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. Nurses General Nursing Article

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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

I am very familiar with the aforementioned terms. Exactly my point. When you say "something bad happens" I am assuming you are in part referring to a patient being admitted/readmitted to a hospital. It has to be measurable for it to hold a financial penalty. This payer structure had good intent however will end up costing people a lot more than just money in the end.

I am very familiar with the aforementioned terms. Exactly my point. When you say "something bad happens" I am assuming you are in part referring to a patient being admitted/readmitted to a hospital. It has to be measurable for it to hold a financial penalty. This payer structure had good intent however will end up costing people a lot more than just money in the end.

Specializes in Med/Surg, OR, Peds, Patient Education.
Mommalee said:
It's not just in hospitals, either. Long term care is what a med/surf/ortho floor was when I was a mere nursing student. They are cutting experienced nurses left and right and some of the staff/patient ratios in some facilities should be illegal. Unions are probably the only way to start to fix this mess.

I could not agree more. Unions in this country have been severely weakened over the years, and they helped, not just the hourly workers, but the exempt workers, also. My husband worked for GE, prior to retirement and benefited from the benefits that were secured by unions for their hourly employees.

That being said, some unions will "play both ends against the middle," some will be in the pockets of the corporate elite. Such may be the case of the Massachusetts Nurses' Association. We never did receive the necessary staffing in all units. Excellent staffing was secured in the CCU and ICU, but not on the Med/Surg Units, MBU, or what was left of our Pedi Unit, and those units have dangerously low staffing.

In fact this hospital in western MA had the only Pedi Unit in the area, and it has been crammed into a small area, with the playroom in the same room as the kitchen, and this is not safe! At first they had the isolation room, sans an ante room or bathroom. Finally that was revised. Since Pedi is a secure unit/locked unit, having a restroom for nurses should have been a given, as often RNs work alone. The RNs working in that unit had to fight to have a restroom in the unit. MNA was of no help, and I feel that their hierarchy may be hand in hand with management. Perhaps SEIU would be a better, stronger union

What ever union you and your coworkers choose to join, be sure that the union works for you and your coworkers. Management does very well for themselves, without any union representation.

I read this article and it makes me sad for many reasons. I've been a nurse manager for over 15 years and have never been asked nor have I ever fired a seasoned nurse for a newer nurse for money or any other reason. I must ask, are your open positions posted? Are your managers enforcing the institution's attendance policy? Do your shared governance councils hold their proper, prominent positions in your institutions? Are your managers accessible?

We live in a new world where the quality or our care matters. Process improvement will lead to better working conditions. You and your peers have the answers. This article was written by an expert problem identifier. I didn't see many concrete ideas for improvement. Experienced nurses have the answers to better teamwork and outcomes. Never doubt the power of contributing what you know as well as what you do everyday.

Regarding unions: Ask yourself if your pay scale is competitive. Ask yourself if your benefit package is comparable. All that you will ensure by traveling that road is that you will lose pay to dues. Nothing else is a given. Unions will not negotiate ratios for you. Legislatures address this (only California has legislated rations and it's a disaster there).

The author is this article is clearly frustrated. Take action. Become part of the solution. Be a leader, a mentor, a change agent. Be an example for the rest of your team.

Specializes in MDS RNAC, LTC, Psych, LTAC.

Amen I am an MDS coordinator and basically this is what our 2 hour stand-up consists of.

kbrn2002 said:
This is a big reason why I have zero interest in a management position, at least where I work. I've been in those meetings while acting as manager, back in the days when I actually felt it was an honor to be asked to cover the position. Well, the meetings are really just one big long ***** session where everything and everybody is discussed and nothing is accomplished. It's amazing how much time management can waste just complaining about whoever the manager was that didn't make the meeting.

And yes, they do spend an inordinate amount of time looking for ways to place blame on the floor staff for every complaint that is addressed. I use to wonder how often my name came up in those meetings, now I find I just really don't care. If they want to find a way to get rid of me because I've been there too long, they'll find a way.

Nothing will be done to correct the many problems facing today's healthcare system unless more healthcare professionals are willing to speak out so that the general public has the truth. They then must be angry enough to put pressure on elected officials to push for changes. Today short-term and profit motives have taken precedence over patient care and safety and is so rampant that managers, CEOs and nursing organizations barely try to hide it anymore The BSN and Magnet Status pushes are both firmly rooted in fraud and are prime examples of this.

