Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

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.

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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.

An Open Letter to Hospital Administrators

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

Careandhope said:
[sNIP] I feel it is imperative to form a national nurses union, so that we can have a strong voice to advocate fair and safe labor practices, and regulate administrative tactics used to intimidate nurses and ancillary staff. United we stand, divided we fall. Another point that needs to be made is that countries who have socialized medicine are not facing what we here in America are having to deal with. Being patient focused and not dollar focused should and can be what makes all the difference in our country.

You mean like National Nurses United?

My career puts me into contact with many clinicians from around the world. The grass is greener is very pertinent.

Secretperson said:
But do not get pissed when you lose your job because you never secured it through improving your worth and creating a reason or need to keep you employed.

Please, if you would, define "improving your worth". When I outline my personal experience, perhaps you will understand why this position confuses me.

I improved what I imagined was my 'worth' to my organization by volunteering, serving committees, receiving special training, being a mentor/resource/clinical lead, accepting the heaviest patient loads willingly, getting in on the "big EMR" implementation project from the ground up (while being the oldest member of the team!), and eventually becoming a Super-User of said EMR system, supporting and training staff of all departments "on the rollout". After 16 years, my 'worth' was valued with a pink slip, for a trumped-up 'offense', and I was blackballed out of acute care in this entire area (yes, HR reps do talk to each other!)

If, by some erroneous idea in my head, you mean getting an MSN to prove my worth, you should know that by the time I was unceremoniously dumped, I would have to spend my entire retirement savings to obtain the prize. My disabled spouse requires care and feeding, and it is likely I may require what's left in my retirement accounts to do that.

That said, I am grateful to all for this discussion. Things are no better in LTC than they were in the hospital, and we nurses are paid much less. However, I am uncertain if unions are the answer. I recall the Several Years War in CA for staffing ratios. It is unlikely our system could become much more broken than it is, but if it does, perhaps lawyers will be around to pick up the pieces.

I've toughed out a lot of changes at the bedside, and I pray we all have the strength and wisdom to continue.

BGBDMOM said:
Although I do not doubt your story, what I take issue with, consistently, is that ANYONE would sit and take that BS. When you fight back with a veracity and facts and Standards of Care, believe me they are VERY VERY careful how they approach you. Sadly, too many women just sit and take the abuse. And, to this day, 90% of Nurses are women.

The reality is that some employers are able to intimidate their employees into passivity through implicit/explicit threats of termination or other retribution. Employers often seek out employees who are not in a strong position to confront or challenge them, and often seek employees who cannot just follow their principles and quit or easily find another job if the work conditions constitute a hostile work environment or are otherwise unacceptable to them. Who might these employees be, in the 21st century, who might be less powerful and have to accept BS because they are afraid of losing their jobs?: How about single mothers and people with significant financial obligations/families to support, and people without other sources of income/support systems?

It is one thing to risk the consequences of your actions when you do not have other people depending on you for their food, shelter, medical care, etc., or when you have a financial support system. It is another thing entirely to do this when other people are relying on you to provide for them, or when you have no other financial support, cannot easily find another job, and are providing your own housing, food, clothing, medical care, etc.

Do you have a greater understanding now of why some people "sit and take that BS?"

Susie2310 said:
Who might these employees be, in the 21st century, who might be less powerful and have to accept BS because they are afraid of losing their jobs?: How about single mothers and people with significant financial obligations/families to support, and people without other sources of income/support systems?

Tru dat. I'm still uncertain if it was my age, my wage, or my disabled spouse's drain on the corporation health plan that got me canned.

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

Needless to say, eloquently stated and I do understand why you would remain anonymously, although I applaud you and in my book your a hero for giving a voice to the rest of your colleagues. Having said that, I foresee this coming long before it became a reality and I fought for my colleagues, in endless meetings to death ears. At times like these I strongly believe the public need to fight for us if they don't, we just have to move on and realize what we gave them was more than they were willing to give in return. Lastly, I have always said that sometimes we nurses expect more from others because we would be willing to do the same for them. Wishing you and all seasoned nurses the best in their future endeavors...Aloha~

BGBDMOM said:
Although I do not doubt your story, what I take issue with, consistently, is that ANYONE would sit and take that BS. When you fight back with a veracity and facts and Standards of Care, believe me they are VERY VERY careful how they approach you. Sadly, too many women just sit and take the abuse. And, to this day, 90% of Nurses are women.

I am not sure you are at the frontline of this issue based on your comment...Challenging as you mention only leads to being escorted out the door and no hope of being hired down the road because in many areas the monopoly in healthcare will prevent any hope of return! We are not allowed to speak our minds even if it is for the good of the patient!

For the last decade I have heard many nurses voice their concern about the nursing licensure not being regarded or respected as a profession. So nursing leaders began to compare educational requirements to other so-called professions and found that the minimum educational requirements for nursing were equivalent to a trade not a profession. So the tide began to shift in a direction to change not just the educational requirement but also the culture of nursing.

Now as I read through this thread and view responses to other posts (including my posts) two major preconceived opinions of nursing are unfortunately validated. Most nurses are jerks to other nurses, and most nurses are resistant to change.

The RN license knows no boundary, yet many people assume the minute you use the terms education or "bedside" the conversation applies only to acute care or educational areas. Education and expertise combined is key for a profession, For example healthcare consultants, pharma sales, HHS, and DHS all employ RN credentials for clinical expertise, and you can bet your *** experience alone did not qualify these RN's for their roles.

