10 Hard Truths of the Nursing Profession You Should Know Sooner

By NT Contributor on Thu, Sep 05, 2013

nursing professionThroughout my 23-year nursing career I have worked in many capacities too numerous to mention. I've become a staff educator, assistant director of nursing for a 500-bed facility, CNA/red cross training, long-term care supervisor and charge nurse, hospice nurse and, most recently, started my own advocacy business. I've learned the most valuable things in life from my patients and all these years, the nursing system has left certain marks on me that those on the front line will be able to recognize. These marks and also themes have never changed and I find it my obligation to illuminate other nurses on the truths of the nursing profession.

  1. I am a fierce patient advocate and in nursing, the patient always comes first.

  2. It is an honor and a privilege to minister to the sick, as they allow us into their lives at such an intimate, trying time. 

  3. Nurses often treat each other terribly, as does management, and this negativity trickles down from the top and, of course, that negative energy transcends on to the patients receiving care.   

  4. The nursing profession has become a business and for true humanitarians it becomes extremely difficult to work under monetary motivation.

  5. Nurses are afraid to speak up for fear of being fired, something we've all witnessed far too many times.  

  6. Few nurses stay very long at a job because nursing burnout is high and there is no motivation to stay without a union to protect you or a pension plan to help you secure some kind of future.

  7. Nurses have no recourse for grievances and no support groups. By the end of their nursing career, many are physically ruined, mentally exhausted and emotionally tapped out. I have witnessed so many nurses pass from strokes and heart attacks because of the constant stress along with broken marriages, relationships, etc. The stories go on and on.

  8. Medicare is broken and Medicare scrutiny has gotten completely out of control, creating so much paperwork that RNs rarely deliver hands on care and have become, at best, pencil/paper pushers leaving the hands-on work to LPNs.

  9. Did you know that Long Term Care (nursing homes) are second most regulated only to Nuclear Power Plants? That fact is absolutely mind boggling, but if you saw the amount of paperwork left for nurses to do, you would be just as "blown away".

  10. No one but no one talks about this stuff. I have long since cancelled my subscription to two popular nursing magazines. They are written by nurses who haven't been on the front lines in years. These are the nurses who have 20 initials next to their names, signaling all kinds of credentials that for many of us, mean absolutely nothing. Their articles are Fluff and Stuff and rarely if ever get to the heart of anything... maybe a heartwarming nursing story here and there. Meanwhile, so many nurses are leaving the field broken, frustrated and frankly lost.

If I ever hit the lottery or came into some kind of money that would allow me to leave my job, I would work to restore what nursing should be. Certainly, nurses would be 'unionized' and there would be plenty of support groups available for them. For God's sake, no one speaks the truth anymore, and if you can't admit the truth, then you can't work on the problem.


To all of you nurses out there – may God bless all of you. Your rewards are those you receive through the eyes of your patients for whom you made a difference. 


In a world filled with greed and disregard for our fellow man, the world starts not with someone else, but in our hearts first, because we are the world. We can change it one nurse at a time. 


I hope someday, in my nursing career, I can be a part of changing what our profession has become. I hope to help put dignity, hope and recognition back where it belongs - in the hands of these most precious people who chose to become nurses because they cared.

About the Author: Marge Helmuth has been a Registered Nurse for over 20 years. She has worked as a patient advocate, long term care consultant, staff educator, assistant director of nursing, medical/surgical nurse, and presently, as a hospice nurse, her most beloved position. "It is both an honor and a privilege to take care of those who are terminally ill. They are accepting a perfect stranger into their lives at such an intimate time, and have entrusted me with their care, giving them, what I hope is a death with dignity."

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faye Brown 2 months ago
Love this list because it states where nursing has gone and it is so sad! we are a necessary profession-with out nurses there would be no health care; yet we continue to fear speaking out, fear for our jobs and fear of not looking like caring "angels" society thinks we should be. instead we need to ban together, form unions and enter the political arena to protect nurses future. our future depends on this-we most activate new nurses, i fear my 32 years as a registered nurse has worn me out but i am still willing to fight the fight.

