Negative Feedback Loop

[dumbnurse, ASN, BSN, MSN, LPN]

I write this at the near end of a 35+ year nursing career. From my beginnings in Education in 2007 until now, I have watched and waited and hoped that more nurses would enter the field of education. While this may have happened to some degree, the number of students and number of educators leaving has outpaced the incoming instructors. Now we have many more adjunct instructors (clinical) than full time faculty, due largely to the serious pay cut from a bedside nurse to a fulltime educator. Covid has smacked us in the face with that reality. So here's the problem, much like that patient with paroxysmal SVT who needs an ablation to correct his/her dysrhythmia, the nature of clinical nursing is at that point. So, a clinical instructor has 10 students on a med/surg/pcu floor and maybe they have a total of 30 students in one week. The first couple weeks of clinical you must identify the high performers, the in betweens and the ones that you will need to spend more time with because they are Covid era students. Now 10 students who are all prepared the same, with backgrounds in health care, possibly an LPN and otherwise familiar with the hospital setting would be wonderful. But that is not the reality...two of the ten are not in health care, three of them are repeaters from last semester, five of them have accommodations for exams and maybe three are already doing an RN's job as an LPN.

Thankfully some facilities are allowing students back into observation areas which takes away some of the pressure of having ten students to watch (but remember, you must ensure their objectives are met and maybe go see them during observation). So, now, five years down the road, managers are seeing that the needed skills for orientation are not there, I.e. giving adequate patient handoffs, understanding charting, never speaking with doctors or even becoming comfortable around them, etc., so we stop observations again to help ensure that those skills are focused on again. And we are back in the same boat or messed up conduction system!

I would have loved to have gotten $100 an hour in an ICU where I worked for 21 years and I do not begrudge those nurses who have stepped up and exposed and sacrificed their lives for patients. But I'm wondering what sort of event will ever make teaching nurses more attractive so that these conduction problems can be avoided? Anyway, that's an old man's damn opinion, and I still love my job, but it needs an ablation!

[adventure_rn, MSN, NP]

On 3/24/2022 at 8:11 AM, dumbnurse said:

I'm wondering what sort of event will ever make teaching nurses more attractive so that these conduction problems can be avoided?

As with bedside nursing, maybe schools will finally reach a point where they realize that they need to pay their educators better?

I get that some schools are more financially well-off than others, but ultimately, nursing schools are businesses (especially these days). They start profitable programs, discontinue programs with poor profitability (as seen with CNS and some NNP programs), and increase class sizes to try to increase their profits and cost effectiveness.

If enough educators quit or can't be recruited because the salaries are terrible, the programs will eventually have poor outcomes and risk losing their accreditation, at which point they will have to pay their educators better. If they don't they'll close, and if enough programs close (and the nursing shortage becomes even more critical than it already is), maybe the government will provide more subsidies (like program grants or student loan forgiveness) for people who become nursing educators.

It does really stink for current educators, because they're the ones who will have to be stretched thinner and thinner until there's finally a breaking point. To be fair, that's exactly what's happening in the inpatient world as well. In the hospitals that refuse to raise salaries, everyone is quitting except for the people who truly can't (I.e. because their families are stuck in the area), so they bear more and more of the brunt of short-staffing while picking up the slack.

[dumbnurse, ASN, BSN, MSN, LPN]

Awesome response thank you!

[RobtheORNurse]

I am a nurse educator, MSN in Nursing education. I left the OR nearly 10 years ago after 25 years because my facility had no openings and no mobility options. I went to the medical device industry for much more opportunity for advancement, able to use my degree/ training, respect that was not found in the hospital. Now, on to when I looked at teaching at the local university, my alma mater, that offered an instructor position, full time, for $55,000.00/ year. Sorry, but I have bills to pay and mouths to feed. 

When salary is what it should be for nursing instructors, more will go into that area. Until then, I will stay in the device industry as an educator and where salary has no cap that I have seen, bonuses are paid, and the opportunity to develop new products for patient care is unlimited.

[feelix, RN]

After COVID-19 there is a new phenomenon. There is a bifurcation of simulation instructors and clinical instructors. Simulation instructors are usually the inner power circle unwilling to risk their lives in the hospitals (just like the coveted coordinator position of the past). The clinical instructors, on the other hand have to go into the hospital just like in the past and risk catching COVID, in addition to dealing with grades and clinical paperwork.

[feelix, RN]

S0ome schools are getting away with paying instructors half a salary by sending one clinical group one day and another clinical group the next day, all under the same section. So the section comprises of 20 students, but the clinical instructor never gets to have more than 10 at a time. That is cheating your adjunct of a few credit hours and salary. They would not do that if instructors were being paid by the hour.