I walked onto my small unit a few minutes before 7 a.m., nurses huddled around one elderly gentleman. A cacophony of alarm bells and call lights went unanswered as the unit’s three overnight staff members attempted to keep him in bed. He voiced his disagreement loudly while climbing over the rails meant to protect his safety. Though he was strong, he was unsteady. Exasperated, the night nurse showed me her message thread with the provider. Trying, and failing, to secure additional interventions to keep this man calm and unharmed, her pleas were met with, “I am sorry he is misbehaving.”
Once security team members lifted him back onto the bed, I tried to secure a safety partner. I was informed by the staffing office that none were available. I also made an effort to contact the provider to establish orders for PRN medications. My other patients were neglected as I repeatedly attempted to reorient this gentleman and keep him from injuring himself and others. My messages went unanswered and his behavior continued to escalate. The provider was listed as “not available” in the paging directory and as the charge nurse, I was running out of options. I approached the man once more, attempting to redirect his behavior. His right fist came from behind his back and unexpectedly struck me in the jaw.
The reality of workplace violence
In the wake of Alex Pretti’s murder at the hands of ICE agents, my social media was flooded with nurses joining together in outrage and experience. “It could have been me,” resounded the chorus of helpers and healers. Because what Alex did, assisting a woman shoved to the ground, is what we are trained to do. We are taught from the very beginning to respond to those who need our aid. His actions, and his death, were a revelation for us all; none of us are safe.
But, then again, safety for nurses is but a veil.
Statistics show that one in four nurses are physically assaulted every year. Up to 81 percent of nurses have experienced at least one incident of verbal or physical abuse in the past year. And in 2022, the Oncology Nursing Society found that more than two nurses were assaulted every hour. What I find most interesting about this particular statistic is that 2022 immediately followed the COVID-19 global pandemic, when nurses were hailed as heroes.
Systemic failures and moral distress
While I am sure there are health care workers who still support the current administration, it seems a large majority are opposed to the ways they have mishandled policies that directly impact the country’s marginalized and most vulnerable. It appears the powerful and wealthy continue to succeed and maybe even operate above the law, as revealed in the Epstein Files. Those of us on the front lines who witness injustice and systemic failures are tired and angry.
Some nurses have channeled that rage into social media posts, which have cost them their careers and subsequently their livelihood. Which begs the question: Should nurses lose their jobs over social media posts?
Most recently, a labor and delivery nurse in Florida was fired after wishing certain negative physical outcomes during Karoline Leavitt’s birthing process. A Virginia nurse anesthetist lost their job after encouraging colleagues to inject ICE agents with paralytics. While I certainly do not condone either of these nurses’ actions, my first thought after reading the news stories about these individuals was, this sounds like misplaced moral distress. Because in addition to the abuse, injustice, and systemic failure, nurses also bear witness to a myriad of events no one likes to talk about. Exposure to human suffering on a daily basis does something to one’s soul.
We see things that keep us up at night, hear things that linger in our memories, and relive things that make us question our choice of profession.
The aftermath of assault
The punch caught me off guard. When I gathered my thoughts, I told my coworker to call a medical response. Once the team arrived, I requested soft restraints and anxiolytics. He responded beautifully, finally able to rest his body and mind. The next day, I received an email from my supervisor listing everything I had done wrong. No one asked if I was okay. There was no mention of my injury. Instead, I was blamed and shamed.
But I was lucky. Not long ago, a nurse was attacked by a patient and beaten until she was unconscious.
I have read quite a few similar stories from nurses who share a common thread: lack of organizational support. Whether it be an absence of appropriate staffing ratios, interventions to reduce burnout and moral distress, or follow-up and care after a patient assault, etc., I wonder what would happen if systems took better care of their nurses? What if organizations got hold of the distress before it became a TikTok video?
A profession unsupported
Some say Alex Pretti would still be alive had he stayed home. And some say those nurses would still have their jobs had they kept their mouths shut.
There are other voices, though. Those who say Alex Pretti’s actions were an extension of who he was as a caregiver, and that he should still be alive because the law enforcement officials who took his life should have protected it. Those who say nurses are chronically unsupported by their institutions, and firing those who expressed their opinions, albeit unkind and ill-aligned with their profession, further reinforces that message.
Reading the comments section of each news story was akin to a witch hunt. Self-identified health care workers called for the removal of licensure while others in the community wrote phrases such as, “It is always the nurses.”
And this person is right, in a way. History has given us examples, time and time again, of nurses who pioneered specialized fields of medicine, nursing education, and health care activism.
It is always the nurses.
It is always the nurses who sacrifice their own well-being for the care of others. It is always the nurses who bear the brunt of the system. Whether it be a trickle-down effect of sickness, sadness, anger, or violence.
It is always the nurses.
Amanda Dean is a palliative care nurse.
