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Insulting

Sometimes at work, upper management makes decisions that astound us. Like the decision to have a department that has EX-ICU nurses come and give the ICU re-education on our charting pitfalls. It is even more insulting the moment you realize the information being taught is incorrect and against protocol.

It just opened my eyes AGAIN to how nurses are treated as things and not people.

It is hard I think, because a VAST number of nurses in the field today are single parents, working to keep the family alive, and there is fear there. Fear to point out unfair treatment, fear of retaliation, fear of losing a much-needed job.

Where does the change begin? Who advocates for nurses in their own workplace? There does not seem to be any sort of advocacy in place to address such contempt for those who work to be all they can be for themselves, their patients, their employers.

Incivility and bullying does not just come from peers on the floor, but many times from management above. Who advocates for whom?

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Lanyard, or badge-reel?

I see both types.

Personally, I feel like the lanyard drops into the bed and can be used as a weapon. I like the badge-reel, but the strings break a lot. I also have to wear a shirt underneath my uniform as I am allergic to some metals and the clips of the badge reels burn my skin.

As I explore getting away from the bedside, I look into being a lanyard kind of girl. There are so many cute ones!

Amazon has Lilly Pulitzer:

oooohhh but then I went to Etsy:

I’m in trouble.

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Nurse Managers, be careful of your response

A very dear nurse friend of mine reached out to her manager for support and guidance during this latest spike in the epidemic. Her unit has been short-staffed for several months, and keeps getting worse as each day goes by.

She confessed her frustration, anxiety, and how much she cries on a daily basis due to the overwhelming workload she is burdened with. Coupled with almost daily losses of the patients she works to save, while enduring unsafe, understaffed conditions, this friend was crushed to have her feelings brushed aside.

“This is how everyone is working across the nation”, “the entire country is short staffed” and “Everyone feels like this right now”…stated in a dismissive tone of voice.

Perhaps it is a mutual feeling across the nation.

But SHE has never experienced this sort of emotion before.

SHE doesn’t know HOW to cope with the perpetual grief and constant anxiety of her unsafe workplace.

SHE is the one who is attempting to carry on as usual, without a single sympathetic shoulder to lean on.

SHE doesn’t know what to do and has feelings of hopelessness and loss of faith in fellow humans.

DON’T BRUSH IT ASIDE WHEN YOUR EMPLOYEES COME TO YOU. IT IS IMPORTANT TO RECOGNIZE AND TREAT.

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Restoring your peace, a perspective from a front-line nurse.

Gardenia from my front porch in June. It was my day off and I was drinking my coffee with my gardenias.

We can all agree that the past 18 months has been the most awful time in our lives regarding the covid-19 pandemic. There have been so many deaths among the inpatient population, that even the most hopeful nurse I know has confessed that she feels as if she cannot pray for the patients anymore because they die anyway. She has since come to realize that perhaps her prayers would better serve the families who are about to grieve and hurt for the one they lose. She has cried for so many people in the past year and a half and is now looking to leave the profession entirely. She confesses that she feels “trapped” due to her age, as it is probably too late to become a horticulturalist or an accountant; she is ready to do anything else besides nursing.

Other nurses have considered the same. Another ICU nurse stated she was looking at manufacturing and retail jobs that she used to do in her younger years. “The ugliness of retail customers is like cotton candy compared to the ugliness of patients, families, managers, and administrators in the hospital right now. We are expected to keep on working through these understaffed conditions and still perform at the pre-pandemic level of care. It’s impossible.” One new nurse came to me in tears because she had been reprimanded for not turning her patients. The problem was, that these patients were all on the ventilator and that there wasn’t anybody to help her turn them. That entire unit was understaffed and all of the nurses were too busy to do anything but frantically manage their own patients. I personally have done some sketchy solo turns myself, pushing and stuffing pillows underneath a 200 pound patient in efforts to get them off of their coccyx because my coworkers were gowned up doing the same in their own isolation rooms. I press visiting family into service all the time as I will never get a patient properly turned if I do not. This type of care is unfair for the patient, and the level of expectation is unfair from management. And yet we continue to receive unstable patients without any additional help and are expected to produce quality outcomes. Working at Walmart sounds sort of nice now.

