The Strong Suffer

English: A right MCA artery stroke.

~this was originally written the week before my last day

We are in the midst of the transition that prompted me to volunteer to quit my job and it sucks. Each day makes me realize what a good decision I made, but makes me worried for those left behind.

One of the biggest issues is that we’re combining two different units, one a typical med-surg/renal unit, the other a progressive care unit. Two very different staffs with different skill sets. The tele nurses are all ACLS and stroke certified, the others not. The tele unit started and built an observation unit and got used to and accepted the turn and burn mentality where you admit and discharge like there’s no tomorrow. The folks coming in rarely admitted in the levels we did and came from a more laid-back mentality.  SO yes, it’s a huge transition, especially for the new folks on our staff, huge changes in both practice and mentality. Add to that increased patient ratios and people are already starting to question the status quo.

The worst though is for the nurses perceived as “strong”. You know the ones that can take anything you throw at them, rarely bitch and just take their lumps, the ones with the advanced skills. They get the more difficult patients, the sicker patients, and more of them.

The other night was a perfect example of that for me. I started with 4, a decent mix of patients. (yes, I know, our ratios are low compared to some, but we have minimal support staff, it’s all about perspective too). Charge nurse comes to me with a proposition: drop one of my patients to take stroke admit. She figured it was easier for me to do this instead of giving the only other stroke nurse a 5th when she had never taken 5 patients before. This is a full on stroke, large MCA nastiness and there are a lot of things to do since we’re in the acute window. What choice do I have? I’m not gong to be a dick and say “no, let ’em suffer” am I? Not really. So I admit the stroke and considering now the CT looks, I lucked out. Then she comes back asking me to take a chest pain admit since the only other nurse just “can’t”. Whatever. They ask because they know I will only say no if I truly can’t. They ask because “you’re strong and can handle it, the others can’t.”

The last night I worked it happened again, I get the admit while the others don’t because “they haven’t done it.” And it’s not like I don’t want to work, I take my lumps but I believe it should be fair, at leadst to an extent. Give an equitable load, don’t dump on the strong nurses because you can. What comes out of that? Burnout. Demotivation. Animosity.

A good friend of mine who is staying mentioned all of this to me the week before we changed over.  He’s a guy who never complains, I mean NEVER.  And he was upset, worried and generally disaffected.  Did I mention he is a guy who always has a smile on his face, even when glove deep in poop?  To see him so upset truly shows me the folly of the madness being inflicted on us.  Here’s a nurse who smiles through everything, who gets every single LOL to love him, who’s clinical skills have grown immensely since hire to be a very competent, caring and effective nurse who will be put through the wringer because he’s “strong” and they run the risk of losing such an employee. But in the end “they” don’t care, it all comes down to money.

That is why I feel bad for my former colleagues.  It’s going to get worse before it gets any better, if it ever does.  The unit we spent years building was destroyed in one fell swoop and is reverting back to a mire of poor management, burned out nurses, massive regular turnover of nurse, disaffected staff and a manager who is crushed by those farther up the food chain.  Sadly it all lands on the patients and while there will be nurses who strive to keep the level of care the same, you can only fight the tide for so long.  Hopefully the worst of my prognostications doesn’t cone true.  One can only hope.

~disclaimer: I know there are places with far worse ratios and worse conditions, we’ve been incredibly lucky for a long time.  Leave it at that.


  1. This happens all the time on our unit. The charge nurses will give admits to the nurses who aren’t complainers. A good majority of our nurses are loud complainers who have worked on our unit for 8+ years. These complainers are also know for their resistance to change and poor management. It is a horrible feeling when you know that you are up to your eyeballs in crap, and no one is there to back you up. I recently told my manager that it gets old helping out the same nurses constantly knowing that they never ever will return the favor. I want to combat the negativity welling up in me! I’m not sure how!


  2. Unfortunately this happens way more often then we can name. I always wanted to work to my greatest ability without complaints but it seemed like more was piled on me. Even now that I am not working on a hospital floor but working in an office, nothing has changed.


  3. About the unit of which you speak, things are still better there than when we started. While there are more admits at all times of the day and night, they are less acute (for the most part). Remember when we started, the open hearts and stents were spread all over the floor? That made assignments challenging with a varying skill skill mix!

    Remember trying to pull an arterial sheath at night while managing 4 other patients with 1 aid on the floor?

    As much of a culture shock as everyone is going through right now, things are still better than they used to be. It is just that there are very few of us left who really remember the good ole bad days.

    It isn’t like I am speaking from my Ivory tower either. We regularly float up now when the census is full. I was up there last week, and took 4 admissions after noon. Was it easy- nope. But everyone thinks that things are brighter on the other side of the street

    On our side you should hear the old-timers complain that the unit is no longer as advertised. That we are no longer cardiac, blah, blah, blah. All these vents. Blah, blah blah. They never wanted to work in an ICU step-down. blah, blah, blah. What do you mean, they aren’t on tele? Blah, blah, blah? etc, etc, etc.

    And, as always, those that complain get their way, and those that are strong take the patients. And those who smile and chat up the manager the most get the kudos, all the recognition and the praise. Then the administration wonders why staff satisfaction is down.

    Anyway, this is turning into a rant, feel free to send me a message any time, and good luck on your move. Let me know when you are going, and maybe I can take you and your wife out for a drink.



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