Have Nurses Created the Nursing Shortage?

[ainz]

Whenever I experienced problems in my life, my father used to say, "To solve this problem, start by looking in the mirror."

Nursing is a great profession and we should all be very proud of what we do. Nursing is the backbone of healthcare, try running a hospital without them--doesn't happen. Nursing is the largest, single profession in healthcare and has more power than we realize, like a "sleeping giant."

When I reflect on my experiences as a staff nurse and in hospital administration, there are some things that stand out. The old phrase "nurses eat their young" is very true in many ways. How many of us have worked on oppressive, negative nursing floors or units? The gossip, character assassination, complaining, whining, refusing to help each other out, lack of teamwork, more patients than you can handle, nurses writing each other up, etc., etc. What new nurse would want to work under such conditions?

As I have said before in many posts, the culture and atmosphere of a nursing unit and department starts with the nursing leadership. I can tell you that hospital administration depends on the nursing leadership to tell them what is needed. If the nursing leadership lacks the skill, knowledge, or general where-with-all to EFFECTIVELY communicate nursing needs then we will get what we have now. The old "bleeding heart" soap box just does not work. Hospital administration looks at numbers, you have to communicate your needs in numbers and show how nursing contributes to making the numbers. Nursing does in fact contribute to making the numbers but "nursing" has failed miserably to portray itself as a generator of revenue and not a mere consumer of resources.

It all starts with the nursing leadership. Staff nurses are generally just too busy and exhausted to jump into doing things of substance, on the job, to advance the profession. This responsibility rests on the nursing leadership--that is the nurse managers and DONs. Improving nursing and advancing the profession has to start at a grass roots level, one hospital at a time, right in your own backyard. The ANA is not doing it for us, no one will do it for us--we must do it ourselves.

If you are a burned out, tired, walk around with a cup of coffee, complaining about management and complaining about the new nurses who just don't want to work kind of manager--please do us all a favor and resign. Likewise, if you are the kind of nurse manager that insists on everyone knowing that you are in charge and create an oppressive, intimidating, negative culture--please do us all a favor and resign. If you are a nurse manager that really cares and is passionate about what you do then help your staff succeed and create an atmosphere that is positive, energetic, professional, and will ATTRACT people, not run them off!!

DONs--please learn how to communicate effectively with administration--know the overall numbers and your numbers, know what drives those numbers, know how to make operational changes that will change the numbers, know how to engage in effective financial management. Demonstrate your nursing department's financial contribution to the hospital. Administrators know numbers not clinical issues. Stand up for your staff effectively. Help your nurse managers learn how to make their staff nurses successful, your success depends on their success.

We should all be more positive and proud of what we do. Our attitudes speak volumes to new nurses and people that are considering nursing. If we are negative and come across as a down-trodden, powerless, victimized bunch of people--who in their right mind would want to go into nursing?!?!

Greedy administrators run over nursing because nursing allows them too. Same with arrogant doctors. Think about what usually happens when there are not enough nurses in a hospital, they either bring in very expensive agency or close beds. Neither option is appealing and an administrator will be in very hot water with their board or corporate boss if they don't straighten it out. Creating an adversarial "us versus them" situation with your administration is counterproductive and will not help nursing, it only perpetuates the negativity that is so common in nursing departments today.

So has nursing created the nursing shortage?? I think nurses have been the MAJOR contributor to the shortage. Let's be positive and help each other succeed so we can attract people, not run them off.

[roxannekkb]

You've made some good points, ainz. Nurses have been a major factor, even though many--including nursing leaders--squirm and get defensive when you tell them that.

Of course, the issue is complex, but nurses have helped perpetuate toxic work environments, have not stood up for their rights, have allowed themselves to believe in the martyr syndrome which has afflicted nursing for so long, and many are great at complaining but slow in voicing an opinion to anyone who matters.

Changes in nursing will have to start with nurses. And nurse managers.

[caroladybelle, BSN, RN]

Did we really need two of these threads?

Just wondering

[sjoe]

ainz, though we don't have the same opinions about nursing being a profession or the existence of a nursing shortage, thanks for a well-considered and clearly expressed view. I couldn't agree more with most of it.

