Retaining workers key to solving nursing shortage

Nurses Activism

Published

http://www.thedesertsun.com/news/stories2003/opinion/20040101032404.shtml

Retaining workers key to solving nursing shortage

By Stephanie Salter

Guest columnist

January 1, 2004

The article, "Nursing shortage hits hard," in the Dec. 21 Desert Sun newspaper falls short on fact and truth.

The "investigative" author Rick Davis, it seems, did not speak to bedside nurses.

He interviewed only doctors and nursing managers at hospitals and the nursing school. When is the last time you saw these folks doing bedside nursing? Right. That is the point.

Dr. Max Harry Weil does come to the hospital now and then. I don't recall that he ever discussed nursing problems with bedside nurses.

The problem with patient care has been the lack of autonomy of the RN.

Now for the first time in history, bedside nurses have prevailed with our patient ratio laws, thanks to the California Nurses Association.

The Association has 55,000 registered nurse members. Perhaps Mr. Davis should speak with the association. He could also have gotten in touch with the Board of Registered Nursing, which says that there are enough RN licenses in this state so that if all those who possessed them practiced at the bedside there would be enough nurses. But they don't, and that is the problem. Why don't they?

I will tell you why they don't.

The solution to the nursing "shortage" is to retain the nurses we have and the ones who are just coming out of school into the profession. We can have a zillion nursing schools, but if the graduates leave the profession and run from hospital nursing, what have we accomplished?

The new graduates take one look at what goes on in the valley's hospitals and leave as quickly as they came. Many say that if they are to be treated so poorly here, they will go elsewhere. Many leave the profession altogether. Bonuses are not the answer. They are hard to collect (if ever). Increases in pay and benefits are the better ways to handle finances.

To retain nurses, we must:

(1) provide safe patient care by allowing the RNs to decide what is and is not safe

(2) provide decent working conditions

(3) provide a financial package that reflects and respects the professional RN's practice (including a retirement fund).

The "coalition" is well-intended but misinformed. It cannot be of help until it comes to grips with the complex structure of the nursing profession.

The first step; speak to a professional "bedside" nurse.

Stephanie Salter, RN, is a critical-care registered nurse in the Open Heart ICU, Desert Regional Medical Center, Palm Springs.

We are all used to reporters who do articles on nursing shortage by interviewing CEOs. I have seen it over and over again on tv. Reporter strands outside hospital, usually next to the sign, with some big wig and talks to them about the problem. It is getting very, very old. However, I think we would all benefit from hearing from all persons who do hands on care. My brother the LTC LPN would have some interesting things to say as well as my sister in law who works in an Alzheimers unit. They lay hands on the people they care for many times a day just as the bedside RN does and to those persons they are they most important health care workers of all.

Specializes in Community Health Nurse.

Bravo!!! Spoken like someone who really knows the challenges nurses face day in and day out. It's written like I could have written it myself. I'm still busy writing and sending out letters, and I've gotten responses from most...the latest being from the UAN, the US House of Representative -- Dave Hobson -- Member of Congress. :)

Fantastic article. Yayyyy!

Spacenurse,

Thank you for starting this string. Like all of your posts, it gives me hope for nursing.

Stephanies commentary is the first of its kind I have seen. Her email lists her as a commentator to the Sun. Is she a member of the CNA Speaker's Bureau or CNAs PR department? Do such entities exist? Are there any other Nurse organiztions who are working on this? Did the Sun do any follow-up on her suggestions, or was it just too much bother to talk to a bedside nurse?

Has anyone checked out "ER" or "Life in the ER" in the way they portray nurses? It didn't take me long to figure out that the scripts for ER were written by a physician. The show accurately depicts the surrealistic nightmare that Cook County really is. What tells us that there is absolutely no nurse input is the way nurses are always just some stupid b*tch with a problem. The DOCTORS do everything! They are always in the middle of every critical case. Never mind that the nurse already did all of his STAT orders before she even bothered to wake him up and tell him that the patient was there. Never mind that the nurse is his eyes, ears, hands, brain and teacher, and that next year he will be making THREE TIMES what the nurse earns.

I watched a couple of those "Life in the ER" shows on TLC. One of them was shot at my "boot camp" ER. They followed the POOR residents and showed how well they rose to every challenge of case management in a big level 1 trauma center. The only thing any nurse did was to save some pizza on her SICU for one of the residents.

PLEASE PASS THE METOCLOPRAMIDE.

Don't any other nurses get their hackles up when the media portrays us in such an irresponsible way? It's hard to believe that after the THOUSANDS in dues I paid to the ENA and the ANA, they do not even try to say something about it. After all, isn't their stated mission to advance the profession? The ANA in my state is a joke. I would like to see my state cecede from the ANA, the way CNA seems to have done. That way I would have some REAL representation on the job, instead of the Punch and Judy Show that they put on in my state capitol and in Washington.

