I'm curious for everyone's thoughts on this article. The nursing shortage or surplus depending on your region has been discussed many times here but I think this article would be more accurate if it said there's a shortage of experienced nurses willing to tolerate the poor working conditions of the bedside. I can't think of a single peer of mine that doesn't have the goal of either going to a non-clinical position, or becoming a nurse practitioner. I think the pandemic is driving even more people from the bedside making working conditions even worse for those that remain. What's happening in your region? Is it feast or famine? What do you feel this article gets right/wrong?
It makes me wonder which "power-brokers" are behind the article...the schools who have lost a chunk of enrollment due to the pandemic (community college enrollment apparently are low this year)? It can't be hospital executives seated in their leather office chairs right now crunching numbers and making sure staffing ratios are stretched as far as possible.
Sure it is!
They stand to benefit as much as or more than anyone. It has been clear for a long time that they will go to any length to not have to deal fairly with the employees they already have. Lots of things have changed solely because of this--two prime examples are the disparagement of experience/expertise in bedside roles and the revolving door staffing model.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
On 12/29/2020 at 5:22 AM, JKL33 said:
Sure it is!
They stand to benefit as much as or more than anyone. It has been clear for a long time that they will go to any length to not have to deal fairly with the employees they already have. Lots of things have changed solely because of this--two prime examples are the disparagement of experience/expertise in bedside roles and the revolving door staffing model.
Maybe my view is biased by the fact that we hardly ever hire new grads where I work.
It's a common theme among Northern California hospitals where there is such a thing as a competitive "new grad" program in hospitals that constantly receive tons of applicants for limited spots. Increasing the pipeline of nursing grads wouldn't necessarily impact our need for nurses as we tend to prefer agency nurses over new grads that need to be trained.
Having said that, the pandemic as it's affecting California has been dynamic. We were patting each others' backs in September and bragging about how we controlled the pandemic only to realize late this year that Southern California have reached the worst case scenario of no available ICU beds. Luckily, we have not reached that dire milestone here...yet.
In my area hospitals do not give ADN's a second look,even experienced ones.
The hospitals caused this themselves. Maybe they could cut back expenses while still having adequate staffing by employing team nursing but with a different approach to the more traditional RN.Lpn,CNA.
Maybe something like BSN RN,ADN RN,then CNA,
In my major city a BSN RN is basically equivalent to an ADN RN... brand new ADN RNs get hired into the NICU, and other highest level floor nursing positions with no bedside experience. There is truly no hierarchy between the two. I believe the pay difference is 1-2$ an hour, so you don’t really save any money hiring an ADN RN. Both RNs have the same education and skill set in regards to floor nursing. The only additional education I am getting in my ADN to BSN program is leadership theory... I believe BSN is a stepping stone to an advanced degree and may be looked at as a requirement for a job like an assistant nurse manager but otherwise serves no purpose.
I mention this because what would team nursing look like with a BSN RN and ADN RN when in regard to floor nursing they have the exact same skill set, make the same pay and have same clinical knowledge , they have the exact same scope of practice, however one has some additional leadership/research education? Doesn’t make sense to me. But RN, LPN, CNA team nursing makes sense as there is a vast difference in scope of practice, pay, and clinical knowledge.
I guess it depends where you live, and you must live in an area saturated by nurses? I do live in a major medical epicenter with 10+ major city hospitals within 20 miles of each other so we are never saturated with nurses. If you guys are now facing shortages with pandemic issues you should just simply hire ADNs.. but they don’t work under BSNs just beside them.
Increasing the pipeline of nursing grads wouldn't necessarily impact our need for nurses as we tend to prefer agency nurses over new grads that need to be trained.
