Isolated nurses and the crisis of LTC identity

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Elizabeth Newman
Elizabeth Newman

For young people starting their careers in journalism, traditionally there have always been the following problems: long hours, low pay, lots of stress and people yelling at you.

It's not that dissimilar to becoming a nurse.

The difference, of course, is that nurses are a highly respected profession while journalism has become, let's say, often distrusted by members of the public (until those members need something). The biggest benefit to embarking on either of these careers, in my opinion, is the firmly rooted sense of identity. When someone says he or she is a journalist or a nurse, chances are he or she has a lot of self-esteem tied up in the profession. Previous studies have found that identity can influence work. In turn, work identity can influence levels of job satisfaction and employee retention.

That's why a new English study is both interesting and concerning related to long-term care nurses. These nurses, according to researchers at Northumbria University and the University of Cambridge, feel isolated and excluded compared to others in the healthcare profession. The title, “I'm not sure I'm a nurse,” published in Journal of Clinical Nursing, says it all.

The biggest challenge is that nursing home nurses care for residents, which differs from nurses caring for patients. Hospitals and other healthcare entities treating the acutely ill, rather than long-term residents who require medical interventions occasionally, may lead to the perception that nursing home nurses have a “diluted” role in terms of clinical skills. Nursing home nurses may start to undervalue their work, telling themselves that it's more meaningful and “skilled” to be treating a gunshot victim in the shock-trauma ward than examining for pressure ulcers.

“Analysis of participants' responses also suggest that the significance and value of their ability to manage complex multi-morbidities is largely unrecognised, suggesting that the focus of nursing is responding clinically to illness and disease rather than maintaining health and well-being,” the researchers wrote.

It's also not going to come as a huge shock that in at least one previous study, hospital nurses confirmed what we've always suspected, which is that they tend to have negative views of nursing home staff and see them as less skilled and less professional.

In one anecdote that may ring home for some, a resident had a Hickman line and the nurses were willing to learn how to treat her. According to the nurse, they were told, “We're not prepared to train you,” which of course ended up costing the system more money. “Why can't we be a partnership?” the nurse asked.

Good question. Granted, there are some acknowledged differences related to a country's healthcare system structure — for example, most nursing home nurses in the recent English study do not work for the National Health Service, but for private companies. Plus, notably, a 2004 study found that nurses don't generally develop a strong identification with their employer, but with the broader professional community around being a nurse. They also found nurses value professional registration and qualifications around work identity as well as patient care management. In other words, this is good news for nursing associations, especially those pushing higher education, but may be challenging for administrators.

Plus, it's easy for administrators to blow all of this off as a “feelings” argument: If you have constant crises to triage, does it really matter if your nurses feel down about whether their work matters?

But here's why this study and other research deserves your attention: As the researchers point out, identification with a group becomes intertwined with that group's values, ultimately relating to whether individuals remain in the group. Whether it's a police officer, teacher or a nurse, it's hard for many people to stay motivated if they don't identify with the sense of helping people and contributing to society.

Given the crisis of the recruitment and retention in our industry, it's incumbent upon administrators to remind those dedicated nurses in long-term care facilities that, in the words of Stuart Smalley, they are good enough, smart enough and doggone it, people like them!

Follow Senior Editor Elizabeth Newman @TigerELN.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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