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
First, the data pool for the study on BSN staffing and mortality rates was used for an earlier study about staffing levels and mortality. The information was just copied onto another template for the BSN study. The authors then said they would simply factor out the results from first study for the subsequent study. BSNs were lumped in with MSNs and nurses with doctorates while ADNs and diploma nurses were lumped together. We don't know how many nurses were originally ADNs who went back to get BSNs. Those nurses would by default have more experience from working as ADNs before they got their BSNs. This factor alone seriously compromises the study's validity and produces flawed conclusions as it does not simply target a population of ADNs and BSNs.
Also, the study only applied data that was manipulated 133 times (according to the authors' own admission) to hypothetical situations, not real conditions. They ran the data through a logistical regression model to see what might happen in a hospital if it had a 10% increase of BSN nurses. They did not even attempt to compare the relative levels of RN education in real hospital situations; which is supposed to be the reason for the study in the first place.
They then say they adjusted for age differences of the patients that died, but in another analysis we read that if there is a very strong statistical relationship between two variables you do not adjust for it , you would analyze it into the data. The hospitals that had the higher mortality rate had a higher mean pt. age. When the data was analyzed into this scenario the death rates in her data equaled about the same as the general population.
Finally, the criteria for the inclusion of certain data for the study was based solely on the discretion of the so-called†‘experts' creating the study. And all those 'experts' were backed by the AACN (American Assoc. of Colleges of Nursing); an organization committed to BSN-entry (for obvious reasons) and an organization which maintains a fierce defense of this study on its website. Nothing bias here, right!
These are just but a few of the many flaws in the so-called landmark study that was idiotically accepted carte-blanche as the Gospel truth. There was no objective search for the truth. The only purpose of this "study" was to bolster a belief along with bolstering the revenues of all institutions involved with supporting and backing it. I only take back one thing. Forget putting pressure on lawmakers to change policy. Giving people the truth so they turn institutions that try to gain from this stupid propaganda is the answer. And that includes Magnet Hospitals that pay the ANA thousands of dollars for a fake seal of approval. It has been my experience that institutions fear bad publicity more than anything else; because bad publicity translates to revenue loss.
I'm going to give a different perspective on the Bachelor's verses Diploma. Take educators of children in the last 80 years called teachers. 80 years ago you had a Diploma educated teacher and they taught in a 1 room classroom. Not only that they had students from kindergarteners to 8th grade together. She, let's call her "Mrs. Crabtree". She was a hard working affectionate and effective teacher. She utilize the tools in the classroom using the older children to help her to teach the younger children reading, writing and arithmetic. But then something happen, research has shown that if you separate the children by grade you allow the older students to excel beyond a basic education and their valuable time in the classroom wasn't waisted but it was utilized to expand their education. More educators were brought in to teach and it was discovered that you needed higher educated teachers to teach these classes and Mrs. Crabtree and her education level was just reserved to a child first couple of years of learning. Years later Mrs. Crabtree was now just a kindergarten teacher. But then parents wanting the best for their children told Mrs. Crabtree to go back to school and get a bachelor's or she wouldn't even qualify to teach Suzy how to tie her shoes or learn how to count to a hundred. Why? Was she now not qualified? With this scope of learning beyond her reach? Was she incapable of such task? Absolutely No! It was that she didn't have a bachelor's degree and the parents demand that all the teachers have a bachelor's degree without exception to teach their little Suzy and Johnny.
Well would we expect anything different now when it comes to Nursing? Absolutely No. Parents having their sick children in a hospital or Parents having their Grandparents or even their marriage mate as a patient lying in a hospital bed want the highest educated Nurse taking care of their loved ones regardless of capability and experience. It's not about that it about what is Perceived and every time education will win because Avengingspirit1 you would be the very first one to complain and be in a uproar if ever the school district lowered it's standards of education and now Mrs. Crabtree was teaching your precious Suzy.
My comment was a metaphor but based on facts of the past eighty years of public education.
Lisa.FNP said:you would be the very first one to complain and be in a uproar if ever the school district lowered it's standards of education and now Mrs. Crabtree was teaching your precious Suzy.My comment was a metaphor but based on facts of the past eighty years of public education.
This is what I'm saying. . . Anyone who has a child would freak out if they were asked to accept a teacher who had less education regardless of whether they were certified or not.
