BUFFALO, N.Y. -- "We are the bouncers, the bodyguards, the
'shotgun' riders, the overseers, the maître d's, the
stewards, the organizers, the managers and leaders for the patient
. . . Often we are the only thing between them and a sentinel
event. See us, hear us, feel us."
Welcome to the nurse's world, through the words of those who
This telling reflection on the profession appears in a paper
published in the current issue of Nursing Forum (July-September
2007) titled appropriately "Giving Voice to Registered Nurses'
Decisions to Work."
Suzanne S. Dickerson, D.N.S., associate professor in the
University at Buffalo School of Nursing, is first author. The paper
presents results of an analysis of written responses to an
open-ended question contained in a survey that assessed work
satisfaction of registered nurses. The study's quantitative results
were published in 2006.
Analysis of the comments identified four major themes: competing
priorities, balancing priorities, practice deterrents and
collegiate support, which encourages nurses to stay in
"Listening to the nurses' voices, it was amazing that in spite
of the volume of deterrents to working, they continued to care for
their patients," Dickerson said. "One emphasis that was newly
apparent was that nurses repeatedly told about their work patterns
or trajectory that reflected the need for flexibility to fit family
Demographically, the respondents were mostly female (97.2
percent), mostly white (89.9 percent) and the majority, 66.7
percent, were married. Those currently working as nurses were
divided fairly evenly between full-time and part-time positions (38
percent versus 32 percent). Of the 332 who indicated their current
position, two-thirds were involved in direct care of patients, and
more than half (53 percent) did so in hospitals. Another 18 percent
worked in ambulatory care settings. The average age of respondents
was 50, and they had an average of 20 years of experience.
Comments categorized into the "Competing Priorities" theme
centered on dedication to nursing as a career and pride in the
work, as well as remarks stating the need to place family needs
above professional needs at certain stages, particularly when there
are small children or aging parents to care for.
In the related theme of "Balancing Priorities," nurses commented
on the need to interrupt their job trajectory to care for family,
described returning to school in their middle years and their wish
for a better work schedule, less shift work on holidays and
weekends, increased opportunity for promotion and for salary
Some nurses described switching positions to lessen stress and
lower the pace, and taking part-time positions for more personal
time and to avoid work-place politics.
As one nurse commented: "I have found as I age…my time
off is more important than most all other aspects."
A major theme under "Practice Deterrents" was pay inequity.
Commented one participant: "Money is a major issue with many
nurses. Although people say money is not a motivator, almost every
nurse I know would be much more motivated if we were paid well
enough so that we are not forced to work two jobs and if our
advanced degrees were compensated."
Another common deterrent was lack of respect, which is the
reason one respondent is leaving the profession: "We have demanding
stressful roles. Yet our employers see us as expendable,
replaceable and interchangeable with a variety of lesser-trained
Other comments echoed this concern: "The voice of experience is
not respected; the older nurse is not valued," comment one
Work demands -- "My heart is at the bedside, the rest of my body
couldn't do it"-- and safety issues -- "I left hospital nursing
after 20 years because I became horrified and disgusted at the
mistakes being made" -- also were mentioned frequently as a
The final theme covered comments on why nurses stay in practice,
and collegial support loomed large. "My coworkers are the reason I
stay," wrote one nurse. "I am grateful for the people I work with,"
wrote another. "…I could never do my job without them."
Dickerson noted, "The fact that collegial support was the most
important factor to continue working demonstrates that
'nurses-supporting-nurses' could be developed into a strong network
to promote a solidarity that could be operationalized through
"It would behoove employers to listen to the nurses voices to
improve quality and at the same time promote retention."
Additional authors on the study were Carol S. Brewer, Ph.D., UB
associate professor of nursing; Christine Kovner, Ph.D., professor
of nursing at New York University, and Mary Way, a UB nursing
The study was funded by the Agency for Healthcare Research and
The University at Buffalo is a premier research-intensive
public university, the largest and most comprehensive campus in the
State University of New York. The School of Nursing is one of five
schools that constitute UB's Academic Health Center. UB's more than
27,000 students pursue their academic interests through more than
300 undergraduate, graduate and professional degree programs.
Founded in 1846, the University at Buffalo is a member of the
Association of American Universities.