Look get mad at me and others who want nursing to be a respected profession. Go ahead and continue to use the victim mentality of how life is too difficult or how you don't have the money to go back to school. Damn that RNs have had the easy pass for years with a tradesmen education and mentality. Sacrifice has been made I get that, but stop discounting the sacrifice others are making right now. You cannot and will not get the days of old back, so stop being mean and start being supportive and embrace what will occur regardless of your complaining.

Specializes in Geriatrics, Dialysis.
NFuser said:
Tru dat. I'm still uncertain if it was my age, my wage, or my disabled spouse's drain on the corporation health plan that got me canned.

Honestly, it was probably the combination of these. You may have been OK with one, maybe two if you are a valued employee but with that trifecta of things that cost the employer money...yeah, I'm sadly not surprised they found a trumped up excuse to let you go.

I agree completely with what the OP has written, but I do not believe for a moment that the OP's post will result in any improvements in working conditions for bedside nurses and for improved quality of patient care. The objective of health care delivery is to provide the minimum level of service legally possible for the lowest possible cost, while charging as much as possible. This was true twenty years ago. When a specialist who works for a large medical group saw my family member in the hospital and told my family member and myself that, "We had some problems with the nurses and we had to replace them," I recalled a mass recruitment day for new nurses at the hospital some time earlier. The nurses taking care of my family member were young, conscientious, and caring, but didn't appear to be particularly experienced. This tells me that administrators, physicians, and other selected staff members benefit from the status quo.

Unless one is trained in nursing or medicine, it is very difficult to evaluate the quality of the care one is receiving, especially when one is very sick, and even more difficult to do anything about it when one is lying in a hospital bed fighting for one's life. So a pleasant, smiling, caring demeanor without much clinical experience is sufficient to lull people into believing they have actually received quality care from an experienced staff member.

Secretperson said:
Look get mad at me and others who want nursing to be a respected profession. Go ahead and continue to use the victim mentality of how life is too difficult or how you don't have the money to go back to school.

Respectfully and in good faith, if subjecting myself to abject poverty to obtain an MSN causes me to consider those who don't "victims", I have no desire to do so. I happen to love bedside nursing, and I am danged good at it. A career as anything else (and yes, I have tried other areas of nursing) holds no appeal for me, and therefore, no satisfaction.

Secretperson, I forgive you your perception that our mentality is responsible for our lot. I have forgiven those responsible for my journey away from the hospital, and will, with my last breath, respect and honor those nurses in the trenches. That said, I joined this discussion to express my solidarity with those experiencing this, and ALL bedside nurses; not to engage in a philosophical discussion of victimization, nurses eating their young, and resistance to change.

As GitanoRN said, how could you NOT see this coming. It had happened to many other industries, starting with manufacturing jobs going overseas to cheaper labor. This is even happening with healthcare too. Digital radiology images are sent to Israel and India for reports. Physicians and nurses are brought in on H1B visas.

Next, older workers who were paid much higher salaries were downsized and replaced by younger workers. This hit financial, marketing, sales, and other white collar workers hardest. Then pensions (defined benefit) were replaced with 401ks (defined contribution).

The last thing to go was healthcare. Employees had to take more of the costs for less of the benefits. Companies and municipalities looked to bankruptcy to shed the burden of retiree benefits. Look at Detroit! Even the US Post Office is not imune. Look at the cut backs. Their business model was unsustainable.

The last bastion are teachers' unions. They too are being required to contribute to healthcare. People are pushed to the brink, cannot afford any more increases in school taxes, so change is starting. Why would anyone think that the nursing profession is immune? Historically healthcare has played "saving human lives" card and nobody questioned that.

In 1972, the Ford Pinto case estimated the value of a human life at $200,725. (Here is the 1977 Mother Jones Article ) Today administrators make every decision based on a cost-benefit analysis: closing facilities, purchasing new equipment, and staffing levels. This neither justifies or solves the problem, but simply explains it.

The Pinto case started with public support that led to civil and criminal actions. On page 27 of the comments, I mention Tenet, HCA and HMA being just three examples of corrupt for-profit hospitals that had civil and criminal actions. (Source:Health Beat Blog) I also mention getting public support (as did others here).

Again, I really don't have an answer, but maybe I put the problem in perspective.

Susie2310 said:
I agree completely with what the OP has written, but I do not believe for a moment that the OP's post will result in any improvements in working conditions for bedside nurses and for improved quality of patient care. The objective of health care delivery is to provide the minimum level of service legally possible for the lowest possible cost, while charging as much as possible. This was true twenty years ago. When a specialist who works for a large medical group saw my family member in the hospital and told my family member and myself that, "We had some problems with the nurses and we had to replace them," I recalled a mass recruitment day for new nurses at the hospital some time earlier. The nurses taking care of my family member were young, conscientious, and caring, but didn't appear to be particularly experienced. This tells me that administrators, physicians, and other selected staff members benefit from the status quo.

Unless one is trained in nursing or medicine, it is very difficult to evaluate the quality of the care one is receiving, especially when one is very sick, and even more difficult to do anything about it when one is lying in a hospital bed fighting for one's life. So a pleasant, smiling, caring demeanor without much clinical experience is sufficient to lull people into believing they have actually received quality care from an experienced staff member.

I have a hard time being hopeful as well. I think the only way to make headway (if any) is to raise awareness of the general public. There is so much emphasis on patient satisfaction now and one would think that a big part of the discourse would be patient safety as it relates to appropriate staffing. When the agencies that are tasked for looking out for the public (funders, licensing and accrediting agencies, professional associations) do not seem to advocate (that strongly anyway) for appropriate staffing, I can only see that a push from patients/"consumers" might make healthcare agencies change