Pamela Patrick entered intensive-care nursing because it promised the excitement and challenge of helping people through dramatic; life-and-death situations.
She quit for the same reasons.
"Granted, nuring is a stressful job. You're dealing with people in crisis . . . you see peak emotions -- high and low -- and it can get very intense. That's one reason people are attracted to the field."
But in addition to the unavoidable stresses inherent in the work, nurses -- and other health-care professionals -- are subjected to numerous "avoidable" stresses, says Patrick, that make things worse.
"It's common for nurses to work rotating shifts (switching frequently from day to night) and double shifts (16 hours straight), so you're constantly fatigued and your body clock is always mixed up. Usually, nurses get no say in their own scheduling.
"There often aren't enough nurses, so you have more patients than you can reasonably handle. And you wind up running errands, doing paperwork, being pulled away from patient care. Sometimes it seems like you're doing everything but nursing."
Coupled with low pay -- "street cleaners earn more than starting nurses" -- and "lack of professional respect," these stresses are prompting thousands of nurses to turn in their caps. "Nurses," says Patrick, "are burning out and dropping out in epidemic proportions."
But unlike other victims of "nurse burnout," Patrick didn't leave the health-care field when she quit clinical nursing 10 years ago. She went on to earn a doctorate in psychology and establish "a burnout prevention and treatment" program for staffers at a Midwestern hospital.
She now presents workshops on "health-care worker burnout" throughout the country and has completed a book on the subject for Blue Cross and Blue Shield Associations. The insurance company's interest in the problem stems, she says, from the "billions of dollars" association officials claim it costs the health care industry.
While burnout affects other professions -- from teachers to business executives -- Patrick says it's particularly severe among health-care workers in general and nurses in particular.
"A hospital is a highly stressful environment. It's like a self-contained city that's working 24 hours a day, 7 days a week. You're constantly dealing with people in crisis . . . a patient in pain, a family member in emotional distress.
"Nurses tend to start out very idealistic. They tend to work through breaks, stay overtime, even cancel vacations, because patients who need them seem much more important than their own tired feet."
But this idealism, exploited by hospital stress-inducing practices, "leads in one direction . . . burnout."
Patrick, 35, says her own experience was typical. "In my first week as a critical-care nurse, I was responsible for three patients in a unit where I should have had one, or at most two.
"Patients would come in directly from surgery or an accident and need constant monitoring. On a routine case you'd have to take critical measurements every five minutes, in between which you'd dress wounds, give medication, stop a bleed. Caring for one patient can be exhausting . . . three is next to impossible."
Then there were the long hours. "It's common to work 12 days in a row, get one day off, then start an evening shift.It messes up your sleep pattern and your family life. You're chronically fatigued, emotionally drained."
And nurses are still fighting "the old, traditional battles with doctors and administrators." she says. "There's a lot of lip service paid to the idea that you're an important member of the health-care team, but nurses get little professional respect."
While few doctors today snap their fingers to order nurses about, "many," claims Patrick, "still consider nurses nothing more than their assistants. The nurse has so much more patient contact than the physician. Yet one of the chronic complaints among nurses is that they still are not getting that recognition from doctors.
"If a doctor and a nurse have a disagreement, hospital administration usually takes it for granted that the doctor is right and the nurse is wrong. And, too often, hospital administrators won't listen to them. That's what leads to strikes . . . it's an effort to try and get the administration's attention."
It is low pay, however, that is often the issue when nurses strike. The median income of registered nurses (97 percent of whom are female) is $297 per week, according to the Bureau of Labor Statistics. By contrast, telephone installers and repairers (91 percent male) earn $379 weekly and electricians (99 percent male) earn $397.
[In 1978 eight nurses sued the city and county of Denver for paying its tree trimmers, painters and tire-service men more than its nurses. Although they lost the case, the issue it raised -- "equal pay for work of comparable worth" -- has become a rallying cry among workers in poorly-paid female-intensive-fields.]
As many as 30 percent of nurses are currently in some stage of burnout, claims Patrick, who calls it "a leading cause" of the serious nurse shortage.
"Hospital nurses are moving to doctor's offices or corporate clinics, or leaving the field entirely. When I was counseling hospital employees, nurses would come in an tell me they were so fed up that they were going to quit and work in a department store. Anything to get out of nursing."
Enrollment in basic nursing programs has been decreasing, says the American Nursing Association, which estimates a shortage of 100,000 nurses nationwide. Most hospitals are unable to fill all available positions, and desperate nurse recruiters offer everything from use of a new car to a $1,000 bounty.
One positive aspect of the shortage, says Patrick, "is that it's getting the attention of management. It's crisis problem solving, but at least they're finally listening."
Hospitals could, she asserts, attract good staff -- and prevent burnout among existing workers -- through some "extremely cost-effective" measures. Among them:
* Hire a psychologist to counsel employees and to run programs geared to improving staff mental health.
* Permit workers to have some say in their scheduling.
* Use a mediator to resolve conflicts among hospital personnel.
* Encourage employe complaints and suggestions, and enlist their help in creating solutions.
* Establish training programs for new employes and those who want to advance.
* Pay extra for less-desirable shifts.
* Establish an employe health-fitness program, run by a trained exercise physiologist, offering classes and counseling in nutrition, fitness and stress-management.
"These things can work," asserts Patrick, who says many of these ideas were successful at the North Mississippi Medical Center where she served as staff psychologist.
Nurses can encourage administrators to make a hospital "burnout proof," she says. "But not if they quit. My advice to nurses is to hang in there. Nurses may not realize it, but they have a lot of power within the health-care system. I'd like to see them use that power in a positive way to make changes that, in the long run, will help everyone involved."