How to fix the nursing shortage?

APRN., DNP, RN, APRN, NP · Apr 13, 2008

Just to play the Devils advocate a little bit.
I do agree with ltos of the things said. But I want to keep it in perspective. 33 years ago, I worked on a med surg floor. 45 patients and night shift consisted of a single RN, a single LPN and a single aide. FOr the most part things are much better now, even without mandated patient loads. The difference is, that the acuity of the few patients per nurse has gone way up. 33 years ago, I only had a half a dozen meds to worry about and only 2-3 different IV meds. My pay is meeting my needs, I'll never turn down more money, but in reality I get payed enough.
Now with the acception of more drugs to memorize, and careplans and nusing diagnosis, the core nursing education is still the same. Add to that the fact that the attitude in the nuses station hasn't changed, and it's no wonder that nurses are leaving. I've posted in other places, that as long as we expect other people to start the change for us, nothing is going to change. We have to start it ourselves. We can't tolerate bad behavior from out fellow nurses, it's not supporting those new grads, and helping them along. It's taking control of our proffesion.
If we band together, and support each other, and quit fighting these counter productive battles, we're never going to get anywere.

33 years ago, my sister worked in the ICU as an LPN and was assigned her own patients in a Midwest hosptial.

The only LPN/LVN's that you see working in ICU now-adays are usually sitting at the tele monitors and are very good at what they do....otherwise, they wouldn't be there.

20 years ago there were something like.....um....10 NANDA nursing diagnoses LOL. Now there's more than you can shake a stick at.

I remember white nurses caps. Every patient got a bed bath and a back rub ( I can still smell that Johnson and Johnson baby lotion after a fresh bed bath mmmmm). Bed pans were made out of metal and hot packs came from the hydroculator and valium was in the med drawer like the tylenol was.

Where was I going with this? Oh yeah...... Things have changed! In more ways than one.

It is not our lack of change...... It is our lack of cohesive guidance to that change that predisposes our profession to overwhelming growing pains.

What if there was one governing body for nursing across the United States? Would we be able to be more focused on recruitment and retention?

What are your thoughts on that?

RN1982 · Apr 13, 2008

Many of us don't buy the whole "nursing shortage" baloney; there is no nursing shortage, there is just a shortage of nurses willing to put up with the lousy working conditions so many hospitals expect us to. Right now, there are hundreds of thousands of licensed RNs in the US who are simply not working as nurses; more than enough to fill every single vacancy in the country. As long as experienced, seasoned RNs are continuing to leave the field in droves, turning out every larger and larger numbers of minimally-prepared new grads every year is not going to help the problem.
Also, I've been in nursing education in NC for a long time, and I don't know (and am not asking -- I don't want to know :chuckle) what school you're at, but IMHO there are quite a few technical/community college programs in the state that not only shouldn't be expanded, they should be closed down, because they are doing a poor job of educating and preparing the students they have now.
I realize that's not helpful for your paper, but you said you were curious about our thoughts on the idea, and those are my thoughts. Best wishes for your paper and your studies, though! :)

Wow, never looked at it like that. I have to agree. If working conditions were much better for RNs, they wouldn't be leaving the profession.

CraigB-RN, MSN, RN · Apr 13, 2008

And don't forget the Tylox and Dalmane in the drawer next to the valium. Reminding your patient who now has baby oil all over them that they can't smoke in bed because the patient in the next bed had oxygen on. :) Ohh how I remember those days. :) Everyone having a last cigaret after getting report on all the patients on the floor before goign out and starting to work.

Remember when Nursing Dx first came out, it was how were were going to get autonomy and be able to bill for our services?

