The Elephant in the Room in Nursing: What's Not Being AddressedThe Elephant in the Room in Nursing

There is an elephant in the room in nursing and it is not being addressed. In fact, I asked nurses on social media, and it turns out- there is not just one elephant. There are several!

A little over a month ago, I asked my social media tribe:

Nurses, what “elephant in the room” needs to be addressed in nursing?” Oh boy! I did not know what I was in for!

Nurses spoke up. They spoke out. Men and women alike commented, shared, and then commented on each other’s comments that were already there.

I almost did not write this post. I emailed my marketing coordinator and told her that I was overwhelmed by the sheer response from nursing. “How will I ever compile everything that was said, synthesize it, and share it with the nursing community in a way that would add value?


I had my work cut out for me.


The topic touched a nerve. Nurses spoke their truth. Shared vulnerable and honest emotion. I couldn’t let you down!

These elephants need to be addressed in nursing. And they need to be addressed now!

While these nurses did comment via their profiles on social media, I will tell you for the purposes of this blog post, I choose to keep names out of my synthesis. What you will read below is stated at times word-for-word by a nurse. However, I will not share the person’s name in order to protect their privacy here on this blog.

I hope you enjoy reading. And hey, if you have an elephant in the room that needs to be addressed in nursing… leave your comment below. I would love to hear from more of you! Together we can unite and make our voices heard.

Oh, one more thing before I get into our “elephants”. Some of the comments were repeated more than once. In fact, I tallied them up and will share that data with you below. While other comments were placed that I just could not fit into one particular category. Some of those unique nursing statements will be shared standalone.

Here we go…




Oh boy. Opened a can of worms on this one. In fact, this was THE number one elephant in the room in nursing.

Whether it was a comment about short staffing, unsafe staffing, staffing ratios, mandated overtime, task allocation, or the demands at work… you name it, you said it. There were over a dozen comments and an additional side bar conversation that went on way farther than this blog has room to go into… staffing was THE main concern.

Two comments stood out to me and I would like to share these, with a solution-oriented strategy for each.

Task and patient allocation, if everyone does a little no one has to do a lot. Doesn’t happen! All talk no action leads to low staff morale!

This is something I teach in the Burnout Proof Live training. It comes from the conditioning we receive as nurses. It starts as early on as nursing school and continues on throughout our career.

We learn at a very young age, right from the start, to never show weakness. That we do not need help and when someone asks us how we are doing, we are to respond “I’m fine” as good nurses do.


This has to stop. Here and now. With you and with me.


The Elephant in the Room in Nursing: What's Not Being AddressedIf someone asks you how you are doing at work and if you really need help- tell them! If someone says, “Is there anything I can do for you” actually give them something to do that can help you.

Nurses want to help. We help our patients and their families all day. Why not lend a hand and help each other!?

The demand of the industry to force nurses to work when sick or injured. Inhumane treatment of exceptional human beings…”

Another comment made about staffing and the amount of work that we do. Now, I have got to tell you. I was at work the other day and this person was coughing and sneezing. And looked plain terrible.

Go home! Stop making everyone else around you sick and do not come to work.

I realize, at times, when we call out of work we receive disciplinary action for this. First off- that is not the case in every single instance. Let’s refrain from the “all or nothing” talk here, shall we? But if this IS the case where you work, have you ever asked anyone about this? Has anyone ever made an appointment with human resources, nursing leadership, or even your own nurse manager to talk this through?

One of the problems the profession of nursing has is that we keep on doing what we’ve always done. We say, “Well, that is the way it has always been around here” and we do nothing to fix it.

Take action, people! If something does not appear to be working. When something is broken- be the person to DO something about it.


Other Elephants in the Room


We spent a lot of time on the above related to staffing. I did this because SO many people commented on this as the main issue in nursing. Additionally, many of the other comments were indirectly related to staffing.

