As a child, I practiced brain surgery on my Cabbage Patch doll, Sally. Because I wasn’t allowed to use knives, I used a red pen as a scalpel, drawing my incisions on her head. I already knew then that I would one day be a nurse, as I would inform the ones who gave me my vaccines at the doctor’s office.
In college, I watched “Grey’s Anatomy” in between studying for anatomy and physiology exams and decided I had a future in ER nursing. Once I started clinicals for my nursing program, however, I quickly lost my romanticized view of medicine.
As a new nurse, my only option was rotating shifts. I worked days, evenings and nights, chugging coffee hoping it would keep me awake. Instead, it gave me an elevated heart rate. I’d return home from a shift at 8 a.m., exhausted, yet unable to fall asleep. I quickly developed back pain from repositioning patients.
After a shift from hell, I sat on the cold locker room floor of the inner city hospital where I worked, sobbing. One of my patients was being coded, another had returned from a test unresponsive, and my third patient was on the call light every five minutes with uncontrolled pain. Nurses are always depicted as having it together, and being able to solve any problem they encounter. Yet caring for these critically ill patients while also addressing patient and family concerns felt like a nearly impossible feat.
(They’re also depicted as sexy, but I sure as hell didn’t feel that way at 3 a.m. in the middle of my shift, when I was covered in poop from cleaning up a patient’s explosive accident entirely by myself.)
At the end of my shift each day, I still had a long list of unaccomplished tasks, and it felt like patients were dying due to my incompetence. I was too exhausted and too close to the situation to understand the problem wasn’t me: It was the system.
I left the hospital a few weeks after that shift from hell, forfeiting my vacation pay and pivoting to research nursing in a calmer clinic environment. I didn’t care about the financial loss; I simply could not handle one more shift. I had only lasted 17 months.
Then, in 2019, I left nursing altogether to spend time as a stay-at-home mom before my daughters were old enough to start school. About five months after my last day at work, COVID-19 arrived in the United States, changing the health care industry permanently. Headlines told of shortages of vital equipment and understaffing, and of course, the illness and deaths of health care workers for whom doing their jobs now meant risking their lives. I felt guilty that I wasn’t using my license, but profound relief that I was avoiding the chaos.
Now that my youngest child is about to head off to kindergarten, people are beginning to ask if I will return to my career in nursing. I generally say something like, “I miss the patients, but not the politics.” But the truth is more complex.
Last week was National Nurses Week, intended to support and honor the contributions of nurses. Just before that, staffing company AMN Healthcare released their 2023 Survey of Registered Nurses, in which only 15% of nurses employed by hospitals said they planned to “continue working as I am” in one year. And a scary 94% of respondents agreed that there is a moderate or severe shortage of nurses in their area.
The shortage isn’t new news: It loomed long before COVID hit. In 2015, almost 40% of nurses were baby boomers over the age of 50, according to Montana State University health care economists. When I left floor nursing in 2014, things were already bad. As hospitals tried to save money, they reduced the number of aides and assigned nurses heavier loads. Our patients were sicker than ever, and we had less staff to help.
Switching to research nursing took me out of the chaos and gave me time to drink my coffee each morning without struggling to get the 8 a.m. med pass completed.
More excitingly, as I gushed to my husband, “I actually have time to sit with patients and answer all of their questions!” The doctors were engaged, taking me seriously when I pointed out a potentially dangerous issue with a patient, unlike the hospitalists who tried to shrug off (or gaslight) my concerns.
Sure, there were thousands of data points to log, thick protocols to follow, and the intricate dance of communicating between drug and device companies, institutional review boards, patients and doctors. But most patients in research trials wanted to be there, unlike the hospital patients, who were often having the worst days of their lives.
That meant a reprieve from the unquantifiable amount of verbal, emotional, sexual and physical abuse I tolerated as a floor nurse. This isn’t something nurses talk about often, but it was a huge factor in driving me out of floor nursing. Because patients are often experiencing altered levels of consciousness, or taking medications that affect their mental state, nurses are expected to tolerate abusive behaviors that would never be acceptable outside of a hospital.
I was regularly yelled at by patients or family members. There were inappropriate sexual references ― the time a patient kissed me without my permission, and the man who undressed in front of me and followed me into the hall. Once, a patient pushed me into a wall and tried to slap me. After he was restrained, he looked me in the eye and said, “I wish you were treated like a Chinese baby girl, put in a paper bag on the highway, and run over by a car.”
I polled some of my nurse friends, asking whether they had ever been physically abused on the job. Their responses not only highlighted the frequency of abuse, but also, how it has been normalized:
“I had an old guy pinch my ass.”
“I was definitely kicked a few times when I took care of adults. Nothing significant.”
“Yes, more times than I can count. I’ve also pressed charges more than once.”
“I have been hit in the knees with a cane… I had a prisoner in my ER one time who pulled a razor out on me and then turned it on himself. I’ve also had a psych patient chase me down the hallway while I was six months pregnant with my twins. Not to mention the verbal abuse received constantly from patients and their family members. Needless to say, I’m now working in hospice.”
And then there’s this: “If it’s not patients and families, it’s co-workers!”
“Nurses eat their young” is a concept that is well-known in the industry. My co-workers often downplayed the abusive behavior I experienced, or responded with arched eyebrows and snarky responses when I asked for help. Maybe I would have lasted longer as a floor nurse if I had a supportive group of co-workers and managers who called abuse what it was, recognized the impossibility of what we were being asked to do, and listened to what we needed.
Sometimes nursing is described as a vocation. And I agree that it takes a special type of person to do the job. But “we need you” isn’t a good enough reason to return.
I genuinely loved piecing together medical and personal histories, caring for patients, and meeting their family members. But when I consider going back to nursing, I ask myself, “Do I really want to subject myself to abuse? Do I want to tank my mental health? Do I want back pain and insomnia? Do I want to be so exhausted when I return home from work that I have nothing left for my daughters?” No.
People often put nurses on a pedestal for the selfless and noble work they do. But when you are a nurse, you see how that selflessness can be and is exploited. Instead of paying lip service to those in the nursing profession, I wish people would consider how they are actually being treated. We shouldn’t have to choose between the job and our mental and physical well-being.