I think having a large national bureaucracy won't help at all, it will prob hurt us. But then again I'm a cynic. Isn't having that large organization still letting someone else try to fix OUR problem. It has got to come from US!! Of course getting involved politically is one way for us to affect change. True and valuable nursing research to support all those things we've been saying are needed for years, and ways to make that change, not spending $$ on energy flow changes in therapeutic touch or developing a new nursing theory. It's time for practical application. And it's time to stop whining about it and to step up as a group. It's time to stop fighting battles that only we see. Think quick, is your hosp pharmacist or physical therapist an MS or PhD? How many of you had any idea, well I'm pretty sure that no one else in the hospital knows whether your a ADN or BSN or MSN. They don't care. The only people who care are nurses. Education is great, we should encourage everyone to get as much as they can. The Doc's sure don't care. They just know that when Sally ( or John) is working, their patients are happy and healthy and well cared for and they don't get stupid phone calls at 2am.

OK I'm going to get off my soap box again. This really isn't what the poster wanted to see or hear.

Yes it has changed, but at this point I'm not willing to say for better or worse.

P.S. I never had to wear a cap, my problem was the patients didn't know if I was their nurse or their Orderly. Guys didn't have caps and I wore the same white pants and shift as the orderlies did. My name tag was the only thing different.

33 years ago, my sister worked in the ICU as an LPN and was assigned her own patients in a Midwest hosptial.
The only LPN/LVN's that you see working in ICU now-adays are usually sitting at the tele monitors and are very good at what they do....otherwise, they wouldn't be there.
20 years ago there were something like.....um....10 NANDA nursing diagnoses LOL. Now there's more than you can shake a stick at.
I remember white nurses caps. Every patient got a bed bath and a back rub ( I can still smell that Johnson and Johnson baby lotion after a fresh bed bath mmmmm). Bed pans were made out of metal and hot packs came from the hydroculator and valium was in the med drawer like the tylenol was.
Where was I going with this? Oh yeah...... Things have changed! In more ways than one.
It is not our lack of change...... It is our lack of cohesive guidance to that change that predisposes our profession to overwhelming growing pains.
What if there was one governing body for nursing across the United States? Would we be able to be more focused on recruitment and retention?
What are your thoughts on that?

t the tylox and dalma

irvins1115 · Apr 14, 2008

Many of us don't buy the whole "nursing shortage" baloney; there is no nursing shortage, there is just a shortage of nurses willing to put up with the lousy working conditions so many hospitals expect us to. Right now, there are hundreds of thousands of licensed RNs in the US who are simply not working as nurses; more than enough to fill every single vacancy in the country. As long as experienced, seasoned RNs are continuing to leave the field in droves, turning out every larger and larger numbers of minimally-prepared new grads every year is not going to help the problem.
Also, I've been in nursing education in NC for a long time, and I don't know (and am not asking -- I don't want to know :chuckle) what school you're at, but IMHO there are quite a few technical/community college programs in the state that not only shouldn't be expanded, they should be closed down, because they are doing a poor job of educating and preparing the students they have now.
I realize that's not helpful for your paper, but you said you were curious about our thoughts on the idea, and those are my thoughts. Best wishes for your paper and your studies, though! :)

Boy, it sounds like you are mad at the world! I don't understand how individuals that are in the field of nursing can be so judgemental. I know everyone of us come from a different parts of the country or situations, but come on and be a little more encouraging! If nursing was easy EVERYONE would be doing it. Use your skills that you have gained through out the years and use them to help the field of nursing to get stronger. I am a student myself and I have had several TERRIBLE experiences since I graduated H.S 23 years ago, but I had to get up and stive on. It hard to work full time go to school and clinicals and find time to study and say I love you to my family. BUT, it is worth it when you make a patient feel that they are cared for. Yes, they are some DR.'s and fellow collegues that just don't do things right, but you need to be you! Encourage individuals to be the future nurses. :twocents:

hope3456, ASN, RN · Apr 14, 2008

Many nursing schools all across the u.s. have already increased their admits.....where I live for the past 4 years the local CC has MORE than doubled the # of nursing students they take per year. this is the case in many demographics.

