Who "Owns" the "nursing shortage?"

  1. I remember talking with a DON at my first "job." She instructed me to solve a problem; first identify who owns the problem. They will be charged with it's ultimate solution/ resolution.

    Here we are in 2002. The chicken little "The sky is falling," mantra of the day is that there are not and will not be enough nurses and other selected health"care" "workers" to provide the necessary "service" to those in need of it.

    People clamor crisis with the best intentions of addressing the "problem." There are committees formed to address the "problem." Yet the "problem" remains; or does it?

    Who owns the problem?

    A working nurse who is short staffed not provided with enough of the avaliable nurses to safely "practice?" No, they do not own the problem. It affects them but they do not own it!

    Educators clamor that there will not be enough educators to teach. A seprate issue, nurse educators; in a league all by themselves I mighn't add. They claim to have some ownership but in all praticality, they do not own the problem either. They are affected by it but do not own it!

    Ownership of "the nursing shortage" belongs to those who hire nurses; solely and wholely! They do not do what is necessary to attract and retain nurses.

    All of the good hearted educators and nursing organizations in the world can only make the actual solution of the problem a little easier for the "employers" of nurses. They can have an impact on the problem but not solve it!

    As an individual nurse you can impact the"solution of the problem" by where you work and under what conditions you will work. You certainly will not solve the problem!

    Trillions are spent on health care in the US alone! Where does the money go? Who hires nurses?

    The problem is clearly owned by employers. They simply continually fail to do the right things to and for the employees.

    The word is out! Nurses are treated poorly and paid poorly. Why should the owners be suprised there are no people willing to do what they ask? Why should people go through the experience of achieving a nursing education for the lack of reward offered by employers?

    I've grown weary reading of the woes of employers and the entities working to address "the nursing shortage." They can not be working toward my best interest. They do not own the problem. They simply make it easier for employers to continue doing business as usual especially regarding poor treatment and pay of nurses.

    Please tell me how I'm wrong and individual nurses can solve the problem. Please tell me how educators can solve the problem. Please show me anyone else who can solve the problem - if , in fact, - one exists.

    Please don't let me keep believing that the only "solution to the nursing shortage" is held by employers. They have proven over time they are not willing to do what is necessary to solve the problem.
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  2. 35 Comments

  3. by   oramar
    That is a very eloquent little thesis Norbert. Hats off to you. Sometimes I sound like a broken record ranting about managment Honestly, nursing has a lot of problems but only one of them drove me out. It was not lateral violence, difficult patients or family, exposure to infections or physical danger that drove me out. It was the unit managers that treated me like a peon, that talked to me like dirt. It was the upper level managment that put them in power and told them "save money, nothing else matters". Systematically removing every decent manager and replacing them with money managers. We jokingly refered to them as hatchet men. On nurse I worked with went so far as to place a tomahawk on the ceiling above the chair where the ADON set and made her cuts. I dealt with difficult situations for many years and hung in there but I couldn't take it anymore . Not only does managment own this problem but they bought and paid for it with my own sweat and tears. What is the solution they propose, BRING IN FOREIGN LABOR. Damn them, damn them all.
  4. by   fergus51
    Management only responds to the same stick and carrot the rest of the world does. As long as they are meant to make a profit, what do you expect them to do but try to keep costs down by not hiring and doing what is necessary to retain nurses? The whole system is bassackwards.
  5. by   Nurse Ratched
    This week, we were told that we were short a nurse (the house supervisor stated that she didn't know until she had already called people off that our census had increased - nurses were available and *could* be called in but at the higher "call in" rate.) She offered to send an additional aide instead, then when we called to confirm she stated that she had some aides call off late and couldn't even do that. My response was an expectant, "So you're calling a nurse in then?" She sputtered that she'd "see what she could do" and the person who was charge nurse made a comment about us being able to "handle it." Dagnabit - management makes a staffing matrix and then doesn't abide by it half the time. And nurses are sick of "handling it." Plus, if we get shorted enough, eventually the wisdom if TPTB will determine that the matrix is TOO generous since we seem to "handle it" short so well, then it must not in fact BE short.

    We got the nurse. We need to squeak. And scream if necessary.

    So in answer to your question, it's jointly owned. The nurse who was willing to "handle it" is following a recipe for burnout and ultimately increasing the nursing shortage. But mgt that keeps adding straw after straw to determine exactly when the camel's back *does* break owns more of it.
  6. by   spineCNOR
    Norbert, oramar, fegus and Nurse Ratched, you all have excellent points.

    Who does own this problem?--in my opinion, hospital administrators, nursing administrators, nurses and the consumers.

    Hospitals are no longer there to be a service to the community--they are there to make a profit, even many of the so-called non-profit hospitals. As a result, hospital and nursing administrators no longer see patients as people we are all there to serve, they are now "economic units" that we must process as quickly and cheaply as possible. In such an environment the main work of nursing, caring, is not valued.
    Most, not all, but most, administrators (nursing and non-nursing) have no respect for the work that nurses do, so they think that replacing nurses with unlicensed personnel to save money is a "good thing"-this improves their bottom line, and ensures their continued high pay and bonuses.

    The individual nurses is powerless in this situation. If only nurses could stick together as a cohesive group to support each other and to advocate for patients.

