Losing Nurses!

gypsyatheart · Jul 18, 2005

GREAT POST!
I always learn something new here, and hopefully can share it with someone who can use it!

ITA! This is really a good post and something the OP should consider.

Again, excellent post, llg! :yeah: :idea:

llg, PhD, RN · Jul 18, 2005

Thanks, my friends, for the kind words. Sometimes it helps to look at an old problem from a new angle.

Lots of hospitals have units that attract new grads looking for a year or two of good general experience to give them a foundation for work on other units. When they leave, it is not because of any failure on the management's part. That was their plan in the first place. Lots of students and new grads right here on allnurses talk about having similar career plans. We need to find ways to work WITH that reality and WITH nurses who have those types of career plans. We can then begin to design the unit, acquiring the right mix of resources, etc. to make it work.

Good luck, everyone,

llg

CritterLover, BSN, RN · Jul 18, 2005

as far as an intensive unit being less stress because of less patients, i am sorry i just don't see it. you take care of fewer people for a reason, they are sick! but i do see how that can be the preception

i just wanted to comment on this. it depends on how your mind works and what kind of organizational skills you have. while i am fairly intelligent, i am also very scattered. i can easily handle two fairly sick patients, accross the hall from each other, without getting stressed, and take quite good care of them. on occasion, i can even do it with three of them. however, give me eight patients on a hall, even if they are stable, and expect me to juggle assessments, meds, doctor's calls, families, documentation and teaching, and i am a wreck. the thought of working med-surg with a list of patients absolutely petrifies me. the med-surg nurses that do it daily have my never-ending respect. i couldn't do it.

Roy Fokker, BSN, RN · Jul 18, 2005

Seems hospitals are GREAT at recruiting people-----few give as near much effort to their retention. Stupid, if you ask me.

Great point Deb.

According to my Father, this is actually a trend being reported in much of the economy - healthcare or otherwise...

mattsmom81 · Jul 18, 2005

Have a brainstorming during a staff meeting about retention of nurses and how to make the unit better. they might have some good ideas. I bet they would welcome a break from training new staff too.

Boy you said it. It is very tiresome isn't it. Seems like we're in constant train mode, which means we do 2 jobs...our nurse duties AND our training duties.

After awhile it gets old...because you put your energies into these people and they move on.

imenid37 · Jul 18, 2005

I commend the OP for caring enough to reach out to her staff. I think creating an progressive adult work environment is great. I think you are a victim of the nature of your specialty and today's job mobility. We are in kindergarten mode where I work. I love the pt's and the location of the hospital, BUT I really hate the cr*p. We are wriiten up for petty things, pulled constantly, and work side-by-side w/ people whose constant sick calls and disordered persoanl lives overtake their job responsibilites. A number of experienced nurses are contemplating a move.

justavolunteer · Jul 18, 2005

I can see things like staff turnover from a different perspective. I'm a volunteer on pt floors at a hospital. I have seen repeated turnover because hospital mgt seems to constantly find things to land on the nurses over. E.g., overtime is supposed to be approved ahead of time. Once a pt fell out of bed right around shift change. The nurses, residents & various others had a long, involved process of getting the pt back in bed, checking her for injuries, etc. They nurses all clocked out late & they all got disciplinary notices for "unauthorized use of overtime". Also, there is a constant struggle to find supplies because mgt. is rewarded for not ordering so much & holding down costs. If the nurses don't have needed supplies, too bad! All the admin. does is say "well, let's run more help-wanted ads & hire another new crop of nurses". Round & round they go! Does anyone consider the cost of all this constant hiring & training? Doesn't seem likely.

I don't know if it's like that on your unit, but I have seen unit supervisors leave also, because they are just as frustrated as the employees.

Why do I stay as a volunteer? Because I mostly have contact with the nurses, not management. They are always so appreciative & thankful for my help.

rn/writer, RN · Jul 18, 2005

"all the admin. does is say "well, let's run more help-wanted ads & hire another new crop of nurses".

my first job was like that. i was working third shift and, with the very capable assistance of two cnas, had to care for 35 patients on a hospice/infectious disease floor of a large and poorly run nursing home.

i had half a dozen tube feeders, patients with severe decubiti (transferred up from other floors), peritoneal dialysis, and a whole flock of people with end-stage hepatic and renal disease, hiv and cancer. every morning that i left work, i felt like a wet noodle and thanked god that i hadn't killed anyone. i left after six months. later, i found out that this place regularly hired new grads, burned 'em out, and brought in a fresh crop.

several years down the road, i was not at all surprised to find out that a demented patient had wiggled his way into a supposedly locked laundry chute and fallen six floors. luckily, there was a partially filled bin below and he was only injured instead of killed. there were other incidents as well--patients escaping from locked units, a woman who fell from a third story porch, many instances of sexual behavior with demented male patients groping disabled female patients. the place was eventually closed down, but it happened years too late for some patients and families.

i would have been very grateful to start my career in a place that made learning important and valued preceptorship. i felt terribly alone and scared and thought that if i said anything or asked for help, i would be shown the door. in retrospect, i probably would have been ignored but they were too desperate for help to fire anyone.

i liked the post about deliberately giving the floor a mentoring/training atmosphere. some people get enough satisfaction from a teaching role, especially if it comes with a few perks, that they might stay for that alone. the other thing that might help you is the perversity of human nature. when you feel you can't leave, you want to all the more. but, if it seems expected that you'll move on after so much time, you might not be in such a hurry to leave a secure position on a unit with good camaraderie.