Such as short staffing leads to burnout. Or staffing issues is why there is bullying. Finally, a few nurses pointed out that nursing leadership, having a voice in nursing, being on boards, and joining the political world to impact policy are ways to impact staffing.

So what else? What are some of the other elephants that need to be addressed?

  • Nurse burnout received about half a dozen responses.
  • Bullying as well, about half a dozen votes.
  • Others stated concerns related to the shift in focus- from a caring to a business model.
  • Leadership, empowerment, public policy, and training/education all were voiced as concerns.
  • The medical model itself was brought to light- with nurses pointing out that healthcare is more about sick care and less about empowering patients to find their ideal states of well-being.

Before I wrap things up and ask you what you believe to be the elephants in the room in nursing that need to be addressed… I thought it would be fun to share some of the quotes that stood out on social media.


I can’t wait to hear what you add to this list. Let’s go…

  • “Nurse’s own addictions”
  • “Poop! Everyone does it – I don’t have time to do it. Patients do – it stinks!”
  • “The elephant in the room to me is that nursing isn’t really in charge of nursing anymore. Oh, nurses get promoted and work their way up the ladder but the power is in finance.”
  • “Nurses in key national leadership roles and represented on governing boards.”
  • “The absence of a strong and visible nurse leader to address the deteriorating health of Americans.”
  • “That we’re so good at self-sabotage, so bad at sticking up for ourselves, and for nurses in trouble.”
  • “Nurse Martyrdom… And the expectation that nurses should be that way.”
  • “This “nursing prudence” S—. It leaves us WIDE OPEN for blame and scapegoating.”
  • “Stop the “deny – don’t tell” when an adverse event occurs.”
  • “Why nurses have tolerated Health care becoming Sick care. We are healers at heart, not pharmaceutical technicians!”
  • “Constant changes, fine for people that come up with a good idea but on top of mandated changes it becomes another burden. Implement but with more careful planning= better buy in.”
  • “We have become ridiculous about being expected to be ‘instantly’ available to higher ups just because of technology. Our work time is just as valuable as theirs but often don’t consider that interrupting work flow can cause mistakes that can impact patients.”

My all time favorite comment that came from a nurse over on Facebook was about the real underlying issue here.

As nurses, we often do a very good job at pointing out the problems. Why? It is part of our training and education.

Think about it- Assess, Diagnose, Plan, Implement, Evaluate. What has happened here? We have become expert in the assessment phase. It is where we spend most of our time.

We often do not have time to plan. Nurses may not have resources to implement. And evaluate, forget about it! We are back to our next patient assessment!

Instead of simply pointing our problems and talking about difficulties, I urge each and every one of us today to choose something different. When we see an issue or come across a problem, we need to speak up. We need to take action. We need to become part of the solution.


As the one nurse on Facebook said,

“No one wants to talk about why nurses don’t band together to get things done that are in their own interest. The fact that the largest work force in the U.S. are nurses with >5 million active people (counting LPNs and RNs), yet nurses are not in control of their work environments (staffing) or writing policy and legislation that affects patients and staffing issues.”

Well, there you have it friends and colleagues. Food for thought. Now let’s hear your voice. What elephant in the room in nursing needs to be addresses? And more importantly…

How will YOU address it?

Thanks for reading and share your thoughts below!

p1050390About the Author: Keynote speaker and virtual conference host, Elizabeth Scala MSN/MBA, RN, partners with hospitals, nursing schools, and nurse associations to transform the field of nursing from the inside out. As the host of the Nurse’s Week program, The Art of Nursing, Elizabeth supports nursing organizations in celebrating and recognizing their staff in a meaningful way. Elizabeth received her dual master’s degree from Johns Hopkins University. She is also a certified coach and Reiki Master Teacher. Elizabeth lives in Maryland with her supportive husband and playful pit bull.



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“I’m a Nurse, but I’m Not Sure I LOVE Nursing Anymore! Can You Help Me?”


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