Director of Quality and Compliance
Spaulding Rehabilitation Hospital – Cape Cod
Nurse Janice Maloof-Tomaso
Twenty years ago, I started nursing school for 2 reasons.
1. I was an only child with elderly parents and I was their caregiver.
2. My father passed away from Alzheimer's when I was 35.
Nursing was not my first career as I had a job right out of high school which paid well. I felt a need to do something that was more people-oriented and I was drawn to helping people. I became A 911 dispatcher and I worked part-time in law enforcement. In 1999 I accepted a position as an emergency room coordinator at Mass General Hospital. That's when my life changed, I was 36 years old, and I can share verbatim what I witnessed the night that I realized I just didn't want to be a nurse I needed to be a nurse.
I was working in the trauma unit at the desk and the burn victim came in. He was a male in his 30s, was in a house fire, and had 80% of his body covered in 2nd-degree burns. I was sitting in front of Trauma Bay 8 as I watched the nurses and the doctors preparing the room, gowning up, moving the heat lamps, filling buckets of wet gauze, and gathering all the equipment they needed. No one was making a sound. You could hear a pin drop as they were completely focused on what they needed to do.
I knew all the nurses and the doctors personally, but I'd never seen them so focused as I did that night. They went into the room, and they were taking reports from EMS, and at the same time began the escharotomies and preparing the patient for the operating room. The next day I started my application with a local Community College for their two-year nursing program.
Nursing prerequisites and courses were what you would expect. I did feel that my Associate Degree Program was a lot of material in a short amount of time, and I did continue and obtained my BSN and Master's.
If I could now go back and invent two courses to better prepare nurses and any caregiver, they would be: 1. Resilience and leadership training 2. Self-Care.
New nurses are not prepared for the dynamics and cultures they walk into and that can be a catalyst for a new nurse to walk away. During Covid, nurses with all different experience levels were left reeling as they had no idea how to deal with the fear, confusion, anger, and eventually the political part of the pandemic. There was a swift effort to try to offer nurses self-help with peer supporters, free gifts, and snacks, but none of these offers really addressed the moral injury.
So, we had a hurt and broken workforce and a staffing crisis at the same time. The broken are training the new. It is a bit of a gerbil wheel that is not entirely effective. When you lose the calling and passion then the teachings suffer. New nurses are leaving acute care and looking for more “away from the bedside” positions.
The leadership training I am referring to should be taught to all nurses. This is simple: all nurses should possess leadership skills. The unfortunate truth here is that not even new nurse leaders are getting leadership support or training so there are more casualties there.
Finally, Self-Care: I am not sure if anyone has really had the time, tools, knowledge, or resources. Another barrier is the make-up of most nurses just wanting to care for others and when it comes to caring for themselves, they will cut corners. Nurses will most always put others' needs first.
In 2020 the World Health Organization shared a statistic of 88% of nurses in the United States are women. So, one would wonder how many of the women have competing priorities when it comes to self-care.
Then we can factor in what happened during COVID to the workforce. Fear, exhaustion, dealing with the public perception, trying to keep a brave face, and trying to keep your outside life together.
People who work in healthcare or any kind of first responder career always need to debrief because they see and experience things that are heartbreaking and traumatizing. For some reason the resources for this type of support were always sparce.
I think we saw the self-help push a little too late, especially when it comes to moral injury and a shortage of mental health access. There were many great ideas and interventions, but the flame always fizzles out because no one has the time or tools to make the time for themselves.
If we could somehow tie the feeling you get when you help a patient and make them feel safe with how we feel about ourselves being able to offer care, we might be on to something.
We should think of self-care like eating, it is necessary. Teaching relaxation, techniques to reset, and practicing self-care is critical and needs to be part of nursing school.
It is a start and desperately overdue.