i have done allot of thinking about this issue. from pay, to hours to work load. i have been in many hospital rolls in my 26 years and i am now convinced that nurses are leaving after years of experience for all of these reasons - and i believe are being encouraged by some admins. i know that acute care is encouraging this. ideally each floor has an experienced nurse on each shift at $30 etc per hour, but that's it. for budget reasons, admin would rather hire (and train) new grads every year rather than pay for experienced nurses (never mind the nonsense about hiring costs - it is a wash). the research is showing that even so called top hospitals have marginally better outcomes (see jama this week). in a way, this intuitively makes sense - as we have moved to formula (evidence based) care (critical paths/specialty units) the knowledge base is well defined, as is the interventions and so is the patient base. why would a hospital pay one nurse 30/hr and another 19/hr to do the same job? look around your unit. what do you see in terms of experience and tenure? who can do your job and what kind of training do they need? are you using protocols? i think cook book care and nursings failure to research, document and articulate their role has damaged the respect, reimbursement and future growth of the profession. there will always be a place for the best $30.00/hr nurse (works when ever asked/does what ever asked) type nurse, but that will be the glass ceiling. nothing wrong with it, if that is your career aspiration. what do you think?
Dec 15, '06
Interesting point. Unless nurses can document the value of their expertise and/or experience, there will be little incentive for employers to "extra" for it.
However, there is an opposing force that helps balance the tendency to replace more expensive senior staff with less experienced (and less expert) nurses. It is this: the cost of recruiting and orienting a new nurse -- particularly one with minimal skill levels -- is enormous. In many specialties, it exceeds $25,000 per year and can sometimes be closer to $50,000. The great expense of all that recruiting and orientating can easily exceed the cost of retaining the good employee.
It's a fluctuating dynamic -- a fluid situation to achieve the right mix -- not a static, set situation.
Dec 15, '06
Just to recruit a nurse it generally costs OVER $10,000.00 per nurse. That is not even to hire and train them. Hiring and training a nurse usually ends up costing between $50-75,000.00 That is a lot of money. Hospitals do not like to just get rid of older nurses and hire new grads at lower pay. It costs them more in the long run to do this and trust me they are aware of the costs.
I hate to say this cuz I probably will get flamed but alot of times I see nurses start to get an attitude of well I am a nurse so I have to be right and no one but me can see what the problem is with this hospital. They think management is just out to screw the nurse and think nothing but profits and put all the burden on the nurses. Well guess what it is not that way in any hosital I have ever worked at and I have over 20 years working as a nurse. Most nurses do not know the first thing it takes when it actually comes to running a hospital and keeping trained staff and keeping the doors open so that there will be a hospital there tomorrow. If every hospital was run as I hear nurses say they are then there would not be any open at all, they all would have either closed due to negligence or the state would have shut them down.
As for the disparity in pay on the units it sounds as if you almost blame the advances in care. You say we have gone to evidence based care/ clinical pathways but is that not the future of care? Taking the scientific method and you are able to predict outcomes and predict the care needed. That is just smart work utilizing the least amount of resources to maximize the amount of output.
Dec 16, '06
Interesting points. I do believe hospitals are a business and in order to keep their doors open, they must function this way; just as Walmart achieves success by tightly managing it's bottom line.
The costs of recruiting and orienting nurses, I believe, are greatly exaggerated. How an organization chooses to recruit is a local decision. Reviewing the literature presents evidence that costs associated with 'nurse recruitment' can be paralleled with functions of recruitment across all industry lines - IE the cost of doing business. How each organization chooses to spend and account for those dollars varies widely. For example - Large hospital in city decides to recruit in Canada, lots of expense there - travel etc. Another hospital same city, stays local (newspapers). Huge difference in budgets. Possibly, same outcomes - # of nurses hire. Same with orientations. One hospital chooses extensive education and "double staffing" with preceptors for 12 weeks. Other hospital chooses a two day class room and partnering with a supervisory preceptor. The end result can be similar outcomes - turnover, retention etc. In a perfect world, the best programs never have to 'recruit' another nurse over the life of the budget - ending the need for a huge recruitment budget - and the potential tax benefits - really a change in paradigm for Nurse oriented HR.
As for blame - I do not think there is any blame to be placed. Health care and nursing are a dynamic system. I do think we as a profession have reached a cross roads. Administrators (who are paid to figure this stuff out) clarified this issue probably about 5 years ago in the "heat" of predicting shortages - some are acting on these issues. It would be interesting to see how many orgs have stopped using nurse recruiters, what budgets are being designated for etc. I suspect the west coast is managing down and the east coast is starting to shift and the mid west and the south are still 'nurse' focused in HR.
My point is that I think we as nurses need a reality check. We are not the be all and end all of health care. What todays nurse needs to understand and be OK with, is there is a set scale on what a nurse can expect in terms of risk (shifts, heavy pts) and reward ( satisfaction, a set level of reimbursement - no matter how good you are). In essence - it is a zero sum game. Some nurses like to bash admin, direct care nurses, med surg nurses, psch nurses etc. We need to stop this and accept what it is we do and that yes, we can be replaced. Hospitals, all health care, will manage to the bottom ine - The bottom line has arrived and it is cost vs outcome.
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