“It’s not your fault that you break down” – a study of self-blame in newly qualified nurses in medical units in Denmark

cajujeThis is the first of two entries from Carsten Juul Jenson, a colleague from Denmark, who is undertaking a PhD in self=blame among nurses.

In an institutional ethnography (IE) with participant observation, interviews with newly qualified nurses (NQNs) and analysis of political documents, I show that NQNs consider themselves as individually responsible for inadequate capacities in problem solving in medical units in Denmark.

However, individual self-blame varies according to gender and age: Thor’s (male), Anja’s (35 years old) and Martha’s (29 years old) emotional responses to their new role as a nurse seem less self-blaming than that of Emilie (25 years old) and Rebecca (23 years old).

Emilie has to go off sick due to physical symptoms of anxiety, as she felt personally responsible for leaving unfinished nursing tasks for her colleagues, even if she has to provide care for a patient, who has been incontinent of urine.

Rebecca reflects, “Why did I do bathroom 6 first?”, while she had helped a talkative and time-consuming patient, instead of answering a bell from a bathroom, where she unexpectedly found a patient, who has collapsed from incurable respiratory distress.

These young NQNs blame themselves even though they are working in conditions that it are above human capacity to predict and live in constant fear of harming patients fatally despite mainly working with older patients with comorbidities and acute illnesses. Anja, who explicitly expressed fear of being blamed for patients’ death, states: “You know, I went home crying, but it’s not my fault, it’s the working conditions that are unreasonable.”

The service-minded approach of new public management reforms of hospitals in Denmark stresses individualism thus these young new nurses find themselves shouldering this responsibility The young women Emilie and Rebecca appear overly responsible and conscientious in their efforts to handle nursing care for the least amount of money in medical units overcrowded with older patients

In an interview for the Danish Nurses Organization in May 2018, I raise my voice emphasizing: “It’s not your fault that you break down”. I wish to relieve the pressure of individualism. NQNs cannot be held individually responsible for discrepancies between delivering health for the least amount of money and demographic changes with an ageing population more than 80 years old, of whom 80 % are hospitalized with acute illnesses.

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