Corporate health care mentality set up nurses up to be inhuman while holding us to superhuman expectations. We’re told to be caring — but not allowed to do it. It’s time to demand that we stop being abandoned and dismissed by dysfunctional leadership.
Early in my nursing career, I was assigned to the pediatric area for one shift in a busy emergency department (ED). Our team received notification of an incoming 18-month-old with a vague trauma history. EMS had been called to a private residence for a “sick baby who fell” and found a toddler with a disconjugate gaze and transient responsiveness. We wondered why a trauma activation wasn’t called. Nevertheless, the charge nurse said we would need to take this little boy in a unit unequipped for major trauma.
When little “Josh” arrived, he only had a minimal response to painful stimuli, and his disconjugate gaze was profound. From the minute I saw him, Josh was my patient, and I was his nurse. I was invested in caring for him. Immediately, I knew Josh was worthy of a trauma activation, but I, early in my nursing career, lacked the confidence to bypass the charge nurse’s decision and call the trauma activation myself. The physician recognized the severity of his condition but also succumbed to the failed system. Little Josh had long been dismissed in many ways we had yet to understand, and we failed him again.
Since there was no trauma activation, his STAT CT was quasi-STAT, left largely at the discretion of the CT techs. The pediatric ED was too busy to let me go to CT with him so the charge nurse went. While I waited for his return, I was assigned to four other patients who were non-urgent. The minute Josh returned, I went to him and could see he was worsening. As call lights for my other patients were ringing, I ignored them. That’s right — at that moment, I was only Josh’s nurse because he needed someone who wouldn’t abandon or dismiss him anymore. While I started an IV and catheterized Josh for a urine sample, I held back tears, felt his pain in my own chest and wished I could just hold him since his own mother wasn’t there. In what would be some of Josh’s last moments of his short life, a bond was forming between us. I wanted to do more, to be more, for him in those moments.
Once Josh’s mother finally came to his side, long enough to verify demographic information, never once touching Josh, she quickly abandoned and dismissed Josh — again — in his time of need to settle herself in the waiting area. What Josh needed most was love and compassion. Thankfully, he had a nurse who was willing to give these things to him.
In his mother’s abandonment, I caressed Josh’s little head, combed through his hair with my fingers, held his dirty little hands, and told him, “Joshy, I’m here, and you are loved. I’m right here with you.” He was my patient. I was his nurse. For ten meaningful minutes, I had the privilege to show love to Josh.
As it turned out, Josh’s mother and her boyfriend hosted a party that evening. Police reported the couple were intoxicated and claimed they didn’t know what happened to Josh, so the history remained unclear. They had put Josh in a bedroom and locked the door during the house party. Later, when Josh’s mother went to check on him, she found him unresponsive.
Josh’s urine drug screen revealed multiple drugs. His head and neck CT showed multiple acute bleeds, but his neck was OK. When we removed spinal immobilization to inspect the rest of his body, he was no longer responding to painful stimuli. What came next was literally nauseating. I felt such infuriation and overwhelming grief when we log rolled this beautiful baby and it became evident that he had been subjected to such extensive sexual abuse that I was secretly thankful he was now unresponsive. Just as Josh was out of spinal immobilization, I scooped him into my arms to cradle him in his mother’s absence.
Once the charge nurse heard about the test results, he suddenly became concerned about Josh and moved him from the pediatric ED to a trauma bay. I wanted to stay with Josh in the trauma bay; after all, he was my patient, and I was his nurse. Instead, a different nurse would take over. With no choice in the matter, I felt forced into abandoning and dismissing Josh. The move into a trauma bay was futile, and a trauma activation wouldn’t have saved him. Nothing further could be done for him, except to offer him some human touch, love, and compassion. Josh died within hours in the ED with no one there to love him. The only nursing staff with him were focused on time of death and turning over the ED room for the next patient. Josh was just a number in the failed system.
I left work unceremoniously that night. Nobody seemed to care that another number had just died. Nobody cared about how another number’s death affected me. In fact, I was just another number. After holding back tears for the second half of my shift, the floodgates opened as soon as I got in my car. For the first time ever, I called in sick the next day. Not an hour went by in my own home that I didn’t think about how I felt like I abandoned Josh during what I believed was a time when the human element of nursing was most important. I also felt abandoned and dismissed by the expectations placed upon my profession by leaders who say they care but don’t know what that means for us nurses. I cried for two days in the isolation of my own home because I was too afraid and embarrassed to say out loud how profoundly Josh’s situation affected me.
Yet, I went back to work. What I thought was a lesson in self-preservation turned into coping mechanisms that caused numbness, apathy, blame, toughness. I went back to participate in a failed system led by oblivious leaders. We sometimes call this phenomenon resilience but fail to recognize when it’s no longer resilience — but apathy. The system is creating apathy in nursing while demanding care and compassion from us.
There’s a better way. It comes with ousting old-school leadership culture and corporate health care mentality — replacing managers, directors, and executives who don’t support the staff who are subjected to this kind of trauma day in and day out. Actually giving useful resources to nurses to support the expectations placed on our profession. And my generation of nurses sharing our experiences openly.
What happened to me — and continues to happen to countless others — is needless but likely inevitable in the toxic culture we’ve created and perpetuate. I was party to the culture for more than a decade before I began to recognize the toxicity and call it out. Finally, I feel like the real me again, but now with more experience and confidence. It’s time for all of us to speak up against the notion that nurses are commodities and against the collateral damage of toxic corporate health care. Start sharing your stories about burnout, post-traumatic stress, and the dangers of metrics-based health care. Something’s got to give, and it shouldn’t be the well-being of caregivers.