Anxieties and Reflections on Entering the Nursing Profession

By M, a comrade from Québec

As a nursing student, I have the very interesting privilege of entering, learning about, and contributing to a new healthcare setting every clinical rotation. While I have met kind, dedicated, and helpful individuals during each of my clinical rotations (both patients and staff), I have also seen how our current healthcare system dehumanizes them in ways I could not have imagined prior to witnessing them. I would like to share a few vignettes from my experiences, because these experiences likely await you as a patient when you are old and frail, if things do not change.

Working in long-term care in Québec, I witnessed such depressing living conditions that they struck fear into my heart, at the same time as my clinical instructor told me that this facility was “one of the good ones – you can tell they really care about their residents here.” And you know what? They did care. Every single staff member, nurse, and care attendant alike worked with speed and dedication to provide the best quality of life possible to their residents. However, you can only work with the resources you have, and the lack of resources not only hindered the staff’s ability to perform, but wore them down psychologically, damaging their motivation and tenderness. 

When a long-term care system is run by a society that perceives humans primarily as a series of numerical calculations, human needs that are less easily quantifiable get ignored. Meals in long-term care become a cost calculation, or a calories in, calories out calculation. The result is me, a first-year nursing student, nervously discouraging a resident from suicidal ideation because that is how much she hated the bland food she would be destined to eat for the rest of her life. The result is residences where there is neither staff nor facilities to spare, so if you take too long convincing a resident with dementia that she must take her shower, her shower time-slot will be forfeited, and she will have to wait up to a week for her next chance to shower. The staff respond to this with force and frustration, not because they’re cruel, but because they don’t have time to shower the resident later, and they desperately want to provide their residents with hygienic conditions that honour their human dignity. In turn, the residents respond to the staff’s force and frustration with fear and violence. I had my first experience with violence in this setting, as I refused to remove the straps holding a resident to his wheelchair (he had dementia and frequently forgot that he could no longer walk, and would fall if he tried to get up). He hit me as I explained to him that it was dangerous for him to stand up. He was a weak man, and I was in no danger, but I was confronted for the first time with the question of whether accepting violence from reasonably frustrated patients was part of my job. Neither I nor the resident had access to real mental health resources beyond the pills we both take every day.

My next clinical rotation took place in the geriatric unit of a big hospital. My excitement to start this rotation was palpable – I love hospitals. The way a thousand different people from the janitor to the surgeon come together in a collective mission to care for vulnerable patients is a testament to the great love humans have for one another. So, you must imagine my dismay at the unsafe and chaotic working conditions on this ward. On one of my first days, I shadowed a nurse as she went from room to room taking patients’ vitals, skipping half of her assigned patients because she just didn’t have time to do the obligatory assessments on her more stable patients, then doing the same round to give morning medications, then doing the same round to help the patients eat their breakfast, then doing the same round to take their vitals once more, before doing this round again to give them their lunch medications, and then to feed them their lunches. This woman, who had trained for years in a competitive program to do complex assessments and administer skilled procedures had become a human pill and food dispenser. The unit was understaffed, and this particular day, with the help of a licensed practical nurse in training, the nurse was in charge of 13 patients. Seeing as this was a geriatric unit, these patients could not, for the most part, do anything for themselves. While it is in our mandate to encourage their independence, you simply cannot wait while a 93-year-old who needs to be supervised for aspiration risks slowly takes the spoon to her mouth. You’re forced to rush her. There can be no pleasant mealtime conversation as you quickly feed her, otherwise her neighbour will go hungry, or worse, have a diabetic hypoglycemic episode as he waits too long for his food. Like me, new nurses on this unit would each express their horror at these conditions – both for the staff and for the patients – and leave soon after, ensuring the unit was never adequately staffed. 

For brevity’s sake, I will not continue to describe my further experiences at following clinical rotations, but the trends did not stray too far from the ones I described above. I will say that I’m terrified to start working on my own. As a nursing student, I never have more than a few patients assigned to me at a time. Though I am still slow and inexperienced, the low number of patients I have to take care of at once gives me the luxury of time, and gives me a taste of what healthcare could be. I have had the time to talk to an unconscious patient as I administer her medications and suction her tracheostomy – wishing her well, telling her that it’s okay, I’ll be done soon, and stroking her hand on the off chance that she can hear or feel me. I have had the time to sit with a patient for twenty minutes, convincing him to take a few bites of his food, because he’ll need the strength to survive his next surgical procedure. I have had the time to sit with his family, hugging his mother as she tries not to cry. I have had the time to properly assess a Deaf patient, which no one else could do because communication with him took too long, and they all had other patients waiting. When I graduate into the workforce, I will no longer have the luxury of time. Regardless of the unit I end up in, I can be guaranteed many more patients in my charge than I have time to properly care for. The experienced nurses that would have taken me under their wing will be long gone due to burnout, and the ones left will be scrambling to care for their own patients, unlikely to have time to check on me and mine. I promise to do my best, but unless the government provides me with the conditions and resources to support me in my work, I won’t have the time to show you the tenderness and care I feel for you as my patient.