Nurses Are Leaving the Bedside In Droves

[panurse9999]

We can debate the why's, where's, how's, when's of the toxic culture in many hospitals and nursing homes.

More work, less support staff. More work, less pay. Too many patients. Higher acuity, more orders, fewer nurses being hired. My boss is dumb. My boss is toxic. Yes, its a BIG factor in a nurses decision to leave. We hate drama. We want to do our jobs in peace.

But those are just workplace semantics. There is drama in every workplace, wether in nursing, retail, law enforcement, food services, housekeeping, gaming, farming, hospitality, transportation, or basket weaving. Yes, its there now, and yes, it was there 50 years ago.

Truth be told, years ago, before corporate mergers/ takeovers/ acquisitions became as simple as buying pizza, we had hospitals and nursing homes. Today we have hospital systems and nursing home chains. With these corporate conglomerates at the helm, our profession was taken away. We lost our voices. We lost our sanity. We lost our zeal. Same thing happened to the banking system in the 1980s. Local stand alone banks were bought up, one by one, until we had 6 or 7 worldwide megabanks.

Corporate mentality stole the nursing profession and burned it at the stake. What used to be patient focus, is now billing focus. Today we do not have patients, we have inventory. Some generate substantial money, others are a drain. This is why, when and how "staffing to census" began rearing its ugly head. Back in the old days, there was no such thing as staffing to census. Nurses were hired on certain units, and that is where they stayed. Some days were super busy, others were not.

Staffing in hospitals and nursing homes today is soley based upon inventory (patients) and money (acuity). Not enough inventory in the burn unit? Float the nurse. Not enough inventory in L & D? Tell the nurse to stay home. Too many nurses on telemetry? Send 2 home, or let them work as techs on med-surg. And the list goes on.

What used to be paper documentation by exception, became EMR to generate maximum amounts of reimbursements from medicare, medicaid, and insurance. This is why we have box checkers (formerly known as nurses) spending 75% of their time at computer stations, and 25% of their time at the bedside. If you're lucky. So the next time your wife, husband, brother, sister, friend or companion starts mocking you for being a serial job hunter/ hopper, send them to this article.

Spread the word. Nurses didn't leave the bedside, the profession left us.

[myoglobin, ASN, BSN, MSN]

Also those “high paying” corporate jobs can disappear in a puff of smoke with no guarantees that they can be replaced.

[guest974915]

After a long tenure in nursing, one of the things I find so repugnant in nursing, is the punitive culture that pervades. There just seems to be a complete lack of professional etiquette or courtesy in some workplaces. As your coworker, if I follow behind you and notice that you made an insignificant oversight or simple error that didn't compromise patient safety, I just fix it then or try to make it right. If I feel that perhaps the error resulted from a lack of knowledge, I try to find a way to diplomatically bring the matter to your attention or give you the information that you perhaps didn't have. Instead, some nurses are so quick to "write them up"-i.e. incident report, RL Solution, tell the NM.... As this is the only job I have ever worked, I wonder if this pettiness exist in other professions? Really!

[Hoosier_RN, MSN]

On 5/28/2019 at 12:47 AM, Leader25 said:

This is incorrect,the difference is small but there is a higher payrate for each level.

It depends. Hospitals in some areas don't acknowledge the education. They will pay variable rates for RN experience, and some for LPN experience as well. It's all about location

[Hoosier_RN, MSN]

On 5/28/2019 at 1:54 PM, HomeBound said:

I make $118K base pay right now. As a floor nurse--no overtime, no shift differential, no "extended hours" to kiss orifice in order to convince someone I am the best choice.

I don't bill. I don't deal with insurance companies telling me that I have to code something in a certain way in order to be paid. I don't have to fudge something in order to be paid.

All while still dealing with the rude patients and their crazy families. The violent drug seekers. The ones who follow you out to your car or wait for you in the parking lot as you exit your "urgent care in a CVS broom closet".

I didn't go into nursing with $$$ in my eyes. I was bored with my former profession. I had hit the ceiling and was literally going through the motions. In a hospital. I've been employed by hospitals since I was a candy striper at age 14.

Don't give me that whole schtick. Older nurses, entering after life experience last longer. It's the YOUNGER ones that cry and whine and complain about how haaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaard it is to work weekends. and nights. and are expected to work overtime. put the phone away. get off their orifice instead of sitting at the nurses' station checking their instagram. taking selfies with the booze and party hats (so that they get fired and then wonder WHY?)

