How to Stop the Mass Nursing Exodus?

[ClaraRedheart]

Hi. My hospital is currently up for magnet renewal,  but we're losing staff constantly. I've even said myself that I can't do another COVID round, but it's here, and I'm still there while my co-workers are leaving and we're having to train staff that have never worked in acute care, because that's all we're getting. I've heard it's the same in many places. I'd like to gather some ideas on what it would take for you to stay, if you left.

Here are some things that pushed me over the top during our last covid surge, and some ideas on how the hospital might could help. 

* Having to transport an extremely sick covid patient to radiology because they were on over four units of oxygen while leaving four extremely sick patients on the unit that would not be looked in on or get their medication on time during the 40 minutes that we would be off the unit.

IDEA: I don't know how else to fix this one but more nursing or RT staff. We're already working short though. A resource nurse to help those that are drowning, or to transport when a nurse is required would help. 

*Trays left outside of covid rooms for 45 minutes when the nurses and techs are in other rooms and our covid patients who are already isolated and sad getting cold meals. 

IDEA: Hire more kitchen staff and TRAIN one of them to don and doff and deliver covid meals. 

*Full trashcans everywhere with isolation gear, in the hall, in the rooms, etc.. I try to empty them when I can but I've always got due and overdue medications and really don't have time to slow down. 

IDEA: Hire more ancillary staff to clean

If you left your nursing job, what would it have took for you to stay? 

[SmilingBluEyes]

17 minutes ago, Justcultureisjustcrap said:

Does anyone really believe that after they've staffed us for so poorly for so long and we're doing it- although not well- that we will ever go back to safe ratios? Not when they can squeeze 2-3 peoples jobs out of 1 person. Then administration gets bigger bonuses for "saving" $$$...

No I don't.

[Hoosier_RN, MSN]

9 hours ago, Justcultureisjustcrap said:

Does anyone really believe that after they've staffed us for so poorly for so long and we're doing it- although not well- that we will ever go back to safe ratios? Not when they can squeeze 2-3 peoples jobs out of 1 person. Then administration gets bigger bonuses for "saving" $$$...

Nope, I feel like it's going to get even worse

[Charlcie, BSN, RN]

On 8/25/2021 at 10:24 PM, Justcultureisjustcrap said:

Does anyone really believe that after they've staffed us for so poorly for so long and we're doing it- although not well- that we will ever go back to safe ratios? Not when they can squeeze 2-3 peoples jobs out of 1 person. Then administration gets bigger bonuses for "saving" $$$...

No way. I've seen this at every contract I have worked at since covid started. It's now common place to triple ICU nurses as part of the normal staffing grid. Even during the time when covid cases decreased and census and staffing were more "normal" every hospital I worked at still would triple us while calling off at least one scheduled nurse, no free charge nurse, etc. 

[toomuchbaloney]

12 minutes ago, Charlcie said:

No way. I've seen this at every contract I have worked at since covid started. It's now common place to triple ICU nurses as part of the normal staffing grid. Even during the time when covid cases decreased and census and staffing were more "normal" every hospital I worked at still would triple us while calling off at least one scheduled nurse, no free charge nurse, etc. 

Short staffing of nurses is a business model adopted in the early 80s. 

[turtlesRcool]

On 8/25/2021 at 10:24 PM, Justcultureisjustcrap said:

Does anyone really believe that after they've staffed us for so poorly for so long and we're doing it- although not well- that we will ever go back to safe ratios? Not when they can squeeze 2-3 peoples jobs out of 1 person. Then administration gets bigger bonuses for "saving" $$$...

I actually do think they'll go back to safe ratios. Safer anyway.  Patients and their families are sort-of-kinda-okayish with delays in care as long as we're operating in crisis mode. But we're not going to be in pandemic mode forever. Reimbursement is tied, in part, to patient satisfaction surveys (H CAPS), and market share is tied to brand perception. The hospitals that provide better patient experience will get more business, better reimbursement rates, and be able to recruit more top doctors.