Pets help

One nurse in a mixed stepdown/ICU environment states that her day is spent running from IV pumps to call bells, and she has so little time to open the charts to look at anything besides medications that she frequently has to spend an hour and half after her shift is over each night to do her actual charting. Everything, from care plans to IV assessments has to be done the same way as prior pandemic, and when she is required to take 2 critical care patients, move a downgraded step-down patient to the med-surg floor and get a 3rd critical patient, the charting is endless. Shifts typically end at 7am or 7pm, but she and her coworkers frequently leave at 8:30 or later. This particular nurse is a single mom and still has to manage dinner and daily life when she finally arrives at her home well past 9 o’clock.

So we go home exhausted, saddened, beaten-down, and oppressed for not achieving the standard of care expected of us. We are trapped in the profession due to lack of skills in other areas. We leave work worrying about the care we gave. Worrying about the care we didn’t give. The burden is heavy and the hours are long.

What do you do to rejuvenate, ground yourself, and restore?

This crazy banana tree makes me so happy. Every day another shoot appears!

Here are some simple ideas:

  1. Stop picking up extra shifts. Yes, the money is awesome, but it is killing your spirit to work so much. Just let it go for now.
  2. Step back to think about the little things which make you sing. For me it changes, but my current one is tea. One day, I had a memory of my mother and I drinking hot tea at the kitchen table and doing crossword puzzles together. I have to drink it in a travel mug with a lid at work, but it is nice to sip on my fancy Earl Gray hot tea and chart. The taste reminds me of spending time with my mother, who was always my rock and best friend.
  3. Spend some time outside. Florence wasn’t wrong, it is beneficial to be outside and it will help you recover from the high stress of being a nurse today. The American Psychological Association (APA) stated in 2020 that exposure to nature has the ability to decrease stress, improve cognition, reduce mental disorders, and improves our mood, empathy, and even coordination skills. Check it out at this link: https://www.apa.org/monitor/2020/04/nurtured-nature
  4. Let stuff go. Here is the front of my house. Makes you feel better, right? Anyways, the hummingbirds love them. I won’t worry about them for a while…just being me is important right now, not spending my free time away from the hell that is work, doing things that make the hummingbirds sad.
These are my boxwood bushes covered in Cypress Vine

5. Yes, you can do the usual tried and true, exercise, meditation, date nights, etc. But sometimes? Sometimes you have to do what you CAN do and that is embrace the little things that get you through.

6. Don’t forget that you are an awesome nurse and if you are working hard all the way through your shift and not getting breaks and meals…the things that didn’t get done are not your fault. You cannot beat yourself up over that.

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I’m a pen geek and I know it!

A few of my favorites but my no means my entire collection!

I just got this most amazing pen off of Amazon. My co-worker showed me hers and I knew an in instant that I must also own this same pen. You nurses will love it. You know those old, four-color Bic pens we all got in nursing school? Well, meet the Pilot Hi-Tec-C Coleto. It is customizable, and has many color options to choose from. AND it has multiple point sizes…I purchased the 0.3mm points and my utter delight at how thin the lines are eeeeeeeeee!!!

It comes with a 10 pack of colors

I am seriously thrilled with the fine writing lines this pen gives me. I purchased another one for a co-worker who shares my delight in pens.

Every new pen I receive is better than the last. How can anything top this one?

I have another shipment of pens heading my way, that supposedly are superior to writing on black paper. Not that THAT has anything to do with nursing, but I just KNOW some of you will be interested in a black journal. Such a soothing thing to see, metallic ink making its sparkly way across a dark surface.

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Enamel pins!

These may not be new to you, but our hospital is going through an enamel pin obsession. These little gems are different from the old, tried-and-true button pins, and will give your badge a little more personality and flair. Some of the pins out there are really clever!

**I am not affiliated with any of the following sellers or websites in any way. This is a post to show the fun pins that I have seen**

Here is my pin. A co-worker gave this to me and it describes me so well! I love it!

You can match any type of specialty, personality, political affiliation, humor style…the possibilities are endless. Here are a few of my favorites:

Anxiety is a Liar Enamel Pin  Nerdy Funny & Real by image 0
Source: etsy

I really love this pin. Why? Because it reminds us all that we are better than we think, and we shouldn’t allow anxiety to rob us of all the best that is in ourselves. You got this!

