The author presents some of the current issues in today's nursing profession including nurse/patient ratio, living wages, bureaucracy, positive mentoring, and discusses possible ways to address them.
My friend texted me a short note that spoke volumes, “Gonna quit. Just can’t handle this anymore. Work here is too hard. Help!” I read her note with sadness and tried to respond with a word of encouragement that might last longer than the appearance of the emoticon on her screen. Getting discouraged in our work as nurses happens to all of us from time to time.
Studies show that nurses change jobs more than other professionals. In fact, the latest trends show nurses leaving the profession in greater numbers often for other lines of work but sometimes to pursue advanced degrees that will move them beyond the bedside and into higher paying positions. This trend, evolving over the past decade, has led to a large number of nurses with advanced degrees and many fewer who see their calling as staying the course in the arena of bedside nursing.
Recently, a friend went to the local ER where she was to be admitted for an appendectomy. The ER was full and there were physical beds upstairs, but the lack of staffing by nurses kept patients on gurneys in the overcrowded spaces downstairs. This problem did not develop overnight but administrators scratched their heads, perplexed as to why they couldn’t attract and retain enough nurses to keep their hospital fully functional. “The RN Work Project reports an average of 33.5% of new RNs leave the bedside within the first two years” (https://minoritynurse.com/why-good-nurses-leave-the-profession/). Staffing levels in emergency departments and intensive care units in some places are better, with less critical shortages. Some have theorized that this is because those areas are seen as stepping stones to leaving the profession to pursue higher education. In other words, nurses apply for ED and ICU jobs more often, stay with them longer, in hopes of going to nurse anesthetist school or getting a nurse practitioner degree. At one hospital, administration is considering requiring nurses to work medical/surgical floors prior to having an ICU or ED job. While this may take care of the problem in the short term, what are some longer-term concerns we need to discuss?
While the problem is widely acknowledged, and the proposed solutions are myriad, it seems that at times the remedies are knee-jerk reactions, running around with band-aids to address gaping wounds. While stop gap measures may be required in the short term, is it possible that a longer term vision might serve us all better? What can we do, as nurses, to help influence the conversation? Do we have a place at the table? Are we invited to give our input?
What would you tell administration if you could sit down and have an honest conversation?
A living wage is important
While money is not the main motivator for most nurses, we all have to pay rent/mortgages and car payments. Having a living wage helps to take that off the table. Most nurses don’t go into the profession with the hopes of becoming fabulously wealthy, but all would like to be able to live decently and retire with dignity.
Patient ratios matter
Administration can ask nurses to do extraordinary duty from time to time but not on a routine basis. Taking care of more patients than you are physically able to is not only dangerous but demoralizing. It sends the message that “what you are doing isn’t all that critical.” By slowly eroding professional pride excessive demands on nurses in the forms of unreasonable staff/patient ratios takes the wind out of the sails of good nurses who thrive on doing a good job, not on cutting corners and making do with less than the best. [There have been a number of articles on this website related to this important issue.]
Keep bureaucracy at bay
Fears, especially fears of litigation, can lead administrators down the dark and dangerous road of micromanaging and over-control. It is a given that mistakes are bad, perfection is good but the road to excellence is not covered in more forms—it is instead, oddly and perversely opposite to trends, in the freedom to pursue excellence as individual professionals. The fear of mistakes and lawsuits keeps us at times in the straight jackets of compliance, endlessly clicking our computers while the patient suffers the consequences of our inattention, at times resulting in units where nurses spend their time congregated around computer screens and less often doing hands on care.
Mentoring matters
New nurses need connection, encouragement, supervision, training. When professionals long to flee their field after a few short months, something is very wrong. Part of the answer lies in what we expect from our new grads. Longer term preceptorships, lower expectations of independent function can work together to promote safety, collegiality and well-supported co-workers who want to stay and find reward in their work. While long term preceptorships cost money, they are an investment in the long term health of our institutions. A nurse who feels the brightness of a the future in his or her job will stay with it and be an asset to the profession as a whole.
It’s complicated…
It is important for all of us to work together to find solutions that fit our situations. With increasing pressures from within and without, hospital administrators daily find themselves in lose-lose situations, working furiously to simply put in place the “less bad” alternative. The answers to our current problems are many are far-reaching, extending from voting to informing our legislators, to speaking with kindness and courtesy to listening carefully. As H. L. Mencken said, “For every complex problem there is an answer that is clear, simple, and wrong.”
