Is the nursing profession causing its own RN shortage?

[RNDave]

With all the RN's going to NP school, is the profession significantly contributing to the RN shortage? Between retirement and RN's in line to become NP's it seems our unit is on a constant hunt for staff.

[dec2007]

RuralRN07: That has been my experience exactly. Our young folks want to work bedside only long enough to get into grad school, CRNA school, NP school, etc. I don't blame them, in fact I admire a lot of them. But it does leave a big hole at the bedside, and for those of us who plan to be life-long bedside nurses, it leaves us chronically short-staffed and a little frustrated. As to your second point, years ago when I went back for my BSN I mostly learned to write papers in AP format. That may have changed over the years, but my nursing skills weren't learned in the BSN program.

[martymoose, BSN, RN]

it leaves us chronically short-staffed and a little frustrated.

Umm, you are short staffed because the suits want it that way. They are glad when people move on- saves them some time.

Its just a shame that we're expected to work this way

[sailornurse]

Management does not care about the retention of experienced RNs. Management cares only about the "bottom line." RNs with many years of service, and experience are more "expensive" than the newly graduated RNs.

I remember a couple of hospitals in the 1980s/early 90s , would only pay for salary difference for 5 years only. There was no extra salary for 10-15-20-25 years experience. Twice as a new hire I came in at top of pay scale & was not eligible for merit raises due to salary caps. (BSN with 15 years experience maxed out to top of pay scale.)

[dec2007]

Umm, you are short staffed because the suits want it that way. They are glad when people move on- saves them some time.

Its just a shame that we're expected to work this way

This may be true, I don't know. It seems like constantly training new staff to do CRRT, IABP, ICPs, "fresh" open hearts, etc. would cost the facility a lot of money, and they would be better off to retain the staff they have already trained and proven competent in those skills. And yes, it is definitely a shame we are expected to work under these circumstances.

[dec2007]

I remember a couple of hospitals in the 1980s/early 90s , would only pay for salary difference for 5 years only. There was no extra salary for 10-15-20-25 years experience. Twice as a new hire I came in at top of pay scale & was not eligible for merit raises due to salary caps. (BSN with 15 years experience maxed out to top of pay scale.)

I guess that must be what is happening at my facility. "Across the board" cost of living hikes have left me (at the top of the scale) with no raise for the last six years.

[sailornurse]

Exactly! And the manager could not understand that I wouldn't get any more money if I took the relief or charge position . As one of the more experienced nurses, I would have, if they would pay me for the responsibility of being charge nurse.

[CHESSIE]

I have seen effective manager / administration cut turn over to the bone with some very simple techniques.

Things like no floating after a certain number of years served on the unit, going out of their way to give people the schedule they want, creating a float pool to even out demands in staffing, lowering nurse to patient ratios and other thing I have seen work.

One place I worked was a basket case. A level I trauma center SICU where on any given shift half of the staff were travelers and the other half had been new grads less that a year before. It was a terrible place to work. Then there was a sentinel event, actually two of them within a few weeks of each other. The hospital's chief nurse was fired, as was the unit manager. The guy they brought in was given wide latitude to fix things.

First thing he did was create an internal agency where staff could make $25/hour bonus if they would sign up to work and extra 8 or 12 hour shift a week. Then he formed a float pool made up of staff who had been planning to leave if they couldn't go part time. He made rules like anyone who had been in the unit 10 years never floated. He made precepting voluntary, created a training program for preceptors and got them a $1/hour bonus for teaching and made rules like those who were precepting got first choice in patient assignments and didn't float.

He would basically give any full time person whatever schedule they wanted and smoothed out staffing needs with the float pool and by creating a bunch or part time positions. When he did that we had quite a few more experienced nurses who had quit to be stay at home moms, or who had taken part time jobs in other areas of nursing, but who would really rather be working in ICU, to come back to the unit. He also started backing up the nurses with the physicians and with patient families. Created a bunch of policies that gave greater autonomy to the bedside nurse. Standing orders for common things, protocols that cut down on the number of physician calls that needed to be made, allowing the bedside RN to determine the visiting hours for each of their patients, etc. When one of our nurses was hurt (not work related) and put on light duty her made her the admission nurse. This proved so popular that a full time position was created. He also created a 6 month nurse residency program and mentoring program for new grads. He also stopped the "BSN only" hiring policy that resulted in losing far fewer RNs to CRNA school each year.

