News media regularly headline severe nursing shortages, particularly in COVID-19 hotspots, causing interrupted services and bed closures. One article chronicled a family's nightmare when their loved one could not access a critical care bed and died. Make no mistake: COVID-19 factors into the dearth of nurses, but deeper issues that predated the pandemic share fault. Moral injury is pushing nurses to seek the exit door; employer expectations mired in unreasonable corporate, administrative, and regulatory burdens are illuminating it.
In years past, nursing practice embodied care that was prioritized and planned according to patient needs. Computers were not taskmasters. Accountability centered on a strong nursing culture, clinical expertise, and a focus on excellence. There were no hard-wired expectations to document low-level tasks at preprogrammed intervals that conflict with higher-priority nursing actions. Today, proponents argue that computer-generated tasks and inconsequential alerts prevent missed care. Perhaps so if used judiciously and with appropriate staffing, but they also can act as a hammer for discipline under the guise of job aides when compliance falls below performance targets. Consider the moral distress of nurses working while short-staffed, caring for more patients due to budget cuts, vacancies, or absenteeism, yet still managing the same litany of bells and whistles competing with actions that matter most for patients.
The last decade also brought a host of new regulations from healthcare accrediting agencies with the noble aim of reducing patient harm. Ironically, some regulations imposed to achieve safe care have made it exceedingly difficult for caregivers to actually provide it. As a case in point, Davidson and colleagues identified moral distress, suboptimal care, and harm as outcomes of The Joint Commission's 2018 standards prohibiting the longstanding practice of critical care nurses titrating lifesaving infusions within defined parameters to achieve hemodynamic targets.1,2 This ruling barred nurses from acting in the best interest of patient safety and imposed a needless regulatory burden. This is but one of many ill-conceived rules imposed in an apparent vacuum without adequate real-world evaluation and frontline nursing key stakeholder input.
Nurses do not feel good about their work when they face a set-up for automatic failure. Albert Einstein said, "We cannot solve problems with the same thinking that created them." Collectively, we must advocate for transformation that reignites nursing passion and achieves top-of-license practice. It will take fully valuing nurses, stripping away unnecessary burdens, streamlining processes, and assuring the right resources are available to stop the exodus. Organizations that heed this call will thrive, along with their nurses and their patients.
Stay safe and well,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2021
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