Okay, so the title is dramatic, but it is truthful in some cases. Last weekend I worked my bedside nursing job in a general ICU and worked two night shifts in a row. I cared for two trach patients, both had been living in the hospital for months, both were depressed, in pain, delirious, not sleeping, pulling at their lines and tubes, incontinent, in isolation for CDIFF and multi-drug-resistant organisms (MDROs), had wounds, needed baths, were overweight, and unable to fully communicate with me. One hit the call light nearly 60 times during my shift. This call light was linked to my nurse phone, which would ring while I was gowned up in my other patient’s isolation room and gave me serious alarm fatigue. Both patients would hit the bed rails with their hands to call me. I never sat down. I had to be stern with them and at one point I snapped at one of them and had to leave the room to collect myself.
When I arrived home the morning after my second shift my whole body ached. Both knees were throbbing from turning my overweight patients and walking nearly nine miles in each shift. My back and head were throbbing in sync with my knees. In the past two days I had slept roughly 8 hours. It took me almost two days to recover from the emotional and physical work, but this is “normal” for many of us.
Now that I’m in grad school and have signed on to work in this career for the rest of my life, I do worry that nursing is slowly killing me even though I love it so much. I am constantly sick, chronically exhausted, I feel like I have the knees of an 80-year-old, but I barrel through the pain because this is just the way it is – or does it really have to be?
In the past couple years, since working this intense schedule, I have also gained weight that I haven’t been able to lose. This is odd for me since I have a naturally thin frame and I also don’t eat much during night shifts because I frequently have GI upset from lack of sleep. However, I drink a lot of coffee to keep me going. It’s sad, but it is definitely my fuel. Working 12-hour, ICU shifts, with minimal sleep makes me crave sugar whether I’m working days or nights.
I see other members of my family who don’t work in healthcare and sometimes am envious of the lives they lead. I asked one of them once, “When was the last time you woke up refreshed and ready to start the day?” She told me she woke up refreshed almost every day. I couldn’t help, but laugh out loud because I hadn’t awakened refreshed in years. Of note, this family member has a very high-powered job and works very hard, but it’s a different type of work and she works for an employer who truly values her.
So is this job killing me faster than other jobs? The short answer is yes, here’s why.
We’ve all heard of compassion fatigue, it’s quite a buzz phrase in nursing. While it’s easy to brush off, it’s incredibly real. Compassion is defined as empathy and a deep awareness of another’s suffering along with a desire to alleviate it. Nurses don’t just acknowledge pain, they want to take action to make their patient’s feel better. Nurses’ characteristically feel deeply. When I see my patient and families in deep emotional pain or distress, I instinctively carry it with me to alleviate their suffering. Although this is an abstract thought, I believe there is truth to it. This emotional fatigue weighs on my mind and my knees.
According to one researcher, “compassion fatigue among nurses can negatively affect patients’ responses and induce financial instability of institutions, as well as lead to nurses’ indifference or apathy toward patients, generate feelings of helplessness/hopelessness, produce headaches, sleeplessness, gastrointestinal symptoms, depression, and/or a desire to leave the profession.”
Shift work – there is tons of research indicating how bad shift work is on the brain and body. Where do I even begin? Shift workers experience disruption in their circadian rhythm affecting both sleeping and waking. Sleep deficits accumulate over time and can’t be “made up” in professions like healthcare delivery. Shift workers experience many physical symptoms like higher rates of cardiovascular diseases, GI tract issues, and obesity. However, they also experience higher rates of depression and fatigue. Additionally, nurses become so fatigued, they frequently experience burnout, apathy, and make more mistakes.
My experience with night shift has been rough, but a necessity in my life. It never gets easier for me and I have tried everything and more that experts recommend to adjust. Unfortunately, like many nurses, I can think of two separate occasions when nurses have died on their commutes home from night shift because of exhaustion. These people and memories will never leave my mind. I have also called in sick more, likely due to shift work. I consciously quadruple check almost every medication I give because I know I’m not cognitively functioning at full capacity. And finally, my typical night consists of me trying to hold myself up at the nurse’s station or coping with continuous headaches and chest pain while waiting to give report. The nurse life can be brutal and I know my experiences are nothing compared to most.
Nurses tend to love the option of working three 12-hour shifts per week. However, these 12-hour shifts frequently turn into 13 or 14 hour shifts, plus a 30-60 minute commute each way. Working an extremely taxing job for more than entire day and commuting is nearly impossible for the human brain and body to process repetitively. This leads to lack of sleep and once again, health problems, apathy and burnout. More mistakes are made when nurses work 12-hour shifts and patient satisfaction decreases, but guess what? It’s cheaper for hospitals to hire nurses on a 12-hour rotation.
If you want to read more, here is one of many studies to check out.
Anyone who works shift work is at a higher risk for morbidity and mortality. Therefore, nurses are usually at the top of the list for the most unhealthy profession – as well as ER/ICU doctors.
So what can we do? We must advocate for ourselves and that begins with imagining a better work environment. What if you went in to work and only cared for one ICU patient for eight hours, then made it home in time to have dinner with your family and sleep a full eight hours? An ICU nurse might even scoff at this idea and proclaim it to be too easy. However, it’s also important to note that nurse to patient ratios haven’t changed in decades. ICU nurses were taking two patients 30 years ago way before the medical advances we have today (ECMO, LVADS, CRRT, etc). So why should the ratios be the same when the patients are exponentially more complex? Just a thought. The healthcare worker must be taken care of first before expert patient care can be provided.
Data exists. Healthcare workers, particularly nurses, are unhealthy. When units are better staffed, patient care is better. More mistakes and higher rates of nurse burnout occur during 12-hour shifts. We work in a profession of gluttons for punishment who think it is noble to stay quiet and just get the job done. But, we must speak up, if not for ourselves, for the patients to which we provide care.
Thank you for all you do, as always. Take care of yourself; you’re more than worth it!