The BSN push is simply a ploy to try to counteract the drop in enrollments in four year colleges and universities:

Here's what they're afraid of: 200 college and university campuses have closed during the last 10 years due to decreasing enrollments as baby boomers aged" (Nursing Spectrum, Jan. 9, 2012). After 1964, not as many children were born as in previous post-WWII years. Notice how it was only a year later in 1965 that nursing leaders, many of whom were affiliated with four year institutions, tried to push for the Bachelor's to be the entry level into the nursing profession. They knew the numbers meant fewer people to have kids that would eventually enter the school systems. So the only way to counter this is to have someone publish a flawed, unreplicated and outright falsely contrived study saying hospitals with more nurses that have BSNs experience lower mortality rates and provide better care. In this way, they will try to force nurses in the 40s and 50s with well over 20 years experience to have to go back to school. It would also help to render the lower cost options; community college and diploma RN programs obsolete so that many would have to close thus leaving prospective nursing students no choice but to have to attend the much higher priced four year institutions This would increase enrollment and revenue for universities, lending institutions, book and supply companies, hospitals that lease space to schools offering on-site RN-BSN programs as well as nursing organizations that get kickbacks for promoting the necessity of the BSN. Remember, with the necessary prerequisites, it would also increase enrollment in many of the non-nursing classes as well.

In the article, "Hard Times on Campus - Declining Enrollment Means Declining Revenue For Colleges" (Philadelphia Inquirer, Jan. 31, 2016), many area colleges and universities are experiencing hard financial times due to decreasing enrollments. Schools are a business just like anything else; and their business is to sell courses and programs and keep a steady stream of customers flowing through their doors.

If enrollments continue to decline, it would result in the downsizing of academic departments and possible layoffs. Many would lose their nice cushy jobs in the world of academia where they had planned to coast to retirement. And finding another cushy, full-time job in the contracting university market would be highly improbable. "For the past 40 years, institutions of higher learning have been relentlessly replacing professors on the tenure track (the ones with decently paying jobs and fringe benefits) with contingent faculty, typically part-timers, who cost a whole lot less" (The Weekly Standard, Nov. 16, 2015).

As far as Magnet Status goes, it is a money making concept dreamed up by the ANA which is marketed to the public in much the same way as the "new and improved" product marketing ploy was used in the 70s. If you go the ANA's website and sift through the pages corporate jargon, you'll find that the minimum standards a hospital must have to meet magnet status are the same as what they would need to pass a JACHO inspection. It is then marketed to the public as an assumption that if a hospital meets those standards, it must be a great place to receive care.

This is a win-win for both sides. Hospitals pay the ANA thousands for Magnet Recognition. Once the check clears and the hospital is granted magnet recognition, it then qualifies for large government subsidies. Meanwhile the majority of nurses stated that after the dog and pony show is over and the inspectors leave, hospitals go back to the same practices of short-staffing, poor management and no dispute/resolution process for its nurses.

The BSN and Magnet Status scams have many players and angles. Those above are just a few I have promised to bring to the public one way or another.

NurseDiane said:
What do you think "quality measures" and "meaningful use" is all about? Providing the least amount of care possible without injuring or killing anybody. If doctors don't order diagnostic testing & the patient ends up being okay, they get a bonus. But, if the doctor doesn't order the testing & something bad happens, they get penalized. The names of the Medicare "initiatives" make it sound like the government is monitoring what is going on to make sure people get "quality care". What it really means is that the government is monitoring how much doctors are spending on care & hoping nothing bad happens. That's all it is. MONEY.

I accompanied a family member who receives Medicare to a hospital ER (of note, my family member had been discharged from an inpatient hospital stay within the previous thirty days, so admitting them again as an inpatient within thirty days would result in the facility losing money) where they presented with sepsis symptoms: fever; tachycardia; elevated blood pressure (for them); chills; hot flushed skin; sudden onset of severe weakness; feeling very ill. After tests and the first few boluses of IV fluids and the first round of antibiotics, with the above symptoms still present the ER physician was very keen to discharge my family member home, and had even started the discharge paperwork, and the nurse said briskly that she was going to bring my family member the discharge paperwork to sign (she refused to look at me while she told us this). I told my family member to refuse to sign the paperwork, and my family member agreed, saying they knew they were far too sick to go home. The ER physician ended up changing their mind and admitted my family member to a monitored unit. My family member spent three days as an inpatient receiving IV fluids and antibiotics. While being this sick and being hospitalized was a hugely stressful experience for my family member, the experience of the ER physician eagerly trying to push to discharge them when my family member had only just begun to receive treatment for sepsis and was still unstable was highly stressful and unpleasant for both of us.