Lisa.FNP said:I'm going to give a different perspective on the Bachelor's verses Diploma. Take educators of children in the last 80 years called teachers. 80 years ago you had a Diploma educated teacher and they taught in a 1 room classroom. Not only that they had students from kindergarteners to 8th grade together. She, let's call her "Mrs. Crabtree". She was a hard working affectionate and effective teacher. She utilize the tools in the classroom using the older children to help her to teach the younger children reading, writing and arithmetic. But then something happen, research has shown that if you separate the children by grade you allow the older students to excel beyond a basic education and their valuable time in the classroom wasn't waisted but it was utilized to expand their education. More educators were brought in to teach and it was discovered that you needed higher educated teachers to teach these classes and Mrs. Crabtree and her education level was just reserved to a child first couple of years of learning. Years later Mrs. Crabtree was now just a kindergarten teacher. But then parents wanting the best for their children told Mrs. Crabtree to go back to school and get a bachelor's or she wouldn't even qualify to teach Suzy how to tie her shoes or learn how to count to a hundred. Why? Was she now not qualified? With this scope of learning beyond her reach? Was she incapable of such task? Absolutely No! It was that she didn't have a bachelor's degree and the parents demand that all the teachers have a bachelor's degree without exception to teach their little Suzy and Johnny.Well would we expect anything different now when it comes to Nursing? Absolutely No. Parents having their sick children in a hospital or Parents having their Grandparents or even their marriage mate as a patient lying in a hospital bed want the highest educated Nurse taking care of their loved ones regardless of capability and experience. It's not about that it about what is Perceived and every time education will win because Avengingspirit1 you would be the very first one to complain and be in a uproar if ever the school district lowered it's standards of education and now Mrs. Crabtree was teaching your precious Suzy.
My comment was a metaphor but based on facts of the past eighty years of public education.
Your analogy is nonsense. Teaching high school calculus requires a different skill set and knowledge than teaching a five year old how to put multicolored blocks in the right spaces. You need to master the subject of calculus first before you can teach it; and you take a certification exam for that. All RNs whether they come from a diploma, associates or BSN program take the same licensing exam and only qualified at the bare minimum to provide patient care. It is the experience they get from there that makes them a nurse. Not one doctor has said they could see any difference in nurse performance based on the educational levels.
And speaking of the public schools; are you aware the dumbing down going on the public schools in the last 25-30 yrs. I personally know teachers who were literally told not to teach and just allow the kids to play computer games in school. Our leaders, especially this administration, doesn't want free thinkers; they want good little obedient soldiers of the state. But that's a whole other topic. Healthcare facility CEOs and managers want nurses young, naive and in in debt as they will be less likely to rock the boat. That came straight from nurse recruiters. Everything I said about the BSN and Magnet status pushes are 100% true. And unlike nursing leaders leaders who lie through their teeth by saying the BSN push is to elevate the profession, I'll give my true intentions. I want to do what they've done to associates and diploma grads over the last few years and prove those driving the push the venal, prevaricating, self-serving "people" they really are.
Oh so true I was an LPN from '72-'92 quit due to burn out and then in '08 I lost my real estate related job and my profession as the market crumbled. After 4 years I was able to get on as a patient sitter at a regional hospital ~ I was laid off 3 weeks before my 65th birthday. The nurses loved me and often requested me to sit with the most difficult patients due to my prior nursing experience, yet all I was told was to apply for other jobs at the hospital which I had done with few interviews.
I have 2 friends who are in their late 50's and early 60's who are still working at that hospital as RN's and live in fear of loosing their jobs since we live rural there are not a lot of options. The 4+ years I worked at that hospital I was quite frankly shocked at how the older nurses were treated ~ they were our gold mines when I was a new nurse.
Everything is so true ~ but what's the answer? Hospitals are unwilling to train and staff correctly and the patient care suffers. I'm terrified of ever being admitted to any hospital in today's world.
It is very concerning that things have taken this route. As a seasoned nurse (20+ years), my last role was as Clinical Director in a 5-hospital Magnet system. I agree with the comments about meetings and the charade of "asking" nurses what they think. They don't really care, I can tell you. At the Executive level, the focus is on the bottom line - patient satisfaction, worked hours per unit of service (which is a person by the way) and ensuring a green bottom line at the end of the year. Even in a non-profit organization, money is king. I was one of the (few) people who dared to speak out about the constant cuts and dangerous tactics. Needless to say, I was not popular and was terminated. Since I have been gone, my staff have been pushed harder and harder to achieve more with much less. I always felt like I could protect them and I was good at my job, but I am not a "Yes" person so I had to go. I worry about where healthcare is headed, especially since I am a Boomer and may need help in the years to come. But mostly I worry about the nurses who are faced with 30 or more years to wrangle with their conscience and be brave enough to speak out, especially when so much is at risk.
Someonewhocares said:It is very concerning that things have taken this route. As a seasoned nurse (20+ years), my last role was as Clinical Director in a 5-hospital Magnet system. I agree with the comments about meetings and the charade of "asking" nurses what they think. They don't really care, I can tell you. At the Executive level, the focus is on the bottom line - patient satisfaction, worked hours per unit of service (which is a person by the way) and ensuring a green bottom line at the end of the year. Even in a non-profit organization, money is king. I was one of the (few) people who dared to speak out about the constant cuts and dangerous tactics. Needless to say, I was not popular and was terminated. Since I have been gone, my staff have been pushed harder and harder to achieve more with much less. I always felt like I could protect them and I was good at my job, but I am not a "Yes" person so I had to go. I worry about where healthcare is headed, especially since I am a Boomer and may need help in the years to come. But mostly I worry about the nurses who are faced with 30 or more years to wrangle with their conscience and be brave enough to speak out, especially when so much is at risk.
