Facilities are firing seasoned, higher paid nurses and utilizing younger less experienced nurses. This cost-cutting measure is putting patients at risk, working nursing and support staff to the point of exhaustion, and causing staff to leave the profession.
Updated:
This article was written by a member on allnurses. Due to the controversial and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system.
I am an experienced nurse that has watched many of my very talented colleagues leave the bedside due to the changes that have taken place in healthcare as of late. I have seen staff cut to the minimum, while patient acuity and nurse to patient ratios increase. I have seen support staff break down in tears because they have not been able to do their jobs properly. I have seen staff pushed to their breaking point, all the while administration stays in their offices, or in the meetings, determining yet more ways they can cut our resources. I see your salaries raised to ridiculous amounts, while we are denied cost of living increases, housekeeping is cut at night, and our benefits cost more, while the services are decreased.
I see our retirement cut while at the same time, the amount matched continues to be diminished or non-existent.
I see ways in which we are constantly blamed for declining patient satisfaction, increased patient falls, late medication administration, all the while we are asked to do more with less. I have seen you fire experienced staff and hire less experienced, cheaper, staff. I have seen that new staff break down because they have no resources, no experience to draw from and I have seen patients suffer from that inexperience. I have seen codes increase, inappropriate admissions to floors, transfers to higher levels of care, all because no one was there initially to advocate for a higher level of care for the patient, to begin with.
I still see you in your office. I do not see you on the floor. I see you with your graphs, your pie charts, your questions about readmission rates when I had already advocated for that patient to stay longer but was simply laughed off by doctors and not supported by you. Yet, somehow, I need to be on a committee to fix the problem.
I am now required to work extra shifts, because staff are getting sick due to stress, or leaving completely because they are tired of dealing with things. I see you develop a culture of fear, where our jobs are at stake and threatened at every turn. Yet, you still look to me for solutions.
"How can we do more with what we have?" I am asked.
My answer: There is no way to do more. We are at our limit. You are losing nurses as fast as you are gaining them, at a time when we need to be building up our profession when the baby boomers are just starting to become a factor in our healthcare environment.
My answer to this is simple. It is time to get real and start valuing your employees. If you want to be reimbursed for patient satisfaction, increase your services. Staff departments with what they need - enough nurses, enough aids, monitor techs, secretaries, ED techs, whatever. Then you will see positive results. Falls will decrease. Medication errors will decrease and medications will be given on time. Patients will get the treatment they deserve and patient satisfaction scores will improve. Your reimbursement will improve and you will stop losing money. Everyone wins: most importantly, the patients.
We need to stop the assembly-line mentality of medicine and return to the service mentality.
Yes, we are a business. But any business that has ever done well has not done well by decreasing the services to people or by mistreating its staff. Otherwise, healthcare facilities are going to see more of the same and suffer more financial penalties, less high-quality staff, and patients will suffer.
I was talking with several of my colleagues just the other day. All of us had many years of experience. Many had been at the bedside for over 20+ years. Many are leaving the bedside due to the unsafe conditions they are seeing. They just don't want to be a part of it. Perhaps this does not scare you, but it should. You must not be a patient yet.
For a follow-up article, please go to Nurses Fight Back! Why Some Hospitals are Despicable
Hospitals Firing Seasoned Nurses_ Nurses FIGHT Back! _ allnurses.pdf
This is awful!! Nursing is a field where you definitely are like a fine wine- better with age!! The experience and confidence of seasoned nurses is priceless to any facility an it blows my mind that they'd be willing to lose one of their most valuable assets bc the end results won't be better for their bottom line- their bean counters haven't figured in all of the lawsuits and settlements to be had for substandard care!!
