dear nursing students

what you should know before your heart is on the line

Healthcare is a business. 

It’s best you understood this unfortunate truth now. I didn’t. I was idealistic, hopeful, and optimistic. I went to nursing school believing I was called to be the hands and feet of altruism; subsequently, I sacrificed health, money, time and sleep in its pursuit. 

I am now struggling with the existential friction that comes from following that call directly into the mouth of a business structured not around purpose, but profit. Soon you will struggle too.

When you graduate you’ll be pinned. You’ll get your hands blessed and your boards passed and you will be proud. You will endure a grueling, stressful first year of work and feel like you’re lost in a fog. Eventually your eyes will adjust, you can see through the clouds, and somehow you will no longer be drowning. You will be swimming. It is then you will see what you were blind to before: healthcare is a business. 

You will start to feel it. 

Healthcare is a business, so you will often be short staffed. You will not be paid what you feel is reasonable. You will not have the support or supplies you feel are appropriate. You will also not be able to change it, as businesses aren’t run according to what you feel. You will begin to feel powerless. 

You will be taken advantage of. You are kind, hard working, and compassionate. Your work ethic does not allow you to stop doing your job; your workplace is aware of that. This is why you will continue to work short, get paid less than you deserve, and feel entirely, utterly replaceable. Because, to a business, you are. Nurses come dime a dozen and someone will fill your position as soon as you get frustrated enough to quit. Or you’ll go back to school, where you’ll feel like you have the control- the chance to provide the care you planned on. 

You’ll feel like the business cares more about customer service than anything else; this will start to sting. 

You’ll find patients who consider you waitstaff, hospital stays akin to hotel stays. This will feel wrong too. 

You’ll hear older nurses say it wasn’t always this way. You’ll see younger nurses lining up to take your place. 

You’ll be asked to do more jobs than your job, and jobs you aren’t prepared for, because that’s the way it’s been done. It was the norm, the standard of what was acceptable, and it shouldn’t have been. You’ll be expected to suck it up and keep working anyway.

You’ll get stressed. You’ll get burned out. You’ll be too tired to fix it. 

Your co-workers will become the reason you show up. They will see you through marriage, divorce, birth, death, and life. They will become your family. You will even find colleagues and doctors and managers who listen to you, try to help you, try to help nursing, and you will be grateful. Eventually, though, they too will come up against the impenetrable wall that is business.

You’ll still get to care for your patients; you’ll cry with them, laugh with them, talk with them, heal them. But there will be a day when your heart will get tired and the rest weighs too heavy. Your optimism will be met with a budget; you will be broken. You will want to leave, but you can’t, there will be no where else to go, because the rest of the system is broken too.

The choice, then, will be yours. You can clock in and out, care for your patients, laugh with your friends, and ignore the rest. You can try to fix what you can, wherever you can. You can reduce your hours, change your career, or move hospitals. Either way, as long as healthcare is a business, nurses will filter through as fast as their profit-producing patients. Eventually the business will wonder about their front-line turnover, but there will be no need for a fix; the ones who spoke up will already be gone. There will be another new nurse, another fresh face, and the cycle will continue.

I wish I knew how to break it.

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