good luck,

miranda

ADONLTC · Jul 23, 2005

Great thread ... great responses....
It illustrates some of the complexities of the "nursing shortage." As the OP has shown, people don't just leave because the unit managers are evil, lazy tyrants as some people like to suggest. Nurses have other reasons for leaving that are often beyond the control of the frontline unit manager.
It might help the OP to re-think the role of her unit within the hospital system. We have such a unit at my hospital -- a general med-surg unit to which new grads often come to get good experience before moving on to a more specialized unit and/or ICU. Rather than bemoan that phenomenon, the unit embraced that identity and even began to market itself as such. They re-organized their care-delivery model to better fit having a high percentage of new grads ... they used nurses with 1 year of experience or more as immediate resources for those new grads, giving those 1-year nurses a good introduction to precepting. They emphasized the importance of precepting and mentoring for their senior nurses and tried to recognize and reward them for taking on those roles. etc. etc.
In other words, the unit leadership knew which battles it could win and which ones it couldn't. They kney they would always have a lot of new grads coming and leaving after a relatively short time. Rather than beat their heads against a wall trying to change something they couldn't change ... they re-built their unit in a way that would take that fact into consideration. They invested heavilty in educational programs, in providing support for new nurses, and in recognizing and rewarding the preceptor role.
It's not a perfect unit ... but it IS working. By marketing themselves as the place where a new grad can get that "year or two of good experience" they usually hire enough new grads to keep themselves reasonably staffed. A few of those stay longer than a year or two. By acknowledging that they will always have a "young staff," they have been able to secure the resources and set up the systems to provide good care in spite of the turnover.
It's a thought ...
llg

EXCELLENT... This was exactly the though I had when I read the orginal post. It may be that this unit will always be a transitional unit. Use that to bring in the staff you need. Take your most senior, best trained staff and encourage them to work with you on this concept. Talk to your administrators, tell them your ideas and get their support and help in accomplishing this.

traumahawk99 · Jul 23, 2005

Boy you said it. It is very tiresome isn't it. Seems like we're in constant train mode, which means we do 2 jobs...our nurse duties AND our training duties.
After awhile it gets old...because you put your energies into these people and they move on.

but why wouldn't they? nursing has become a very mobile career, with no shortage of job alternatives. it reflects broader trends in our society as mobility has increased exponentially. two years is becoming a long time to hold the same job.

doing the same thing for years just doesn't cut it for most folks. the average career (not just job) for a paramedic is 5 years. they're beating the bushes to find medics, and paying premiums for shifts... up to 40 an hour to ride ambulance in my town...

we may as well get used to this landscape, because it's not changing anytime soon. i find that it contains a lot of opportunity for those who want to work.

mandrews · Jul 23, 2005

[This is what makes me want to at least look for another job.

I had a patient last night, ck 294, ckmb 4.4, troponin normal. No complaints. I am a new nurse. Supervisor and preceptor told me they thought I should wait until 0500 and call the doc with her results because, " if you don't he might complain that he wasn't notified just tell him you just wanted to let him be aware."

He got dressed and came to the hospital to complain about me calling him because unless the ckmb was over 5.0 he didn't want to know. Supv comes to tell me that he complained and their response was "i know but you know she is new." He made rounds with a smirk. he has been my family physician for 7years and I felt that he could have talked to me about it, and my supv and preceptor should have told him they told me to call him. Of course they didn't.

THANKS FOR THE VENT!!!!

melissa

fab4fan · Jul 23, 2005

It's totally inappropriate to tie raises in with "extra shifts worked." Fine if you're single, have no kids; people with families or other responsibilities don't have the same flexibility. And even if one doesn't have other things to attend to, there is such a thing as "having a life" and not getting burned out.

That just really fries me. It takes the onus off the hospital for actually doing something about the staffing problem. When are people in admin. going to start having their raises based on retention of nurses? Boy, there'd be a hue and cry if that ever happened!

Basing raises on attendance is a bugaboo for me, too. It can foster the mentality of nurses dragging themselves in to work when they are clearly too ill to be there. And face it, we are all subject to the same chronic illnesses as our patients have. Should an excellent nurse be penalized because she needs to call off periodically because she has a chronic illness? FMLA exists in the US, for now, anyway, for a reason; people shouldn't be punished for getting cancer, having major surgery, being diabetic, etc. Indiscriminate use of sick time/abusers...yes, they should be dealt with, but all too often, good people get swept up in this "inside the box" mentality.

Not wanting to leave because "you'll let your friends down" isn't a great reason for a nurse to stay. If the work isn't satisfying, eventually apathy sets in. If staff can't grow, they'll go. And I don't see anything wrong with nurses wanting to advance, gain other skills...if they can't get it there, they'll get it somewhere else.

As far as the ICU/tele comparison, while the ICU patients may be sicker, it's still a lot less stressful than having a boatload of tele pts. (who can go from "stable" to "crashing" in the blink of an eye), running from pillar to post for 8-12h, and having to be in charge. For me, it would be no contest.

If only hospitals would talk to staff, and then listen; I mean really listen. They'd find out exactly what they needed to know about why nurses leave. If they truly valued experienced staff, they'd take the steps to see to it that their experienced nurses felt respected and needed. Until then, I'm afraid we're all in for more of the same band-aid approaches.