A nurse walking to work with a contemplative look on her face.

As a nurse, you know our profession comes with unique struggles that set it apart from other vocations. And while we've always had to walk a fine line between public perception and reality, the hidden struggles of the staffing shortage have us treading on eggshells. We're carrying loads we were never meant to bear, and it's wearing us down. So, what can we do to build ourselves back up?

We're in a tough spot. The public sees us as caring and compassionate superheroes who swoop in to rescue them from pain and suffering. We do a good job upholding this persona, from gently palpating radial and pedal pulses to adeptly changing complicated dressings to holding the hands of dying patients. But as we work to protect the image of nursing, we're losing sight of ourselves.

Never before have there been staffing shortages of this magnitude. Healthcare facilities expect nurses to deliver exemplary care for more patients with less staff.

Members of the public don't see the true impact of the nursing shortage because we're working harder and longer hours to fill in the gaps. They don't realize how we protect them from the behind-the-scenes drama in trauma and treatment rooms. And why should they? We're professionals doing our jobs in a competent, caring manner.

Nursing Struggles Are Real

Despite public opinion that nurses are extraordinary individuals, we're human beings who also feel mental and emotional pain. But we hide our distress from patients and the public, and it's taking an emotional toll on our mental health. We feel guilty and ashamed when we cannot complete our tasks or feel our care is substandard. After a failed resuscitation, we leave the trauma bay and put on a smile before entering the next treatment room. There's no time for us to mourn or be human.

Nurse Commitment at a Crossroads

In today's culture of staffing shortages and pressure from employers to work long hours, nurses can choose between commitment to patient care or adherence to self-care. There's not enough time to do both. We're at a crossroads.

We can either accept extra shifts or go to the gym. We must choose between coffee and lunch breaks or skip both to complete our workload. We come to work early, stay late, and binge on ice cream and chips to deal with the stress.

The cost of caring is high, and it's leaving us with:

  • Anxiety

  • Depression

  • Moral Distress

  • Emotional Exhaustion

  • Nurse Burnout

The choices are palpable. Do you care for your patient, or do you care for yourself? Do you wonder why the commitment of being a nurse means choosing between your health and others? We know we need to balance caring for others with self-care, but what happens when choosing self-care means poor patient care because not enough nurses are left to work? Is being silent and hiding reality the right choice?

Nurse heading to work and showing signs of emotional labor.

Emotional Labor of Nursing

People expect nurses to deliver safe, competent care and be polite, self-assured, and self-controlled. Their unruffled calm makes the public feel safe, reassured, and understood. Only the public has no idea of the emotional labor beneath the calm demeanor of nurses.

Emotional labor was first coined by Arlie Hochschild, an American professor in the early 1980s, to describe the internal work of regulating one's emotions in public. Emotional labor is masking your true feelings when you know you cannot give your best patient care due to staffing shortages. It's your calm attitude when you're crying inside. Emotional labor is the pain that nurses hide to:

  • Protect Patients

  • Maintain Patient Trust

  • Safeguard Patient Dignity

  • Present a Professional Image

Healthcare employers expect emotional labor from nurses. However, it's seldom spoken of or publicly recognized. And when you conceal your authentic self by masking negative emotions or feeling forced to exhibit positive emotions, you:

  • Have Increased Stress Levels

  • Distance Yourself from Others

  • Experience Emotional Exhaustion

  • Heighten Your Chance of Burnout

The emotional toll of silence is contributing to the mass exodus of nurses leaving the profession. Since 2020, over 100,000 nurses have abandoned their jobs. Over 600,000 more are projected to leave by 2027, some through retirement but many more citing stress and burnout. 

If hiding pain contributes to burnout, should nurses speak up?

Start Open Conversations

Is it possible to speak up and maintain your professionalism? How do you speak up and keep details and patient information confidential? Should the public know how the hidden pain of nurses is contributing to increased burnout? Breaking the silence on nursing struggles should happen at the public and private levels.

Public Discussions

Nurses have a professional ethic to maintain while caring for patients in hospitals and clinics, and patients deserve to feel safe and supported without contending with a nurse's emotions. However, the impact of staffing shortages and nursing burnout should be discussed publicly.

Explore the options of an open forum with your manager and employers. Nurse burnout is affecting the entire healthcare system. Do your research and be ready to present factual data underpinning the causes of burnout. It should include increased workload, emotional labor, and the lack of support for nurses at the political and systemic levels.

Private Discussions

Due to patient confidentiality agreements, nurses don't have an outlet to express their feelings of stress and burnout. Ask your supervisors and mental health professionals to offer open conversation forums about disturbing issues, such as the delivery of poor or incomplete care secondary to staffing shortages. Ask for educational sessions on mental health issues and how to reduce the stigma of nurses voicing their struggles.

Address Root Causes

Political and systemic issues significantly influence nurse struggles and burnout. 

Political Climate

Nursing unions and associations warned politicians of a coming nursing shortage years ago, but they did little or nothing. The COVID-19 pandemic accentuated the issue, and healthcare is now in crisis. Both state and federal governments must recognize that nurses are the backbone of the healthcare system. 

Systemic Issues 

Most nurses acknowledge that healthcare facilities listen to issues presented by nurses, but nothing changes. Emotional labor goes unrecognized, and workload continues to increase. Nurses give up their health to work for companies that don't acknowledge their hidden pain.

There are no simple answers to these deeper issues. However, nurses can begin the process by breaking their silence, seeking support, and engaging others in addressing nurse struggles.

So, if you've been hiding in the shadows, it's time to step into full view and talk about the hidden struggles that nurses face. You owe it to yourself and your fellow nurses.

Alice Blackmore, MN, RN, Content Writer

Alice is a registered nurse and healthcare writer. She has more than 20 years of nursing experience, which ranges from labor and delivery to long-term care, with pediatrics, community nursing, and critical care sandwiched in the middle.

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