Why We Need to Reimagine the Healthcare System: Creating a More Sustainable Future for Nursing

In 2021, IntelyCare sought out the best nursing blogs on the internet. We compiled a list of the best blogs on the internet and asked our audience to vote! IntelyCare’s Top Nursing Blogs are curated by nurses, for nurses, making it the go-to place for nurses to get the stories, opinions, and information that matter to them while connecting with their peers. We ask Paula, author of Life of a Nurse and our first place winner, to write a piece about the how we can update the way we see the future of nursing and improve our health care systems. Here is her take on the real issues facing nurses today.

“How are you feeling?”

To be honest, this is not a question nurses get asked much. If they are asked, the answer is rarely about their mental health, but rather focused on the medical practice, COVID-19 effects on operations, or current experiences. This leads to many nurses leaving the profession due to a lack of support, emotional burnout, moral distress, and dissatisfaction in the workplace.

How can you blame them? Look at this brief window into a nurse’s life (name changed for confidentiality).

Agnes Maria works in Intensive Care. Her seven years of experience means that her clinical judgement and critical thinking are well developed, and she is typically given the most complex patients every shift. This is a lot to take on. On this particular night, it included the additional stress of being short two nurses, overseeing three critically ill patients, and having a novice nurse supporting her who already expressed how she was terrified of the monitors and IV pumps.

Within the first hour of her shift, there was a Code Blue, and a patient on the floor was dead. Twenty minutes later, one of Agnes’ patients had the same fate. She checked on her second patient and observed the 40-year-old male had mottled skin, his saturations were down, and he was already prone—she called the intensivist who ordered STAT labs and asked for a respiratory therapist. As the team quietly discussed treatment options, the monitor showed an arrhythmia—the patient’s cardiac output was minimal, and he died within minutes. 

At this point, Agnes was feeling lightheaded, and her heart raced. She had never felt this way before. She excused herself and entered the staff washroom. She tried to take a moment to consider these losses, but at that moment another Code was called – it was her final patient under her supervision that night. Still coping with the first three losses of the evening, she struggled to hold back tears as she donned her PPE. Her usually calm and stoic ICU persona was being stripped away by the overwhelming grief and weight of the evening. They weren’t able to do anything and her fourth patient of the evening (and tenth patient in two shifts) was gone. In two short hours, four patients died with no family present, all alone. She was struggling to hold it together after this intense experience, and no one was acknowledging that their ‘ICU warrior’ was hurting.

This vignette is one example of many that could be told, showing that there is a complete lack of a support system for nurses. They are expected to “just deal with” anything that is thrown at them, without complaint, and without consideration of the significant emotional and mental toll their jobs take on them. It is unreasonable to request this of anyone.

Healthcare Challenges Have Evolved

The challenges faced by healthcare professionals over the last 24+ months in hospitals and long-term care are the result of working conditions that have evolved over 20 years. With the restructuring and trimming of workflows, team culture, and staffing ratios, nurses are left to care for themselves on their own. Workload and staffing levels were key dissatisfaction indicators before COVID-19. Organizations added more: tasks, interventions, and safety protocols, as well as patient experience expectations requiring empathy and compassion. Right now, nurse vacancy rates in many North American hospitals are 25% or higher. Nurses have gone beyond their limits. Leaving the profession is now the only way to survive.

There needs to be a complete reimagining of how governments, HMOs, and organizations treat nursing professionals and create a healthy workplace. It’s time to inspire nurses to choose this discipline and remain.

What does this mean, in practicality? It means that hospitals need to consider implementing things like bonus structures, tuition reimbursements, and life services (i.e. day care and gym memberships). They need to create work environments that support flexible schedules and provide access to education and mental and physical health resources. They also need to ensure that there are replacement nurses available so that staff can take time off. With these improvements, there will not only be an increase in people choosing to pursue and stick with nursing, but it will also elevate the science and art of the profession. Having stability and sustainability for nurses will translate into safer, higher quality, and more innovative patient care.

By the way, to all those working to make a better future of nursing, thank you for being there at point of care, leading, teaching, developing policy, and administering any and all of these roles.

Namaste.

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