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"We see the problems, and we want to do better," she said. "We know we can do better. We were trained to do better."

Bad connection

A study by the Joint Commission on the Accreditation of Healthcare Organizations released Aug. 8 found a startling connection between
nurse shortages and patient outcomes.

In the last five years, 24 percent of unanticipated hospital deaths, injuries and permanent loss of function were tied to a shortage of nurses. Such research findings can add to a nurse's guilt, Montalvo said, but they also can help bolster the professionarguments that they need more staff. Any nurse knows rates of infection and patient falls are related to staffing shortages. Having research to back up the stories can help nurses prove
to administrators how badly they need better staffing, Montalvo said.

Nurses find little support for their idealism, said Dorothea Hover-Kramer, Ed.D., RN, a clinical psychologist whose San Diego counseling practice caters to nurses and other health care professionals.

"There's such a hiatus between the ideals we're taught in university and the real situation, which is very exploitive and detrimental to nurses," she said.

Students are taught active listening skills and other caring techniques, but when they get into the trenches, they find little time to practice them.

They must struggle not only with their own expectations, but with a
public that expects nurses to walk on water, Hover-Kramer said. People's expectations for nurses are way beyond what nurses can accomplish, she said.

When Hover-Kramer counsels RNs, she reminds them that overly high expectations can lead to frustration. It's OK to lower expectations sometimes, she said, and to acknowledge the difference between your
work setting and what you hold up as the ideal.

One way to conquer guilt is to set firm boundaries between work and home and start practicing better self-care.

"Nurses are depleted," said Karilee Halo Shames, Ph.D., RN, a certified holistic nurse. "Many nurses are not as healthy as they need to be."

Shames, a clinical specialist in psychiatric nursing and a holistic healing proponent, wrote Energetic Approaches to Emotional Healing with Hover-Kramer. The book explores ways for nurses to practice the art of self-care. Shames' newest book, Thyroid Power: 10 Steps to Total Health, expands on the holistic healing themes she advocates as essential for nurses to do their jobs well.

Shames paints a dismal setting for hospital nurses-10- to 12-hour shifts, unhealthy cafeteria food, poor ventilation and lighting and little opportunity for quiet and relaxation.

"The staffing shortage is costing lives, and it's costing nursing lives with high divorce rates, high addiction rates," Shames said. "The more beaten down nurses get, the less energy we have to meet the challenges."

Shames, founder of Nurse Empowerment Workshops and Services, is passionate about the need for nurses to start taking better care of themselves. Nurses can't say no, so they end up taking on more than they can handle. Then they go home feeling lousy because they couldn't do the job well enough, she said.

Unfortunately, more and more nurses are saying no by leaving the profession. Shames believes more would return to nursing if they were honored for the work they do.

"We have to be able to define boundaries; we have to be able to say, 'These conditions are unsatisfactory and killing my spirit,' " Shames said.

To some extent, nurses-with a natural inclination for compassion-are more vulnerable to guilt feelings. But much of that guilt could be erased if health care administrators rewarded nurses with more money and more control over their own practices, said Joan Hrubetz, Ph.D., DSc (honorary), dean of Saint Louis University School of Nursing.

Hrubetz received her nursing diploma in 1956 and has witnessed more than 40 years of nursing practice. Our health care system can't work without nurses, she said, and nurses themselves need to make people realize that.

"I think guilt is the most useless of emotions unless it motivates one to act," Hrubetz said.

If nurses are going home every day feeling bad, that should tell them they need to do something about it. "Nurses need to take more responsibility," she said. "Instead of being Pitiful Pearls, they need to let administrators know their needs."

Contact Donna Hemmila at dhemmila@prodigy.net