, and counselors.
- Have dedicated space(s) on or near the units where they work where they can have some quiet time or time to eat their meal or have their break without interruption.
With these ideas in place, nurses can have a better shot at overcoming compassion fatigue and burnout. When these are not a factor or are a mitigated factor, the more a nurse can feel happier staying at the bedside.
Nursing is definitely a contact sport, as stories like Brathwaite’s prove. Transferring patients is getting more and more difficult with increased body weights. In addition, various specialties are more susceptible to transfer related injury. For instance, operating room nurses are at great risk because they must move patients who are unconscious and essentially dead weight. However, that doesn’t make your typical bedside nurse any less at risk. Moving and lifting are just as much a part of the job, and mechanical equipment is usually not available to help.
“There is only one of you, [and] there will always be more patients,” says Nick Angelis, CRNA, MSN, author of How to Succeed in Anesthesia School (And RN, PA, or Med School) and cofounder of BEHAVE Wellness.“If no one is available to perform a task safely with you, don’t do it. Hospitals always push putting the patients first, but you’re a danger to patients if you give and give until your weekly schedule must also include time for massage and chiropractor appointments. Flu vaccines, unsafe equipment, dangerous staff ratios, risk of physical harm from unruly patients because hospital security resembles nursing home patients—these all require putting yourself first.”
It really does come down to this: Nurses need to learn how to put themselves first. If you can’t lift that 300-pound patient, then don’t even try, no matter how much it needs to be done. Similarly, hospitals need to make allowances for nurse injuries. Providing mechanical lifts, better security, and education about safety could go a long way towards protecting nurses and keeping them at the bedside.
In the end, the question of keeping nurses at the bedside is definitely multifactorial—and controversial. Patients have been cared for all this time with the methods we’ve been using, so why change? The reason to change is that the nursing shortage is real, and it isn’t what you think. It isn’t a lack of trained nurses. It is a lack of trained nurses willing to work. If we can make the bedside more appealing to these nurses who have run for cover, perhaps the nursing shortage wouldn’t really exist at all.