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Short staffing and iatrogenic stressors: can we survive our own doings?

If there was ever a time when the nursing profession was under the spotlight and gaining national and local attention, this is it. There are those whose efforts will help with nurse recruitment and retention. There will be increased funding for scholarships and other financial inducements for nurses. Regulators are looking at mandated nurse-patient ratios and examining mandatory overtime for nurses. External change agents can--and are--influencing the state of nursing. There are changes that need to be made within nursing. Systems, role, and environmental change is best directed by nurses. We are called to be internal change agents within nursing with an eye toward seriously re-examining how we create our own stress. Using a 1970's team model for eight-hour shifts is redundant with 12-hour scheduling models in place. Recalling the scarcity of vital information in days gone by (i.e., blood gases were drawn but once a day as an adjunct to intense nursing observations), today there is a plethora of unending clinical data, such that limits need to be established. Failing to sufficiently address the human condition in a coordinated and effective manner, given the cost of care and the rising expectations of consumers is a constant challenge if we fail to address the soundness of our operational systems. Systems must be kept current with the times. For instance, how we blend temporary workers with "core resource" nurses remains largely unanswered. We must systematically address these issues, or be subject to the stress caused by the failure to do so. Nurse leader--and effective nurse followers--should use the spotlight to demand a re-hauling of our ineffective practices. Not in the spirit of work reengineering aimed at cost savings alone, but pragmatically to address the essence of the nurse-patient relationship and to create a savory environment for nursing professionals.