Inky the Cloud Enamel Pin image 0
Source: Etsy

I have a another coworker who sports this pin on her badge. She works in the ED and seems to always bring in code blues with her shift. I laughed a lot when I saw it and think this sort of pin would be fun to pass around to each other as sort of a “badge of honor” sort of gag.

Purple Wipe Enamel Pin Nurse Enamel Pin Doctor Enamel Pin | Etsy
Source: Etsy

We are all familiar with these purple wipes!

Float Nurse Pin  Nerdy Funny & Real by RadGirlCreations image 0
Source: Etsy

If I were in the float pool, I would want this pin SO bad.

HIPPA Police Pin  Nerdy Funny & Real by RadGirlCreations image 0
Source: Etsy

This pin is so funny! I kind of want this one because I feel like I have to be the police with every phone call I accept from family members. Night shift seems to never establish HIPAA passwords for their new admissions!

Finally, not an enamel pin, but so stinking cute: here is a badge reel that my friend made for me. I wanted an enamel pin that was just a van with this phrase, but they all seemed to have the word Ativan on them as well. I like a more subtle message.

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New nurse anxiety

I hope you get a good laugh out of this post – and some hope for your own journey.

Today I found something I lost 6 years ago. I will show it to you at the end of this post and you will feel so much better. I am snickering at myself already.

When I was a new nurse, I was 42 years old. I had been out of work as a stay-at-home mom for 10 years; the only work I did was by-the-piece sewing gigs. I sold some of my own, but mostly just sewed for others. Needless to say, my resume was less than impressive, and I was blessed by God to land a job in a market saturated with new graduate nurses.

It was a nightshift ICU position in which I was astounded that this hospital would hire me. I mean, who would want a new grad with no real job for ten years and no prior medical experience.

I doubted everything. I was sure to lose the job. I had no references other than my teachers in school and my pastor. This one nurse I worked with hated me. The day shift nurses seemed to gleefully point out my mistakes from the night before. I would drive home each morning and go over everything in my mind from the night before and stress. But my biggest fear was the co-worker who seemed to hate me. I would get in knots thinking about working with her and started seeking out coping mechanisms to help me through my nights. Here are the top three (gosh I was such a noob):

Product Large Image
This did nothing

Chamomile tea.

Probably the worst thing I could have used on a night shift where I needed to stay awake. I stocked the breakroom with a box and attempted to soothe my stress with sips of this sleep inducing tea. It didn’t work. Chamomile tea cannot change the people you work with.

This also did nothing. Smelled nice though.

Essential oils for stress.

Now, I actually believe in some of these oils for stress relief. I contacted a friend that sold Young Living and got this bottle. I practically bathed in it at work. Again, it did nothing to change my co-worker. In my situation, the Stress Relief blend did little other than distract me with a pretty scent. I wonder where that bottle went. I bet I associate it with new grad nostalgia now…

And now, the most ridiculous item I used to cope with my co-worker that hated me…oh boy was I really searching…

Are you ready, my peers with degrees in science? Let me preface this one – I was really stressed! My doctor prescribed Xanax but I didn’t want to take it and I was night shift anyways….

I found it in my closet today as I was clearing up some things.

Here it is…

Yeah. This did nothing.

BLACK TOURMALINE!

Apparently, in the world of crystals and such, black tourmaline absorbs negative energy and protects you. Me being a Christian – I felt very guilty over this purchase. I went to a local gem and mineral show and searched dozens of tables of items for sale by various sellers before I found this. I think it cost 15 dollars. Small price to pay to absorb my co-workers negative energy!

I carried this thing around in my pocket with my alcohol wipes and pens. I would reach in and rub it. I lost it not long after I purchased it and always chalked its disappearance up to God telling me that He is bigger than a lump of rock.

And He is. Eventually, the co-worker and I became close friends. I would spend my evenings trying to make her laugh and my attempts of humor broke the ice and we got closer. She shared her nursing experience with me and as I grew into friendship I grew into an experienced nurse.

And now I laugh at myself and the pitiful attempts I made to use external products to fix an internal conflict.

My poor little black stone. It is still pretty though. I will keep it as a memento of those early days, scared to be me, scared to be a nurse, scared to make a friend.

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Pulling into the Frustration Station!

Steam Locomotive JS6546
I was STEAMING

I had a patient recently that had an interesting hospital course of action. To the nurses, it was clear what was going on. The residents and MD disagreed – and did not share this information with the nurses.

