Bedside Nurses: Undervalued, Poorly Retained and What Experts Say

[J.Adderton]

In hospitals across the country, experienced nurses provide orientation to an ever-revolving door of new hires. The need to retain beside nurses is well known and solutions widely researched. Yet, work conditions in acute care settings are slow to improve and many nurses turn away (or run) from bedside nursing.

According to NSI Nursing Solutions, Inc., hospitals saw the highest turnover rates in 2018 when compared to the last 10 years. From 2014-2018, hospitals turned over a staggering average of 87.7% of staff. While most hospitals identify nurse retention in key strategic planning, it is not followed through in operational practice and planning. According to the report, only 43.2% of hospitals have put their strategic plan into formal retention strategies.

Do Graduate Programs Play a Role?

I recently read an editorial, authored by Maureen Kennedy, MA RN FAAN in the American Journal of Nursing, questioning if the push by colleges for students to attend graduate or doctorate nurse practitioner programs is contributing to the devaluing of bedside nurses. Research has clearly shown hospital working conditions to be the primary reason nurses are leaving the bedside. Most of us have experienced long hours, lack of flexibility and poor leadership while working in acute care at some point in our careers. And, the large need for advanced practice nurses in today’s healthcare environment, as well as the need for qualified nurse faculty, is undisputed.

Hospitals typically don’t have work environments that offer nurse autonomy or promote professional practices. Nurses may see an advanced degree as offering job opportunities that are more supportive, with greater autonomy and less stress. The editorial’s author summarized the issue by quoting a colleague:

Quote

“The narrative must be shifted to embrace the full range of roles and contributions of all nurses. Our healthcare system depends upon a well-trained, experienced workforce. The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome”. If hospitals want to retain nurses long-term, workplace environments need to change and demonstrate the value of bedside nurses."

Keeping Nurses at the Bedside

Healthleaders magazine recently published an article sharing what three nurse executives did to retain RNs with the right skills and experience needed to deliver high quality care. Here are a few of the ways the executives improved their facility’s retention rates for the long haul.

Improve the Organizations Reputation

Rush Oak Park Hospital in Illinois was plagued with a negative reputation because of consistently poor quality outcomes. The hospital’s reputation bled into the work environment resulting in nurse dissatisfaction. In addition, there was a “revolving door” of chief nursing officers leading to inconsistent leadership and vision. Karen Mayer, chief nursing officer, knew the work environment needed to change and hospital leadership was up to the challenge. Over a period of years, leadership worked to improve quality indicators to improve patient care and nursing job satisfaction. After many years, turnover rates decreased from 22% to just 8.3%.

Entice Nurses Back to the Bedside

Press Ganey’s 2017 National Database of Nursing Quality Indicators RN Survey found newly licensed nurses and those who have been in practice 2-4 years at highest risk for attrition. Claire M. Zangerie, chief nursing executive at Allegheny Health Network saw the same trend within her organization. Under her direction, the RetuRN to Practice Program was created to address some of the issues leading to attrition. The program was designed to attract nurses who have stepped away from nursing and want to return to the bedside. As a result, the workload of all nursing staff was successfully lessened.

Attract nurses with flexible scheduling

RetuRN participants offer managers at least 3 hours availability at any time, on any day, day shift or night or any weekend or holiday. The nurses help ease workload in high need areas and perform “rover-type” duties, such as admissions, discharges, patient education, covering other nurses’ patients for breaks or for continuing education. Extensive on-boarding, remediation, training and support is offered to RetuRN participants to ease the transition back to the bedside.

Support Professional Development and Work Environment

Kelly Johnson, vice president, patient care services and chief nursing officer at Stanford Children’s Health understands a healthy work environment and professional development programs are critical to retaining nurses. Therefore, Johnson developed and implemented several programs to support nurses in various stages of their career. Nurses have opportunities to continue growing through personal success plans, a succession planning development program, certificate and advanced degree programs.

The organization has also committed to creating a healthy work environment and culture. This includes initiatives embracing HeartMath concepts that empower employees to “self regulate emotions and behaviors to reduce stress, increase resilience, and unlock their natural intuitive guidance for making more effective choices”. The goal is to create a work environment that is caring and healing, where nurses care for each other and themselves.

What programs or initiatives have you experienced that improved the work environment of bedside nurses?

Additional Resources

NSI Nursing Solutions 2019 National Healthcare Retention Report

Want to Keep Nurses at the Bedside? Here’s How

Nurses at the Bedside - Who Will Be Left To Care?

[Queen Tiye, RN]

20 hours ago, llg said:

My experience (which may not be universal) is that it has staff nurses who want the 12-hour shift. When I was young, almost everyone worked 8-hour shifts. But gradually, over a period of a few years, things shifted to the 12-hour shift as the norm. I have been through 2 votes (in 2 different hospitals) asking staff to vote for either 8's or 12's. Management was willing to go either way. Both times, the staffs voted for 12's. They preferred having to work only 3 days per week to be considered full time instead of 5 days per week. People with kids didn't want to pay for child care 5 days per week. Students wanted more days off to go to focus on schoolwork, etc.

