I became a musician because when I was young, I loved listening to music and was drawn to learn how to make music myself. Fast forward half a century, and my music has led me, together with my wife Susan and our creation, the C.A.R.E. (Continuous Ambient Relaxation Environment) Channel, to associate with the most dedicated healthcare providers in the country.
This past weekend, Susan had been invited to speak at this 2.5 day nursing retreat for oncology nurses sponsored by Healing Journeys, an organization that provides support to those affected by cancer. This event was led by Theresa Koetters, RN, MS. and other associates.
In addition, we were privileged to weave our music throughout these days that were spent sharing personal, professional, and intimate experiences. The retreat was held at the Westerbeke Ranch in Sonoma County, California, that has been adapted as a convention/retreat center. There are many cabins built to provide accommodations, and the food was great.
Without question, oncology nurses are angels of healing. I can only imagine that when they were young, they felt drawn to become healers, to care for the sick and dying. It sounds so noble as to be almost romantic. But the reality is something else. When these nurses-to-be followed up to pursue their healing instincts, they were not thinking of having to clean the blood, vomit, and waste, of having to witness the pain and suffering that characterizes cancer. They weren’t thinking about losing patients with whom they had formed personal relationships, for them to die despite the nurse’s best efforts. They didn’t consider the sorrow of having to communicate the sad news to the family members that their loved one had died during the night.
This weekend retreat was an intimate inside view of the profession as told by these angels of healthcare (all women except for one male radiologist), many of whom have worked in oncology for three or four decades. One sentiment expressed was that they “love the work but hate the job.” That means, they love giving care to patients who need it, but they hate the stress, the bullying that may come from either doctors or nurses, the pressures of insurance company paperwork, the long hours, and the lack of respect from politicians who propose to deny healthcare to millions who need it because taxes would be required to pay for it (as is the case in every modern country except the US).
We heard tales of stressful working conditions that no caregiver should have to endure. Some nurses are so overworked that they cannot take a bathroom break in peace because there’s no one to cover for this short absence. They often choke down their lunch standing in the break room because there’s no opportunity to step away from the patients under their care. Shifts are commonly twelve hours long. It’s well documented that more medical errors and more patient falls occur at the end of a long shift compared with the beginning.
Current California law limits the number of patients a nurse can be assigned. Research from the NHS in Britain has alluded to a 1:4 ratio being the optimal. Also studies have shown that nurses taking care of six patients have a 14% higher mortality among patients during the first thirty days. For nurses taking care of eight patients, the mortality rate increases 31% during the first thirty days of hospitalization. Thus, it’s clearly documented that poor working conditions are resulting in avoidable patient deaths. The overall statistics for preventable medical errors are staggering. Overall preventable errors (from doctors, nurses, and associated personnel) were estimated in testimony to Congress in 2015 (cited in Wikipedia) at around 400,000/year! That’s over a thousand preventable deaths every day! Thus, our best healthcare advice is to stay out of the hospital, if at all possible. But if you end up there anyway, I hope you will be lucky enough to be cared for by one of the angels we met at this nurses’ retreat.
The stress of long hours and high acute patient loads results in “compassion fatigue.” This means that the nurse in no longer able to deliver the highest quality of compassionate and competent care that each patient deserves. The end result is “burn out”, a condition that negatively affects the nurse’s personal health, well-being, and professional practice. Unaddressed, it results in many nurses leaving the profession. Indeed, the job is so stressful and difficult, that around a third of nurses entering the profession do not last one year. Many other nurses leave their profession after several years, not because they aren’t natural healers, but rather because the healthcare system is not serving them or their patients. The whole country suffers from this dysfunction within our healthcare system.
Susan spoke about Jean Watson’s nursing theory of Human Caring, a practice called Caritas. Central to Jean’s work is the goal of helping nurses to get in touch with what led them to the profession in the beginning. The essence of nursing is, indeed, human caring. Watson’s theory provides specific tools inherent to caring, but not necessarily written into operational manuals. She speaks of a Caritas Moment, when the connection between nurse and patient is soulful and authentic, resulting in healing for both.
One nurse told her life story, which was very touching. Her mother had inspired her because she was a nurse. She had volunteered to help her mother in the hospital at age sixteen. This solidified her goal of helping people with cancer, and in those years the specialty of Oncology Nurse had not been established. She graduated from nursing school and became one of the pioneers in this specialty. She related that in her first year of practice, between age 21 and 22, she had cared for three hundred patients who had died. She eventually married an oncologist physician. Then after many years, in a single year, she lost her husband, mother, and a brother. The main subject she spoke about was grief, and how an oncology nurse might deal with the inevitable grief that arises when many of their patients die. I don’t know how these nurses handle the losses inherent to this profession.
Many of the nurses spoke of the need to be able to grieve with their colleagues. Some departments established regular rituals to honor and remember those who had died. The important thing is for the nurse not to deny, suppress, or ignore the natural human impulse to grieve the loss of a patient for whom she has cared. It is important that nurses be able to support each other and to receive support from administrators and other healthcare professionals to acknowledge and express gratitude for the difficult work that they do.
The subject of current politics was mentioned in terms of the increasing anger and fear within the general population. The healthcare industry is fearful these days. Threats to abolish the Affordable Care Act (aka Obamacare) would remove the access to healthcare for millions of people that the ACA has established. These nurses “in the trenches” simply want to do their job, which is to take care of people in crisis.
One nurse stated that Americans have to answer the simple question, “What is the right thing to do?” What is the right way to provide healthcare to all the people who need it? This is a question that should be discussed in the spirit of the best of American traditions. These nurses agreed that they must come from love…love for their profession, love for caring for those in need. Their antidote to anger and fear is love. They promised that they will continue to deliver quality care to as many people as they can, no matter what the politicians say or do. These nurses represent the type of professional that I would want to take care of me should I ever need it. Thank you to all nurses for your service!