Hospitals are big business. The physicians should of never allowed the hospitals to purchase their practices. Then they implemented hospitalist to make rounds on patients. Patient care started going down the tubes then as the hospitalists don't know the patients history. CEO's and upper management forced the managers lower on the pole to treat their staff badly by giving them bad reviews and in every unit meeting you were treated like children as the manager sat and told you how bad their press gainey's are and scolded you like a child. Instead of team nursing they started assigning nurses more patients so they felt like they were drowning and nobody had time to help each other out. Turned staff against each other so they don't reach out and organize for union. Nurses are one of the most popular professions and hospitals and health care couldn't run without nurses. I have prayed for several years for nurses to stand up for themselves as well as their patients. If we all walked out the hospital couldn't function and the CEO's would run in circles not knowing what to do. They feel we are like stepford wives and will keep trying harder and jumping to their demands. The best union to become involved with is National Nurses United. It is run by nurses that are still working at the bedside that know what a patient acuity means. NNU will give you a voice for you and your patients. Please do yourself a favor and look up NNU and see all their affiliates in many different states. The time is now because patients are dying because of mistakes, falling breaking hips, not getting their meds on time, experiencing pain and suffering because of new staff that thinks the most important thing is to get your charting done and don't have the experience at the bedside. The seasoned staff is so burnt out they just can't believe what is going on and everyone is worried about getting fired. You tell me is that a safe environment for anyone? Let's get a backbone and stand up for our profession. You read about nurses on strike and who will take care of your patients. The hospital is notified well in advance of a possible strike and their are nurse out there that actually travel to fill in at facilities that are on strike so patients continue to get care. When you start making things public to the communities around the hospitals they back the nurses every time as they want their family and themselves to get exceptional care when needed. I would love to hear from other nurses what they think of how things are going in their hospitals. I am ashamed to say what hospital I used to work at as it has changed so badly. I wouldn't even want to be a patient there. A lot of the nurses were diploma nurses with many years of experience. We were like a family doing the best we could do. Most of them have left because of being written up or worried they would get fired so quit and can't find a job now. Just makes me cry because we used to be one of the best and by the way Magnet doesn't mean anything it is just a bunch of papers in a pile and a whole lot of money going out to the American Nurses Association who is a union of management and paper pushers. They need the money as a lot of union nurses have withdrawn form the AMA so they make up these awards and charge mega bucks. Also the American Hospital Association is also union. I was with a nurses rally in Chicago and marched to the AHA building. They locked the doors so several went and set in the street witched stopped traffic. Police came with their vans and plastic hand cuffs is was an awesome day to be involved in a protest and feel so strong. Then I had to drive back to realty in Rockford, IL. Just imagine is we all marched across the United States. Our patients deserve it and our self esteem needs it. Hope to see you out there one day.
Like any industry, for-profit entities are seeking to fill positions with the lowest cost employees that they can in order to maximize profits, and healthcare is not an exception. And yes, there are managers who are given mandates, against any sort of ethics, to cull their higher wage staff. This has become more onerous due to recent changes in Medicare and Medicaid reimbursements and penalties enacted under the Affordable Care Act, and hospitals are not seeing the reimbursements they once received. Hospitals are sold to corporations, merged into large systems, and shifts in management occur as a means to try and utilize the least amount of personnel to achieve the most profitability. Look at most job descriptions for hospital administration and they are seeking someone with project management experience in addition to a healthcare background.
No, this isn't the optimum for those of us who have worked on the floor for many years. We know that even the most sophisticated and expensive bed monitors and electronic health records system will never replace the intuition that experience brings in knowing when a patient with dementia is going to remove all lines in a Sundown episode and fall getting out of bed. Or that a diaphoretic episode warrants a call to the physician at 3 am even before the patient's vital signs signal a myocardial infarction has occurred and your experience already has a bed in ICU ready to take the patient. Your experience has saved many lives that new graduates will only obtain after years on the floor.
Are unions the answer? The U.S. Supreme Court says no in their Knox v. SEIU decision which granted employees the right to work without union membership in those states where unions held a largesse of healthcare employees. With the ANA, they also direct their funds to support those nurse legislators and PACS in a few states, and support them very well according to Influence Explorer (American Nurses Assn | Influence Explorer: Campaign Finance, Lobbying, Regulations, Federal Spending and Advisory Committees) which does little to help us with this issue of fair employment practices and staffing. I want my membership in an organization to help those causes I support for nurses, not to fund Californians for Fair Elections.
So what is the solution? In Texas, we have Safe Harbor when you and your patients are placed in an unsafe situation. Evoke it when you are at risk. There is a trend towards not-for-profit hospital systems which have better staffing ratios and higher patient satisfaction survey results on the HCAHPS Hospital Surveys. Then there is the power of your voice. Call and write your local legislators on their website submission forms, by email, and by writing them a letter to send by surface mail. Let them know your concerns as a healthcare provider and always, always vote. Apathy does nothing if you do not get out and make your voice heard. You can take action by contacting your representatives without fear of retribution from your employer to advocate for secure, safe working conditions for you, and for your patients.
Gooselady said:I am completely on board with the OP's assessment of the way things are.I am NOT clear on how experienced nurses are being 'forced out' for inexperienced, cheaper nurses. How is this happening? We need concrete explicit examples of how this is happening or no one will listen to us, it just sounds like rhetoric. And I KNOW it's not!!
I 'avoided' bedside nursing as long as I could, and then spent the last six and a half years doing acute care in a hospital (a good one, fwiw, that didn't noticeably put the crunch to expensive, seasoned RNs). Even so, our ratios went up while I worked there, in exchange for us to finally get CNAs and leave that 'primary RN care' fiasco behind us. Not all of us agreed adding CNAs in exchange for one or two more patients was a great solution for US, but it did make the patients happier.