After 4 or 5 years the unit was turned around. No more travelers, dramatically reduced staff turn over, better moral, and according to what we were told, saved the hospital a lot of money in recruiting costs and best of all, better patient outcomes. Were before we had surgeons who did everything they could to avoid admitting their patients to the SICU, we started to attract surgeons who wanted their patient's cared for in our unit.

One other thing he did right away, he stopped the recertification for Magnet process in that unit. It was simply not something he cared about. No more 3x5 cards with preprinted answer to likely surveyors questions and other silliness.

So management CAN do it, all they have to do is decide they want to .

This manager needs to be "cloned." Every hospital sorely needs these types of managerial persons . He is one in a million, and has really acted upon the input from those "in the trenches."

How long did he last before those at the very top fired him? He sounds as if he is antithesis of most managers, but he certainly knows how to value and retain staff along with keeping patients safe and receiving great care.

[CHESSIE]

I just experienced my first code as a new grad, and in the aftermath of the code, I was told by a nurse that it was a good learning experience for me -- to be sure that I charted everything that was said and done every single day of my nursing life and to trust no one. The reason for this is that both MDs and nurses will not hesitate to throw me ("me" being all RNs) under the bus to save themselves. If this is what the profession does to nurses, I understand why they leave, and why I may not stay very long myself.

Sadly, this post says it all. Part of this is due to the ever increasing litigiousness that has permeated the medical industry, and it is "an industry."

When I reentered the nursing profession, after a hiatus to raise children, I was told exactly the same thing along with some sage advice to carry your own Liability Insurance, just not to "broadcast" that fact.

[toomuchbaloney]

I recently saw something that showed that New York is the most expensive state to live in, followed very closely by California.

I should know---I live in New York, and the cost of living is through the roof.

Hawaii is considered to be the most expensive state to live in with a cost of living index of 125.2 (greater than 100 is considered high). In HI the grocery index is 124, in Anchorage it is 131.6, health index in HI is 113.3, in Anchorage 140.

[Farawyn]

Hawaii is considered to be the most expensive state to live in with a cost of living index of 125.2 (greater than 100 is considered high). In HI the grocery index is 124, in Anchorage it is 131.6, health index in HI is 113.3, in Anchorage 140.

Note to self: Stay in the lower 48.

[Jensmom7, BSN, RN]

I guess that must be what is happening at my facility. "Across the board" cost of living hikes have left me (at the top of the scale) with no raise for the last six years.

I've been an RN for 36 years. Any guesses how long I'VE been at the top of the pay scale at every new job??

Also, I got my BSN 36 years ago as well, because way back then TPTB were pontificating that BSN would soon be "entry level" for Nursing. *cough* bull**** *cough*.

Not once in 36 years have I ever gotten more money because of my degree.

Fortunately, my husband and I are at the point in our lives where we don't have much debt, so we are able to give some, spend some, save some. And not live paycheck to paycheck.

[CHESSIE]

Yes, I believe there is a 'nursing shortage'. Why? Not because there are not enough nurses, but because Hospitals (and other patient facilities) purposely understaff floor RNs to save on salary costs, thus blame delayed, frantic, poor patient service on the nurse stating, "we're understaffed due to the nursing shortage". Hospitals (I'll use them as an example) have been purposely doing this FOR YEARS. And they will continue to do so. Why? Because they can. Remember one state out of 50 in the United States has mandatory nurse to patient ratio limits. One. All the others can (and often do) assign monstrous loads on floor RNs with NO LIMITS, yet expect perfect patient care--which is impossible. Plus, hospitals are much more concerned with their stock holders, profit margins, and doctor retention than they are of nurses. It takes an RN approximately 7-10 years to be considered a nurse--(not including impacted programs which commonly have a waiting list of 1 1/2 years): (2 years pre-nursing college classes, followed by 2 years clinical AND nursing classes, 2 years bachelors upper division nursing classes, plus 6 months to 1 year floor orientation, then 1-2 years independent floor work; for specialty nursing such as ER, L&D, Neuro, Psych, OR=add 1-2 more years). Yep, to become an RN takes a lot of training and a lot of work (and a lot of money). So show some respect.

I agree with everything that you stated in your post, except one. Most hospitals have insufficient experience staff to give a new grad six months to one year orientation. The usual "orientation" is six weeks max, with four weeks of "orientation," being the usual time that a new grad is supposed to be able to be "up and running" independently.