This patient, who was an octogenarian, was Covid-19 positive. She was admitted for altered mental status and decreased blood pressures. Her D-Dimer was high. Now for those of you working with Covid patients, it is not unusual to see high D-dimers. Those patients are treated with high dose Lovenox to prevent clotting. Altered mental status and low blood pressure is also common in the elderly when sepsis occurs.

This patient was only getting standard subQ heparin Q8, and they had started her on midodrine for her low blood pressures. She was out on the medical-surgical floor when the staff out there decided her O2 saturation level on a non-rebreather was too low and she needed to come to the critical care unit. I accepted the patient as a STAT transfer, and once she came to me, I realized that everyone was freaking out.

Her O2 was 100% on the non-rebreather. Her blood pressures, taken hourly, were all in the 105-115 range systolic and 65-75 diastolic. She wasn’t short of breath. She was alert and oriented, and was quick to tell us that she didn’t live with her daughter, but that her daughter lived with HER. We all got a chuckle over that.

We got her settled, put her on continuous monitoring, and watched. Nothing happened. She remained stable. I was thrilled to have a completely stable “critical” patient. The next day, I noticed that her oxygen went down to the 80s. I went into the room and found her with her oxygen off talking on the phone. The mask kept bumping into the receiver while she talked so she just slid it down out of the way. I replaced the mask and she recovered, but true to many Covid-19 patients, it took quite a few minutes to get back to the 99-100% range I had been seeing. Mystery solved. This is most likely why she was so low out on the med-surg floor. They probably didn’t wait that 10 minutes to see how she did before checking her oxygenation status. I called cardiopulmonary told what I witnessed and we switched her over to a high-flow nasal cannula so she could talk on the phone without the mask bumping – she did great. Again, O2 saturation was perfect in the 95-100% range, and never once did I notice any tachypnea. The patient was happier as well.

Later on that day, the ultrasound team came in to check her legs for DVT. I never got to read that report as we had several critical goings on in the unit at the end of the day that took precedence. It turned out she did have a small DVT in her lower leg. It wasn’t until I was giving report that it happened.

I received a phone call from a local hospital stating they had received the transfer of my patient and was calling to give me a bed assignment.

WHAT.

THE.

HECK.

I called the resident, explained that I was in the middle of giving report to the oncoming staff and that I had no idea that shipping this lady out was on the table and WHY ON EARTH WAS SHE EVEN GOING OUT ANYWAYS??

He came over to explain. The physician team felt she had a submassive pulmonary embolism and needed immediate transfer.

She had no chest CT done.

She was not on a heparin drip that indicated this concern.

She was not short of breath in any way.

She had no clinical indication whatsoever that this was going on. This was just a sweet old lady in bed who took her oxygen mask off to talk on the phone.

I was highly frustrated. The MD team could have taken 2 minutes out of their day to TALK TO THE NURSING/CARDIOPLUMONARY staff to see how she was doing. Or I don’t know, how about updating us?

Physicians of the world: talk to your nurses.

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Wherever you are in your nursing journey – I want to encourage you –

I have noticed a running theme in the last 9 years I have been in the nursing world. And that theme seems to play out in everyone I meet: you must be better than all of your peers. I see this time and time again. Almost every nurse I meet feels like they must impress me with their vast knowledge. If I say I do it this way, a great many nurses will tell me my way is wrong, and the way they do it is the correct method. This is a DAILY struggle. Why do we all have to one up each other?

Hug Clipart and Stock Illustrations. 29,489 Hug vector EPS illustrations  and drawings available to search from thousands of royalty free clip art  graphic designers.

When I took the position of resource nurse in my unit, one of the other nurses had a BIG problem with it. She told a new employee how my unit stunk, and that all the nurses there were incompetent, and how I was not qualified for the position. She promptly took another position in another part of the hospital, and now rolls her eyes at everyone from our unit. We all breathed a sigh of relief at her leaving.

But the damage was done. Just yesterday, I had probably one of the hardest days on our unit, and was overwhelmed at a few points in the day. That nurse’s words kept coming back to hurt me, over and over.

Maybe I AM incompetent.

Maybe I am not worthy of this position.

Why did they choose me?

