How Secure Is Your Job? A Reality Check for All Nurses

How many nurses does it take to screw in a light bulb?

Just one, but at the same time she’s passing meds, hanging blood, admitting a patient, greeting families, helping docs, pacifying administrators, juggling paperwork, explaining procedures, deciphering orders, answering lights, discharging a patient, changing an IV, charting notes, and performing CPR. Sounds familiar to all nurses out there?

After one of my presentations, a nurse came up to me and shared that her hospital had a recruiter stationed at the front door. Should an RN come in and sign for a nursing job, the hospital would write them a bonus check of $7,000, right then and there. She shook her head and laughed. “The hospital can’t figure out why that same nurse will flee from the building as if it were on fire as soon as her commitment is up. But that $7,000 is the only money they (the hospital) will spend on that nurse. No one cares about the employees. We’re just numbers figured into the budget. And if the hospital isn’t making money, the people are expendable.”

Sounds discouraging, doesn’t it? And yet, there are incredible men and women who dedicate their lives to the noble profession of nursing. For the last 10 years, much of the focus regarding staffing has been recruit, recruit, recruit. Recruiting is a good thing, but studies are finally starting to show that the focus may be better spent on nursing retention. What a concept. Make the work environment so great that the good people you have on board want to stay. Hmmm… sounds like a job for The Service Prescription!

Take for example, Spectrum Health. In 2004, they decided to create The Center for Exceptional Services. They realized that this was much more than just a project. We’re talking changing corporate culture! It was a multifaceted approach with a highly engaged multidisciplinary team. There was lots of passion, commitment, and creativity. Some of the strategic tactics included:

A “no meeting zone” from 9-11 a.m. to allow leaders to see patients as well as staff.

Storytelling to share successes and reinforce positive behavior.

A Patient and Family Advisory Council comprised of community members and hospital staff.

A “What If” fund created to encourage staff to propose new ideas.

Issues with Nursing: Let Your Voices Be Heard

I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that most issues with nursing remain unaddressed. Nurses still have not necessarily found their collective voice. Despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.

Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book - nor a comprehensive enumerating of its content - there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.

What's in a Name?

In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of nurses on a collective whole.

When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.

Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."

The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.

Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.

As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.