I have read other nurses express on this forum how impotent they have at times felt in their ability to advocate for and protect their own family members when they are in hospital, and this has been my experience too, and I am an RN and have a number of tools at my disposal in order to enable me to be effective in these types of situations. If nurses feel this way it is no surprise that members of the public have even more difficulty.

This doesn't just happen in hospitals. With the new healthcare system as it is, docs in general are being paid less. When/if you go to an Ergent Care Center or other type of 'walk-in' clinic, if the doctor orders a test for you, that is that much less money that they make. They therefor, don't order tests as they had in the past. It only means less money for them.

I hear it said in the news how this or that agency thinks that docs order too many unnecessary tests and then try to tell the public how useless the tests are, but then turn around and blast docs for over-prescribing meds like, oh, antibiotics. Seems like a severe catch 22. In these cases, you have to INSIST on care. The scary part is, most wouldn't know where to begin to tell the docs what they need. That is why they go there in the first place.

It's becoming scarier every day.

Specializes in Nurse Scientist-Research.
avengingspirit1 said:

The BSN push is simply a ploy to try to counteract the drop in enrollments in four year colleges and universities:

So the only way to counter this is to have someone publish a flawed, unreplicated and outright falsely contrived study saying hospitals with more nurses that have BSNs experience lower mortality rates and provide better care.

First of all, I'll start by saying that you seem extremely driven to defend and advocate for your patients and that is to be commended. You also advocate for a lot of injustices in the nursing profession that I totally agree with.

I have however, kind of always had a problem with your contention that BSN push is ONLY motivated by greedy educators.

I encourage you to explore literature on a regular basis. Of course I know you say that the evidence is bought and paid for by the interested parties, but what standard do you use to support arguments that you do accept? As long as you stick with anecdotal (though passionate) stories, you are unlikely to get more than a smattering of acknowledgment. Here are some newer replications of similar studies associating educational level with patient outcomes. I'm not including the ones about associations of educational level with nurse outcomes. Yes, some of these studies are by the same authors that cause you to froth at the mouth, but they are published by a whole different set of Journals, so, a different set of peer reviewers. Some of these however, are not written by the authors you have continuously disparaged, though I'm sure they all know each other and conspire to ruin the lives of nurses and patients through their research. Oh, and sorry if you don't have library access. If you really really want to, I can arrange to get you a full copy if you are interested to read more than just the abstract that's available on Google Scholar. But please stop writing that Aiken's studies have never been replicated since the early 2000s.

I mean, we could get into an abstract argument on the constructivist nature of our reality and whether any study is truly valid past the date of its occurrence, as all conditions change and every individual brings their own uniqueness to the situation that could never be quantified by a list of demographics, blah blah blah. . .

Can you tell I've been concentrating on qualitative research for the last 2 semesters?

Kutney-Lee, A. & Aiken, L.H. (2008). Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness. Psychiatric Services, 59(12), 1466-1469.

Kutney-Lee, A., Sloane, D.M. & Aiken, L.H. (2012). Increase in the number of nurses with baccalaureate degrees is linked to lower rates of post surgery mortality. Health Affairs, 32(3), 579-586. DOI: 10.1377/hlthaff.2012.0504.

Yakusheva, O., Lindrooth, R. & Weiss, M. (2014). Economic evaluation of the 80% baccalaureate nurse workforce recommendation: A patient-level analysis. Medical Care, 52(10), 864-869. DOI: 10.1097/MLR.0000000000000189.

Blegen, M.A., Goode, C.J., Park, S.H., Vaughn, T., Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. JONA: The Journal of Nursing Administration, 43(2), 89-94. DOI: 10.1097/NNA.0b013e31827f2028.

LockportRN said:
This doesn't just happen in hospitals. With the new healthcare system as it is, docs in general are being paid less. When/if you go to an Ergent Care Center or other type of 'walk-in' clinic, if the doctor orders a test for you, that is that much less money that they make. They therefor, don't order tests as they had in the past. It only means less money for them.