K Gaz 2 months ago
Marge, you are so right on with your article. I am a nurse for 28 years having worked, ER, trauma ER, Asst. Nurse manager of the ER, Nurse educator, CCU. PACU, Cath lab, Hospice and have worked in several hospitals in 3 states. These problems are everywhere .Anytime you try to get Nursing back to the way "it should be" and "used to be" all Administration says is well you don't have your Master's degree so you can't participate in Committees or administrative forums. Forget about all the experience I have to offer. If you ever decide to form a "real Nurse" hospital please let me know. I have several collegues who would qualify besides myself. We still LOVE being a nurse.

Anonymous 4 months ago
What you have written, I have been trying to articulate to everyone for years. I deeply appreciate the truth you have spoken. I started as a CNA in 1981, LPN for 10 years then RN since 1992. My mother was an RN and graduated in 1948. She told me not to go into nursing because she saw the trend back in the 80's of managed care/HMO's and hospitals turning from ministry to money makers. I have also done many different roles including management but most of my 33 year career has been bedside ICU. I have recently become a certified Faith Community Nurse through my church doing health seminars and outreaches for the community. It is the only time since the beginning of my career that I actually feel I am making a difference. Especially the mission trips we take to 3rd world countries. They have been life changing. Nursing is a calling, not a job. Nursing is touching people and touching lives, not pecking the keys of a computer all day to appease the regulatory agencies. I applaud you for your boldness , truth and patient advocacy. I too want to see changes to this system and am praying for direction. As an older nurse, the last 10 years have been difficult for me physically. But I will continue to press on trying to minister to those God places before me being the hands and feet of Jesus as my hospitals mission statement says we are to be.

M Anonymous 5 months ago
Thank you for this article. I have only been an ICU nurse for 6 years but this article basically sums up all the reasons why I needed a break. The stress and anxiety was not worth it anymore as much as I loved being a bedside nurse. I worked in a poorly micro- managed unit where nurses treated each other terribly creating a toxic and discouraging environment. I am currently a clinical nurse reviewer for Harvard clinical reasearch institute in boston. I know someday I will go back to bedside nursing but maybe this time I will be more prepared and rested :)

T Spevak 6 months ago
First, I want to say that I cannot be more excited to be a nurse. I am unable to imagine any other career that is as satisfying on so many levels. I look forward to going to work each day. My enthusiasm, at this moment, does not wane in the presence of seasoned, more jaded medical peers. I know I have a great deal to learn, but I look forward to each new challenge. As many of you may have already guessed, I am two weeks into my current career as a registered nurse. The ink on my diploma, as well as the newly minted license has barely dried. However, unlike nearly all of my classmates; I have been in the work force for several decades. I've had several "mini-careers" which have included being a science teacher, home health care manager, insurance agent and network administrator. I've had to reinvent myself and adapt to a provide for myself and my family. My last job as a network administrator (for nearly 10 years) ended with a downsizing. Inspired by a NIGHTLINE or 20/20 television special on 40-something men who were downsized, but reentered the work force as registered nurses; I decided to become an RN. It's been the second best decision I've ever made (The first one, of course, was having the wisdom to marry the woman who became my wife). I share this, because my life experience tells me that this list rings true to reality. Speaking generically,at the moment, I've already had my 'save the world' attitude/enthusiasm evoke less optimistic commentary from experienced nurses. I've already seen people lost in the health care/community support services infrastructure. I see problems that, for whatever reason, are seen - talked about - identified as problems, but no one seems interested or motivated to address. I whole-heartedly agree that for any problem to be addressed and managed, it needs to be accurately identified. That does not occur in this environment. Those of us still warm with the idealism and spirit of serving others are at risk of alienating our peers. Not all view change as good, some - worse yet - have an adversarial relationship with it...and those who, they believe, might trigger it. I've decided to be remain on the optimistic side of change, at this point. I will make the best of every situation, work to my fullest potential and be the best advocate for all of my patients. Nursing rocks! And I can be part of the force that keeps it that way. =)

M Anonymous 5 months ago
I am glad you are very enthusiastic. May I ask how long you have been nurse?

patrice king 7 months ago
thank you so much for such a timely piece of truth...nurses need to speak up and speak out because as necessary as we are when we are needed...we are not remembered or considered otherwise....we are trained to be everything to everybody...but who cares for the care giver?

