Is the nursing profession causing its own RN shortage?

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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.

In my view management is management. Yes there is upper management and lower management, but THEY set the culture of the nursing department.

If the staff are leaving in droves, consistently because of the patient population that is also a management problem. Management interviews them, hires them, prepares them for the job, and is expected to support and regulate them to insure excellent delivery of nursing care.

If those staff are so sorely disappointed by the actual work on the unit then the management is doing a bad job of getting the right people in the right jobs. Or they are bad at making certain that they are giving people the information that they need to make good employment decisions. Or management is not supporting the staff as they deal with difficult patients and families, or...

I think you get my drift.

Management cannot get a pass. Good management can get people to love shoveling crap, bad managers can make people hate polishing gold.

This last part? I'm stealing it.

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Specializes in SICU.
Yeah advanced practice where every other bedside nurse is going...

Less belittlement maybe but more competition for jobs and dilution of pay.

.... And that's perfectly fine with me

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Specializes in Critical Care and ED.

After 23 years in nursing, my insight is this: nurses are leaving the bedside because of working conditions. My own observations from my last unit made this clear. Constant floating (I'm an ICU nurse...I don't want to work med surg so don't float me there), constantly changing assignments (get those patients to the floor before they're ready so we can admit more patients and make money), calling off (I was hired for 36 hours...it's not my fault your acuity is low), disrespect from just about everybody (even the PAs treated us like idiots, the surgeons worse), b1tch1ng between nurses (everyone was so stressed out it was survival of the fittest), no breaks (because running 12 hours straight on no food is really conducive to critical care), no raises (3 years in a row), lack of value (we got ice pops on Nurses Week. That's our worth folks), an act of God to get a vacation (leave your life at the door), no recognition for certifications (I got a $5 gift certificate to the cafeteria for my CCRN), no CNAs (constantly floated as per the stupid staffing grid), added workload like making us take foleys out of incontinent patients because it's supposed to enhance outcomes - but excoriates the patient), constant inservices on off hours, and complete lack of encouragement or appreciation.

When you see NPs rubbing shoulders with the doctors, having input, respect and autonomy, who wouldn't want that?

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Even in anesthesia/OR, you still have nurse managers trying to tell you how to do your job. I am a CRNA too, and I've had the OR nurse manager yelling at me about "WHY DID YOU KEEP THE PATIENT IN THE OR FOR SO LONG AFTER THE PROCEDURE WAS DONE???????? WE ARE SUPPOSED TO HAVE A 4 MINUTES TURNOVER TIME!!!!!!!!!!!!!!!!!!!!!!!!!!" At one place I worked, the nurse manager would run around yelling this s*** into almost every OR. "REMEMBER WE HAVE A 4 MINUTE TURNOVER TIME!!!!!" One anesthesiologist screamed back at her "GET OUT OF MY OR!!!!!!! WHEN YOU GO TO MEDICAL SCHOOL & BECOME A DOCTOR, YOU CAN GIVE ANESTHESIA ANY WAY YOU WANT!!! I AM NOT GOING TO KILL THIS PATIENT BECAUSE YOU WANT A 4 MINUTE TURNOVER!!!!" The managers are getting heat from their managers that are getting heat from the Chief Nursing Officer & administration to increase volume no matter what the consequence is, as long as there isn't a sentinel event or death within 24 hours. S*** rolls downhill, people. When there is a sentinel event, none of those administrators or the CNO will accept any accountability for pushing the issue to move as many patients through as possible----they point fingers & say the nurses aren't qualified enough, doctor's didn't move fast enough, blah blah blah. At least as a CRNA, we have more autonomy & take less crap from managers because we are actually higher in status than they are----they try to flex their muscles with us, but they can't because they don't know anything about anesthesia. They only know how to pass instruments, do sponge counts & kiss administration's ass. When the nurse manager yells at me, I just look at her with a blank stare. She doesn't know what to do when I do that, LOL.

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Rock Nurse, my quote feature isn't working, but Amen to every word you said! I got a free movie ticket for my CCRN (one, not two). Thanks for saying what I was thinking!

