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- by nursebedlam Jun 26, '04Sat, Jun. 26, 2004
Nurses' problems deserve attention
Reports show many in N.C. aren't happy, and that's bad for all of us
Here's one thing I've learned covering health care: If the nurses are unhappy, then we all have a problem.
Nurses are the backbone of hospitals and other health care institutions. They are the ministering angels who assist doctors and then coordinate and provide care after doctors leave. A good nurse can be the difference between life and death for a patient; many good nurses improve a patient's chances even more.
So it's worrisome that recent reports indicate many North Carolina nurses are not happy, and that we may be heading for a serious nursing shortage in the next 10 years.
The problem was highlighted in a report this month by the Task Force on the N.C. Nursing Workforce, a group convened by a state policy development agency, the N.C. Institute of Medicine.
The task force found the state is not producing enough nurses to fill vacancies when nurses resign or retire, or to keep up with the anticipated demand from an aging population.
If the situation continues, the state could have a shortfall of 9,000 nurses by 2015, the group reported.
One problem is the state's education system, which doesn't have capacity to train more nurses. But there's also a challenge retaining nurses: Only 43 percent of hospital nurses say they are happy with their jobs, the group said.
That unhappiness has contributed to high turnover rates, the task force said.
The problem is clear. But what's behind it? Why are nurses unhappy?
Pay is one reason. In 2002, registered nurses were paid $46,370 on average in North Carolina, or 7 percent below the national average. Licensed practical nurses averaged $31,200, about 3 percent below the national average, according to the task force report.
Other sources of unhappiness are inflexible scheduling, strained relations with doctors and lack of opportunity for career advancement, according to the task force and various nursing groups.
But according to several sources, nurses' No. 1 complaint is staffing ratios.
The task force found that 33 percent of N.C. hospital inpatient RNs said that on a weekly basis, inadequate staffing affected their ability to meet patient needs. About 17 percent said it was a problem on a daily basis.
That's scary, because it means some nurses are overburdened and unable to closely monitor and care for all the patients they're assigned. That can lead to trouble.
A 2002 University of Pennsylvania study found that a patient's odds of dying rose when the number of patients under a nurse's care increased.
The researchers looked at data on patients who underwent surgery or other procedures at 168 Pennsylvania hospitals. They found that when a nurse was responsible for six patients, rather than four, the patient death rate grew by 14 percent. With a load of eight patients, instead of four, the death rate rose by 31 percent.
It's such a concern that one Congressman -- U.S. Rep. Jan Schakowsky, D-Ill. -- last month introduced a bill to set minimum staffing ratios for U.S. hospitals.
One state, California, enacted similar legislation that took effect this year. Currently, about 70 percent of California hospitals comply, said Carolyn McCullough, an official with the Service Employees Internal Union, one of the nation's largest labor organizations representing nurses.
I couldn't find N.C. hospital-specific data, but concern about nurse-to-patient staffing ratios seems to be a recurring issue at local institutions, too.
Last week, I talked to employees at Carolinas Medical Center who complained about understaffing. One RN said young nurses are routinely assigned to night shifts and asked to handle more patients than they should.
"It's dangerous," she said.
Last week, CMC spokesman Alan Taylor declined to answer my questions about hospital staffing. They were among a bunch of questions I had asked based on complaints from CMC employees. The workers were angry about an article the Observer had published about the hospital system's reimbursement of spa costs, greens fees and other travel expenses for some hospital executives, physician leaders and their spouses.
Such an article was bound to elicit calls to the paper from a few disgruntled workers, Taylor said. Most CMC employees are happy, he insisted.
Let's all hope he's right. Mike
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- Jun 27, '04 by Audreyfay"One RN said young nurses are routinely assigned to night shifts and asked to handle more patients than they should."
My question is...what else is new? This was going on 28 years ago when I was a GN! Sure wish that would change!
- Jun 27, '04 by RN4NICUQuote from AudreyfayAs long as hospitals are run by administrators who live in fantasy land (where all the patients sleep through the night, doctors don't round after 7pm, there are no admissions between 7p-7a, patients don't crash if it's dark outside, and families go home and don't bother the staff) it's highly unlikely that this will ever change. I'd say that if any jobs opened up in fantasy land, I'd put in my application, but on second thought - I'd get bored."One RN said young nurses are routinely assigned to night shifts and asked to handle more patients than they should."
My question is...what else is new? This was going on 28 years ago when I was a GN! Sure wish that would change!
- Jun 28, '04 by GromitQuote from RN4NICU(the Fantasy land comment. hehehe. I like that. )As long as hospitals are run by administrators who live in fantasy land (where all the patients sleep through the night, doctors don't round after 7pm, there are no admissions between 7p-7a, patients don't crash if it's dark outside, and families go home and don't bother the staff) it's highly unlikely that this will ever change. I'd say that if any jobs opened up in fantasy land, I'd put in my application, but on second thought - I'd get bored.
