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.
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 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
I'm sorry you have had a tough time. You might try your local community college placement office (they often provide services free of charge to the whole community not just their students) and maybe brush up on interview techniques and making a better resume. I hope others will have suggestions for you too. Wishing you the best. Stick with it. Sometimes finding a job can be a full time job in and of itself!
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On 1/22/2019 at 10:01 AM, jeastridge said:
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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.
Joy Eastridge, BSN, RN
THIS!!! Until we nurses (from the bedside to nursing leadership) strive to uplift, support and mentor our own - nursing will always be one of the most undesirable positions in healthcare. The role of the nurse will always be challenging, and therefore requires continual support from our colleagues and leaders.
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.
I could not agree more!! There is never enough (if anything) done re: bedside nurse retention. Maybe in days gone by there was a little, but now admin just says if you don't like it there is the door. Bottom line is the almighty dollar and I don't see that changing anytime soon!
THIS!!! Until we nurses (from the bedside to nursing leadership) strive to uplift, support and mentor our own - nursing will always be one of the most undesirable positions in healthcare. The role of the nurse will always be challenging, and therefore requires continual support from our colleagues and leaders.
I agree that this would help, but I don't see this alone solving the problems that exist at the bedside. The only way to solve them is a higher nurse to pt ratio with (at least) adequate ancillary staff. The consistently overburdened/overworked nurse is what makes this position undesirable to most.
The only way to solve them is a higher nurse to pt ratio with (at least) adequate ancillary staff. The consistently overburdened/overworked nurse is what makes this position undesirable to most.
I could not agree more. Had I never been overloaded with patients, not enough CNAs, and impossible expectations with no guaranteed break in a 12-hr shift, then I think I would have loved inpatient MedSurg.
jeastridge, BSN, RN
83 Articles; 560 Posts
Well said and good points. Thank you for sharing.