I understand what you mean but my overall point is that it is never ever going to be bad for huge healthcare corporations if the nursing labor pool is flush with plenty of nurses. The more the better. It's exactly what gives them additional leeway to mess around with these various staffing paradigms and initiatives and anything they want to try. Both the situations you describe require adequate availability of nurses to pull off: If there is a huge nursing shortage there is not an affordable pool of travelers to order up on any given day. If there is a huge nursing shortage then new grad orientation can't suddenly become some exclusive "residency."
I'm just thinking out loud. But it would seem to me that there needs to be more than enough nurses to achieve either of ^ these. Neither one of them involve the average nurse of adequate education/training/experience going to an employer and saying I'd like to consider working for you and them being under any pressure to entertain that whatsoever.
Agreed. Either scenario uses a model that does not make an effort in investing on retention and workplace satisfaction. To me it's both a strategy of feeling things out and seeing where things would fall eventually...hire new grads while established ones are leaving through a revolving door OR keep a pool of established ones and add some "relief" workers who can fill-in in times of need only to go back to where it was when things are "better". What is unfortunate though is that we are proud of our California RN staffing ratio that is now thrown out the window in some places because of the pandemic.
Regarding the new nurses that started during the pandemic, the abbreviated orientation problem doesn’t only apply to floor nurses. We had two new hires that started right when the pandemic hit so they got a trial by fire orientation to the OR. First elective surgeries got canceled so they moved everyone to the Main OR and they were only seeing emergencies. That’s good to know how to do those, but the problem is, we work in a surgery center normally and the bulk of our surgeries are elective, quick turnover types of cases.
They both are doing fine now but it was rough at first. Neither had any exposure to the OR before..I give them credit for hanging in there.
Because if you have to wager a bet, chances for being treated like a human being are better in any of those other roles/places (except maybe the middle management role). That's just sad.
I guarantee you that some of it isn't just some need to shore up oneself with the idea of "advancement" but rather laying eyes on the situation and just saying no.
There are a ton of people that love bedside care. But not enough to lose any sense of well-being.
Yes, this. I myself am looking to get out of the OR for the last portion of my career. I like where I am now but I cannot imagine doing this in my late 50’s, early 60s and beyond. My boss is great but he’s the exception. Far too many places are run by clueless, vindictive and manipulative management and administration. Workplace culture counts for a lot.
I left one place where I was making $62.00 an hour after about two months. The money simply wasn’t worth my sanity and well being.
brand new ADN RNs get hired into the NICU, and other highest level floor nursing positions with no bedside experience. There is truly no
Please don't pull the 'specialty card' to infer one area is harder than another. For entry level positions, any new graduate is faced with a multidimensional job and there are orientations in place to assist everyone to achieve a safe level of practice, whether it is taking care of one neonate or a team of 6 acutely ill adults.
On 12/29/2020 at 7:22 AM, JKL33 said:
Lots of things have changed solely because of this--two prime examples are the disparagement of experience/expertise in bedside roles and the revolving door staffing model.
JKL33 -
I respect you and your knowledge but you are so negative about everything in a nursing job. I just don't share that trait (or so I believe). I just could not continue to work in a field I saw so many faults in. I am retired, yes, but I put in 45 years and worked under many of the problems you state. Sometimes you just need to reframe your experience so you have a better feeling. I cannot imagine going home at night being so negative.
Yes, this. I myself am looking to get out of the OR for the last portion of my career. I like where I am now but I cannot imagine doing this in my late 50’s, early 60s and beyond. My boss is great but he’s the exception. Far too many places are run by clueless, vindictive and manipulative management and administration. Workplace culture counts for a lot.
I left one place where I was making $62.00 an hour after about two months. The money simply wasn’t worth my sanity and well being.
I don’t look down or up on different RN roles but I was told in college that ADNs can’t get hired into ICU, ED ... and yet so many people I went to school got hired into those roles with no experience, so my point was that in some areas ADN does not hold you back at all in that sense.
Also I am personally glad I started in a telemetry/step down unit with 5 patients which was extremely challenging in regards to time management and catching issues before they got out of hand, before going into the ICU and did see it as a stepping stone.