I left bedside nursing in June and am now in private duty -- something I NEVER dreamed of doing (life is funny like that
). I've only been doing it for a couple of weeks but DAMMM is there a difference in having time to take exquisite, detailed care of your patient! A 12 hour shift may drag a bit but I go home physically tired but NOT emotionally exhausted and grumbling or feeling guilty. I almost want someone to pinch me. If I keep my back in shape I can do this until I'm too old to work
and I'm loving the littles I take care of. I know I'm 'new' to this and there's always a honeymoon period. I also can see past this honeymoon and into a much less stressed out and disgruntled future as a nurse -- far, far away from acute hospital nursing.
This is happening in subtle and not so subtle ways.
Past experience paperwork and excellent evaluations are suddenly "missing" (or they switch the way in which they are doing them, as to erase past evals). Unless you can "prove it" it never existed.
Older nurses are set up in a variety of ways--some of which are going on to take on debt to continue their education, only to be told that the positions available to them as "new grads" pay them sometimes up to 7-8 even 10 dollars less than their former position, and they lose seniority. They are told that "no one" is "available" to "precept" them in their new role, and not offered a position outright. In the case of LPNs, this is a "take this or see ya" approach to their job security.
Nurses are complained upon, set up to fail, blamed for things out of their immediate control--and are written up, warned, then let go for these things. For any number, literally, one week all is good, staff is good, morale is good, and the next it is the epitome of the ax falling, and there's too many patients and not enough nurses.
This affects a lot of nurses, and most affected are the nurses who were educated by and hired at the hospital in which they received their education. 20 years later and they are not interested in keeping you. And the comment from a pp regarding the hospital school still churning out ADNs--they get more federal bucks for their bang with this--each ADN student applies for federal aid, and it is paid to the school. And they can keep going and going with this every 2 years with a fresh crop--and no guarantee for a job (which is somewhere in the fine print).
The nurses who are being hired to manage are mostly a little "off" meaning they have their own issues which become apparent when they are passive aggressively demanding that nurses do more with less staff. Bedside nurses are so taken aback by the style of "let's let all of my personal problems my whole life become my 'management style' tactics" that when the stun wears off the job hunt begins.
There could be a full time job in how to clear out a unit successfully, and start a new with all cheap labor, nurses who are eternally grateful for crumbs, no expectations other than to do as one is told. Period, end of story.
Corporations are run by business people. Nurses are a unit of cash out. A liability. And the more seasoned ones FAR too questioning for anyone's liking.
It is a sad state of affairs.
Oh, and as a complete aside, the "knowing" wink-wink, nod-nod of "ohhhh don't listen to the grumblings-they are resistant to CHANGE, they are psychologically scarred from being told that they have to get more EDUCATION--can you believe it?!? Like it is a BAD thing...." They make you feel paranoid, and then you and everyone new around you tisk-tisks and sighs......
One is not paranoid when they are after you......
katfish67 said:I have been a nurse for 25 years and have seen the same thing. I was working home health & hospice and was the ONLY nurse with any experience. I was laid off because I "was the highest paid LPN" they had (I wasn't making that much believe me) and I said "I would hope so I have 20 years experience", all the other nurses including the RN's were fresh out of school...so I had to go because with experience I "cost" more. Even before I was laid off I saw the real cost of the inexperience to the patients we had and it was sad. For me the hardest thing about nursing is...working for a business .
And businesses don't care about loyalty. Or passionate pleas to keep one's job--all fall on deaf ears, they don't think like that.
However, if one were to go into a "meeting" and negotiate with them that due to the sad state of affairs, you would take half your pay and no benefits to keep your job---LPN would not even be an issue. Heck, find 2 more of your LPN friends in the same mindframe, and yes, folks, we have a ballgame!!
I, for one, have been made to feel paranoid and ineffective for being loyal to the same facility for over 20 years. Demoted without a blink of an eye. And told that should I go and get a BSN, (the entry level they are deeming appropriate) they would "see" if there was a job available to me, however, at a huge pay cut, and complete loss of seniority.
No thanks, for a pay cut such as that, I would rather just answer the phones or be a "greeter" or something a lot less stressful.
Secretperson said:Thanks for the welcome, I did not intend for this to be a debate:)I am a realist my motivator is my family, please understand at this point in time in society if someone says "I do this because of a calling" or "I'm in it for the traditional sense of nursing" they are either well supplemented by their spouse, still living with their parents, or delusional. Tradition does not pay the bills its a cop out used over and over to justify a disappointing career choice. Own your worth for crying out loud.
You say I'm lazy for stating that a generation of nurses. neglected to validate their career for future generations .... Please... I consider myself atypical from a nursing standpoint. I am not a victim of circumstance, and I actively support change.
if you honestly believe that it's simply about a calling, tradition, or its what you're meant to do, give me your paycheck for two weeks and see who's more satisfied:)
and finally, some of my best preceptors were LPNs so by no means am discounting experience or degree level.
