Be A Nurse They Said...

Beth Prather, BSN, MSN

Have you heard; there’s a nursing shortage? I would beg to differ and say there are plenty of nurses, many who would like to remain in practice even if it meant long hours at the bedside, if they were given the respect they earned with their degree. However, the mindset at large is that nursing is a job, not a profession. The tolerance for accepting low wages, unsafe staffing ratios, working long hours, and constant abuse, has decreased, which is a good thing.

Why are they leaving the bedside?

Nurses want to leave because it has become overwhelming. Arriving to work and never knowing if you will remain on your unit vs. being sent to an unfamiliar unit, the patient: nurse ratio (4:1 vs. 8:1), and the availability of ancillary staff. These variables lead to anxiety before a shift even begins. Add to that the question of the new nurse: "Am I going to be forced to be charge nurse with only six months of experience?" These are genuine issues that are seen at the bedside every day.

What are nurses to do? Until state boards of nursing mandate flexible work schedules, mentorship programs for new nurses, increased autonomy, and safe staffing ratios, this will continue to be an issue.

Are 12 hour shifts safe?

Mercer (2021), recommended nurses work four days per week, 10-hour shifts. The nurse would provide 8 hours of direct patient care and two hours of thorough patient handoffs and quality improvement projects. This would reduce the stress and exhaustion the 12-hour shift places on the nurse, which in reality is a 14-hour shift. Other research has demonstrated a correlation between medication errors, near misses, and fatigue.

Why do nurses eat their young?

Mentoring new graduate nurses has been lacking for far too long. The old adage, nurses eat their young, is real. The nurse residency craze has been active for several years now but has failed to provide the mentorship so many new graduates crave. Originally designed to provide support and mentorship for all new graduates for their first year in the profession, it has instead become a continuation of nursing school. Nursing staff turnover of new graduates would likely decrease, and job satisfaction scores would likely increase if they were given the tools and support necessary for success. Most nurse residency programs have turned into one day a month of lectures and projects with very little mentoring.

How many are too many?

The Conversation at every hospital across the country is “Safe RN-to-Patient staffing ratios”. According to McHugh et al. (2016), in four states with a better work environment and low patient-to-nurse ratios on medical-surgical units, there was an increased survival rate if the patient had a cardiac arrest.

It is common sense that fewer patients per nurse will result in more care provided for each patient and less stress on the nurse, increasing job satisfaction. But as we know, common sense isn’t always common. By reducing the amount of stress per nurse, job turnover rates would decrease which in turn would decrease the need for contract and PRN nurses, ultimately saving valuable dollars. Nursing organizations such as the American Nurses Association (ANA) encourage nurses to participate in national, state, and local nursing organizations that focus on policy that impacts nursing practice. Something as simple as writing to members of Congress to encourage them to support safe staffing ratios in all hospitals does not require much time or effort on our part. It is only through these mechanisms that we will see change.

Me, myself, and I

There are very few hospitals that allow nurses to practice with any degree of autonomy. Nurses are educated and licensed professionals who spend 12 hours a day with patients, yet we are not trusted to hold blood pressure medications on patients with low blood pressures without calling the healthcare provider for approval. We take years of pharmacology but are forced to have a dual sign-off when administering anticoagulants and insulin. We cannot make our patients NPO without a doctor’s order even when we clearly see our patients struggling to swallow without coughing. When nurses are given the freedom to make decisions in non-life-threatening situations, the physician, nurse, and patient are all satisfied, and the delay in care is removed from the equation.

Increasing enrollment…Who is going to teach them?

Unfortunately for nurse educators, the answer to the nursing shortages throughout history seems to be increasing the number of students admitted to nursing programs. This is not always the best solution due to the shortage of nursing faculty. Much like bedside nurses, nurse faculty are overworked, understaffed, and underpaid. Universities must understand that while their institutions need students, it should not be at the expense of their faculty. The demographic of nursing faculty is an ever-aging group. Young nurses do not have the experience or desire to be educators at the beginning of their careers when looking for top dollar to pay back student loans and raise families. The vast majority of nurse faculty are over the age of 50 and looking towards retirement. According to the International Council of Nurses, it is estimated that by 2030 a million more faculty members will retire, adding more strain to the system.

In addition to the issue of decreasing faculty, add a pandemic, which prevented students from entering the hospitals to perform necessary skills training. Instead, training was done via simulation, which is not as effective as live patient care. This reduces scores on the National Council Licensure Examination (NCLEX) and further exacerbates the nursing shortage. It is a vicious cycle.

Just keep swimming.

So, nurses, what do we do? We put on our Dori pants and just keep swimming. We face adverse situations head on, we advocate for our patients, and – most importantly - we show up. It is what we do. We make jokes and eat our pizza party wins and our 3:00 candy bar delivery from the Chief Nursing Officer, and just keep swimming. But we do not have to like it. Wouldn’t it be amazing if nurses were cared for the way football players are after a hard game? Facedown on a massage table, aromatherapy and peaceful music playing in the background, hot tea, and a nice, healthy meal. Aah, one can dream.

Be a Nurse They Said.docx

References

American Nurses Association

International Council of Nurses: Nursing workforce crisis looms as expected six-million shortfall will be increased by more than four million nurses retiring by 2030

Krupnick, M., “When nurses are needed most, nursing programs aren’t keeping up with demand.”, The Hechinger Report, Dec. 2020,

McHugh, M. D., American Heart Association’s Get With The Guidelines-Resuscitation, I. (2016). Better Nurse Staffing and Nurse Work Environments Associated with Increased Survival of In-Hospital Cardiac Arrest Patients. Med Care, 54(1), (pp. 74-80)

Mercer, M., “It’s time to rethink the 12-hour nursing shift.” Nov. 2021,

Sloan, D., Barnes, H., Cimiotti, J., Jarrin, O., “Patient safety in hospitals still a concern.” Health Affairs, Nov. 2021,

Venant, K., “Nurse mentorships: A two-way street.”, Oct. 2018,

National Nurses United: Safe Staffing Ratios

Western Governors University: What is autonomy in nursing?