Sorry....but i don't think I've ever seen a nurse at 50+ years old taking selfies of her alcohol induced self love fest for the world to watch....including the cleavage shots.

There's another little girl on my unit who struts around saying she's "going to be a CRNA"---she's applied! One whole year of ICU---and she still needs her preceptor to help her handle anything more complicated than 2 drips and a vent. She's just so sure. She's gonna own it all.

Oh. Yeah. She forgot. You gotta do all that hard stuff....organic chemistry. Biochem. Statistics. Pathophys and advanced psych.

Omigerrrrrrsh! Don't these CRNA people know who she is???

Medical school and these skilled advance practice jobs---such as CRNA---are hard. FOR A REASON.

But but but but but....I wanna make $170K like someone told me I can by flying through barely 1 year of actual clinical training and 4 years of writing papers! Someone told me I could!

There's yet another person on my unit who is going the "Psych NP" route...as well as my best friend who is pursuing it.

Why? Both of these men say the same thing. "All I have to do for a paycheck is sit and tune out some crazy while they talk...write a care plan and prescribe". Crazy person complains? Who cares. Nobody listens to crazy people anyway.

This is the general attitude of the "younger nurses" that I have come across. My friend is early 40s, and he's pretty much the exception to that I've met.

And before you go all---well---I know so many in my 3 whole years as a nurse. Have you been a traveler? Have you gone through these other hospitals across the country and had a good dose of this? Have you worked in hospitals alongside and as a nurse for over 35 years? Have you even changed units within your own hospital system?

Here's another tidbit---floor nurses that work for Kaiser Permanente make $160K to start. Just sayin'. Wanna know why it's so hard to get into that system? Because their pay is ridiculous---but it's also got it's serious problems---and signing a confidentiality agreement is standard procedure with that company if you do get hired on. And it's not about "proprietary information". It's about appalling work conditions and standards...how they treat patients as cattle.

I shouldn't have to live in upstate Wisconsin or in Death Valley in order to make a decent living. I shouldn't have to be threatened, kicked, punched, spit on, followed or otherwise placed in mortal danger---if I wanted that---I would become a deep sea fisherman in the North Atlantic or a police officer.

I am hearing:

Yes....we do get threatened and it's crap on the floors and my colleagues suck and the patients are horrible and I never sleep and my back is broken and my pay is garbage to do all of this.

But I just looooooooooooooooooooooooooooooooove nursing and I'd recommend it to my kids!!! You all just are so unhappy that you can't just get over the third world working conditions! What a bunch of malcontents. Oh I know. You must be the "older, second career" nurses.

I love this 100%. Another 2nd career nurse that comes from a family of nurses, PAs, and NPs. As far as malcontents: there are some posts as soon as I see that "X" is the poster (sorry, not naming names), but I scroll on by. Their posts are so venomous that I think that it must really suck to be them. Do I have crappy days at work? Yes, but so does every other job out there. Overall, I like what I do, and I have some of the same issues as others do. I just vent appropriately and move on...

[kbrn2002, ADN, RN]

On 5/28/2019 at 6:09 PM, OUxPhys said:

Its crazy how costs of living and education costs/requirements have gone up yet wages have been stagnant.

Not just the cost of education but basic cost of living. In some highly sought out places nobody can afford to actually live there. Even in a reasonable COL area it's getting tough. My taxes have gone up, not down as promised. My insurance premiums have doubled while the coverage has diminished. My wages haven't kept up with the increased cost of living, not even close. But I also don't think this is at all unique to nursing. I'm just glad I didn't go into teaching or become a social worker as those professions are definitely worse off financially than I am, at least where I live.

[SmilingBluEyes]

My daughter, a few years back, expressed interest in nursing. Then upon graduating HS, she got a job as a patient care tech. She got to see up close, personally, what nurses go through and decided in less than a year, nursing was not for her.

I did not push her one way or the other. But she is smart enough to see that her education is better off in an area she has more interest in, and will be more fulfilling. I hope it turns out that way.

I feel for millennials and others entering the work force these days. EVERYWHERE workers are being abused, doing more with less and job hopping multiple times to keep their sanity. There IS not corporate loyalty on either end. I can't blame the young generation for their shock and dissatisfaction.

I am at the other end where retirement is finally in sight. I used to say I would nurse til I dropped dead. (and I meant it, 22 years ago). Not any more. As soon as financially possible, I am out. I have a lot of plans for retirement and being a dog for the corporate machine is not one of them.