Oh geez...Very concerning indeed. I cringe hearing this. I am so sorry but please have some pride for doing the right thing, speaking up. "No good deed....."
This whole ADN vs BSN being the better educated turns my stomach. Yes I have a BSN after my ASN...my employer paid for me to get it....online. Now there's a "quality" education.
My daughter is in a BSN program right now. The only difference between her basic education and mine is college fluff.
I don't care what the study says. Until they include specifically seasoned nurses with ADN in a non academic center.....the results are nothing more than a study fabricated to prove what the author wanted. Any study can be skewed to show the desired outcome.
I, too, know that at the executive level is money and patient satisfaction. Patients as a whole don't know nor care whether you are ADN or BSN just that you are licensed and they feel better. I think forcing nurses at the end of their career to go back to school inter $20,000.00 in debt to be able to continue working one of the greatest errors this profession can make. They have a valid license. They should work. But what better way to decrease the over $$ bottom line but to get rid of the expensive (seasoned) employees. How can they do that without discrimination? Oh " I know lets be passive aggressive and make them go back to school....we should lose about half of the as they quit". .....and the budget improves.
How sad that we, as a profession, are allowing this to happen to our senior experienced mentors. I know that is how I learned how to be a nurse. Who do these young nurses with their bright and shiny BSN think have been working at the bedside as all of this new technology has evolved? Chances are it was a ADN or diploma grad.
Esme12 said:This whole ADN vs BSN being the better educated turns my stomach. Yes I have a BSN after my ASN...my employer paid for me to get it....online. Now there's a "quality" education.My daughter is in a BSN program right now. The only difference between her basic education and mine is college fluff.
I don't care what the study says. Until they include specifically seasoned nurses with ADN in a non academic center.....the results are nothing more than a study fabricated to prove what the author wanted. Any study can be skewed to show the desired outcome.
I, too, know that at the executive level is money and patient satisfaction. Patients as a whole don't know nor care whether you are ADN or BSN just that you are licensed and they feel better. I think forcing nurses at the end of their career to go back to school inter $20,000.00 in debt to be able to continue working one of the greatest errors this profession can make. They have a valid license. They should work. But what better way to decrease the over $$ bottom line but to get rid of the expensive (seasoned) employees. How can they do that without discrimination? Oh " I know lets be passive aggressive and make them go back to school....we should lose about half of the as they quit". .....and the budget improves.
How sad that we, as a profession, are allowing this to happen to our senior experienced mentors. I know that is how I learned how to be a nurse. Who do these young nurses with their bright and shiny BSN think have been working at the bedside as all of this new technology has evolved? Chances are it was a ADN or diploma grad.
It's all I've been saying for the last four years. Using the private option, if you contact me, I can give you the email address and phone number of the CBS reporter I was trying to get the story pushed with. She may not be interested anymore as it was a couple of years ago when she asked if any nurses or former nurses would be willing to speak out; but it's worth a try.
By he way, if anyone is interested, there is a company in Ivyland, PA which is near Warminster that is seeking to hire registered nurses to provide pharmaceutical drug information to patients. The recruiter is a family friend and asked if I could help as she needs to hire approx. 30 nurses by August. If you use the private option, I can provide contact information.
avengingspirit1 said:Your analogy is nonsense. Teaching high school calculus requires a different skill set and knowledge than teaching a five year old how to put multicolored blocks in the right spaces. You need to master the subject of calculus first before you can teach it; and you take a certification exam for that. All RNs whether they come from a diploma, associates or BSN program take the same licensing exam and only qualified at the bare minimum to provide patient care. It is the experience they get from there that makes them a nurse. Not one doctor has said they could see any difference in nurse performance based on the educational levels.And speaking of the public schools; are you aware the dumbing down going on the public schools in the last 25-30 yrs. I personally know teachers who were literally told not to teach and just allow the kids to play computer games in school. Our leaders, especially this administration, doesn't want free thinkers; they want good little obedient soldiers of the state. But that's a whole other topic. Healthcare facility CEOs and managers want nurses young, naive and in in debt as they will be less likely to rock the boat. That came straight from nurse recruiters. Everything I said about the BSN and Magnet status pushes are 100% true. And unlike nursing leaders leaders who lie through their teeth by saying the BSN push is to elevate the profession, I'll give my true intentions. I want to do what they've done to associates and diploma grads over the last few years and prove those driving the push the venal, prevaricating, self-serving "people" they really are.
I agree with most of your analogies. You are absolutely correct when you say that our educational system has been deteriorating over the past 25 to 30 years, but this cannot be blamed on the Obama administration.
fakebee
120 Posts
What I find interesting is the concept that completing the RN to BSN transition has to be enormously expensive. Several schools offer online programs for less than $10,000. An enormous amount of debt you say- well consider that the average new car costs 32,000 dollars yet millions of 50 and 60 year olds sign up for as long as 10 years of monthly payments for that new car smell. But 30 year olds won't invest in something that pays them back in the long run, unlike a car that depreciates the minute you buy it.