Suzanne C Gordon 7 months ago
This is very well said. I have explored these issues in many books including Nursing Against the Odds: How Healthcare Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care. i wonder if you have read it. Also have just come out with a new edition of From Silence to Voice: What Nurses Know and Must Communicate to the Public. if more nurses spoke up, and acted on these issues and explained what they do to the public, I believe the situation would improve Suzanne Gordon

susan meier 7 months ago
I've been a Hem/Onc nurse for 38yrs. Every one of the 10 points ring true. Although I doubt I'll see it in my life time, I truly hope RNs will be able to speak up without being, "put down". Institutions will tell you to speak your mind, but if you do....you are black listed in oh so many subtle ways.

Jim Kelley 7 months ago
My mother was an LVN in the E.R. in Lancaster Community Hospital in Lancaster, CA. in the late 60's-late 80's. She would bring out of town patient family members that were not injured in an accident to our home, cause she did not want them to sleep in the hospital waiting room. Her compassion and passion for the Nursing profession made a huge impact on her four sons. Two of her four sons became E.R. Nurses, because we saw her tireless dedication. Five years after she retired, I was taking mom out to Breakfast at Denny's(mom's favorite place), and while we were waiting for our order to come; a waitress was showing another group of people their table. Suddenly one of the people who pasted our table came back and said "You're Ms Kelley, You took care of my son five years ago, we all still remember you he doing very well now and in the Army". I thought to myself,"my God I hope to be at least just half the nurse my mom is". A few years ago some one caught me in Safeway, and said to me, "Your the Hospice nurse that took care of Nanna (grandmother)". I responded "I'm sorry for your loss". She responded "No you spoke peace and hope to our entire family, and we know Nanna is in a better place, you were a God send". Priceless moments like this, are which keep me going. On a personal note I keep my batteries charged by listening to K Love Radio.com My Grandfather and Father were ministers, and just like there are laws of gravity, there are spiritual laws as well; "What people sow into the lives of others they will also reap in their own lives".

Patrice Patrick 7 months ago
I wanted to do my part for humanity and nursing was a calling that I answered to nine years ago, Prior to joining the Nursing Profession, I admired the Nurses who cared for their patients, still do. I saw it as a glorified entity until I became a Registered Nurse. I must admit from time to time I experienced many 'miracles' in my career, but with that came too much disappointment, disillusion, and even heartbreak. Ms Helmuth has 'hit the nail on the head' on her list of "Hard Truth about the Nursing Profession..." It is sad, that the Nurse Managers who were once bedside nurses on the ward are the one who would take anyone else's side but the Nurses whom they supervise. And its like a fight down between the nurses and nurses and nurse managers (in other words, fighting among each other rather than being united for the better and stronger profession). I want betterment for Nurses, more appreciation for the work that we do. I want to see more nursing involvement in planning of care, hospital decision making policies, even in its construction. I wish for those in authority to listen to the nurses on the ground level because from us they can get the first hand knowledge in what is going on in health care. That being said, I hope for change and will try to be a change agent for my fellow colleagues without repercussions. I pray for a better future for nurses.

