Temporal Structures That Contribute To The Stress Of Nurses’ Work

Memorial University of Newfoundland Nurses play an extraordinary role in our healthcare system. They often know patients and their families best, are involved in the day-to-day aspects of their direct care, and help people through what might be one of the most difficult times in their lives. Nurses, also, however experience high rates of stress and burnout due to their careers and its impact on their lives.

In this paper, I aim to examine the underlying temporal structures that contribute to the stress of their work. By examining the temporal organization of hospitals, and the moral imperative for continuous care, I aim to show how these underlying temporal structures influence the lives of nurses through the hierarchy of social time, stresses that come from forms of cyclic time, and the resulting temporal segregation that lead to such high burnout rates. The current healthcare system is one that is still striking a balance between the moral imperative for continuous care, with ever increasing bureaucratization. Healthcare as an industry is based on the idea of caring for patients no matter when that care may be needed.

This means that since its inception, there has been a moral imperative for continuous care. Zerubavel argues that it is this founding moral belief that underlies the temporal organization of hospitals and healthcare clinics, along with the, “indispensability of ever-available medical and nursing coverage” (Zerubavel, 1979b, p. 78). Due to this, hospitals and continuous healthcare clinics operate on a rotating schedule, where both physicians and nurses complete shift work. At the end of their shift, they then debrief the incoming healthcare worker on the status of their patients and the responsibility of care is passed on from the original nurse to a new one. As Zerubavel (1979b) notes, there are many problems associated with the bureaucratization of care. Namely, he discusses that there is an, “impersonalization of coverage”, due to the bureaucratization of healthcare acting on the belief that nurses and physicians are interchangeable (p. 79). It is simply more efficient, if one person can just replace another’s role without missing a beat, and emotional relationships with patients don't interfere with the machine that is continuously churning. This temporal organization has many effects on the healthcare workers that subscribe to it, including the creation of hierarchy of social time, and stress related to cyclic time.

The concept of a hierarchy of social time is certainly not new and has effects of workers in many different careers, however I believe the effects of it are especially amplified in nurses and other shift workers. This is because the distinction between their public and private time is more blurred than say a clerk, who clocks out at 5pm consistently Monday to Friday. Lewis and Weigert (1981), discuss the levels of social time in quite detail, however for the purposes of this paper, I would like to highlight the micro levels: self time, and interaction time, and the macro levels: institutional time, and cyclic time. From these distinctions, there is a hierarchy that forms which prioritized institutional time over self and interaction. This is seen time and time again in healthcare workers such as nurses, since they often stay quite late past their 12 hour shifts to debrief the next nurse on the status of patients, respond to codes, and catch up on charting that they were unable to complete during their scheduled shift.

This could mean staying up to or over 2 hours at the hospital that otherwise would be spent on micro levels of social time. Despite being relieved from their duties in clock time,what charting they didn’t finish they must complete before enjoying self or interaction time. Zerubavel (1979a) further expands upon this idea in his discussion on what he terms, “relative flexibility“ (p. 48). The boundaries of a shift are marked not by clock time, but by the completion of required duties, even if that means encroaching upon self or interaction time of the nurse. From this temporal organization of the hospital environment, a hierarchy of social time is formed, where institutional time is prioritized over self or interaction time. This, no doubt, contributes to the stress and high rates of burnout of nurses because of the increasing pressure of their professional duties blurring the boundaries of their self care. To continue the discussion of self care, and the impacts of the temporal organization of hospitals on nurses, the impacts are shown in units of cyclic time as well. These units of cyclic time are, “three cycles that in our society are defined as meaningful units of time… the daily round, the weekly routine, and the yearly seasons” (Lewis & Weigert, 1981, pp. 439-440). These three units are a way in which we categorize our temporal experiences, and thus why I chose to examine the temporal effects of the structure of hospitals at each of these 3 levels.

The daily round is, “marked by the two organic events of waking up in the morning, and falling asleep at night” (Lewis & Weigert, 1981, pp. 439). For nurses and other shift workers, their daily round does not even meet the definition set by Lewis and Weigert due to their hospital schedules. These, “organic events” of waking and sleeping are often disrupted on a rotating basis. This causes a sense of temporal panic, as the nurses that work night shifts may lose their sense of temporal location. This has serious implications not just with the self, but also with others. With the self, being out of sync with institutional temporality can in a way discredit one’s membership to the greater temporal community. Nurses I have encountered often say that they don’t feel like, “a real person” when they are temporally dislocated in this way. From this, the nurses can experience temporal segregation from society. The disruption of the daily round also causes stress in regards to interaction time. If a nurse works through the night, they may miss interaction time with their spouse at night, putting their children to sleep, or sending them off to school. They often sleep during the day when their spouse is at work, and then they are awake only for interaction time in passing with their family as they eat dinner or prepare for bed. This is an example that returns to the hierarchy of social time, in which institutional time takes precedence over familial interaction time.