For my friend who found herself upset and angry, a word of encouragement was just what she needed to get through the day and face a new tomorrow. When the going gets rough, we can all be that voice of hope for our co-workers in need.
There are also many nursing jobs away from the bedside and the hospital that are much less stressful. That is one of the benefits of nursing - you are not restricted to bedside nursing.
Other jobs...Let's see. School nurses, office, insurance, educators, case managers, utilization review...all nursing jobs involve patients, of course, but not all positions are like the ones in the hospital. Finding the perfect fit often takes a while and a dose of perseverance....Maybe other nurses can contribute here on other ideas. All the best!
Hello all. I could speak on this topic the whole day long but I will not. The biggest infection to the healthcare industry is called business. Business does not belong in healthcare. Healthcare deals with human beings, it is a humanist profession. Money is indeed the root to all evil and if money is your focus and your only focus then you will pursue that to any ends regardless of who gets hurt that's a problem. At the end of the day what truly needs to take place is that the industry of healthcare has to throw away all policies, SOP's all directives that they currently have and start again. Healthcare has to have its own model of doing things. You cannot apply other business models to healthcare. So in short this industry has to be a leader, be separate in how it functions, because the product that Healthcare deals with for-profit is a human being. When dealing with human beings especially in the ways that we deal with them, meaning their vulnerability, nudity, personal information, etc. Due to the fact that the healthcare industry's product is the human being, not a car, not inanimate objects, not houses, but people real people, given this you have to have directives that fit your product and right now that does not exist.
I have been a nurse for past 7 years. After i graduated i tried to find job in a hospital. At that time most of them were not hiring new grads. I was forced to work in a nursing home for one year. I have been in pediatric home health private duty for past full five years now. I need a change and for that again i tried applying in hospitals. But nope. All i get is "at this time we are perusing other candidates for this position". To me its just became a dream working in an acute care. Its not easy to change your career in nursing. Does anyone have an advice for me. I feel so behind and helpless
There are also many nursing jobs away from the bedside and the hospital that are much less stressful. That is one of the benefits of nursing - you are not restricted to bedside nursing.
Therein lies the problem, or at least part of it. The myriad of jobs away from the bedside provides zero encouragement to actually stay at the bedside. Instead of encouraging nurses at all levels of experience to bail out of bedside nursing as soon as possible we need to find ways to make the bedside tolerable so more nurses are willing to seek out and then keep those positions.
You list some serious problems and these that you listed often go unmentioned because they are more subtle--but the pressure is there. Maybe some other nurses can chime in on their strategies for maintaining healthy boundaries in a demanding profession? For me, part of it is simply acknowledging that they have a problem but I can't always be the answer...but it is hard. For sure. Joy
My strategy for maintaining a healthy boundary is simple. I just don't answer the phone. For instance I ignored three calls/texts today, all asking me to come in for the same shift! If I feel like picking up more hours because for whatever reason I want to I'll answer, otherwise I don't. My employers inability to fill a hole on the schedule is not my problem, nor is it my responsibility to plug said hole. If it come's down to not a single nurse agreeing to fill the hole then management steps in when all other options are exhausted.
I have been a nurse for past 7 years. After i graduated i tried to find job in a hospital. At that time most of them were not hiring new grads. I was forced to work in a nursing home for one year. I have been in pediatric home health private duty for past full five years now. I need a change and for that again i tried applying in hospitals. But nope. All i get is "at this time we are perusing other candidates for this position". To me its just became a dream working in an acute care. Its not easy to change your career in nursing. Does anyone have an advice for me. I feel so behind and helpless
Are you able to take a nurse refresher course? They are not cheap, but this may be necessary in order to work acute care. I would also try to obtain an informational interview with a nurse recruiter, to see what exactly they are looking for and if a refresher course would be of use.
Other jobs...Let's see. School nurses, office, insurance, educators, case managers, utilization review...all nursing jobs involve patients, of course, but not all positions are like the ones in the hospital. Finding the perfect fit often takes a while and a dose of perseverance....Maybe other nurses can contribute here on other ideas. All the best!
I have a few Joy.
