It seems as though the nursing profession, esp hospital nursing, has reached some dire straits in the past 15 years - getting worse, in particular, over this past decade. Would you agree?
The patient load is simply too high. Insanely so, and yet now these ratios are hard-stamped into the system due, in large part, to the way managed care reimburses hospitals. And, of course, the way managed care reimburses hospitals is rooted in a complex array of factors - more patients, more older patients, more obese patients, ever-changing medical technology, just plain more demands placed on the health care system.
As I read through these posts, I'm simply amazed at the case loads being described - and so consistently! Such case loads are just not rational, and yet there they are, with hospitals treating them as though they're normal.
It looks as though the only thing that can solve the nursing staffing problem is an overhaul of the health care system that embraces some tough realities. Such a (theoretical) overhaul, I think, would mandate absolutely no more than 4 patients per, say, a med/surg unit RN (with an aim of 3:1), with no corresponding sacrifice of ancillary staff. And because this would take an overhaul of the system to realize this, and would address a problem that affects the public health mightily, I really think the feds need to do it.
It may mean hospitals, to find the money to do this, will have to close beds, will have to stop accepting so many patients - perhaps triage will have to intensify - and perhaps the feds will have to set aside money to fund hospitals to keep them afloat. And that will mean other fed-funded programs will have to get cut.
And hospital admin people (MSHA's, etc.) AND staff nurses will have to put their heads together to figure out how to overhaul the system. Staff nurses simply must be part of the health care reform process. THEY know the realities. The "suits" don't.
If this goal is achieved, maybe there wouldn't be such a "nursing shortage". Maybe all those thousands of current nurses out there would return to the hospital. It looks as though we certainly have enough nurses "out there", not to mention the ones being churned out of the schools yearly. But there are so few who want to STAY at the bedside, in such working conditions - we can keep churning and churning, and importing and importing, but this will serve as only a stop-gap measure.
But... maybe that is what the "system" has settled for - constant stop-gap instead of real retention.
Anyway, I've just seen so many posts about nursing burnout and insane case loads, and observations about how "nursing is just not the same anymore" (I believe it!), that I don't think any amount of stress management skills or even changing one facility at a time (unless we can follow the example of a "model facility") will do anything to improve the worsening nursing situation.
If any silver lining comes out of the current systemic understaffing of hospitals, maybe it will be an increased emphasis on preventive health - i.e., the government tacitly warning us to try our best NOT to become an inpatient!
Anyway, just my $0.02. I think I'm basically writing this out of fear - fear of what I will encounter when I graduate from nursing school. I hear about "reality shock"; but I think it's much more than that - I think it's a shock that we need to listen to - a shock at a system gone awry.
Because they say only a newcomer to a country can really see the essence of that locale - during those first few days or weeks he/she is dwelling in that locale - before becoming acclimated. Then, once acclimation sets in, surroundings take on an appearance of normalcy, and some of the truth that was contained in that initial glimpse into the "reality of it all" is lost.
You could say shock is the only really rational reaction to the current situation!
If we - the public - accept today's nursing working conditions as normal, it will only get worse. I fear what the bedside will look like in 10 years. Maybe the fact that the aging boomer generation (the "gray tsunami") is about to hit the hospitals will help the public face reality...
