You’re all absolved from nursing’s biggest issue


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The biggest issue in nursing isn’t training or hours. It’s staffing.

We, as a profession, have become so used to short-staffing and double shifts that having less-than-horrible staffing is cause for celebration. Horrible staffing saves money, and let’s face it: Management’s chief concern (outside of Press Ganey scores) is money.

As a result of this drive to save money, Manglers push nurses to the limit. We’re asked to come in extra, sometimes even offered extra money to do so, and guilt-tripped when we don’t.

There’s a thin line between not being a good team member—and I do value somebody who works extra when we really, really need it—and being somebody’s patsy. So how do you not get the reputation as somebody who can be abused?

Well, first, you work when you’re supposed to, and you work extra only when you’re really needed. That means keeping an eye on your unit’s staffing. It’s not hard to glance over the schedule for the next week and see when the unit might be really short. It’s also not hard to ask around and see how many surgeries or admissions are expected for the next few days. People who work in just-in-time areas, like EDs and trauma units, have their own mysterious ways of predicting busy times. If you work in one of those places, learn their secrets.

Second, don’t be afraid to say no. This is hard, especially for new nurses or people who are new to a particular place. “No,” though, is one of the most valuable things you’re ever going to learn to say. If somebody comes to you two hours before the end of your fourth day in a row and asks you to stay over four hours, you are allowed to say no. Repeat after me: “Your lack of forethought and planning is not my emergency.” I once had a Mangler who tried to guilt-trip a nurse who’d worked eight twelve-hour shifts in a row into working a ninth; things did not end well for him.

Third, don’t be afraid of confrontation. By that, I mean don’t be afraid to confront Manglement about why you’re constantly unsafely staffed or why they’re routinely calling people in for extra shifts. If you have a union, this is a situation in which you get the union folks involved. If you don’t have a union, a few pointed questions can do a lot to change the culture you live in. If you work in a place where asking questions will get you fired or send you to the Hell Unit, it might be time to find another job.

Finally, remember: Being a nurse is a career. It’s a job. It’s a calling. It’s not your life. If your life outside your job is suffering, that’s all kinds of bad. You have to be a healthy, well-rested person to be an effective nurse. Being a healthy, well-rested, guilt-free person is good for you in general. Learn to say “No,” learn to say “Eff you” (if necessary) and keep your work/life balance firmly on the “life” side of things.

Agatha Lellis
Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at

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