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.

[mani96]

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.

[Stacydo]

Why do you think RN's want to go higher in their program? Why not stay an RN?

[martymoose, BSN, RN]

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.

Yes, yes , and yes.

[NurseDiane]

Travel nurses, in the long run, are far cheaper for hospitals than hiring staff nurses. That's why they do it.

[flying_ace2]

Most hospitals that are horribly short staffed all the time either simply don't pay their staff enough money to retain them or don't make the work environment practical to work in.

Annnndddd that's why I left the hospital after just one year and four months. Well that, and the completely toxic work environment......

[NurseDiane]

Management can do it if what happened in your SICU with 2 sentinel events within a short period of time happens. Somewhere in the infinite wisdom of the administration in your hospital, the executive staff realized that spending $$$ on getting the SICU in shape was far cheaper than paying the money out for losing a malpractice lawsuit and the increase in malpractice insurance premiums that would go with that. The unit manager sounds like a great manager----he should probably have advanced to Chief Nursing Officer of that place with the improvements he made in the SICU.

[NurseDiane]

100% right on point.

[NedRN]

As a travel nurse, I seldom see a hospital that is "well-staffed". Perhaps my perspective is skewed because I only go to hospitals with open needs, but folks like the American Hospital Association routinely report that vacancies for nurses run between 5 and 10% on average nationwide (varies by the year). That is how reports and news items about a national nursing shortage appear from time to time (for those of you in denial about a nursing shortage). Mind you, these are only the open jobs that hospitals report. Nothing to do with optimal staffing levels. If every hospital staffed optimally (some better balance between morbidity and mortality and staffing costs), the real need for nurses would increase by perhaps a third!

On top of any current nursing shortage, the aging baby boomer cohort is a double whammy with many nurses retiring just as patient census is going to be increasing. The need for both replacement nurses and additional nurse to take care of increasing patient census balanced against new grads is why the nursing shortage is predicted to become more critical.

Again, from my perspective as a travel nurse, pay rates have increased dramatically in the last two years. This doesn't happen with a surplus of nurses. Basic supply and demand.

Back to the title of the thread "Is the nursing profession causing its own RN shortage", there is an interesting paradox about travel nurses. There is some base demand for travelers due to seasonal demands, staff nurses out on leave or vacation, and regional shortages, but over and above that, for every new travel nurse, a staff job is lost, thus creating a demand for a travel nurse!

So in this current economy, it appears to be "safe" to quit a job as a staff nurse and become a traveler. The more that nurses become travelers, the more need for travelers there will be! So yes, we can cause our own RN shortages. It is a small effect as there are only around 30,000 nurse travelers at its peak out of 3 million nurses, but it is still noticeable.

[bluebonnetrn, BSN, RN]

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.

OH. MY. GOSH.

Wow - just WOW....

I was friends with a nurse who's dad was a pedi. He told her "You should hear how they talk about you in the board room meetings" referring to how hospital admin referred to nurses.

I believe it.

The problem is that somehow, someway admin came to believe that we are the lucky ones because they give us a job. WRONG! The only reason to admit a patient to the hospital is for nursing care. Hospitals exist for providing nursing care. Hospital administrators have a job because of US.

[DavisaRN9]

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.

[Dranger]

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 .

Problem is the rest of the units are understaffed too (i.e. wouldn't function without floating) and the hospital patient population is all medicare/medicaid who are readmitted frequently for the same condition screwing billing.

There are simply no funds or staff to promote these type of changes. Instead they putz around with employee of the month or staff of the day garbage with $5 Starbucks cards that does nothing. Intermediate level staff get disillusioned when senior staff leave, bad travelers keep getting hired and new nurses fresh off the street are your only co-workers.

At least that unit was a LV 1 SICU, we aren't. I have been at both kinds of places and this place is one of those that will never keep it's staff. Like I said above the patient population and daily working conditions have a lot to do with it.

[xenonRN]

I quit bedside nursing after 8.5 years to pursue CRNA school. Why? I could've gotten an undergrad degree in finance/human resources/etc and worked a comparably easy 9-to-5 admin job for the same or higher salary. It just didn't make sense to stay while physically busting my butt pushing heavy, vented, sick pts to MRI every day. Or fighting with pharmacy. Or dealing with rude families. Or waiting forever for floor beds. I don't mind taking the labor-intensive pt if charge RNs evenly distribute the "bad" assignments, but in ICU we all know the peachy assignment quickly becomes a trainwreck admission that keeps you there past 7. Personally, bedside nursing simply wasn't worth the stress. I love anesthesia so much more and not because of the $. Yes, the BS is still there from hospital mgmt but it's fraction of what RNs endure.

Full disclosure: I did work PACU for 5 years. There's a reason why seasoned RNs have to die or retire for a job to open up. They work hard up in there, but it's controlled chaos and far less weekend/holiday coverage.