The problem is that the hospitals can only hire so many 'new grads' at a time due to the extensive training that one needs to become a competent nurse. Where I work, there is alot of competition for the 'new grad' positions

twistedpupchaser · Apr 14, 2008

I think that re-thinking strategies for maintaining retention would be more beneficial for the nursing profession than training new staff. I have lost count of how often I have heard of nurses turning off their phones so they don't get called in for overtime. Why would someone want to do overtime when they have to apologise profusely for not completing scheduled tasks, (never mind that patient x had a happen and resulted in no breaks for the nurse who spent the next 4 1/2 hours trying to catch up) After apologising the "knowing" looks from other staff members taking over...they would never leave stuff undone.

And don't get me started on the rotating shift rosters that could have been better written by a half drunk baboon........whats with the late shift followed by an early with only 9 hours to get home, sleep, eat and get ready to start again? does anyone get more than 4-5 hours sleep?

Pay could always be better but in my opinion the previous posters who state that improving conditions would increase numbers hit the nail on the head. Nursing is a great stepping stone for bigger and better things and will be continued to be used as such until conditions improve.

Toquay · Apr 14, 2008

I think "Nursing Shortage" would be better termed as Nursing Bedside Shortage. I feel there are plenty of nurses but many move on to less stressful environments. The ones that stay bedside frequently transfer to other specialties to prevent burnouts. It seems the management sect continues to grow faster than the peon worker ant sect in efforts to keep control. If there is a problem.... hire more management. The monies spent on hiring outside help to pinpoint problems could be put to better uses if hospitals would just listen and talk to their staff. One would think with as many nurses in management, we would have some voice. It all boils down to money, nursing pay makes up a large part of a hospital finances, and therefore, when management looks at the bottom line, we are a liability not an asset. Money and finance are not about feeling and caring and nursing is, two different extremes.

Toq

queen777 · Apr 14, 2008

All I wanted to be ever since I was a little girl was to be a nurse. But I had epilepsy which kept me out back in 1971. So I went on to get married and had 2 children when the thing about segregation came into effect which opened the door for me.

Oh was I in for a rude awakening. Guess what? Nursing is not at all like you think its going to be. When I started working on the floor most other nurses were rude and would not help me for anything.

Then one night another RN from another floor, she was the head nurse there, she called me onto the elevator. I had no clue why. She told me if I didn't quit or transfer to another floor, Virginia would stay on my back until I quit. And also that she had done this to other new nurses. This Virginia had 29 yrs of experience I couldn't imagine why she would want me off the floor.

But one night I was set up. I was given 9 patients. The older more experienced nurses only had 7 pts. Well, as the story goes I was expected to go down to the ER with this new pt q4h for xrays. She was being monitored for appendicitis. How on earth was I expected to be in two places at once? The other nurses were expected to watch my pts. A elderly lady who had radical bowel surgery went into CHF and died and they fired me!

No, no actions were taken against my license either. So why could they fire me? I still don't know to this day. If anyone out there knows please write me so that my mind can be at ease. I took my nursing very seriously and it boggles my brain how this could happen.

I was home after this and a man calls my husband anonymously and tells my husband the difficult pts I was give compared to the other nurses. I had no idea anyone was watching so closely. No other nurses wanted to come forward though, unless they were subpoenaed. How sad. I still sit here and feel why after over 10 years ago.

I admit I do let things get to me. I just can't understand any nurse acting in this manner. All I know is that I was there to do a job which was to take care of pts and she wasn't doing that she was in my business! She sat there at the nurses' station all night and ate and gossipped.