And 50+ year old LPN's who need to go to 4 years worth of college, then back for a masters is either being supplemented by their spouse, living with their parents or delusional.
20+ years ago nurses were HIRED on their sense of loyalty, or traditional sense of nursing, especially in small community hospitals and LTC facilities. The motivating factor was the patients. When the motivating factor became money, then a sense of a calling or tradition was made to feel silly, senseless or crazy. At one time, we were highly rewarded for these traits.
They DO keep LPN's on long enough to train highly educated nurses to do the clinical aspects of their jobs--which is really ironic, no?
Resbug, what a great idea. The act alone would, maybe, scare some administrators.
Every single word of this article is TRUE. Nurses work to the point of exhaustion, yet get hassled when they call out.
People responsible for placing admissions have no idea or care about acuity or staffing.
Nurses are pressured to down size staff based on a current number occupied beds and then 10mins later get 5 admissions to the floor, with a response of, oh well.
The public still foresees nurses as servants. There still is a lack of understanding and therefore respect as to what nurses truly do.
In my last job, some Doctors treated nurses like idiotic children causing more annoyance then assistance. I've seen Doctors make nurses cry. I've had the phone slammed in my ear when calling to ask for an order, or to report an issue with a patient. When reporting a Doctor for inappropriate behavior, I've been told, why did you do that? It will just make matters worse.
Unfortunately, nurses can be there own worse enemy. There is a lot of catty behavior and backstabbing within our own profession. How many of us have been involved in arguments over assignments and admissions?
How many of us have been eating lunch, or having a break (if these things truly exist) and the minute a co-worker leaves the break area, the gossip and smack talk may begin about a co-worker we were just sharing a coffee with?
I must also say, I have worked in some of the best hospitals in the country and some of the most poorly run. These scenarios while exist, are not the norm everywhere.
I am not currently working as an RN due to a cross Atlantic move. Despite all the bad, I truly miss it. I miss the amazing and brave patients and families I have met through the years. I miss the patients who's hand I have held while they are near death. I miss collaborating with Doctors who understand our importance in patient care.
I am in a position, once I get registered, to be in a less stressful situation. I fear for my fellow nurses in the States, esp the wonderful women and men I worked with before my move. Truly hard working, dedicated people under the thumb of a very poor administration. Not only my colleagues, but the patients deserve so much better.
Until we can all come together in a united front of health care professionals, we will never be able to persevere and gain control over our own and our patients health and safety.
I've worked in hospitals for over 20 years now. I've noticed (in my limited experience) that hospitals that are owned by Fortune 500 companies, whose primary reason for existence is to make money for their shareholders, simply SUCK! The equipment is shoddy, they do not value having an educated nursing workforce, nurses have little voice in the governance of the facility, and nurses are literally worked like dogs-except that most compassionate people will actually let a dog drink some water, eat some food, and have time to "do their business." I'm curious to know...what are other nurses' experience with for-profit versus not-for-profit facilities? I've recently started working at a catholic hospital. Although I'm only in my third week there, I've been exceedingly impressed with their thorough orientation process, and exceptional hospital education department.
This article needs to spread! As for remaining anonymous, I understand! I can tell you what happens when you advocate for what's right! I am still fighting a corporate-owned facility that tried to bury me. Nurses by their very nature are fighters! I am no exception! I fought for my license, despite the allegations waged against me! My attorney said at the very best I should prepare myself for suspension. I said I would not accept that! I did nothing wrong! I went through every piece of paper the Hospital "provided" to the Board of Nursing, and found their mistakes! The mistakes that would lead to retaining my license, and enough to warrant investigation via the EEOC! I encourage all nurses to visit the EEOC's web site, it is a lengthy process, but well worth it! I guess my point is, DO NOT STOP BEING THE ADVOCATE! These corporations will never be properly reimbursed by Medicare/Medicaid if the "level of care/satisfaction is not met" we all know this, I am considered a "new nurse" but I worked acute care right off the bat, loved my job and lossing it was a grieving process I have not yet complete. Therefore I will not stop fighting!
Hospitals need to remember the patients don't come there for the medicine or doctors. They can go see the doctor at his office and take medicine at home. They come to the hospital to see the nurses and aides. They won't someone to take care of them during thier time of vulnerability, when they are 2 sick to take care of themselves. They come to find compassion, someone to take care of them, for the basic levels of maslow hierarchy of needs.Nurses and aides are the true backbone of a hospital, without them or limit them and you are setting yourself up for your demise. W
tokmom, BSN, RN
4,568 Posts
I heard a HR person call the nurses FTE's. We aren't even human to them.