It’s hard to miss a story these days about the struggles within the nursing profession: staff shortages, lack of educators, burnout, workplace violence, health consequences of shift work, and more. No one ever said nursing was easy.
But if we look at the single source of all these issues, nurses can help the situation more than they think by just taking care of themselves. How so? If all 3.4 million nurses took care of themselves—their well-being physically, emotionally, personally and professionally—we could make an incredible impact, role modeling healthy behavior for each other, our patients, our families, our communities, our society.
I admit it: I’ve worked while sick on multiple occasions as a bedside nurse, and I was wrong to do so. One time sticks out the most: I was truly miserably ill. I showed up for work because I was a new nurse to the department and the charge nurse was scary. When I started my shift, I was not my normal, energetic self. She looked at me and asked, “What’s wrong with you?,” in an annoyed tone. I said, “Well, I really don’t feel well and, honestly, I don’t know if I will last all night.” She replied, “Are you kidding me? I hope you’re not serious,” before storming away.
Not only did I work the next 13 hours without a break, she “punished” me by giving me the most complicated, critical patient in the ED—intubated and on a huge number of drips with pressors, insulin, sedation, antibiotics and blood products. The ICU was packed and the patient wasn’t going anywhere. Not only was he at risk for catching my illness (I was in head-to-toe PPE, including N95 respirator, mind you), he was at a much greater risk of medical error because I was not thinking or operating at 100 percent.
You might be thinking: You should have just gone home. You should have gone up the chain of command. You should have … And you are 100 percent correct! But I didn’t. It was not just the intimidating charge nurse that made me stay; it was much more complex than that. The ED was slammed and we were not adequately staffed. What if I had left? Who would take care of this patient? Could he be at higher risk with one less nurse around to help patients? Would my teammates be overwhelmed with tasks if I left? How could I do that to them?
When nurses choose between the risk to their patients while working ill, and the risks of decreasing nurse-to-patient ratio, continuity of care, and their reputation as a team player, the decision is not so clear. Many of us have asked ourselves: How contagious am I really? I can just wear a mask and douse myself in hand sanitizer all shift, right? Our patients are our No. 1 priority. That’s why the decision is so difficult.
The July issue of JAMA Pediatrics published an article about why clinicians work while sick. The reasons for deciding to work while sick include:
- Not wanting to let colleagues down
- Staffing concerns
- Not wanting to let patients down
- Fear of ostracism by colleagues
- Concerns about continuity of care
- Difficulty finding coverage
- Strong cultural norm to come to work unless remarkably ill
- Ambiguity about what constitutes “too sick to work”
Every one of these factors raced through my mind that night. Does it stick out to you, though, that none of the factors address concern for one’s own health?
I may be “coloring outside the lines,” but our patients shouldn’t be our first priority; our own health should. The risk we are to them while we work sick is real. It is important. However, it isn’t what is most important: We are. You are. I am. Think for a second about what you’re told on an airplane prior to take-off: “Place your oxygen mask on first, before helping others.” Such simple logic.
I can’t recall how many times I heard the phrase, “suck it up” that night. My patient survived, but it is something that will never leave me. There is definitely another topic at play here too–nurse bullying—on which you will surely hear more from me.
I want you to seriously think about this: Why don’t we take better care of ourselves? Why don’t we take better care of each other? Unfortunately, it is a part of the culture we have cultivated. But it’s time to end it. The oxygen mask goes on you first.
So how do you, as 1 of 3.4 million, start to change a cultural norm? Start by commiting to putting your health first, now. An easy first step is a click away: Take the HealthyNurse Risk Appraisal from the American Nurses Association at: http://anahealthynurse.org. This allows the ANA to assess the state of nurses’ health and develop more resources to promote healthy behaviors and create healthier work environments, and it gives you a baseline from which to begin
Let’s help one another by fostering a profession that stands for nurturing the mind, body and soul. I welcome your thoughts, experiences and perspective in the comments below.