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In order for the big greed factor to take over our hospitals. They have to get rid of the vintage nurses who have seen the drastic downfall of healthcare. There is still a great deal of older nurse in the workforce who still remember the days of healthcare service as opposed to healthcare business. Its not the fault of the new nurses. They just never had the glory days. That many of us miss. We still share the tales of those days and it causes distress at times to us older nurses who adapted to the transition but still knows deep down that very good patient care is less important, and the appearance of Very Good healthcare is the selling point. So to make it easier they need to get an abundance of nurses in the batting cage and ready to run on the field, while slowly letting the older nurses go. So this shortage has been in the making for a long time. Its the supply and demand factor. The more nurses they have looking for jobs, then the less money and amenities they need to use to recruit. Also they can handpick the nurse that seem to fit their agenda.. How many new nurses to you see not being able to find jobs? Around here much more than expected. But while they are waiting in the wings the older nurses must move out. just my opinion.....

I LOVE THIS POST!!! YOU ARE SO RIGHT!! I am one of those nurses that saw the "glory days", and that is a perfect way to describe it. Go find me a bedside nurse that has been in the game for 20 or more years that likes---not even loves---their job, and I'll show you a pink unicorn in Times Square drinking a Starbucks latte. How I long for the days where appendectomies stayed in the hospital for 3 days & chole's stayed in for 5 days, you walked your patients around the units to get them back to where they were before the surgery, you actually gave "P.M. care" to every patient on your assignment (I used to give all my patients back rubs before bed at 8pm!!!), you taught patients how to give themselves insulin shots & they couldn't leave the hospital until they were proficient at it, you got to know their families (for better or for worse), nurses worked together to get their work done on time, managers weren't a P.I.A., there were disposable CHUX, not having every patient on "contact precautions", handwritten nursing notes, and everything wasn't "get it done as fast as possible so the patient can be discharged and another one flopped in the bed ASAP". New nurses will never get to experience those days where patients were grateful for what we did because we actually helped them. Running around, throwing pills at patients, doing an inordinate amount of charting to cover the hospital in the case of a lawsuit, writing the same things in 5 different places, having to comply with the "script" of what management wants you to say to patients in order to get positive patient surveys is not the definition of "patient care". Nurses used to be known to have compassion, education & empathy. Not anymore, and that is just sad.

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Rock Nurse, my quote feature isn't working, but Amen to every word you said! I got a free movie ticket for my CCRN (one, not two). Thanks for saying what I was thinking!

I got a pencil once.

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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 .

I'd say "Where is this? I'LL MOVE!" but they probably aren't hiring because they're keeping the good nurses. :::wistful sigh:::

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Specializes in School nurse.

Yup - one year they had a "prize wheel". I spun the wheel and got a chip clip with the hospital logo printed on it. Yippeee......

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I am sorry but i really have difficulties finding in my own posts any mentions of "all bedside nurses".

I did mention that doing the same entry-level job for 35 years cannot be named a good career, although it may be satisfactory for someone. I think it is pretty much correct about nursing as about anything else. Staying for 35 years near conveyor belt doing the same operation was considered a career when Henry Ford started his automotive business. Nowadays, it is still a job and respected as such, but it hardly be named a "career".

I did not mean that all bedside nurses are mindless task machines (as a matter of fact, I am working bedside). But, as kalivianya mentioned and as one can easily see from this very forum many posts, in many places they are treated just as such. Add to that anti-intellectualism and bullying culture which are often flourishing in the very same type of places, and also lack of power in decision making and inability to practice the skills and knowledge they posess, and you will better understand at least one reason why so many nurses go back to school.

I am sorry if my posts hurt anyone's feelings.

Katie, some of us know exactly what you meant. Some people here like to overanalyze every single word.

I'll give you a perfect example:

Exercise is useless to lose weight unless you change your diet. An absolute fact but watch how many people argue with me saying I said "exercise is useless" which is not at all what I said.

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Katie, some of us know exactly what you meant. Some people here like to overanalyze every single word.

I'll give you a perfect example:

Exercise is useless to lose weight unless you change your diet. An absolute fact but watch how many people argue with me saying I said "exercise is useless" which is not at all what I said.

I know exactly what she SAID, because I read her words.

She later explained what she MEANT.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Katie, some of us know exactly what you meant. Some people here like to overanalyze every single word.

I'll give you a perfect example:

Exercise is useless to lose weight unless you change your diet. An absolute fact but watch how many people argue with me saying I said "exercise is useless" which is not at all what I said.

The trick is not to let those nit pickers get to you or to drive the conversation.

Let them perseverate.

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