Also, people are burning out with these ratios. It's expensive to hire and train newbies only for them to leave. Travelers to fill the gaps are expensive. At some point, it's going to make more financial sense to retain staff than to churn it.

And don't discount the financial impact of a sentinel event. Litigation is expensive, and the more errors and bad outcomes the hospitals end up with, the more families will have a basis to sue.

Finally, the worse the patient experience becomes, the more the public becomes sympathetic to mandated ratios. CA has shown it's possible to legislate safe ratios. One the public no longer trusts the hospitals to use their flexibility to adequately take care care of patients, the more willing they are to vote to mandate safe staffing. Since most hospitals want to avoid this, there is an incentive for them to staff well enough to avoid it.

I am admittedly coming at this with the bias that our CEO is a doctor, so while our ratios aren't great right now, and there are business considerations, I don't believe the hospital system is willing to completely scrap patient safety in the name of short-term profits.  We'll see. We are currently trying to hire, and according to the nurse educator I talked with yesterday, the on boarding classes are really small compared to previous years. "Doesn't anyone want to work as a nurse anymore?" She asked. I replied, "yes, but probably not here." When I spoke with nursing students who did their clinicals at our hospital this past Spring they all said they would be applying to a different hospital when they graduated - given the stress and short staffing they witnessed during their time with us, I am not even a little bit surprised they're having a hard time getting candidates to apply.

[Rose_Queen, BSN, MSN, RN]

1 hour ago, turtlesRcool said:

Patients and their families are sort-of-kinda-okayish with delays In care as long as we're operating in crisis mode.

I have access to patient feedback in my role. I can guarantee you that while at first we weren’t getting patient complaints while in crisis mode, they are flooding in now. 

[turtlesRcool]

1 hour ago, Rose_Queen said:

I have access to patient feedback in my role. I can guarantee you that while at first we weren’t getting patient complaints while in crisis mode, they are flooding in now. 

I believe it. But I also think that depends on how much of a perceived crisis it is. As the pandemic drags on, people are more likely to believe that hospitals should have figured out staffing by this point. They're not entirely wrong. A crisis is a short term period of instability, and people are not going to accept it becoming a new normal.

That's not a bad thing. The more patient complaints we get, the more pressure it puts on administration to staff appropriately to address those complaints.

Yesterday, we got a call from the CEO's executive assistant stating there had been a complaint that we weren't answering the unit phone. The charge nurse pointed out our secretary had been floated - again! - and the nurses and aides were in patient rooms. So clearly someone who couldn't get through took their complaint right to the top. Oh well! Not my problem. I'm doing nursing. You want someone to answer the phones, hire more people and stop floating the person hired to answer the phones. And we were answering some of the calls, if they came in when we happened to be available and in the nurse's station, but we couldn't just sit there to do secretarial work when we had patient assignments.

[Justcultureisjustcrap]

Yes, I am truly tired of doing 3-4 peoples jobs.

[SmilingBluEyes]

On 8/27/2021 at 8:43 AM, turtlesRcool said:

I believe it. But I also think that depends on how much of a perceived crisis it is. As the pandemic drags on, people are more likely to believe that hospitals should have figured out staffing by this point. They're not entirely wrong. A crisis is a short term period of instability, and people are not going to accept it becoming a new normal.

That's not a bad thing. The more patient complaints we get, the more pressure it puts on administration to staff appropriately to address those complaints.

Yesterday, we got a call from the CEO's executive assistant stating there had been a complaint that we weren't answering the unit phone. The charge nurse pointed out our secretary had been floated - again! - and the nurses and aides were in patient rooms. So clearly someone who couldn't get through took their complaint right to the top. Oh well! Not my problem. I'm doing nursing. You want someone to answer the phones, hire more people and stop floating the person hired to answer the phones. And we were answering some of the calls, if they came in when we happened to be available and in the nurse's station, but we couldn't just sit there to do secretarial work when we had patient assignments.

After all what is the priority? Patient care or answering the phone? Let that same CEO see a nurse sitting "doing nothing" at the station while lights are going off, but answering said phone and watch the fur fly.