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?

[Forest2]

On 9/20/2019 at 9:29 AM, J.Adderton said:

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.

They got this backwards. Nurse dissatisfaction led to poor quality outcomes. It's pretty simple, happy nurses =happy patients.

[L-ICURN, BSN, RN]

I have a pinched nerve, plantar fasciitis, more recently shin splints, insomnia, and still occasionally have stress-induced dreams of work. When I call off, it's counted as 1.5 days because i work 12s. But my vacation days are only awarded based on an 8 hour day. I'm tired, and I haven't even been doing this that long. I'm leaving bedside nursing and taking a pay cut. I need a break.

Management needs to take notice. Dangling a "stable" blue-collar wage in front of somebody isn't enough.

[OUxPhys, BSN, RN]

4 minutes ago, L-ICURN said:

I have a pinched nerve, plantar fasciitis, more recently shin splints, insomnia, and still occasionally have stress-induced dreams of work. When I call off, it's counted as 1.5 days because i work 12s. But my vacation days are only awarded based on an 8 hour day. I'm tired, and I haven't even been doing this that long. I'm leaving bedside nursing and taking a pay cut. I need a break.

Management needs to take notice. Dangling a "stable" blue-collar wage in front of somebody isn't enough.

Unfortunately the higher ups wont care, they will just replace people leaving with new grads. Its a vicious, endless cycle.

[Tron8622]

Yes unfortunately I havent been in the game that long either going on 8 yrs . As I talk to nurses that nursed from 15-30 + yrs ago hospitals just keeps adding more work to the nurses . It puts a strain on things . At job interviews I learned to trim the fat . I find that Hospitals are less educated , they are less safe , management has less and less experience . The job turn over is very High . My last manager has changed jobs 3 times while I have been employed at 1 in only 1 yr. I check in on my old jobs nobody is there everyone is new . This what happens when corporations take over . they just care about the money and not the product . Thats the problem .

[CardiacRNLA, BSN]

1 minute ago, Tron8622 said:

Yes unfortunately I havent been in the game that long either going on 8 yrs . As I talk to nurses that nursed from 15-30 + yrs ago hospitals just keeps adding more work to the nurses . It puts a strain on things . At job interviews I learned to trim the fat . I find that Hospitals are less educated , they are less safe , management has less and less experience . The job turn over is very High . My last manager has changed jobs 3 times while I have been employed at 1 in only 1 yr. I check in on my old jobs nobody is there everyone is new . This what happens when corporations take over . they just care about the money and not the product . Thats the problem .

Even at “Magnet” and so-called “highly rated” organizations. I interviewed and took a job at this type of an organization at their cardiac clinic. Stupid me. I was star stuck because of the name. Actually I turned down a job with them, then a few months later, another position opened up (should have been red flag number 1). I took the job. I interviewed with two different managers in the timeframe of a few months. Then during my long year there, there was another manager.

The nursing staff was miserable, undervalued and disrespected. As a result, the staff was gossipy, backbiting and underhanded. I left after 9 months. Sadly, it seems regardless of setting, IP, OP, clinic, case management, SNF, “good jobs” are few and far between. My point being to never rely on a name or status as if that makes a difference. Learned it the hard way. Lol.

[L-ICURN, BSN, RN]

7 minutes ago, Tron8622 said:

Yes unfortunately I havent been in the game that long either going on 8 yrs . As I talk to nurses that nursed from 15-30 + yrs ago hospitals just keeps adding more work to the nurses . It puts a strain on things . At job interviews I learned to trim the fat . I find that Hospitals are less educated , they are less safe , management has less and less experience . The job turn over is very High . My last manager has changed jobs 3 times while I have been employed at 1 in only 1 yr. I check in on my old jobs nobody is there everyone is new . This what happens when corporations take over . they just care about the money and not the product . Thats the problem .

This is what's happening at the hospital I'm at now. New management came in and is all about the money. They hacked through positions, scheduling, and extra resources. And they sit there in the administration department and ask why people are leaving in droves. They've lost more nurses in the past year than the last 5 years combined. And they know that there are 4 schools in the immediate area that will churn out at least 60 new grads this spring. What's really funny though is all our new grads leave after a year to become NPs or move on to nonbedside jobs. And then it happens all over again.

[Tron8622]

believe me I worked at the number one ranked hospital in texas and then to the number two ranked hospital . I saw worse problems job wise not pt wise at both than at level 3 trauma hospitals I use to work at . Then when I found out that ranking only pertains to what specialized services are available in that system and not ranked on healthcare ratings or pt satisfaction I learned that the rankings are just fake rating to get more pts to come to them . I have worked enough and have everything I want . I dont have kids So I dont have starving mouths to feed , and Im not hungry so lol. My heart goes out to the mothers locked in to bad hospitals due to their children and hospitals know this . Im taking my time when picking a job and Im educating myself on how to interview to get better jobs. I even learned how to bring up the fact that a hospital is setting their expectations to high on a job causing it to be vacant too long and have high turn over . I have had a few call me back and tell me I was right and that if I wanted the job . I declined becuase I also found out that they dont care about the pts just by my questions I asked so . I guess you do need to learn how to interview

[Tron8622]

Very much true . And my millennial colleagues lack the leadership to see when they are being used and manipulated. Time and time I see them get shmoozed it to doing illegal practices and GO WITH IT . Shocking . I have always learned to listen to my tenure nurses they been there longer and can tell me what rights nurses have lost over time at a job at that hospital .

The way I think hospitals see us is that we are playing their game on their board . We have to do whats best for them not the pt. Thats my number one problem .

[Forest2]

On 9/21/2019 at 5:03 PM, 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.

Walk a mile in our shoes. He doesn't know what he is talking about.

[benharold1, BSN]

I have been a nurse for over 35 years and have also seen a drastic change in the way bedside nurses are treated. It used to be if a nurse wanted to manage or be a charge nurse they had to earn that position and prove their expertise and competency as a nurse. Now it is open to anyone who has a BSN or MSN but may lack the actual patient care experience. Some of this is due to the ANA's expectation that all nurses have degrees and in the process have encouraged a culture away from the bedside. In addition, upper-level managers are basically the watch-dogs to ridiculous patient perception initiatives such as Studer. The shortage is once again here and the most difficult jobs in nursing (BEDSIDE nursing Care) are the least respected. I am so sorry for anyone who is reliant on safe care in a hospital or other care institution in which nurses and aides are understaffed and over-worked leading to unsafe conditions for patients. It's time the top-heavy management roll-up their sleeves and do the real work of nursing, caring for patient's at the bedside. I wish they would quit blaming the bedside nurse for problems with patient care and man up and take some responsibility and accountability for the issues that really contribute to less than satisfactory and safe care.

[JyVans]

Things have not changed for the betterment of nurses. The conditions and pay have worsened. All other healthcare employees now have larger salaries and benefits with banker hours. The patients are receiving poor to no healthcare. Nurses take care of yourselves.

[tinyRN72, BSN]

I don't see anything mentioned here about pay. I am sure that nurse's salaries vary greatly from state to state, and from hospital to hospital. Where I am, I could seriously work in a good restaurant and make the same amount of money that I do as an RN BSN.

I don't do it because I love nursing, and I love the 12-hour shifts and the life/work balance that it offers. However, a few months ago, I was really ready to trade my scrubs in for an apron because the hospital I was in was so terrible. I am thankful that I found a hospital where I really do enjoy my job again, but the pay is so low!

My 30-year-old daughter with no college degree makes the same amount of money that I do! She does not save lives! She saves accounts by retaining clients for her company (Account Manager). There is something very wrong with this.