I would rather be inexperienced caring for a patient with less critical issues first before having the responsibility or caring for someone who is so critically ill, but that’s just me? I don’t think that’s necessarily looking down on another level of nursing but I do feel a higher sense of responsibility and need to know every aspect of my critical patients condition on a minute by minute basis, and operate high level equipment such as balloon bumps, CRRT etc .. I wouldn’t want to take that responsibility on top of learning all the other basic nursing skills and titrating 10+ high risk medication drips... I could go on and on... but hey brand new nurses go into critical care all the time and most don’t have any issues!
I just personally look at that as taking on a higher level of care, specialized clinical education and training and responsibility.. it’s not better or worse but having basic floor nursing experience first is significantly helpful and can serve as a stepping stone or a halfway point and allow smoother transition into critical care. Take that however you want...
I would rather be inexperienced caring for a patient with less critical issues first before having the responsibility or caring for someone who is so critically ill, but that’s just me?
I am coming from the position that the 'less critical' patient often doesn't stay 'less critical'. And what do you have to assess other than your own eyes and ears? Often they are not even on telemetry. Assessment skills are critically needed. There are no medical students or residents hanging around. Stat labs are done by the regular phlebotomists with general lab equipment and when a transfer to ICU is planned, it may take hours. Meanwhile the RN has a team of patients, as do the other RNs.
43 minutes ago, ohbejoyful said:
I just personally look at that as taking on a higher level of care, specialized clinical education and training and responsibility.
And orientation to a critical care area represents that.
45 minutes ago, ohbejoyful said:
I was told in college that ADNs can’t get hired into ICU, ED ... and yet so many people I went to school got hired into those roles with no experience,
The areas dealing with critical care patients have grown so much in the past years. It is no wonder that so many new nurses get hired for those areas. If you are a patient in any way stable, you spend so little time on a general floor, have no patient education prior to discharge. And then we see the readmissions.
49 minutes ago, ohbejoyful said:
Take that however you want...
Hospitals employees keep the myth alive that there are good nurses and even better nurses....just listen to patients describe their ICU nurse ..."always there for me, pain medicine in a minute..." and then on a general floor ..."no one answers my call bell here...."
I am coming from the position that the 'less critical' patient often doesn't stay 'less critical'. And what do you have to assess other than your own eyes and ears? Often they are not even on telemetry. Assessment skills are critically needed. There are no medical students or residents hanging around. Stat labs are done by the regular phlebotomists with general lab equipment and when a transfer to ICU is planned, it may take hours. Meanwhile the RN has a team of patients, as do the other RNs.
And orientation to a critical care area represents that.
The areas dealing with critical care patients have grown so much in the past years. It is no wonder that so many new nurses get hired for those areas. If you are a patient in any way stable, you spend so little time on a general floor, have no patient education prior to discharge. And then we see the readmissions.
Hospitals employees keep the myth alive that there are good nurses and even better nurses....just listen to patients describe their ICU nurse ..."always there for me, pain medicine in a minute..." and then on a general floor ..."no one answers my call bell here...."
Yeah I don’t disagree with any of this especially with my prior experience in acute care. Also most ICU only nurses admit they would drown on a regular floor and admire what step down and med surg nurses do on a daily basis the multi-multi tasking and time management is an art
..the schools who have lost a chunk of enrollment due to the pandemic (community college enrollment apparently are low this year)?
The schools I am knowledgeable about had many applicants in the pipeline and did not have a decrease in enrollment. Can you tell me your resource for these statements? Was it in a specific geographical area?
JKL33
7,038 Posts
Sure it is!
They stand to benefit as much as or more than anyone. It has been clear for a long time that they will go to any length to not have to deal fairly with the employees they already have. Lots of things have changed solely because of this--two prime examples are the disparagement of experience/expertise in bedside roles and the revolving door staffing model.