Outpatient oncology(infusion, radiation, clinic, phone triage) Urgent Care, same day surgery, IR/cath lab (higher acuity and more stressful kind of outpatient job), employee Health center.
I don't think nursing is a calling. I specifically chose nursing, and then specifically chose ER nursing because it is a steady job, with a good paycheck, that has the ability to get overtime on a regular basis compared to med/surg nursing. There is always a minimum staff ratio to the ED because you staff based on what could happen, not what is currently in the ED at that specific moment.
I do think a lot of nurses would be better able to handle nursing and the drama/politics/etc that go with nursing if they viewed it as a job and not a calling. The reason that is important to me is because a job is something that you go to, and leave. A calling implies a lot more, and thus you are less likely to leave the drama/politics/bs behind.
If the job is not working out, you are free to leave the job. But more importantly you are free to think about what it is about the job that you find unsatisfying. If it is a calling that is not working you, there is a bigger onus of self blame because it's "your calling" and "if it's not working out I must be doing something wrong".
So, in conclusion: Nursing is a job. Not all jobs are perfect all the time, but bedside nursing has definite pros. And by thinking of it as a job versus a calling you can remain more detached/leave work drama at work/have a better work/life balance and remain a bedside nurse for (hopefully) longer.
I have been a nurse for 33 years. I have done a little bit of everything and have seen many different styles of nursing. Team nursing and primary nursing. I started on a med-surg floor and stayed 2 years. It cemented all the basic skills that nurses need. Our patient ratio was 6 patients to one nurse--Primary care nursing.
I became a nurse to take care of patients. New nurses need a long mentorship with a seasoned nurse, a kind nurse, for at least 6-8 months. It makes me sad to see nurses leaving the field. I have often felt like I need to leave nursing. The number of patients you take care of has increased. It seems that everything is based on how much money the company, hospital, or clinic can make.
I tried to find other jobs but they did not pay enough to pay my bills. Currently, I am working in pediatric home care with one patient at a time, for an agency. It is ok for now. Like the article above says, I have switched jobs many many times in the last year--at least 5-6 different companies due to high patient case load, drama, politics, high stress and no benefits.
I am not paid much with this new job, however, I have peace and less stress. The general public does not really know what a real nurse does and TV does not help the "nurse image" either. nursing is more diverse than when I started. You can pretty much do anything, education, teaching, bedside, just remember to keep your head up, believe in yourself, stand up for yourself respectfully, and if it does not work--give notice and look for something else. Not a failure, it just does not fit for you.
Specializes in OB (labor, delivery, pp and nb nursery).
I have been working for 37 years and the last 6 1/2 as a traveling nurse. There certainly are pros and cons to this type of nursing but the biggest pro I see is being able to avoid much of the drama/bullying/politics of a facility. I also wish there were options other than bedside nursing open to me. Unfortunately, many of the facilities as well as other areas of nursing (school nurse, company nurse) are requiring a BSN or higher. The hospitals are all wanting to be magnet facilities. I am a 3 year grad! I don't have many years left to work and am struggling to make it on my current finances without adding the financial and mental stress of schooling to my life (I detested school). I do not fully understand these demands, I have yet to walk into a patient room and have that patient or the family ask me how many years of schooling I have had. I do love what I do but not sure I will be able to physically continue to do the bedside nursing until I am able to retire so will have to struggle to do what I can or retire before I financially want to.
Are you able to take a nurse refresher course? They are not cheap, but this may be necessary in order to work acute care. I would also try to obtain an informational interview with a nurse recruiter, to see what exactly they are looking for and if a refresher course would be of use.
Good luck!
These information are totally new for me. Never heard of nurse refresher course or informational interview with a recruiter. How can i get these. Thanks for your reply
Nurse refresher courses may be taught at local community colleges, here is one found just doing an internet search: http://www.nurserefresher.org/
As for informational interviews, you just have to ask. Many hospitals have nurse recruiters, so I would look at their websites for contact information.
jeastridge, BSN, RN
83 Articles; 560 Posts
Other jobs...Let's see. School nurses, office, insurance, educators, case managers, utilization review...all nursing jobs involve patients, of course, but not all positions are like the ones in the hospital. Finding the perfect fit often takes a while and a dose of perseverance....Maybe other nurses can contribute here on other ideas. All the best!