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Chattanooga Columnist's Controversial Recommendations For Area Nursing Shortage

Nursing Shortage

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Specializes in Clinical Leadership, Staff Development, Education.

Healthcare leaders cite widely known reasons for the current nursing shortage. Most likely, at least 3 immediately popped into your own head. One Chattanooga opinion columnist challenges hospital administrators to examine their treatment of nurses and rethink sign-on bonuses.

Chattanooga Columnist's Controversial Recommendations For Area Nursing Shortage
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A Chattanooga, Tennessee newspaper recently published an editorial analyzing the root cause of the area’s nursing shortage. Roy Exum, a local controversial opinion columnist, offered an alternative explanation that contrasted the underlying problems identified by area hospital leaders. The op-ed was written in response to a news article highlighting Chattanooga’s nursing crisis and recent events surrounding Erlanger Health Systems.

Erlanger Events

In May 2019, the physicians making up Erlanger’s 11 member Medical Executive Committee unanimously approved a no-confidence vote “in the structure of the current executive leadership”. The letter raised concerns about the quality of care and patient safety within Erlanger Health Systems, specifically understaffing, poor morale and policies that cause overcrowding in the emergency department and operating rooms.

Chattanooga’s Nursing Shortage

According to the Times Free Press, there are six different nursing programs in the Chattanooga region. Nearly 500 students graduate each year and more than 6,500 nurses live in Chattanooga’s Hamilton County. However, local hospitals are still challenged to fill critical positions. Rhonda Hatfield, chief nursing officer at the area’s CHI Memorial acknowledges Chattanooga’s supply of nurses is better than many areas. However, city is experiencing the same staffing challenges that are faced nationwide. Hospitals, insurance companies, ambulatory centers and physician practices all compete for nurses not only locally, but also in nearby Nashville and Atlanta.

Local leaders attribute the challenge of recruiting and retaining nurses is related to several factors, including:

  • Aging nurse workforce
  • Low unemployment rates
  • Lack of nursing faculty
  • Patient acuity increase on hospital floors
  • Nurses entering nurse practitioner programs
  • Unable to maintain work-life balance
  • Demands of nursing

The greatest need is for medical-surgical bedside nurses, however, increasing patient acuity often steers nurses away from this area.

Strategies for Recruitment and Retention

Chattanooga hospitals have implemented a variety of strategies to attract and retain nurses. These include:

  • Sign-on bonuses
  • Tuition reimbursement
  • Scholarships
  • Student loan assistance
  • Retention bonuses
  • Funding of faculty positions
  • Partnering with area nursing programs

Roy Exum’s Recommendations

In "Roy Exum: A Nursing Shortage?", published July 15, 2019 in the Chattanoogan, Exum shares his own controversial reasons for the shortage in Chattanooga hospitals. I admit, his reasoning does provide food for thought when considering the nation’s nursing crisis. According to Exum, the real root cause of the nursing shortage in Chattanooga is “gross mismanagement at the middle and upper levels of nursing” in the top 3 area hospitals. Other contributing factors expressed include:

  • Poor treatment of nurses
  • Forced overtime
  • Off day call-in
  • Verbal “bashings”
  • Poor staffing and overworked
  • No merit system for raises
  • Lack of reward for individual excellence

The Darkside of Sign-On Bonuses?

Exum takes aim at a popular recruitment strategy, sign-on bonuses. After signing the contract and receiving the bonus money, Exum claims nurses are assigned to floors with “1 nurse for 24 beds”. And with the bonus money spent, the nurse is unable to pay it back and trapped working in miserable conditions.

The article proposes doing away with sign-on bonuses, and instead, implement retention bonuses. Without sign-on bonuses, nurses will have a “no strings arrangement” and be in control of if and when they seek other employment opportunities. Without a sign-on bonus contract, Exum predicts hospital administrators will be forced to take “gigantic steps” in retaining nurses.

Conclusion

The nursing shortage in Chattanooga is not unique. And, the events at Erlanger Health Systems most likely parallel other U.S. hospitals. Factors contributing to the nursing shortage identified by Chattanooga’s hospital administrators are familiar and widely accepted. These factors are much “cleaner” and broadly brush over the harsh reality of the opinion article. Does Exum’s analysis of contributing factors have teeth and legitimacy?

What do you think?

Erlanger Board Approves Budget

Chattanooga Hospitals Struggling With Shortage of Nurses

Nurse with over 20 years of experience in a variety of settings and roles. Enjoys writing about topics, questions and of interest in her own nursing practice.

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OUxPhys, BSN, RN

Specializes in Cardiology.

The greatest need for M/S nurses isn't because of increased acuity, it's because the acuity, along with the demands of bedside nurses, are increasing but they aren't staffing to accommodate these increases. I dont know, maybe it's because you get 5 RNs with 1-2 aides for 24 or more pt's and upper management says "deal with it". You can throw in low pay and low shift/differentials and administration who care only about their careers and numbers into the equation and it's easy to see why nurses don't want to stay or leave as soon as they get that 1 year of experience to move elsewhere.