Name Withheld 7 months ago
Oh My Word! Finally someone has written what me and my colleague have been talking about for years!!!! Yes, we are both "burned out," and have no desire to ever enter another facility to work for companies who speak out of both sides of their mouth and over utilize the nursing staff to reap monies to support their six figure salaries. In addition, Bravo' to number 10! Nursing hasn't changed in the last 100 years except for the corporations who own facilities and updated pumps. Yet, because facilities want the patient population to believe everything is great, nurses are supposed to always smile and the patient is ALWAYS correct! In addition, under the cover of "Magnet Status," these same corporations are making nurses return to school to attain a minimum of a BSN without I might add, their monies paying for the additional schooling. Therefore, dedicated nurses who work tirelessly toward their patient's healthcare, must now find the time and monies to return to school or lose their jobs. How does attaining "Magnet Status," ensure better patient care? It does not. Does my MSN ensure that? How about a PhD? Until the corporations realize nursing is a caring profession requiring more than five minutes with a patient vs. how much money they can make, will anything change. Unfortunately, I do not see this now and/or in the future. I will continue the type of nursing I am now and in the future as I can truly spend more than five minutes with any patient and, at the end of the day, I know I have made a difference vs. mega dollars for a corporation. Thank you.

Melanie Krueger 7 months ago
The trouble with looking elsewhere for a career is that this kind of thing is going on everywhere. U.S. worker productivity has gone through the roof - up over 200% in the past few years - but pay continues to stagnate or even decrease in real terms. There are no unions to protect workers, so everyone is getting squeezed harder and harder. I went to home care several years ago and now find that, as you said, I'm expected to fit a 10 hour day into 8 hours. I don't get paid for all the hours I work, and this seems to be industry standard in home care nursing. Sometimes I think of leaving nursing but I don't know what else I would do. I'm not convinced the grass would be greener. I've been a nurse for 20 years. I really like caring for patients, but the pressure is tremendous at times.

James Yearwood 7 months ago
I agree. I have worked in management and bedside. My experience is that most administrative or manager nurses have forgotten the realities of bedside nursing. There's so many barriers to giving safe, efficient, compassionate care. Support systems are not in place plus policies are made only with regulators and money taken into account.

Lee Reed 7 months ago
Marge, I applaud you for your honesty. I would be interested in talking with you further on this topic. I think if this honesty was presented to ppl before they decide to pursue nursing, maybe the nursing 'pool' of the future would turn out to be more invested, looking for a vocation vs a paycheck, like most of us 'oldtimers'.

Lee Reed 7 months ago
I once worked at a union hospital, 'back in the day'. It was an innercity hospital, and our patient population came mostly from the inner city, not necessarily paying customers. We were a tight knit group in the ER and I loved serving the underserved. But the union? Basically, they rolled on a lot of issues when contract negotiations came around. The few of us willing to speak up were ignored because the bulk of the membership were more worried about keeping their jobs. So I don't know that unions are the answer. Yes, they will help you if your job is threatened, but in the bigger picture, they don't hold they sway they once did.

Lee Reed 7 months ago
Boy oh boy...what truth is shared here! And it doesn't change much when you leave direct care, either....I have been doing telephonic disease management for the past 5 yrs, I LOVE educating patients, but the past couple yrs the focus has gone to 'selling' our program and meeting metrics more than what we do for the patient. I'm too young to retire, too old to go back to the bedside, and I refuse to buy into programs that want me to 'invest' in them in order to become independently wealthy! At 50 yrs old, I am not willing to take on the expense of an advanced degree, i DON"T need to acquire that debt. So I don't know that I will continue to work in nursing in any capacity, I think I need to start looking outside the nursing profession for employment options

June Benedick 7 months ago
This article hit the nail on the head for me. I feel that nursing is who I am. However after 36 yrs at the bedside, I am tired. I have a very hard time adjusting to the new customer is always right attitude. The scripted conversations with our pts - make sure to say the key words- irritates me. I find it hard to play the game, that is now health care.