At the end of the day, her poisonous words from two months ago had taken their toll. I was completely defeated, and the two new-hires I had been precepting all day probably saw this at the end.

I am now more determined than ever to spread hope and love throughout my career.

You, whoever is reading this right now, YOU are a fantastic nurse TODAY. You might now be the smartest and the quickest in the field you are in, but you are everything you need to be TODAY. Keep up the great work, lift your head high, and know that you are exactly where you need to be. Tomorrow you will shine a little brighter, so kick off the grime and wash off the poison from others who do not see the greatness within anyone besides themselves.

You are a wonderful nurse.

You are a fantastic student nurse.

Keep up the fight, and stay strong.

(((HUGS)))

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Another hard day at my dream career

I am in a small hospital ICU as the resource nurse. Now when I took this position, the unit I work in was quite different from what it is today. Then we had 4 beds, with 2 patients per nurse. Our days while sometimes very busy and sometimes quite hard, but they were always – doable. The quite hard days were far and few between which allowed us to forget about them easily.

With the advent of Covid-19, however, this has all changed. We have hard days almost every day now. Too many patients are suffering to make positive outcomes the norm. Our hospital decided to open all 8 beds in our unit, and staff accordingly. My job as resource/charge nurse, while simple before, is now becoming difficult. Why? Because all of our nurses are leaving to go to where the money speaks: Covid-19 travel nursing. Honestly, I cannot blame them. The money offered is fantastic compared to a small town hospital. I understand their decision, but it leaves me to train all the new staff.

Today I had 2 orientees and 2 nurses that literally got off of orientation the day before. One of those new nurses is a new grad. One orientee had no ICU experience. We ended up intubating a unstable Covid patient, advocating for a central line for the same patient because the residents were going to wait until the surgeon on-call got out of surgery do put one in and she needed one NOW, doing a lumbar puncture on another ventilated patient (this was attempted the day before unsuccessfully as the doctor pushed the patient so far into the mattress the day before that the tube became bent in half and dislodged. We had to take it out and reintubate), move out two patients to the med-surg floor, receive another med-surg patient that was Covid (no Covid beds on the med-surg floor so the ICU gets them all), received one more ventilated patient that had only one working IV, call a tele-consult for another patient (this process is so time consuming), and we were all. Just. Swamped. We have no CNA, no secretary. The phone rang all day from family members needing updates.

At 1800, one of the residents came up to me and told me that the hospitalist wanted us to prone the slightly stable covid patient we had intubated earlier that day.

And I said NO.

NO. NO, we are not going to prone this patient right before shift change. NO. She was barely stable, barely sedated on drips that were at the maximum level, and her O2 sats were in the low 90s at best…and she was quite the kilogram heavy patient. NO. This is not right time to do this. By the time they got enough staff to go get the proning bed, gown up in PPE, start the paralytic, and go in to flip the patient, it would be well past 1845, a great time for let’s say… the tube getting dislodged? How about a drop in O2 saturation that was fatal, right at the end of the day?

NO.

I have never said no before.

I have always done everything that was asked of me at work. I have never said NO!

I called the supervisor, confessed, and told her how to spell my last name if she needed to write me up.

She laughed and agreed with my decision. And after all the worry that I was making wrong decisions all day long, that little bubble of joy made me feel so much better.

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MIROCO Light therapy unit

***THIS IS A REVIEW OF A PRODUCT. IT IS NOT INTENDED TO REPLACE TREATMENT FOR DEPRESSION***

I purchased mine from Amazon. I am not affiliated with Amazon or Miroco in any way.

Miroco Light Therapy Unit

I purchased this neat little light therapy unit the other day. Every year I tend to suffer from SAD (Seasonal Affect Disorder), and I thought I would try to stave it off this time.

I have used this unit for over a week now, and I have to say that so far it is working. Light therapy, when done correctly, can reduce SAD in many individuals (Reeves, et al., 2012). Every year I just get so down and in the dumps. I am hoping this year will be different. Fingers crossed!

I am the girl that chooses the sunlit table in restaurants all the time, to the dismay of my friends. I feel like a plant, constantly seeking the light. As nurses, most of us work 7-7, and whether we are inside all day in artificial lighting or asleep after working all night, during the winter we just do not get the same amount of light.

This great little unit is budget friendly, portable, lightweight, and has adjustable settings. It delivers 10,000 lux at its brightest setting.