This is getting exhausting seeing the same "Why doesn't anyone want to work the floor?" articles. YOU KNOW THE REASON WHY.

Salisburysteak, ADN, RN

Specializes in Long-term Acute Care.

Well, the author of the original article is not wrong.

Common sense. Aside from pockets of shortage, there is no shortage of nurses, just a shortage of nurses who enjoy being treated like [blank]. I should think everyone already knows that people don't enjoy positions of zero autonomy + high responsibility where nothing can be done according to actual nursing standards and even if it could it still wouldn't be good enough in one way or another.

🤷🏽‍♂️

A retention bonus is a great idea. The key is getting which ever hospital organization the nurse is working for, to actually make enough headway for someone to want to stay on board.

Has anyone else ever wondered why managers aren't required to work on their units every so often to really know what's going on? Even just twice a month?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education.

9 hours ago, 2BS Nurse said:

Has anyone else ever wondered why managers aren't required to work on their units every so often to really know what's going on? Even just twice a month?

The good managers don't need the requirement. The nurse manager in one of the units I cover will frequently take the charge role, will be the circulator or scrub in a trauma case, has come in at 3am when call staff didn't answer the phone. The director has been spending one day a week being clinical so that those who requested time off wouldn't have to be denied vacation time. All assistant managers routinely help out with lunch reliefs and have been taking over ORs at end of shift so those who weren't on call didn't have to stay late.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, Elder Care, L&D.

There is no nursing shortage it's a myth with new grads complaining they can't find a job sometimes for up to two years post graduation there's lots of nurses waiting to be hired.

Chan Chan

Specializes in RN BS.

5 hours ago, hppygr8ful said:

There is no nursing shortage it's a myth with new grads complaining they can't find a job sometimes for up to two years post graduation there's lots of nurses waiting to be hired.

Agreed. Only in certain parts of the country.

Edited by Chan Chan

Wow, what Rose Queen posted above. I've never seen managers doing this!

A shortage in my area. I'm seeing signing bonuses that were definitely not posted 6 years ago. New nurses are barely making it 6 months on a med surg floor and have several options to transfer.

Edited by 2BS Nurse

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

On 7/25/2019 at 5:21 AM, 2BS Nurse said:

Has anyone else ever wondered why managers aren't required to work on their units every so often to really know what's going on? Even just twice a month?

Because they make the rules. It also defeats the purpose of clawing your way up the food chain to have to do actual work.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Back to the original post: So Chattanooga is awash with nurses but local hospitals can't retain staff? And the hospitals put forth reasons explaining why none of it is their fault. And Roy's reasons are "controversial" even though we've all experienced them to be true.

Being unable to retain nurses is not one of the Great Mysteries of Life. The Great Mystery of Life is why hospital management has to leave its brains at the door.

I'm going to try to clear this up for them: NURSES COST MONEY. YOU CAN'T RUN A HOSPITAL WITHOUT ADEQUATE NUMBERS OF NURSES. YOU HAVE TO FACTOR THIS INTO THE BUDGET OR YOUR HOSPITAL WILL BE A PIT WHERE NO ONE WANTS TO WORK, ADMIT THEIR PATIENTS, OR BE ADMITTED AS A PATIENT.

There. Think they'll get it?

OUxPhys, BSN, RN

Specializes in Cardiology.

17 minutes ago, TriciaJ said:

Back to the original post: So Chattanooga is awash with nurses but local hospitals can't retain staff? And the hospitals put forth reasons explaining why none of it is their fault. And Roy's reasons are "controversial" even though we've all experienced them to be true.

Being unable to retain nurses is not one of the Great Mysteries of Life. The Great Mystery of Life is why hospital management has to leave its brains at the door.

I'm going to try to clear this up for them: NURSES COST MONEY. YOU CAN'T RUN A HOSPITAL WITHOUT ADEQUATE NUMBERS OF NURSES. YOU HAVE TO FACTOR THIS INTO THE BUDGET OR YOUR HOSPITAL WILL BE A PIT WHERE NO ONE WANTS TO WORK, ADMIT THEIR PATIENTS, OR BE ADMITTED AS A PATIENT.

There. Think they'll get it?

Sadly, no, they wont. They will continue to ignore it until they hear what they want.

RN-to- BSN, ADN, RN

Specializes in SCRN.

In my opinion, it takes a special person to be nursing manager, and I say it in admiring kind of way. The level of fake-ness someone had to display. Pure acting.

I hate unit politics. The shared governance, the shared projects, improvement initiatives, etc. Shared, shared, shared. I thought I got away from socialism by moving to the USA. Come in on your time off to do a project. No, thank you.