Nancy Johns 7 months ago
This article is spot on! Thank you for writing it. I have worked in a hospital more than once and in home health and these problems exist everywhere. Nurses eat there young and it's troublesome that they do. Managers who should not be managers remain in their positions because of seniority, not because of ability. I will probably never work in a hospital again because of how I and so many of my peers have been treated. I am finally with an agency where my bosses care about their employees and my co workers treat each other with the upmost respect. I have been a nurse for almost 10 years and I sometimes question my decision to become a nurse.

ruth sutton 7 months ago
Finally...the truth in print. Management especially, because of terrible fiscal restraint, have become people of no honor. When they decide to end your career(because they are "reducing staff by 20%") they hand pick who to get rid if based on your age, length of time you have been working - experience is NOT a good thing in this scenario-and ease of getting rid of any particular person they chose. Nursing has changed dramatically on as little as three years. At the last hospital I was at nurses worked in fear, wondering who would next have their head on the chopping block...it is terrible!

Gail Sandidge 7 months ago
This is so true and I think many of the people becoming nurses today are there for the money and not the patient. They walk around talking or texting or using their cell phones in other ways and do not focus on the patients. I have been a nurse for 35 years and have turned down management jobs because I like making a difference at the bedside. Nursing is a passion and a calling.

Lee Reed 7 months ago
SO agree, Gail! I went back to school for RN at age 28, 15+ yrs ago, and even back then saw the same thing...it wasn't a passion or vocation for many of the younger ppl in my program (there were a few exceptions, of course). It was all about the almighty dollar and what they could do after a yr or two of experience.

Jeryl Morando 7 months ago
This article rings so true, it's not bitter, it's honest. I've been a RN for 19yrs, worked in a variety of situations. LTC is my favorite. Sometimes the paperwork is overwhelming, not enough time to interact on a casual basis with the residents. I've taught Nursing Assistant classes, and have tried to impress upon them the reality of the job; that's important so that they know what's in store. Sometimes your best is not good enough for some residents and families. I've never worked in a facility where RNs were included in the union; I don't advise that situation, the RN is left hanging by herself is an LPN on CNA decides to file a grievance. Nurses in general tend to "eat their young", but sometimes, you'll find yourself working with a group that is very supportive, I say, "stay put".Nursing is special, it's not just a job, it's a way of life. Burnout can happen, if you let it. Try to be flexible, try to leave personal problems "outside". Remember, nurses are there for the patient/resident, If a nurse is at work just for the paycheck, there's not enough money in the world to pay for counseling, let alone Tylenol.

Anonymous 8 months ago
You sound very bitter and that concerns me because you are educating new nurses and potentially passing your biases on to them. What you describe has not been my experience in nursing and I hope your students recognize this is just your opinion, not hard fact.

Wanda Gengler 7 months ago
You must work in a privately owned facility, without corporate interference, I once worked in a wonderful facility like that before we were gobbled up by a large corporate hospital in Central Florida and it is still growing and monopolizing our area. We once were a small town community type hospital, we were a family, we looked out for each other. There was some bickering and grumbling at times but, generally it was a fun, caring place to work. Laid off after 15 years and a back injury, Central Florida

Anonymous 1 year ago
Wow, I am depressed by this article.

Anonymous 1 year ago
I completely understand that this is your perspective but I have to say that this is not at all how it is where I work. Been working at my hospital for 17 years and several of the points you make are not things I see. People are not "afraid to speak up" or "treat each other terribly" and we have many avenues for support or to bring grievances. While this may be how it is in some areas of the country or in certain organizations, I have to believe this is not "the norm". At least I hope not!

Anonymous 1 year ago
Thank you so much for this eloquently written article. You have done a great service to this noble profession and I am grateful.

Anonymous 2 years ago
Hey Marge great article! I wrote the article about Truth in 21st Century Nursing. I don't know where you are, but I have wanted to try to form a support group for nurses for a long time. I recently pulled some information on Nursing Unions off CNU web site and gave it to a few nurses at work. The trouble for most of us is that fighting the battles at work just to survive and keep our jobs leaves most of us too exhausted to fight for ourselves in our profession. If we don't reach out and get the help of union professionals, we will stay in this sinking ship we call the profession of nursing and we will all drown with the medicaid dollar in the near future!