After I left the ANA I got a letter of solictation for contunued membership from the CEO of my state union. The letter from this guy, (I don't even think this butt hole was a nurse) said, "nobody represents you better in your state capitol...nobody represents you better in Washington." So I wrote back to tell him how well his union represented me on the job. I told him about how their biggest contract hospital scr*wed me X2. In both instances the union president and vice president were right there with plenty of Surgi-Lube!

I recall 5-10 years ago the Reader's Digest had a story about a man who was CEO at Cedars Sinai Medical Center in New York. This guy took a hospital system that had a horrible turnover rate, and in 2 years turned it into one with a long waiting list for jobs. He did this by looking at why people worked in his hospital in the first place. To his great surpise number 1 on his list was NOT money, but the satisfaction derived from providing the best medical care for their patients. This guy didn't just talk the talk, he also walked the walk. He makes it a practice, once a month, to work in the delivery end of his hospital for an entire shift. On his day to be a housekeeper he puts on a housekeepers coat and slings a mop, broom ect., with the guidance of one of these professionals. On his day to work on a nursing unit, he puts on a white coat and works as "handy hands" on a nursing unit.

He figured out the number 1 priority for workers was working conditions and a sense of shared governance in how they do their jobs. I think the RD article was an exctract from "In Search Of Excllence" or "A Great Place to Work", by the same authors.

I believe that Stephanies ranking of priorities for nurses are similar, if not identical to his findings.

I would recommend reading both of the above mentioned books to anyone trying to solve the health care (nursing) crisis. In one of them Disney is cited near the top of GREAT places to work. The last hospital I worked was concerned about customer satisfaction, and decided to do something about it. Like they ALWAYS do they tried to do it on the cheap. They sent two people to the Disney Institute in Orlando for a week. These folks gave a series of slick presentations in the hospital auditorium that I eagerly attended. I learned a great deal about customer satisfaction, including how to treat my customers and co-workers. Whenever anybody asks me how I am, the answer is the same, "GREAT, REALLY REALLY GREAT!" Try it few times. At first it feels comically phony, but after few tries I really do feel better. I know from trial-and-error that applying Maxwell Maltz's principles of psycho cybernetics to my work day really works. I have learned to adapt myself so that the worse my day becomes, the more pleasant I am to be around. I decided to stop having bad days years ago. Every day is a good day, even if that only means I walked out of the hospital alive, which is more than I could say about all of my patients.

The biggest disappointment at the presentation was how there was not the merest mention of how Disney made their organization such a great place to work. Disney built its entire industry around EMPLOYEE SATISFACTION, before they even looked at customer satisfaction. Isn't that what Dr. Maslow taught us about our "heirarchy of needs?" How does the hospital expect me to be so nice to my customers if they treat me like a turd?

Oramar,

I would like to talk to your sister-in-law and your brother. The more I look at LTC nurses, (or any other "back ward" nurses, for that matter) the more I respect them. The longer I work with LPNs, and CNAs the more I respect them. They are the bottom of the heap in terms of respect and pay, yet I beleive that in most instances any of them could work circles around me, and teach me more clinical skills than I could learn in any other way. Every day they are at the cutting edge of critical care by being the first one to spot a sick person.

Cheefuldoer,

Tell us more. What are you learning in your quest? What have you heard from Hon. Dave Hobson and UAN?

In the area of integrating administration and nurse educators is where there is the most work to be done. I would MANDATE any administrator or educator to walk in a staff nurses shoes at least once in a while. When is the last time you saw a muck-de-muck "nurse" wipe a sh*tty behind? I have a great deal of difficulty with someone telling me not only to DO my job, but HOW to do it, particularly since none of them would make it to lunch. As soon as a nurse bureacrat exchanges her lab coat for a smart business suit and gets put on profit-sharing she forgets all about her sisters on the floor. Indeed, I have seen countless instances of how they SABATOGE any efforts by staff nurses to improve their practices.

I know that I am ranting. I know that I am getting worked up. Please do not suffer the misapprehension that I am THE LEAST BIT burned-out. As I already stated, I believe I have rendered myself burnout proof. Every time I am immolated by my profession I arise, like Phoenix, stronger than before. I will devote every breath that God gives me to trying to fix the profession that I was BORN into.

I am looking forward to more good responses to this excellent post.

:kiss

How do you define "safe?"

How do you define "decent working conditions?"

Exactly what do you have in mind that constitutes a financial package that is a reflection of the RN's practice with the proper respect?

These are broad, general statements that does not take a rocket scientist to figure out. Yes, to remedy the nursing shortage we must retain our nurses. That is the easy part. When you begin asking bedside nurses to specifically define safe care, decent working conditions and good financial packages the variation begins.

Don't mean to sound sarcastic, but . . . come on, we all know this, how about some specific suggestions.

Specializes in Rehab, Med Surg, Home Care.