Sad.

[SmilingBluEyes]

And the NP route? GOOD LUCK with that. I have a friend who became an NP and she has to see patients all day, every day every 10-15 minutes and spend hours and hours clicking boxes just for reimbursement. And for the amount of time/money spent on her master's degree, she barely breaks even.

So word to the wise: don't go thinking the NP route will save you from what we all are being put through. ICD-10 coding and box-clicking will be the thing you spend time on, the most.

[Hoosier_RN, MSN]

17 hours ago, SmilingBluEyes said:

And the NP route? GOOD LUCK with that. I have a friend who became an NP and she has to see patients all day, every day every 10-15 minutes and spend hours and hours clicking boxes just for reimbursement. And for the amount of time/money spent on her master's degree, she barely breaks even.

So word to the wise: don't go thinking the NP route will save you from what we all are being put through. ICD-10 coding and box-clicking will be the thing you spend time on, the most.

I can work 40 hrs a week (notice, NO OT) and make more than NPs with 3 years experience in my area. I used to complain about pay, but now have a job that pays appropriately, My area is also flooded with NPs, some working at bedside to get paid. Those who are working as NPs tell me that with charting and reviewing at home, they are working 60-80hrs/wk, easy, and are salaried for 40. If they complain, there are others just waiting to take their place. Some can argue that NPs don't have to lift. I work in a clinic, I don't lift...Overall, most of my NP friends wish they hadn't done the NP route, they say that its a whole new level of crummy. I don't know what it's like everywhere else, but this seems to be the common theme everywhere.

Another note about NPs I've seen on here: a few years ago, a couple of NPs were happy in general. Now with many years experience, practices don't want to hire them with their salary demands, but sure do want their expertise. Independents (in states that don't require MD oversight) are supposedly seeing less and less in reimbursement because these are being cut constantly. My cousin does this in another state and has went back to being with an MD because the overhead of a basic office couldn't be sustained with cut after cut after cut on what an NP can bill vs an MD. She was making less a year than I was, and was working herself to death.

CRNAs is another area of nursing that is beginning to see a market flood. In my area, some did this, but have to travel. Why? Local hospitals won't use CRNAs because we are rural, and the anesthesiologists that were there are young, no need for them. The anesthesiologists can bill higher as well...

So, there is some more food for thought. Again, this pertains to things I see locally, other's experience may vary...

[OUxPhys, BSN, RN]

6 hours ago, Hoosier_RN said:

I can work 40 hrs a week (notice, NO OT) and make more than NPs with 3 years experience in my area. I used to complain about pay, but now have a job that pays appropriately, My area is also flooded with NPs, some working at bedside to get paid. Those who are working as NPs tell me that with charting and reviewing at home, they are working 60-80hrs/wk, easy, and are salaried for 40. If they complain, there are others just waiting to take their place. Some can argue that NPs don't have to lift. I work in a clinic, I don't lift...Overall, most of my NP friends wish they hadn't done the NP route, they say that its a whole new level of crummy. I don't know what it's like everywhere else, but this seems to be the common theme everywhere.

Another note about NPs I've seen on here: a few years ago, a couple of NPs were happy in general. Now with many years experience, practices don't want to hire them with their salary demands, but sure do want their expertise. Independents (in states that don't require MD oversight) are supposedly seeing less and less in reimbursement because these are being cut constantly. My cousin does this in another state and has went back to being with an MD because the overhead of a basic office couldn't be sustained with cut after cut after cut on what an NP can bill vs an MD. She was making less a year than I was, and was working herself to death.

CRNAs is another area of nursing that is beginning to see a market flood. In my area, some did this, but have to travel. Why? Local hospitals won't use CRNAs because we are rural, and the anesthesiologists that were there are young, no need for them. The anesthesiologists can bill higher as well...

So, there is some more food for thought. Again, this pertains to things I see locally, other's experience may vary...

Very well said. I make more working 40 hours than a lot of new NPs (and if I work more I get paid OT and shift diff). CRNAs in my area are a dime a dozen now along with NPs.