Lericalpoet · Apr 14, 2008

Well, here's my two cents. From the perspective of a male student trying to get into a nursing program. I have a 4.0 GPA, all of my sciences completed, and most of all, I love people. Helping them etc... I have applied to four nursing schools here in Philadelphia. I was denieded entry into three. I know that there are proboably not eneought seats to go around. But is that the real issue? I know alot of fellow student who got in and their grades where not even close to mine. With that said, I'm starting to think about other areas I could go into. Namely, Pharmacy. One problem is this, like it or not, because of the aging population there is going to be a need for more nurses. Not just people who want a stable income, but folks who have a good work ethic, who really love working with the public, and who care about what they are doing. If the schools don't start to make the whole application entry process for nursing school more appealing, the future does not look cute. Why would anyone in their right mind, sit around and wait two or three years to get into a program for a profession that many of you have said is not all it's cracked up to be. When, with grades like mine they can go into a more lucrative field like pharmacy? I really want to be a nurse, but I tell you one thing When I talk to other, younger, smarter students around me, they all say the same thing. :confused:

1964nurse · Apr 15, 2008

I too am another "new" RN, that would like to express my thoughts on the nursing shortage. After spending the last 14 years as an LPN, working agency, Long Term Care, and Homecare, decided to return to nursing school to prove to myself that I could achieve it and open the doors of opportunity for myself. I accepted a position in Med/Surge at a local hospital and the first week of orientation to the hospital went well. Then the second week comes along and we're told we've been signed up for the mandatory telemetry class :cry: , and are given 2 chances to pass, then have to retake the class. Basic tele... No it is not. But all RNs in the hospital have to be tele certified. (God help the poor guy who has a heartatache while I'm working). Although, I can honestly say there are plenty who would come to the rescue. Like we don't have enough to worry about. Then onto the floor for orientation with the preceptors, who do not get reimbursed for teaching us and being bombarded with a ton of questions every day and get somewhat bitter if they have to show/tell us more than once. Who also have to carry the same patient load as those who are not precepting, which leads to some bitterness which the new nurse is subjected to, in whatever form the preceptor expresses it. :banghead: Okay now because I have been an LPN for the past 14 years people assume I can handle a normal patient load. So give me 4 patients, the same acuity as the regular staff, and I"m still on orientation and it's been 8 weeks. (Why shouldn't I be able to handle the same load?) As I overheard one nurse say, "Well sometimes you just have to jump right in. That's what I had to do". :bow: I love being able to help a person out, I love meeting new people and talking with them. But please get all of us some help! Not just us new nurses, but the regular staff. I can't call MD's with critical labs, take new orders, make sure everyone's paper work is properly signed befor a procedure, deal with unrealistic patients who want to leave AMA, get discharge papers ready, arrange for transportation, hang IV's and blood all before noon :bugeyes: . Lower the staff ratios, these nurses are overworked. Yes I plan to talk with my supervisor, who wants to help, but if there are no changes, no I won't be staying. Over the road truck driving is starting to look pretty interesting.

Valerie Salva, BSN, RN · Apr 15, 2008

elkpark and llg each hit the nail squarely on the head.

Valerie Salva, BSN, RN · Apr 15, 2008

Just to play the Devils advocate a little bit.
I do agree with ltos of the things said. But I want to keep it in perspective. 33 years ago, I worked on a med surg floor. 45 patients and night shift consisted of a single RN, a single LPN and a single aide. FOr the most part things are much better now, even without mandated patient loads. The difference is, that the acuity of the few patients per nurse has gone way up. 33 years ago, I only had a half a dozen meds to worry about and only 2-3 different IV meds. My pay is meeting my needs, I'll never turn down more money, but in reality I get payed enough.
Now with the acception of more drugs to memorize, and careplans and nusing diagnosis, the core nursing education is still the same. Add to that the fact that the attitude in the nuses station hasn't changed, and it's no wonder that nurses are leaving. I've posted in other places, that as long as we expect other people to start the change for us, nothing is going to change. We have to start it ourselves. We can't tolerate bad behavior from out fellow nurses, it's not supporting those new grads, and helping them along. It's taking control of our proffesion.
If we band together, and support each other, and quit fighting these counter productive battles, we're never going to get anywere.

I'm willing to bet that one of the reasons that you were able to take care of so many pts back then is because mgmt actually expected you to focus on pt care, not on "customer service" and not on paper-work/computer documentation.