By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Increasingly, acute care areas are now staffed with nurses with three years or less of clinical experience. Most new graduates today are young, and in addition to lacking clinical expertise, they also lack life experience. Consider the story of an urgent care director who recently discussed this during a program:
Last week, we had a 55-year-old man walk into our urgent center complaining of back pain. He was checking in at the desk when he suddenly collapsed. A code was called, and EMS was notified, but we were unable to resuscitate him. I have several new graduate nurses working in our center. After this happened, I looked around and saw these young nurses crying. They were in shock that a seemingly healthy and athletic man could suddenly die. I asked them about their experiences with death and learned that not one of the three nurses had ever been present for a patient or family member’s death. This was a shocking experience for them, and they had difficulty emotionally absorbing it. We are part of a more extensive health system, so I could access our chaplain service to come onsite and conduct a critical incident debriefing to help our young staff. We have had patients die in the past in our center, but I have never seen the reaction that I did with these young nurses. It made me more aware of things to pay more attention to.
As she told the story, several leaders spoke up about their experiences. One critical care director noted that today’s ICU population is much sicker, and even in the post-COVID environment, they are seeing more deaths. She had recently spoken with one of her new grads, who told her that the ICU was not a happy place and that seeing this many deaths was not good for her mental health. The ICU director noted that she had seen so much death in her career that she had not given much thought to how the environment might be affecting today’s nurses, who are younger with less life experience. She has added a question to her interview to assess how much experience applicants have with death and dying and found the answer is usually little to none.
Right now, health systems are challenged with widespread burnout and psychological distress among nurses that is contributing to staffing shortages that create a cycle of overwork, inadequate coverage, and strained morale. Press Ganey has sounded the alarm about the challenges nurses face today decompressing from their work. This situation becomes even more complicated in environments where acuity is high, and many patients die during their hospitalization. There are few expert nurses on most units today who can help talk younger staff through these experiences. Providing critical incident debriefings when needed helps nurses process their emotions and reset them before they move back into the work environment.
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