Am gnashing my teeth here cause I just read YET ANOTHER article on how to fix the entire U.S. Healthcare system; this was in the Boston Sunday Globe, was written by a Doc and MAKES NO MENTION of the EXISTENCE of nurses in said system (except for a single example describing a nurse making a med error)... is it me that's clueless or is this as widespread as I think it is?

Specializes in Community Health Nurse.
Originally posted by Owney

.............................................................

Cheefuldoer,

Tell us more. What are you learning in your quest? What have you heard from Hon. Dave Hobson and UAN?............................

........................................I am looking forward to more good responses to this excellent post.

:kiss

The 'body of the letter' I received from Dave Hobson says:

[bEGINNING OF QUOTE]

"I have the utmost respect for the work of nurses. Nurses are an integrel part of the health care team. Often, nurses are the patient educator and advocate. Numerous studies have also show that patient outcomes improve when there are appropriate staffing levels. Yet, the nursing shortage is placing tremendous pressure on the nurses that are practicing and pushes many institutions to staff-to-patient ratios that are not ideal. Congress has recognized the importance of intervening in this situation.

I am pleased to tell you that, with my strong support, Congress passed the Nurse Reinvestment Act. President Bush signed this legislation into law in 2002. This legislation focuses on recruiting more nurses, ensuring that nursing schools have sufficient faculty to train new nurses, and retaining the nurses currently working in the health care system. While it will take time for these programs to increase the number of nurses actually practicing, it is my sincere hope that in the future we will see the tide turn on the nursing shortage.

Again, thank you for taking the time to contact me. Please do not hesitate to let me know if I can be of further assistance to you."

Sincerely,

Dave Hobson

Member of Congress

[END OF QUOTE]

The Honorable Hobson will most definitely be hearing from me again regarding this past year of hell I experienced as a nurse. He needs to know my firsthand experience with how I was out of nursing for a time, returned after almost six years, only to be ran away by the nurse manager.

He needs to know the things I witnessed there firsthand. Not hearsay....facts of how patients are being shortchanged due to lack of sufficient staffing, and lack of morale on the unit, or support from management. He needs to know that nurses are not given their due respect. Oh yes....I'm looking forward to writing my second letter to Mr. Hobson this upcoming week.

I'm also going to join the UAN.

The UAN enjoys getting stories about nurses experiences in the hospitals, and asked me questions, etc. I am still corresponding with them, so when I have something more concrete from them, I will share it with you all.

I will fight for my right to speak up and use my voice for a worthy cause such as the nurse-patient relationship. :nurse:

Cheerfuldoer,

Thanks for your last post. It's nice to know somebody else cares enough to try to fix something that is so broken.

So these guys in D.C. are going to fix our profession by throwing money to some of their bureacrat friends instead of looking at the real problem. What else is new.

If you give Mr. Hobson and earful about how your sisters have screwed you, do you think he will listen? Do you think he can or would push his majic button and fix you? If he does, please let me know. I have been shafted out of my specialty of over 20 yrs and may be out of nursing for life.

Read the goals of the Nursing Reinvestment Act. They mention retention as their LAST goal. Isn't RETENTION OF WORKERS the first word of this string? :kiss :kiss

I am not really offended by the way nurses are portrayed on TV. Does anything on TV reflect real life anyway?

Originally posted by ainz

How do you define "safe?"

How do you define "decent working conditions?"

Exactly what do you have in mind that constitutes a financial package that is a reflection of the RN's practice with the proper respect?

These are broad, general statements that does not take a rocket scientist to figure out. Yes, to remedy the nursing shortage we must retain our nurses. That is the easy part. When you begin asking bedside nurses to specifically define safe care, decent working conditions and good financial packages the variation begins.

Don't mean to sound sarcastic, but . . . come on, we all know this, how about some specific suggestions.

I have read two of your post on two different forum today. Both are VERY antagonistic toward the beside nurse. You are not the only one here who is in administration or management. However, others who are in those positions who post here do not take the stance that you do.

Consider looking at your own attitude toward the nurse in the trenches. You just might see something we do. And it ain't pretty.

I have been on both sides of the fence both as a staff nurse and as an employer and I can tell you I would not ever consider hiring you to sweep my floors with your attitude.

I know you are stressed and have your challenges too. But I have to wonder if you ever practiced nursing.

It is NOT up to the staff nurse to solve the staffing problems. Stop trying to put it back on them. I know you are trying to make them take ownership. I am all for ownership. However, in this case the problem does not belong to the staff nurse to solve it belongs to management. Management in this case needs to take ownership.

Don't use sneaky tactic here trying to put it back on your staff.

ainz,

Did you read the original two posts on this thread, or my responses to it. NOBODY IS LISTENING TO BEDSIDE NURSES.

I suspect that as soon as you exchanged your lab coat for a business suit you forgot about all of your sisters on the floor. Just like other beuracrats who are on profit sharing, every call in represents money in your pocket.

Mr. Hobson did just like all other bureaucrats who talk to try to fix the health care crisis they talk to other bureaucrat nurses with no input from bedside nurses.

:kiss

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