    Consumers - is is time for consumers to wake up and realize that the day will come when EVERYONE will need a nurse, and what if there is no nurse there??? As it is now, most lay people think anyone they see in the hospital other than their doctor - lab tech, housekeeper, etc, is a "nurse". Consumer groups, similar to those who have fought for health concerns such as smoking in public places, need to advocate in the media and legislature for the presence of an adequate number of licensed nurses in health care facilities.

    What is the solution to this problem? I honestly wish I knew.
  7. by   hapeewendy
    sadly we all own it
    by no fault of us good old bedside nurses
    or even our well intentioned management
    we all own this problem
    but I'm willing to sell my share for dirt cheap in order to be able to work with the proper number of staff any day!
  8. by   nimbex
    well, here's one for more staff..

    My facility had to day double time to staff a step down in constant crisis. I took one of the shifts..

    I was given a 6 patient assignment, when ICU nurses only ever get 4, period.

    When I politely reminded the charge that I had two additional patients that needed readjusting, her response was "you're making double time... and COMPLAINING about the assignment... you're geting paid more than us.. deal with it"

    yep! This is their thinking.. like the money was coming out of their pockets.....

    I replied you either want the HELP or you don't... Assignment was changed but everyone refused to help me.

    So even bigger picture is why is there never enough staff? May well be a small piece of how we treat each other. I'll never work there again.... I think many nurses that left there thought the same.
  9. by   Brownms46
    Originally posted by nimbex
    well, here's one for more staff..


    I was given a 6 patient assignment, when ICU nurses only ever get 4, period.
    4 in ICU??? What happened to 2??? Four ICU pts...hmmm...now I'm wondering if those 4 pts...were actually critical care pts...as I know them...or really step down??? How do you take care of 4 critical care pts??????
  10. by   nimbex
    sorry, I work Icu, took a shift on step down, used to 2-3 patients in ICU... the step down takes 4-5, they were trying to give me six!!!!!!!
  11. by   sjoe
    Norbert--Well said, but one point you left out is about nurse educators who, along with hospitals, PROFIT from this "shortage," as it maintains a constant demand for students and nursing schools and legitimizes their requests for more funds, for scholarships, etc. You can't expect them to be a part of any real solution.

    Spine--Nor will US consumers ever be much help, as they would rather stay in denial about illness when they are feeling well and are "too sick" to do anything about the problem when they are not. Their primary interest is keeping THEIR co-pays and THEIR share or premiums as low as possible.

    IMHO.
    Last edit by sjoe on Sep 9, '02
  12. by   Lacey
    I think the thing that I hate he most is the previously described scenario when they called people off and then "like magic" the ER fills up and the matrix goes out the window. I think when the supervisor goes over the matirx, he or she better find some scrubs and take an assignment! One time I was argueing with the supervisor about the 11 to 1 ratio that he was about to enforce, he claims that he had called the DON at home and she had okayed it, I said why can't you call in some of those managers that had just gone home after a hard 8 hr day behind the desk and he said he would never do that because they work hard and need their rest! But, I have seen nurses absolutely refuse to do it and after much back and forth, the same DON closed the ER to admissions. I 'm going to have to study their techniques!
  13. by   flowerchild
    Hi Norbert,
    Hope things are going well for you.
    I agree that the solution is in the hands of the employers. I also think they know the solution but don't want it. They want to pay as little as possible for the services they provide. It's the bottom line.PERIOD. You know that there are plenty of studies out there about "how to attract people for employement". There is no doubt in my mind that, they who are in control, know exactly what they could do to solve the potential shortage. They are using the baby boomer example as a reason to create an even greater shortage. It's not rocket science and it is totally up to them to solve. Here's an example of solution; Higher wages, comfortable working environment, empowering the employee by allowing them to think for themselves, providing a safe as possible working environment, excellent benefits, providing education, etc.... this example could pertain to any career. Provide these things and they will come. But hospital big wigs don't want to do this b/c they would rather find other ways that won't cost so much money, like hiring out of country, closing in house programs that educated nurses, keeping wages as low as possible, etc......... It's all about the bottom line imo.

    They get away with this b/c nursing isn't just a career, like computer science or accounting or a retail manager, for example. It is a calling....and so the nurses come anyway. This gives/gave the hospital more power to control. There are so many of us who truly love our work. We could not fathom doing anything else. In fact the majority of us are this way. But where does that leave us? But it's not always going to be this way forever especially if the above solutions are used. It's those nurses who are not in it for the calling but there for the money, benes, etc who will be most empowered. But if the hospitals have their way, this won't happen b/c they will find people who are complacent with what ever is handed to them or hire UAP's to do our duties. The hospitals will provide the care anyway they see fit and get away with it b/c there is a "nursing shortage". Created, controlled, maintained, and unsolved by the hospitals. They do have the power AND the money to fix the problem but won't.
    And, don't think the govt is going to help or fix this b/c they won't either.
  14. by   brown rice
    why is there a nursing shortage? there seems to be no single answer, but a number of factors involved. Poor treatment among staff that drive nurses out, mangement only concerned with profits, lack of nurse educators, burn out, nurses just putting up with bad working conditions..
    Would I be correct to say a large part of the problem comes down to money is more important then good health care in this country?

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