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.

[Farawyn]

Read my lips: Stop believing the lie. There IS NO nursing shortage.

Read your fingers?

[SmilingBluEyes]

Now reading my FINGERS could be, um, dangerous. LOL

[ddaviddudley]

Being micromanaged is definitely a strong reason to drive seasonal nurses out of the job. I had recently took a travel assignment to a facility where the doctors had nothing better to do than micromanaged the nurses. I was out of there real quick. The place is notorious for going through endless travelers

[Dranger]

Sounds like incompetent management. Why do they refuse to take measure to cut turnover?

It's one of those situation when being chronically understaffed, a few people jet out which creates a domino effect. Pay and benefits are about par for the area. Resources over the past few years have been drastically cut.

The patient population is absolutely terrible too.

[toomuchbaloney]

If there is a never ending turnover of nurses in your nursing department the culprit is management. PERIOD.

[joanna73, BSN, RN]

Definitely no shortage of nurses, but there is a shortage of experienced nurses. Just today, I've received an email from a recruiter offering sign on bonuses for 2-5 years of acute care experience at various facilities in the US.

I'm a Canadian born and educated RN, with a BSN (mandatory up here now) and the required years of experience. I didn't apply, rather they found me on LinkedIn.

As others have mentioned, working conditions have deteriorated so people are burning out and hospitals refuse to staff appropriately.

[PMFB-RN, RN]

It's one of those situation when being chronically understaffed, a few people jet out which creates a domino effect. Pay and benefits are about par for the area. Resources over the past few years have been drastically cut.

The patient population is absolutely terrible too.

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 .

[martymoose, BSN, RN]

I get told that is how we are staffed from now on. Our ratio increased.There's no shortage. They are running like that on purpose to save a buck.

And I have been told"you don't like it, then leave"

Others have left, and they don't replace them.

[PMFB-RN, RN]

I get told that is how we are staffed from now on. Our ratio increased.There's no shortage. They are running like that on purpose to save a buck.

And I have been told"you don't like it, then leave"

Others have left, and they don't replace them.

That sucks. However it is exactly why employers have worked so hard to a) get rid of unions, and b) use the false "NURSING SHORTAGE" propaganda to extort tax payer money from state and federal governments to vastly increase the number of nurse to create a glut. They wanted to be in the exact shoes your hospital is in, to have the ability to tell nurses "this is the way it is, suck it up or hit the door". In the not too distant past they wouldn't dare for fear nurses would vote with their feet. It is also (I believe) much of the motivation behind the push for all BSNs. I once hear a top level health system administrator comment that the more an RN owed in student loans the less likely they were to rock the boat.

[ThePrincessBride, MSN, RN, NP]

Sounds like my wet dream...

Management at my hospital sounds the exact opposite and instead of looking at the real issues (ridiculous ratios, unsafe work environments, etc), they are forcing everyone to take stupid stress management courses, as if it is our fault. Want to know how to decrease my stress levels? Stop forcing me to take seven acutely ill Med-Surg patients. Stop expecting me to spend two or more hours of my shift being used as a sitter and expecting everything to get done. Give me a unit clerk during night shift. Hire more nurses and ancillary staff. Make the ED give report instead of shipping the patients up and dumping them into an empty room.

I wish we had a manager like the one you described but my hospital is penny-wise and pound-foolish.

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 .

[ddaviddudley]

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 .

Wow.. Amazing. So glad I read this.

[ctomrn]

My personal experience has colored my opinion of this noble profession of late. I have been an RN for greater than 20 years. I chose nursing as a 2nd profession after having gotten an undergraduate degree in English and decided not to teach. I went to a diploma nursing program not realizing at the time that the BSN nurse would soon become the "gold standard" for qualifying for a job. Nevertheless, EVERYBODY wanted to hire me knowing that as a diploma nurse, I was ready to hit the floor and work. The focus there was more on practice and less on the theoretical. I did, however, move through the ranks and became nursing leadership and DON as well, without the benefit of the BSN.

I later left the hospital setting went to work for a software vendor as a nurse consultant. Most everyone knows that this is a lucrative field where you can use your nursing skills and learn the technology side of healthcare now. The catch is the travel. After 15 years away from the bedside, I decided that I am done with the road and wanted to do my last 10 years or so in the hospital or other setting. No one will hire me without two things...a certification from a refresher course and a BSN!!! If you look at my resume, you would think that there is nothing I haven't done but even with the refresher course, I hear that many older and experienced nurses are not guaranteed a job.

I have lost a great deal of faith for this profession. Forget about how hospital nurses are understaffed, underpaid...how about how our profession turns its back on established nurses who spend money to go back and refresh themselves and still find that in today's market, they are inadequate. In the meantime, I am going back to consulting, getting back on the road where I make at least twice what the bedside nurse makes and I am appreciated for the fact that I am a nurse and my skillset and knowledge is valuable in a different way.

It is sad...