Then at midyear review, my manager goes, "I understand that you prioritize your little ones". Ok, call it that, I'm good. Come in, help patients, get paid, go home. No part of work goes home with me besides my nursing bag.

But still, kudos to the management, I cannot do what they do.

There is no nursing shortage. Since the beginning of nurse time, hospitals simply understaff and overwork nurses.

Hospitals spend funds on shiny new gadgets, innovative new programs, and non-professional staff, ANYTHING but simply having adequate number of Registered Nurses on staff. Pleeeease …don’t send any more efficiency experts to tell me how to do my job! Yes, not performing instrument, sponge and sharps counts IS more time efficient. Maintaining a sterile field IS NOT time or money efficient. Efficiency experts on med-surg floors are just as absurd.

Nurses are educated and trained to perform to exacting standards, with serious consequences for failing to do so, yet they are forced to work as if they are perpetually under siege.

I have witnessed the deterioration of bedside nursing care over the last 3 decades. My attempt to return to bedside nursing in the past year was a disaster. Over worked, understaffed, lack of support, no breaks or lunches, under a barrage of demands and requests, and unattainable goals were the norm. Try as hard as I might I was unable to give decent nursing care because not only was I performing nursing duties, but I was waitressing, working as a customer service representative, a nurse aide and a whole myriad of other nonnursing duties. I can be a great nurse, but I can't do it all. Hospitals put themselves in this position because they see wages as being an area where they can control spending. So they cut staffing, then say the floors are fully staffed according to staffing levels. That is the biggest load of poo that they try to get people to swallow.. They might as well say they are fully staffed at one nurse per 50 patients if that is what their self-made staffing levels indicate. There needs to be a whole new way of doing business here.

Adequate staffing would improve nurse job satisfaction and reduce turnover therefore saving money. Patient care would improve thus reducing medical errors and readmissions therefore saving money. I can visualize a huge impact of savings in a vast number of areas. Nurses don't need fancy looking places to work, we need function and efficiency. Hospitals should stop the smoke and mirrors that they use to entice the public into believing they provide good care and invest in common sense approaches that can actually make good bedside care achievable.

I understand progress and the need to keep up with the times. However, hospitals should make great inpatient care a priority (the primary reason they exist in the first place), then address the other issues secondarily. I believe that if hospitals had the mentality that every care provider, therapist, pharmacist, tech, administrator, manager, dietary staffs, etc, etc, purpose is to assist and support the bedside personnel to provide the absolute best care possible then we would see unprecedented change toward improvement. But, it seems like everyone has their own agenda instead of putting their energies where it truly matters.

Ok, my rant if over, It just felt good to get that off my chest. Thanks.

On 7/24/2019 at 1:31 PM, J.Adderton said:
On 7/24/2019 at 1:31 PM, J.Adderton said:

Chattanooga hospitals have implemented a variety of strategies to attract and retain nurses. These include:

  • Sign-on bonuses
  • Tuition reimbursement
  • Scholarships
  • Student loan assistance
  • Retention bonuses
  • Funding of faculty positions
  • Partnering with area nursing programs

Get rid of all this and add nurses to the floors. I would not be surprised if that worked.

babydolltoo, BSN, RN

Specializes in Med-Surg.

The article's title should have left out the word "Controversial". Title needed only to be "Chattanooga Columnist's Recommendations For Area Hospital Nursing". Who decided it was controversial? Maybe it isn't & just has some truth to it! Need to know all who thought it was that! Just because "they" think of Roy Exum as controversial doesn't mean all he writes about is "controversial"!

I agree with above comments written. There is no Nsg shortage (minimum staffing allowed per hospitals)! Just hospitals being run by those who see it as a business & want to profit from it (not caring what the results will be to patient care & those who take care of patients!!!).

Edited by babydolltoo

babatee, MSN, RN

Specializes in Geriatric, Acute, Rehab, Psychiatry.

On 7/24/2019 at 3:03 PM, OUxPhys said:

The greatest need for M/S nurses isn't because of increased acuity, it's because the acuity, along with the demands of bedside nurses, are increasing but they aren't staffing to accommodate these increases. I dont know, maybe it's because you get 5 RNs with 1-2 aides for 24 or more pt's and upper management says "deal with it". You can throw in low pay and low shift/differentials and administration who care only about their careers and numbers into the equation and it's easy to see why nurses don't want to stay or leave as soon as they get that 1 year of experience to move elsewhere.

This is getting exhausting seeing the same "Why doesn't anyone want to work the floor?" articles. YOU KNOW THE REASON WHY.

You are right. The acuity is increasing but management keep putting the "efficiency" narrative.

On 7/25/2019 at 5:02 PM, hppygr8ful said:

There is no nursing shortage it's a myth with new grads complaining they can't find a job sometimes for up to two years post graduation there's lots of nurses waiting to be hired.

Its hard for me to believe that a nurse with a bsn cant get work for two years. Its earlier they are not willing to move or only want to work in the hospital setting

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