I hear it said in the news how this or that agency thinks that docs order too many unnecessary tests and then try to tell the public how useless the tests are, but then turn around and blast docs for over-prescribing meds like, oh, antibiotics. Seems like a severe catch 22. In these cases, you have to INSIST on care. The scary part is, most wouldn't know where to begin to tell the docs what they need. That is why they go there in the first place.

It's becoming scarier every day.

I have read that today some practitioners are not thinking of patients as individuals, but are instead thinking of patients as "populations" and are approaching their care from this perspective. This is quite horrifying to me as statistics apply to populations not individuals, and should only be used to guide individual care. Yet, we (my family) have personally experienced this, and from health care providers who have even stated to us that "broad statistics don't apply to individuals and should only be used to guide care" just a few years earlier. You are right that one does have to insist on care, in my experience, at all levels/settings.

The only saving grace I can see is that in court The Standard of Care is still The Standard of Care.

 

On 3/30/2016 at 2:46 PM, TiffyRN said:

First of all, I'll start by saying that you seem extremely driven to defend and advocate for your patients and that is to be commended. You also advocate for a lot of injustices in the nursing profession that I totally agree with.

I have however, kind of always had a problem with your contention that BSN push is ONLY motivated by greedy educators.

I encourage you to explore literature on a regular basis. Of course I know you say that the evidence is bought and paid for by the interested parties, but what standard do you use to support arguments that you do accept? As long as you stick with anecdotal (though passionate) stories, you are unlikely to get more than a smattering of acknowledgment. Here are some newer replications of similar studies associating educational level with patient outcomes. I'm not including the ones about associations of educational level with nurse outcomes. Yes, some of these studies are by the same authors that cause you to froth at the mouth, but they are published by a whole different set of Journals, so, a different set of peer reviewers. Some of these however, are not written by the authors you have continuously disparaged, though I'm sure they all know each other and conspire to ruin the lives of nurses and patients through their research. Oh, and sorry if you don't have library access. If you really really want to, I can arrange to get you a full copy if you are interested to read more than just the abstract that's available on Google Scholar. But please stop writing that Aiken's studies have never been replicated since the early 2000s.

I mean, we could get into an abstract argument on the constructivist nature of our reality and whether any study is truly valid past the date of its occurrence, as all conditions change and every individual brings their own uniqueness to the situation that could never be quantified by a list of demographics, blah blah blah. . .

Can you tell I've been concentrating on qualitative research for the last 2 semesters?

Kutney-Lee, A. & Aiken, L.H. (2008). Effect of nurse staffing and education on the outcomes of surgical patients with comorbid serious mental illness. Psychiatric Services, 59(12), 1466-1469.

Kutney-Lee, A., Sloane, D.M. & Aiken, L.H. (2012). Increase in the number of nurses with baccalaureate degrees is linked to lower rates of post surgery mortality. Health Affairs, 32(3), 579-586. DOI: 10.1377/hlthaff.2012.0504.

Yakusheva, O., Lindrooth, R. & Weiss, M. (2014). Economic evaluation of the 80% baccalaureate nurse workforce recommendation: A patient-level analysis. Medical Care, 52(10), 864-869. DOI: 10.1097/MLR.0000000000000189.

Blegen, M.A., Goode, C.J., Park, S.H., Vaughn, T., Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. JONA: The Journal of Nursing Administration, 43(2), 89-94. DOI: 10.1097/NNA.0b013e31827f2028.

I stand by everything I wrote. As I said the BSN and magnet status pushes have many players and angles; not just "greedy educators" that fear losing their cushy jobs in the fantasy land of academia.

About every 2-3 years since the original study, one of the authors or their colleagues rehashes the same garbage, repackages it, then has it published again to give the BSN push a booster shot. Once they're convinced they've accomplished the BSN push scam, they're hire someone to publish a "study" saying hospitals staffed with more MSNs experience lower mortality rates. What a bunch of mindless robots many nurses have become.

I have consulted many sources outside of nursing publications, including nurse recruiters themselves, to know for a fact that the BSN push is one moneymaking scam that provides no benefit to nurses or patients.

And for the record, it is far more likely for research claims to false rather than true. Any heap of data can be sifted and manipulated to show results that are "statistically significant"; especially if there's a lot of money contingent upon those results. And who was the original study and the booster shot studies supposedly peer-reviewed by.

Specializes in Nurse Scientist-Research.
avengingspirit1 said:

And for the record, it is far more likely for research claims to false rather than true.

I just can't . . .

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