The only drawback I have about this unit is the ugly light it produces. Since it is not a home lighting product, I can easily get over the ugliness for the short time I use it!

Reeves, G. M., Nijjar, G. V., Langenberg, P., Johnson, M. A., Khabazghazvini, B., Sleemi, A., Vaswani, D., Lapidus, M., Manalai, P., Tariq, M., Acharya, M., Cabassa, J., Snitker, S., & Postolache, T. T. (2012). Improvement in depression scores after 1 hour of light therapy treatment in patients with seasonal affective disorder. The Journal of nervous and mental disease200(1), 51–55. https://doi.org/10.1097/NMD.0b013e31823e56ca

When your work home is forever crushed

We are short staffed in our hospital right now. Covid-19, you might say, is causing all the nurses to leave. But is it?

A nurse friend of mine was recently called into her manager’s office. It had been a hard month in the CCU; every day was short staffed with high acuity patients. Every day was staffed by primary nurses only – no CNAs or LPNs to help. She had been communicating the unsafe staffing ratio with her manager and found the manager unresponsive to the messages. My friend has been working for that hospital for over 7 years and wasn’t really looking to leave the position. She felt that her work family was dear to her (with the exception of a few bad eggs) but for the most part, she adored everyone there. Here is how this scenario played out:

Manager: I’ve had a lot of complaints about you.

Nurse Friend: Me? Really? (she relayed that she was floored by this)

Manager: Yes, it was overheard that you refuse to get credentialed in bedside sedation procedures.

Nurse Friend: Yes, right now I do. That’s no secret. If I get credentialed in this, I will be required to do ALL the procedures which are one-on-one patients, and that is unsafe as I will also have my other three critical patients….

Manager (dismisses this) You also go around all day long telling people that you want to go home. Is there something wrong with you I need to know about?

Nurse Friend, again, stumped. “I don’t say I want to go home any more than anyone else?…? I guess I am worried about money and my life?

Manager: Well, several people have complained.

Nurse Friend: Well, it has been really awful up here lately. No one has not complained. There isn’t enough time in the day to do everything that we need to do and the ratios are unsafe…

Manager: You don’t hear of my ED nurses complaining when they have 4 patients to take care of.

Nurse Friend (had nothing to say about that, as she had received half dead, soiled dirty patients with 24g IVs from the ED many times. She also knew that most of the ED nurses left to go to float pool. The ED was the main culprit over why they never had a CNA in the CCU as well, as the ED frequently pulled their ancillary staff down there. No words)

The result of this meeting, which was in the middle of my friend’s 10 minute lunch attempt, was that she was demoted from her charge nurse position. She had never once gotten a write up in that company. She never once was approached by ANY of the “complainers” about the scenarios that were complained about. There was never an official complaint, never a performance review, never any sort of disclipinary action of ANY KIND. But apparently, without her knowledge, there was an upper management meeting about my nurse friend and she was accused, judged, and sentenced without a representative or a trial. All on complaints from “other people”.

She left that meeting emotionally devastated and is now unable to trust anyone in her work home. Everyone that was before a friend is now a person of suspicion, and her happy nature that was full of love for her work family has been shot down and killed. She is unhappy, crushed, and confesses that she can never trust anyone at that place of employment ever again. One of her biggest upsets is the CNO, who she knew to be a born-again Christian, no longer responds or comments to any of her emails or Facebook posts. She is confused and deeply hurt at the actions and back-stabbing that was taken as gospel truth. No one ever spoke with her on a personal level. How unprofessional.

But is this scenario uncommon? Personal sources that have since come to me since this incident proves that this happens all too often in the medical field. This sort of gossip and hearsay has damaged several people and their careers. When I told this story to some of my peers, many people related to it with first-hand accounts of their own similar stories of hurtful co-workers and management that turned against the worker.

Perhaps THIS is why nurses are leaving? The going gets tough, but management doesn’t do a thing to help. Or find out what is going on. They set the SAME STANDARDS as pre-pandemic times and expect their nurses to comply and perform at the same level. It is not fair. It is not safe. It is not professional.

Managers and Administrators. STEP UP. Stop putting up “Heroes Work Here” signs and step onto your units and find out FIRST HAND what is going on with your employees. YOU are the reason people are leaving. NOT sicker patients.