Hell is other nurses

October 12, 2006 - Recent Dear Abby columns have addressed the problem of new nurse "Susan in St. Louis." In a letter published on August 30, Susan says she "hates her job" and is already "getting ready to change careers," mainly because of "other nurses and the environment." Abby's initial response and letters from other nurses that Abby publishes in a follow-up column today stress the many different options that those with nursing degrees have within nursing and health care generally. Unfortunately, there's nothing about why nurses might (as one nurse says) "eat their young," what might be done to improve the conditions that are driving nurses like Susan from the profession, or how important it is to world health that we find ways to keep them at the bedside saving lives. We thank Abby (Jeanne Phillips--right) and her correspondents for raising these issues in her column, which is widely distributed through the Universal Press Syndicate.

Susan's letter asks Abby to tell her it is OK to change careers even though she is only one year out of school. Susan also seeks possible responses to "people who are going to criticize" her for doing so after she has just spent four years getting her nursing degree. Susan notes that the problem is not the patients. Abby responds that she has no problem with Susan leaving a career in which she is unhappy, but she urges Susan to consider nursing alternatives such as "private-duty nursing," nursing "with a cruise line," and travel nursing. Abby makes a special effort to sell this last option, advising Susan to "Google travel nurses," and noting:

Agencies offer opportunities to travel and work anywhere in the 50 states. Some provide housing, meals allowance, continuing education courses and signing bonuses.

No doubt this is why some travel nurse agencies have reprinted this column on their web sites. Of course, it's not clear that simply working at different hospitals will solve any of Susan's problems; we're aware of no data showing that working conditions are better at hospitals that rely on travel nurses. And while Abby's other two options are certainly possibilities, they hardly convey the range of options a nurse like Susan would have. We do thank Abby for suggesting that Susan find some way to use her training within nursing.

And Abby offers many more options for Susan in today's follow-up column, printed under the headline "Nurse has many job options." The column starts with a letter from "Been There, Done That in Virginia," a nurse who appears to have had an experience similar to that of Susan. "Been There" notes that she recently quit nursing after five years. She explains that she "loved the intellectual stimulation" (we thank "Been There" for that phrase), but

dealing with the other nurses was an entirely different matter. There's a saying in nursing that "nurses like to eat their young." While it doesn't seem logical that experienced nurses would sabotage younger ones, it does happen -- more frequently than you might think.

Abby notes that a number of nurses wrote to her with similar sentiments, and she offers some excerpts to illustrate the range of available alternatives. "Veteran Nurse of 24 Years" outlines options that would actually keep Susan in direct care, where nurses are desperately needed:

If she likes hospital work, among the specialties she might try are: obstetrics, pediatrics, intensive care and dialysis. If she doesn't like hospital work, there is school nursing, which includes teaching, screening for various problems like scoliosis and first aid. There is also industrial nursing, working for a private company.

"Veteran Nurse" closes by noting that when you become a nurse, "the world is your oyster" because the field offers so much variety. A letter from "Legal Secretary in Ohio" explains that "with just a little more training" Susan could help attorneys handle malpractice and personal injury cases, doing "the same job as a paralegal." And "Carolann in Lilburn, Ga." notes that among the "unlimited opportunities" open to Susan are jobs with drug and medical companies involving "clinical testing protocols, data review, on-site visits, customer support and interaction with medical professionals."

Neither column offers any recognition that Susan has identified a significant public health problem or any ideas on what might be done to solve it. Why might nurses "eat their young?" Could it relate to the "environment" that Susan mentions, but that no one here seems to pick up on? Could that "environment" include short-staffing, mandatory overtime, a sense of disempowerment in the clinical setting? There has been a good deal of discussion of aggression within nursing. Some have suggested that it may relate in part to the profession's relatively low level of
power, particularly relative to physicians and financial decision-makers. Others have suggested that the profession's extreme gender imbalance is not helpful.

It is critical that these issues be confronted, because despite increased interest in nursing careers in the U.S., the profession lacks the resources to train those interested and to keep them at the bedside in the face of the daunting nursing shortage. Fewer nurses at the bedside means worse patient outcomes, including higher patient mortality. If we cannot figure out how to keep nurses in direct care--rather than simply telling them all the ways they can leave the bedside--the negative effects on global health will be severe.

We thank Abby and her correspondents for raising at least some of these issues in such a prominent forum.

See the Dear Abby column "Nurse has many job options," from October 12, 2006 -- and the original column "Nurse disillusioned with job contemplates career change" from August 30, 2006.