A stressed-out ER nurse tells her story

An emergency-room nurse tells an all-too-common story.

I work in a very busy metropolitan emergency room.  It means that we take care of a high volume of patients daily, regardless of whether or not the trauma services are needed.  I recently heard the numbers: last year, we cared for an average of 150 patients per day.  This year, we are caring for an average of close to 200.  Now, fifty people doesn’t maybe seem like that much, but you multiply that by the fact that each nurse is caring for an average of close to 6 additional patients per day, it adds up.  Each of those people is another assessment; each more than likely means lab draws, IV’s, medications, re-assessments, other treatments as needed, final assessment, discharge, and escorting to the discharge area.  All of that needs to be crammed into the same time period as the previous patient load used to be, and means that everyone is constantly under time pressures as well as direct pressures by management to ‘move them through!’

sunbelt-er-nurseWhen I went from being a firefighter paramedic and working 24 hour shifts to being a nurse and working 12 hour shifts, probably the biggest surprise to me was the fact that working a 12 hour shift is as mentally and sometimes physically taxing as working a 24.  That’s because as a nurse, you don’t get ‘down time’ in between patients.  You always have at least one, usually more, and you are always thinking ahead to what has been done, what still needs to be done, who is sitting in triage and will probably be your next patient and what will be need to be done immediately for that patient, and so on…for 12 hours.  Now, I’ve worked 24 hour shifts and worked two jobs at a time for nearly 20 years, but this is without a doubt the most stressful job I’ve ever done.

Add to that the fact that our administration is –wasting- hundreds of thousands of dollars on ‘consulting groups’ to *supposedly* increase our productivity, and we are in a constant state of flux because of that, and there are now constant and unrelenting pressures on us to produce as though we were assembly line workers pumping out auto parts, and you can maybe understand that my level of stress has been bumped up by more than a few notches in the last eight months or so.

via My job is making me sick.

The writer goes on to cite business school studies that supposedly indicate that stress and fear are better motivators than rewards and incentives, and points out that at her facility, the people who do the work get all the stress and fear and the decision-makers get all the rewards and incentives.

What she describes reflects a corporate business model that subordinates everything to economic efficiency, and defines economic efficiency as maximum use of resources, including human resources.  If the goal instead was to give the best feasible service to the patient, there would have to be some slack and redundancy in the system.  If you’re pushing people to the utmost under routine conditions, they have nothing extra to give under extraordinary and emergency conditions.   And when you treat people like cogs in a machine, you’re depriving yourself of the most valuable thing they have to give—the fruits of their knowledge, experience and thought.

I hear of this business model being applied to newspaper reporting (which I retired from 14 years ago) and public education (in which I have friends and relatives).  I don’t think this is a good business model even for assembly-line workers making auto parts.  You may maximize output, but you don’t maximize good work.

Health care “reform” like educational “reform” nowadays consists of people with seven-figure incomes hiring consultants with six-figure incomes to make recommendations on how to step up the pressure on people with five-figure incomes.

The writer says she loves nursing, but she is less and less able to do the things she entered the nursing profession to be able to do.  This is a kind of comment I get from friends and acquaintances across a whole range of occupations and professions.   In my opinion, things will get better only when people who just want to do their jobs organize into unions and fight for the right to do their jobs.

Click on My job is making me sick for the whole thing.  It is well worth reading.

Click on Hospitalists and the price of medical efficiency for an earlier post of mine on this subject.

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