Toxic Nursing: the stories, the solutions

Patients as Victims

Aria, an RN with 10 years of experience on a medical-surgical floor at Community Hospital, has worked a double shift after another nurse calls off sick. After 10 hours of caring for difficult patients, she is tired and grouchy.

A patient, Mr. Truman, is recovering from major abdominal surgery. He needs a dressing change and pain medication, but Aria is busy helping another patient who has IVs and mobility problems get to the bathroom. Mrs. Truman searches her out. “My husband really needs you,” she tells Aria. “He’s got a lot of pain.”

“I’ll be there as soon as I can,” Aria replies.

Ten minutes later, Mrs. Truman shows up again, repeating her request. This time, Aria follows her down the hall and tells Mr. Truman she is getting his meds and the supplies for his dressing change. Aria completes her care of Mr. Truman, but is rough and unpleasant as she does so, because she feels stressed and unappreciated. Mrs. Truman later files a complaint with Aria’s nurse manager.

The Expert Weighs In:

The impossibility of one nurse needing to be in two places at once comes up over and over again in clinical practice, and it’s actually an easily solved problem. Answering call lights should be everyone’s responsibility, and there should be enough staff on the floor that Aria could call an aide, another nurse or even the nurse manager to either help the patient get to the bathroom or give the pain medication to Mr. Truman. Managers also need to be tuned in to whether nurses are working a double shift and be prepared to give an overtired nurse more backup.

The real problem here is the chronic one of hospitals not having enough staff to cover call-offs and expecting nurses on the floor to make up the difference without any negative consequences to themselves or patients. Aria is only human; being confronted in the hallway by an irate family member is likely to produce irritation. The nurse manager will need to hear Mrs. Truman’s complaint and then apologize for not staffing the floor adequately and not giving Aria the support she needed to do her job. She also needs to follow up with Aria in a supportive way, admitting Aria was overworked, but making clear that being rough with patients is, of course, not okay.

–Theresa Brown, BSN, RN, OCN, Staff nurse, contributing editor to Scrubs, columnist for The New York Times and author of Critical Care.

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