People chose to work harder/longer for 3 days a week rather than have a shorter workday, but have to work 5 days. Those votes were actually several years ago. I wonder how they would go if there was a vote today. I suspect most would still choose 12-hour shifts for the same reason.

The 12 hour shift was created to staff hospitals full-time with less staff — as a solution to the nursing shortage. Not all moms want to work 12s. In fact most probably prefer eights so they can get home and be with their children and not be bone tired. I think two eights and 2 12s should be worked in for who needs it.

[Secretperson]

Yup, the 12 hour shift was implemented for the benefit of the HCO, not it’s employees. In fact many large HCO’s are now rolling management into the three 12’s, nights, and every other weekend, so they can pay them hourly and get more with less.

Academics are still stating there’s a nursing shortage, yet real world HR and nursing leadership in the acute care setting, home health, LTC, etc, know damn well we have a surplus of nurses in our economy. We just have limited “good jobs” available, and good nurses want better.

For the last couple of decades, we have pushed bachelors and Masters degrees in nursing (now pumping out phd’s), yet then we get are confused when a nurse who has a masters degree doesn’t want to stay on the floor wiping asses all day for minimal pay working three twelves:)

Nursing accreditation leadership, academia, and yes ma’am/men nurses who are now “nursing leadership” in our HCO’s are the reason retention is low....

‘‘Tis a tired topic, but we continue to go down the road. The next discussion that will cause panic is a recent study that patients who have their nursing care done by nurses with PhD‘s have better outcomes?new magnet requirement for bedside care!

[guest974915]

21 minutes ago, Secretperson said:

Yup, the 12 hour shift was implemented for the benefit of the HCO, not it’s employees. In fact many large HCO’s are now rolling management into the three 12’s, nights, and every other weekend, so they can pay them hourly and get more with less.

Academics are still stating there’s a nursing shortage, yet real world HR and nursing leadership in the acute care setting, home health, LTC, etc, know damn well we have a surplus of nurses in our economy. We just have limited “good jobs” available, and good nurses want better.

For the last couple of decades, we have pushed bachelors and Masters degrees in nursing (now pumping out phd’s), yet then we get are confused when a nurse who has a masters degree doesn’t want to stay on the floor wiping asses all day for minimal pay working three twelves:)

Nursing accreditation leadership, academia, and yes ma’am/men nurses who are now “nursing leadership” in our HCO’s are the reason retention is low....

‘‘Tis a tired topic, but we continue to go down the road. The next discussion that will cause panic is a recent study that patients who have their nursing care done by nurses with PhD‘s have better outcomes?new magnet requirement for bedside care!

^^^Nice! Completely agree. What really grinds my gears about it is that somehow the opinions of bedside nurses regarding core issues of our profession (nursing shortage, staffing issues, retention...) are completely disregarded in lieu of our 'nursing experts'. Yet, staff/clinic nurses live and breathe these issues every day and intimately know the contributing factors and often, the solutions. Most of the MSNs and PhDs in academia and research haven't laid a finger on a patient or staffed a nursing unit in 25 years! Unbelievable

[futurepsychrn, ADN]

23 hours ago, llg said:

My experience (which may not be universal) is that it has staff nurses who want the 12-hour shift. When I was young, almost everyone worked 8-hour shifts. But gradually, over a period of a few years, things shifted to the 12-hour shift as the norm. I have been through 2 votes (in 2 different hospitals) asking staff to vote for either 8's or 12's. Management was willing to go either way. Both times, the staffs voted for 12's. They preferred having to work only 3 days per week to be considered full time instead of 5 days per week. People with kids didn't want to pay for child care 5 days per week. Students wanted more days off to go to focus on schoolwork, etc.

People chose to work harder/longer for 3 days a week rather than have a shorter workday, but have to work 5 days. Those votes were actually several years ago. I wonder how they would go if there was a vote today. I suspect most would still choose 12-hour shifts for the same reason.

And then they make sure the 36 hrs is in 2 different shift cycles and you don't get the 4 days in a row off anyway. So tired of it!

[OUxPhys, BSN, RN]

1 hour ago, futurepsychrn said:

And then they make sure the 36 hrs is in 2 different shift cycles and you don't get the 4 days in a row off anyway. So tired of it!

That’s the whole point of working 3 12’s, to have more days off in a row.

[kbrn2002, ADN, RN]

The job can suck bad no doubt. In my opinion the massive increase in documentation has been a huge factor in nurse dissatisfaction. Seems like I spend more time clicking off a ridiculous number of things in our EMAR/ETAR charting than I do with my residents. Plus I'm still required to do a fair amount of narrative charting as well [SNF setting]. I mean really, can anybody provide a decent explanation for why I am clicking off 6, yes 6 different orders daily for one CPAP? The only explanation management gave me is the blanket "It's required now."

Then the biggest insult to experienced nurses is the big bumps in pay to new hires to get them in the door without a similar pay bump to more senior staff. It's not OK with me that a brand new nurse starts off making only a couple dollars an hour less than a nurse with years of experience. We are not a union facility so the bargaining power for those experienced nurses is zero. Of course even if we were union it probably wouldn't help much since the experienced nurses have been leaving so the voting block would be mostly the more inexperienced nurses anyway so they certainly have no incentive to reward seniority or experience...yet.