When we nurses haven't created today's problems by our actions, we have created them by our inactions. Regardless, we are responsible for most of them, IMHO.

[ainz]

Maybe we need about as many of these threads as can be posted!! :) Not sure. How does change begin in your opinion?

[WinkRN]

"Think about what usually happens when there are not enough nurses in a hospital, they either bring in very expensive agency or close beds. Neither option is appealing and an administrator will be in very hot water with their board or corporate boss if they don't straighten it out."

In my hospital this never happens. I work in an MICU that will give 3 and 4 patient assignments before ever considering using an agency nurse or closing beds. And most of the nurses I work with allow this to happen. Personally, I refuse. Thus I am a trouble maker and whiner. (Because I stick up for myself and the safety of my patients.) So my question to you Ainz is this - how can we as nurses effectively tell management what we want/need without being labeled as troublemakers? And if management won't listen, how can we create change?

[essarge]

IMHO change begins in the "ranks". If the ranks can't come to some common ground, they will continue to be divided. Leadership in the ranks needs to be people that remember/know what it's like to work in the treches and are like a dog with a bone. They will not give up just because the "higher ups" say that they can't have what they are asking and need.

I agree that nursing is the backbone of healthcare and without it, it would be a sorry sight (and not very safe I might add).

The problem as I see it is that in order to get control of the profession, control must come from within and followed through on.....no matter what consequences, threatened or real, come about.

As a very "giving" profession, it's gone just a little too far.....letting the corporate idiots take and take and take while nursing gives and gives and gives.

[SmilingBluEyes]

Your post brings out VERY legitimate points, but I am sorry it falls short. The shortages and its reasons extend beyond nursing itself. BUT YES I agree, we would ALL do well to look in the mirror and examine how we can contribute to betterment of our OWN career/destiny. As to changing it all by changing ourselves, that is quite simplistic thinking really. You leave out too damn many other players, my friend.

[NurseBoricua]

Ther is no doubt that budget, the higher ups, and other variables influence the workplace and morale. Constantly changing to the demands of healthcare is challenging. However these problems are not exclusive to nursing. As the nursing shortage gets worse and patient safety is further compromised, healthcare will do what it needs to just as it has done in the past to try and slow down the nursing shortage. As for the troublemaker part..as if we've never heard that before. That has been going on for yeeeaars. Labeling someone that pretty much is a cop out. So yes there are more guilty parties than just management. But tact and thinking before acting can help some. Believe me, management is very aware of the problem when they look at their high turn over rate. New nurses now realize this also. There are more opportunities now for nurses thinking about a career change. So when nurses notice that things haven't gotten better, they leave. And can you blame them? For some it is not worth the stress, no kids, no major debt, easier to get and up and go among other factors.

[Edward,IL]

I think this is an excellent post.

I also add the suggestion that EFFECTIVE nursing leadership in positions in hospitals (and other nursing service administration positions) develop and maintain strong on-going relationships with nursing leaders in NURSING RESEARCH and NURSING EDUCATION from our universities. Draw on the expertise from these other areas. With the internet/e-mail, this can now be done today much more easily than just a few years ago.

Just my opinion, Edward, IL

[fergus51]

I definitely agree that nursing shares some of the blame for the shortage. In my experience the most gossipy backbiting workplaces have the worst shortages. But, overall the shortage has been largely created by mangers laying off nurses and leaving them to work in bad conditions. Some nurses stay and fight, but a lot choose to make their lives better by saying BYE!

[roxannekkb]

Originally posted by fergus51

I definitely agree that nursing shares some of the blame for the shortage. In my experience the most gossipy backbiting workplaces have the worst shortages. But, overall the shortage has been largely created by mangers laying off nurses and leaving them to work in bad conditions. Some nurses stay and fight, but a lot choose to make their lives better by saying BYE!

Yes, many nurses vote with their feet. They leave. I left nursing and am much happier for it.

But I wonder what is really going on. Hospitals are aware of the problems, they've dealt with nursing shortages since the 1950s. Is their current inaction just a step to bringing in cheaper overseas labor, bringing in more ancillary personnel, or what?

Many questions, too few answers. Nurses are part of the problem, and in my opinion, need to get organized on a large scale.