In Australia, it is estimated nearly 20% of nurses will leave the profession within their first year of practice (National Nursing and Nurse Education Taskforce [NNNET], 2005). Internationally, this figure ranges from between 35% and 60% (Halfer & Graf, 2006). Many have speculated on the reasons for this, with high workloads, the difficulties of shift work and unrealistic expectations of what nursing entails all given due consideration (Halfer & Graf, 2006). However, as I entered my second year of practice, I began to wonder what role disillusionment plays in this exodus of newly trained nurses.
Disillusionment, to me, occurs when you feel your passion dwindling, when you suddenly find it that little bit harder to get ready for work, when you start feeling a sense of dread as you walk onto the ward. This wasn’t caused by long hours or ever increasing workloads coupled with diminishing resources. It wasn’t caused by physically demanding duties or the lack of a social life due to shift work. It wasn’t caused by dealing with things that might not look or smell that great. Unfortunately, it was caused by the people around me and an almost institutionalised lack of power, not only for nurses, but, more importantly, for our patients.
I was dismayed and frustrated to hear how many of my colleagues, from all health professions, referred to patients. I was disheartened to see how easily some could dismiss the suffering we see and the heartache I felt. I was overwhelmingly saddened to realise not everyone had the same passion for their profession or empathy for those we are charged to care for as I did.
This culminated for me towards the end of my first year of practice. There wasn’t any one big incident; more an accumulation of things that were gradually wearing me down. I had a worried patient confide in me that they had been too scared to push the call button on the previous shift because of the response they would receive from the nurse. I saw patients constantly being made to fit into everyone else’s schedules, regardless of their requests. It seemed everyone was more important than the person we were there to help.
I heard patients referred to as ‘cactus’ or described in the notes as ‘unsalvageable’, meaning there was no chance of the patients making meaningful recoveries. I wondered, is this really how we refer to people? Or did we forget they were actual human beings we were talking about?
I had other health professionals dismiss me with comments such as nurses ‘just wipe bums all day’ or roll their eyes at me when I raised my concerns. When I dared to challenge or question, I was met with comments of “I miss the old new grads”. I felt tired, washed out and was beginning to wonder whether I could stay in this profession without losing myself.
Luckily, I found some inspiration. I listened to a presentation by Drew Dudley, a well-known American academic and motivational speaker, where he discusses the idea of ‘lollypop moments’. These are small moments when the people we see and work with everyday demonstrate leadership. They aren’t big, grand, over the top statements. They are small gestures which, often unknown to the person who did it, have an amazing impact on the lives of others. I was lucky enough to have some of these lollypop moments, just when I needed them. These few sparks were all that I needed to reignite my passion for nursing.
The first spark came from an RN2 caring for a patient at the end-stage of a number of diseases, who had expressed to the nursing staff multiple times her wish to simply be made comfortable, as she knew this was the end of her fight. Despite this, the patient was not only receiving active treatment, but was also currently documented for full resuscitation if she deteriorated.
The nurse raised the issue with the medical registrar asking him to have a discussion with the patient regarding her wishes and planning end of life care. The registrar dismissed her, saying ‘well that’s not what the consultant wants’. The nurse wasn’t satisfied and responded “it’s not their choice; it’s the patient’s decision”. This nurse had the courage to stand her ground and make sure her patient’s voice was heard, which ultimately led to the patient’s wishes being honoured.
The next spark came soon after. I was working with a nurse who came from a different cultural background to me, where it was seen as impolite to question anyone in authority, especially if you were female. This meant even if a doctor was accidently standing in her way, she would prefer to simply wait, rather than ask them to move.
Then one day, we had a patient who deteriorated rapidly and was in a very critical condition. This nurse suddenly became one of the best clinical leaders I have witnessed. She led the team; questioning orders, prompting treatments, suggesting causes and outlining the options available. I soon realised the difference; this was about her patient. She was going to ensure her patient received the best care and outcome possible. When it was about her patient rather than herself, she found her voice.
There were a number of smaller incidents that soon followed. Sparks came from the senior consultant who re-educated her advanced trainee on the importance of listening to the nurses and acting on their concerns. Sparks came from our ward social worker, who day after day demonstrated his passion for helping and advocating for those with no voice and often no options. Sparks came from the medical residents who expressed their gratitude when you picked up a mistake and were heartfelt in their appreciation of the work nurses do.
The brightest sparks came from my patients and their relatives. It was their ‘thanks’, their ‘you don’t know how much that means’, their ‘you’ll be back tomorrow won’t you?”, their squeezing of my hand, that reminded me why I do what I do. I didn’t have to search for inspiration; I was surrounded by it. The trick was to change my focus.
Perhaps all nurses are disillusioned at some point during their careers. Perhaps it happens multiple times. Perhaps it is a rite of passage, with those who make it through the other side, the ones with a true passion for nursing, who turn around and help a colleague on their journey.
As I continue my nursing career, I now look for the brightness that I know is always there, far outshining the negativity that we have to deal with. I stockpile my ‘lollypop moments’, knowing the amazing examples of kindness and leadership I see every day, will in turn help me grow and become a better nurse, and hopefully, I might be able to be a spark for someone else.
You can listen to Drew Dudley’s talk at www.ted.com/talks/drew_dudley_everyday_leadership
Halfer, D. and Graf, E. “Graduate Nurse Perceptions of the Work Experience,” Nursing Economics, June 2006, Vol. 24, No. 3, pp. 150-55.
National Nursing and Nurse Education Taskforce (2005) Mythbusters. Available online at http://www.nnnet.gov.au/downloads/mythbusters_attrition.pdf Accessed June 2014.
*** This article was originally published in #7 edition of The Hive 2014