[myoglobin, ASN, BSN, MSN]

I see it a bit differently. Just because I'm becoming an NP (in my case PMHNP) I won't stop being a nurse/RN. Many of the NP's (primarily FNP's) that I know still pick up one or two shifts per month or more PRN in my ICU either to supplement their income or to keep their skills relevant. Also, I believe that ultimately, to make a better income that NP's will need to "be in business for themselves". That is to say work in independent practice states and bill directly (as my friend in Arizona does with her three affiliated NP's and two counselors). Of course fighting for better (and maintaining current) reimbursement levels is "part of that fight". Don't think for a second that one of the ways that MD's and hospitals won't strike back is by trying to limit, reduce, and increase burdens for reimbursement. That's why NP's need to lobby and work with their RN family to maintain the situation they have and improve it for the future. I truly believe that by offering the best evidence based care (in mental health) along with the best evidence based complementary and alternative health approaches (including diet, exercise, and meditation) that NP's can offer outcomes that significantly exceed what standard, allopathic medicine and begin to reverse the wave of chronic disease (ie epidemic obesity, insulin resistance, and metabolic syndrome, depression) that has engulfed our civilization. Indeed, while I would like to make more money than bedside, it's not what motivates me (then again at age 50 with 150K in student loan debt, no IRA, and no health insurance perhaps it should). Also, keep in mind that I counseled my son to "become an RN" for several specific reasons that have little to do with becoming an NP.

[ThePrincessBride, MSN, RN, NP]

On 5/31/2019 at 5:10 PM, SmilingBluEyes said:

My daughter, a few years back, expressed interest in nursing. Then upon graduating HS, she got a job as a patient care tech. She got to see up close, personally, what nurses go through and decided in less than a year, nursing was not for her.

I did not push her one way or the other. But she is smart enough to see that her education is better off in an area she has more interest in, and will be more fulfilling. I hope it turns out that way.

I feel for millennials and others entering the work force these days. EVERYWHERE workers are being abused, doing more with less and job hopping multiple times to keep their sanity. There IS not corporate loyalty on either end. I can't blame the young generation for their shock and dissatisfaction.

I am at the other end where retirement is finally in sight. I used to say I would nurse til I dropped dead. (and I meant it, 22 years ago). Not any more. As soon as financially possible, I am out. I have a lot of plans for retirement and being a dog for the corporate machine is not one of them.

Sad.

Thank you!

I feel that Gen Y gets a lot of crap for job hopping but honestly, the only way to get a decent raise is to job-hop or even transfer. I had to transfer in order to have my pay match my years of experience and it was a crap-show after being grossly underpaid for over two years.

It just doesn't pay to stay in the same spot for more than three or so years.

[ThePrincessBride, MSN, RN, NP]

8 hours ago, Hoosier_RN said:

I can work 40 hrs a week (notice, NO OT) and make more than NPs with 3 years experience in my area. I used to complain about pay, but now have a job that pays appropriately, My area is also flooded with NPs, some working at bedside to get paid. Those who are working as NPs tell me that with charting and reviewing at home, they are working 60-80hrs/wk, easy, and are salaried for 40. If they complain, there are others just waiting to take their place. Some can argue that NPs don't have to lift. I work in a clinic, I don't lift...Overall, most of my NP friends wish they hadn't done the NP route, they say that its a whole new level of crummy. I don't know what it's like everywhere else, but this seems to be the common theme everywhere.

Another note about NPs I've seen on here: a few years ago, a couple of NPs were happy in general. Now with many years experience, practices don't want to hire them with their salary demands, but sure do want their expertise. Independents (in states that don't require MD oversight) are supposedly seeing less and less in reimbursement because these are being cut constantly. My cousin does this in another state and has went back to being with an MD because the overhead of a basic office couldn't be sustained with cut after cut after cut on what an NP can bill vs an MD. She was making less a year than I was, and was working herself to death.

CRNAs is another area of nursing that is beginning to see a market flood. In my area, some did this, but have to travel. Why? Local hospitals won't use CRNAs because we are rural, and the anesthesiologists that were there are young, no need for them. The anesthesiologists can bill higher as well...

So, there is some more food for thought. Again, this pertains to things I see locally, other's experience may vary...

I get what you are saying but it took you twenty years to make more than a fairly new NP, so it isn't a fair comparison. You should compare your pay to an NP with 20 years of experience.

The minute clinics in my area start new grads off at over 50-55 per hour which equates to about six figures. That is about five to ten dollars more per hour than the most senior of nurses. Prison Paych NPs are pulling 140k starting (a new grad I know was offered this a few weeks ago).

Again, it is all area dependent. But in order for me to make near as much as an NP, I would be working a crap ton of overtime shift work OR have to wait 16 years.