One of the most recognizable rituals in ringing in the new year, at least for New Yorkers, is the famous ball drop in Times Square. The collective countdown is our raucous symbolic farewell to the year that just ended. Watching the ball drop this year made me think of the idiomatic expression, “drop the ball.” I don’t think I have ever used the phrase, verbally or in writing, mostly because, up until now, I didn’t know what it meant. A quick googling tells me that to drop the ball means to make a mistake, or to miss an opportunity. As we move into year three of the COVID-19 pandemic, the nursing profession is experiencing an existential crisis, best manifested by the critical nursing staffing crisis. In September 2021, the American Nurses Association (ANA) wrote an open letter to the Secretary of the Department of Health and Human Services urging the administration to declare the nurse staffing crisis a national emergency.
In what seemed to be a prelude to the increasing number of nurses who wish to leave the bedside, a 2017 study on career choice among nurses reported that 15% expressed career choice regret. Various studies done after the pandemic hit reported that between 11 to 40% of frontline nurses expressed a desire to leave their position. The most frequently cited reason why nurses left their positions was burnout and its multitude of causes. There is no shortage of good advice online on how to mitigate and address the work-related nervous exhaustion that nurses experience. Although I no longer practice bedside nursing (I am a full-time nursing faculty), I’d like to reflect on some of the reasons why I would not “drop the ball” on nursing if I were still a frontline worker during this pandemic and its succeeding waves.
Thank you for the opportunity
In 1990, while I was still in orientation as a new nurse, I serendipitously took care of a gentleman diagnosed with AIDS who was in protective isolation. For most of the day, hardly anyone entered the patient’s room. Since I didn’t have a patient assignment on my own, I volunteered to bring in his food tray (left on top of the isolation cart outside the room), fed him, and cleaned him up from his incontinence. Noticing that he had an unruly beard, I offered to shave him. After the shave, I held a mirror for the patient to examine his gaunt but clean-shaven face. This made him cry. Just at that moment, the patient’s sister walked into the room and slipped a five-dollar bill into my scrub pocket. I thought I could cry, not for sentimental reasons, but for feeling lost in not fully understanding that there was a prize (or price) for doing what nurses ought to do. The patient’s sister did not yield to my protests against accepting the money, so I graciously said “thank you” and hoped that I did not offend her. I felt a spring in my step after this encounter.
This experience did not make me rich but my life has been enriched because I realized that the flipside of being the object of gratitude is also acknowledging that this virtue is a two-way street. Plenty of research shows that those who practice deliberate giving of thanks report heightened well-being compared to those who do not. Heaven knows, we need well-being now more than ever. When our patients thank us, we must also inwardly give thanks for the opportunity to serve, to bear witness. It is good for our health, and it can boost our resiliency when the going gets tough. To learn more on how to cultivate gratitude check out the Gratitude Practice for Nurses – https://ggsc.berkeley.edu/gratitudefornurses
It is a vocation
Unlike Florence Nightingale, I did not hear a call from God to go into nursing. I had a more practical consideration in why I enrolled in nursing school. However, what started for me as a blind career choice became a vocation; a state of being – I nurse, therefore I am. I am convinced that working with patients made me the person that I am today, for the better. If I were still a staff nurse, my way of paying it forward to the profession that has given me so much would be to continue nursing, until retirement do us part. Perhaps this sounds a little mawkish, but working as a nurse is a particular way of being needed. Seen as a vocation, bedside nursing is a commitment, not a short contract. A contract implies a financial transaction, whereas a commitment is about identity. Without a sense of vocation, the hardships of bedside work will mostly shock and never inspire wonder and self-examination.
Refocus and reframe
I don’t know when the pandemic will be over (the CDC doesn’t know either), but I am sure it too shall pass. In the meantime, I can focus my energies on reframing how to think about my job to improve my sense of satisfaction. There are nurses who lament that cleaning an incontinent patient is beneath them, making them feel no better than a glorified servant, albeit very highly paid. Viewing this task as helping to maintain skin integrity and preserve the patient’s dignity can make the work more fulfilling. There are many aspects of nursing during a pandemic that are beyond the control of individual nurses, but we still have some autonomy on how we react to, or perceive our scenario. We can choose to find sense, or to be angry.
Experts on well-being remind us to savor and celebrate small things or small victories. As a staff nurse during the AIDS epidemic, I was keenly aware of the diagnosis as a death sentence. This, however, did not prevent me from feeling delighted when I managed to get a patient on a ventilator get out of bed or shampoo their hair. These activities allowed me to be in the moment with the patient and share an unspoken hope that we have not lost our sense of purpose. The 7 o’clock clapping for essential workers has stopped and the banner on the corner of 77th and Lexington Avenue declaring “You have always been essential” is gone. Nurses must continue to look inward for strength and validation. I have no illusion that the nursing shortage and the ongoing exodus of nurses leaving their communities for better paid travel nursing assignments will be resolved soon, but wherever they work, I pray that nurses won’t “drop the ball,” for all our sakes.
Raso R, Fitzpatrick JJ, Masick K. Nurses’ Intent to Leave their Position and the Profession During the COVID-19 Pandemic. J Nurs Adm. 2021;51(10):488-494. doi:10.1097/NNA.0000000000001052.
American Nurses Association. ANA Urges US Department of Health and Human Services to Declare Nurse Staffing Shortage a National Crisis. Accessed January 2, 2022. https://www.nursingworld.org/news/news-releases/2021/ana-urges-us-department-of-health-and-human-services-to-declare-nurse-staffing-shortage-a-national-crisis/
Fidelindo Lim is a clinical associate professor at New York University – Rory Meyers College of Nursing.