Well, I may be an oddity, but I like working nights, so I wasn't put-off when they told me that night-shift was all that was available. But your point is very valid. Night-shifters have to be more independant (sp), because they DON'T have the resources that the Day-timers do (on the other hand, unless poop happens, it tends to be less hectic at night -fewer people running around, asking for things and getting in the way -docs and administrator types, family, etc).
However, I don't think its proper to send a newbie (such as myself) to the nights, since we have no experience yet, and we need some time to be comfortable with our new roles as nurses. In my opinion, this elevates a patients' risk level, and puts a strain on the other nurses, since a newbie tends to struggle at first.
I'm greatful to my fellow nurses who put up with my "beginners struggles".
One thing that surprised me was that quite a bit of management never worked in this field, or anything even remotely similar to it. How do they presume to know our needs, if they can't even relate. This is NOT about a bunch of numbers and columns -that tells nothing of the story. It doesn't surprise me that there is such a high attrition rate in this field.
It does, though, kind of annoy me (and makes me a little sad) when older nurses (or more experienced, anyway) look at me, and (when they found out that I had finished school) asked me "Why bother getting into this field? Are you nuts?" -just because you're burning out, don't put that kind of attitude into someone who is new. They probably have the same fire and desire that you once had when you were getting into this field. Don't dampen it (time may do that for you, but at least let them have a chance).
- Jun 28, '04 by RN4NICUYou are definitely not an oddity. I have always loved night shift. I'm not sure I would work day shift even if the differentials were offered on days rather than nights for the very reasons you describe. Too many a-holes running around getting in the way and wanting (demanding) this or that. I have also witnessed your point first hand about newbies on night shift. Many times I have been one of maybe 2 or 3 experienced nurses surrounded by new grads, and this was in critical-care areas.
Nothing against new grads - except those that think they know it all just because they're starting off in the units rather than med-surg - but as you pointed out...we just don't have the "backup" on nights. More patients per nurse (or less CNAs and techs to help), less experience in the pool - not a good situation when the poop hits the fan.
While I understand that it is only fair that those with more experience get the "prized" day shift positions, it is irresponsible (IMO) to throw new grads on night shift before they have been in nursing long enough to know what they can handle and what they can't - especially when the other nurses they turn to are likely to be as inexperienced as they are.
- Jun 30, '04 by RepatAs long as nurses are seen as "ministering angels who assist doctors", nothing will change! And this from someone who "covers" healthcare! The reason patients do well with more nurses is due to the NURSING care they receive, not because the nurses have "assisted" the doctors effectively.
- Jun 30, '04 by mattsmom81Quote from RepatYeah that line kinda bothered me too....but I AM glad some reporters are at least hearing and writign about the fact nurses are unhappy...now if they'd only get to the real nitty gritty behind it.As long as nurses are seen as "ministering angels who assist doctors", nothing will change! And this from someone who "covers" healthcare! The reason patients do well with more nurses is due to the NURSING care they receive, not because the nurses have "assisted" the doctors effectively.
- Jun 30, '04 by RepatI wrote to Mr. Stobbe - here's a copy, and his almost immediate reply!
Dear Mr. Stobbe,
I read your article on the www.allnurses.com <http://www.allnurses.com>
website. While you itemised many of the very real problems that exist for
nurses throughout our healthcare system, as long as nurses are portrayed as
"ministering angels who assist doctors", there is little hope that things
As your article pointed out, more nurses means better outcomes. I wish
to add that this is true due to the nursing care the patients have received,
not due to the efficient assisting nurses have performed. Nurse are well
educated, professional members of the healthcare team, colleagues of
physicians, not assistants to them.
As someone who writes publically about these issues, with many
excellent points made, I hope that we can rely upon you to clear up this
misconception. It is difficult for the debate to move forward, when such
antiquated perceptions are supported by statements like the one quoted
above. I appreciate your attention.
Thanks for the e-mail. I didn't mean to minimize, in any way, the role
nurses play. And I'm sorry to hear that that line in the column was
upsetting. In hospitals, doctor's offices and other care centers, I've seen
both to be true. I have watched nurses assist physicians. And I've watched
them function as independent providers and coordinators of care, some of
them doing most or nearly all of their work independent of physicians or as
apparent equals performing in tandem with doctors.
If i'd had a little more time before deadline and been a little more
thoughtful, I would have rewritten that sentence to make that more clear.
Anyway, thanks for the input. - Mike Stobbe
Nice to be acknowledged so quickly!