UNDERAPPRECIATED HEROES
NURSES ARE THE HEART OF HEALTHCARE

As a critical care physician, I would be nearly paralyzed in my job without quality ICU nurses. Could I fumble my way through many situations? Sure. I mean, I’m an expert at pushing the “silence” button on the pumps when they are screaming at me. But could I make it even half a day without my highly skilled co-workers? Not a chance.

I have so many thoughts about RNs, but let me say that I am 100% biased. In the ICU, the RNs are generally kick-ass. So, kick-ass, in fact, I feel sorrow when I see them leave the ICU for administrative or higher educational aspirations (NP, CRNA, etc.). I’ll admit that may be selfish – I should be happy for anyone to pursue “more” for themselves. But, I see more and more going this route, not to merely pursue higher aspirations, but to escape the grind of the bedside and the micromanaging of their careers.

I can’t help but wonder what nursing would be like if we made the bedside job one that doesn’t need escaping from. (This was an issue BEFORE the pandemic….) I’d love to hear an RN tell me he/she is going to XYZ school because it’s always been a dream….not because “I can’t do this forever.” The great RNs I’ve worked with give of themselves 100% – it’s important to THEM to do the very best they can, to be the most educated they can be at doing their bedside jobs. So, when those same RNs walk away from the bedside as an escape from a malignant system, it’s so sad.

I’ve done a lot of locum work during my career and have had privileges at over thirty facilities. Just in the past two years alone, I’ve staffed five ICUs. The ICU is a unique place because it’s not a unit where casual relationships develop between physicians and staff. It’s a place where people on every level of the work force come together during times of ultimate craziness to save a life, to get a family member to the bedside before a loved one passes, to ensure medications are obtained from pharmacy as quickly as possible, to track down needed supplies for a bedside procedure, to figure out the most efficient way of doing something that needs to be done for a patient – and, so, so much more. It’s a place where trust is critical, and knowing the skills of your coworkers is paramount. However, another crucial aspect of this relationship is knowing the hearts of these nurses – knowing why they do what they do. And, in my eleven years of practicing critical care medicine, it’s become quite clear that the best care is given through a symbiotic relationship amongst everyone involved with giving that care. Personally, I don’t see how this can exist without truly knowing one another.

In the ICU, an RN who can recognize subtle changes happening within a patient and know exactly what those changes mean is invaluable to both the health and outcomes of patients, but also to the rest of the treatment team. No physician can be everywhere at once, which is why the bedside nurse not only provides care but also serves as the eyes and ears of the team. And, as with any skill, this severity recognition only gets better with experience.

So, seeing bedside RNs leave so early in their careers saddens me.

Every single place I’ve worked, I’ve seen RNs be denied negotiating power and leave, only to be replaced by travel nurses making significantly more than the initial RN was asking for. It is perplexing that any system would let a quality RN leave only to take their chances with a traveling RN who (with the agency fees) is costing the facility significantly more. Don’t get me wrong – I’ve worked with some awesome travel RNs too….But what if there was a system where travel RNs weren’t needed??

What if there was a system that fostered an environment where great bedside RNs were so valued that they’d never WANT to leave the bedside, unless it truly was a dream to pursue another career? We’d have the absolute best, long-career RNs training our younger RNs. We’d have an environment that didn’t require escape….a feeling that is contagious and spreads like wildfire. It seems like young RNs come onto the scene already with the knowledge that it’s not a sustainable, lifelong career from the get-go. I realize this isn’t as simple as I’m making it. Because…the exact same thing happens with physicians and has happened to me.

This is a system problem, not just an isolated facility problem. I don’t pretend to understand the nuances of nursing administration or what goes into these decisions. And, there are a lot of reasons people feel the need to move on. But what I do know is that the sense of not being valued and appreciated leads to more people leaving than anything else….especially when one is giving their all, and their intentions are pure of heart. I know this because I’ve worked at a lot of hospitals….and the conversations between the nurses are the same at all of them – literally 100% the same.

I’ve heard dozens of conversations between young RNs in the ICU who were thrown into patient care with suboptimal bedside training. (Not saying it was inadequate training, but certainly

“Kick ass” bedside nurses need to be paid andappreciated more…not replaced by travel nurses

not optimal for a newly certified RN in a high-intensity unit.) They comment on how they hear about the money their travel colleagues are making, and that seems to be the answer to the inevitable burnout. They are tired of administrative overreach at a facility to which they’ve been loyal for years. I hear about flexible scheduling, only to have that flexibility taken away with staffing shortages and passive-aggressive, public comments in meetings about being a “team player” – so they work extra without time for self-care. These are all conversations I’ve heard over and over – from Georgia to Wisconsin. They do not feel heard or valued.

I genuinely hope someday this changes and RNs feel that a bedside career can be rewarding and lifelong, if it’s what they want for themselves. (If they want more – by all means…GO FOR IT!) But if the decision to leave the bedside is a result of a broken system that promotes burnout and loathing for a job they once loved, it needs to be looked into because I need good bedside nurses to do my job optimally.
I need my team!

Written by Linda Hodges, D.O.., Intensivist