[ppfd, BSN, EMT-P]

I was a medic/FF over 20 years,RN for 10 now.

I finish this BSN,I'm hauling *** into the finance/insurance/real estate business, fast food, wal mart greeter, gas station clerk etc.

Like public service, no way I'd ever recommend nursing to someone I liked.

Granted I work for a *** outfit and thats on me, and the ED to boot. But I can't see nursing anywhere, overall any better.

And before asked I just wanted a bachelors degree. And its a Fing BS filled joke as well. Two things I've learned, APA is king and you can never do it right. Nurse teachers hate nurse students.

4 classes to go kids!

[DallasRN]

Read this article:

https://www.chicagotribune.com/business/ct-biz-university-of-chicago-hospital-nurse-strike-20190920-7ddk2jacgbgsxea47kqwp6delu-story.html

Focus on Dr. Stephen Weber, U. of C. Medicine’s chief medical officer, comments:

Weber disputed the nurses’ claim that more staffing is needed on a regular basis to keep patients safe.

“I think there’s very clear information that that’s just not the case,” Weber said. “The benchmarks show that nurse staffing is not our challenge. Like any place, we have other challenges but we’re going to keep directing our resources and investments based on the needs of our patients.”

Doesn't that explain a lot of the issues we encounter in our profession? I'd love to ask him how often he's gone 12 hours without eating? Or peeing?

Yep, I'm one the ICU/ER nurses that left the bedside 12-14 years ago. Well qualified at that time but tired of the incredibly long hours, lack of respect from managers/doctors/patients/families. Tired of not having a change to hardly sit down during those 12 hour shifts (many of which ended up being 13-14 hours), tired of having to stay over "until your replacement arrives". Tired of going home 95% of my days worried I had forgotten something, knowing I had not given the type of care to patients I wanted to give.

Tired, tired, tired. And then the likes of Dr. Weber wants to tell ME more staffing is not needed??? And I guess those thousands of Chicago nurses are striking because they have nothing better to do. Right.

[guest974915]

51 minutes ago, DallasRN said:

Read this article:

https://www.chicagotribune.com/business/ct-biz-university-of-chicago-hospital-nurse-strike-20190920-7ddk2jacgbgsxea47kqwp6delu-story.html

Focus on Dr. Stephen Weber, U. of C. Medicine’s chief medical officer, comments:

Weber disputed the nurses’ claim that more staffing is needed on a regular basis to keep patients safe.

“I think there’s very clear information that that’s just not the case,” Weber said. “The benchmarks show that nurse staffing is not our challenge. Like any place, we have other challenges but we’re going to keep directing our resources and investments based on the needs of our patients.”

Doesn't that explain a lot of the issues we encounter in our profession? I'd love to ask him how often he's gone 12 hours without eating? Or peeing?

Yep, I'm one the ICU/ER nurses that left the bedside 12-14 years ago. Well qualified at that time but tired of the incredibly long hours, lack of respect from managers/doctors/patients/families. Tired of not having a change to hardly sit down during those 12 hour shifts (many of which ended up being 13-14 hours), tired of having to stay over "until your replacement arrives". Tired of going home 95% of my days worried I had forgotten something, knowing I had not given the type of care to patients I wanted to give.

Tired, tired, tired. And then the likes of Dr. Weber wants to tell ME more staffing is not needed??? And I guess those thousands of Chicago nurses are striking because they have nothing better to do. Right.

Dr Weber sounds like not only a corporate tool but also a scab of a human being!

[chacha82, ADN, BSN]

I am going to limit this because otherwise I could go on.

1. Have visiting hours twice a day AND STICK TO IT. I cannot provide good care in a cramped room of 2 patients and they each have 5 family members who want to be updated all day and ask "What's taking you so long."

2. Stop with the hotel mentality! I can never be as good as the Ritz. Provide each patient with a phone number to call for ROOM SERVICE for their trays. I cannot get "fresh, hot french fries" for my patients when I have other things to do and no extra staff to go get them. And then to get a report that I didn't do everything that the patient asked. ?

3. Trim down the bedside admission database for the RN. Many of the questions can be asked by case management during their rounding. I'm happy to make sure they're not suicidal and check their belongings, as well as verifying that they want to be treated. I need to start caring for the patient, and care for the other patients in my assignment.

[futurepsychrn, ADN]

4 hours ago, OUxPhys said:

That’s the whole point of working 3 12’s, to have more days off in a row.

That's the point, where I work the way they do the schedule, I never get 4 days off in a row.

[KlineRN, BSN, RN]

In the 80s, most patients were 150-250 pounds with a few health problems and a couple of medications. Visiting was limited so sick people could rest. I worked with good NAs & LPNs & didn’t care about your degree. We helped each other. The public mostly treated us with respect. My 30th year, I had 4 stepdown patients with average weight load of 1000 pounds per night, easily. Screamed at almost daily & rarely sat down. Retired from bedside.