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.

[OUxPhys, BSN, RN]

39 minutes ago, ThePrincessBride said:

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.

I left a floor with good management and great coworkers for another job because it paid more. I had to. I have no desire to become a NP or CRNA.

[myoglobin, ASN, BSN, MSN]

Area of the country matters significantly as well. Thus, in Florida, a Med-Surgical nurse might find themselves with, six, seven or even eight sick patients, no lunch (that they can actually take they will still have to clock out and lose the pay or get in trouble), and a starting dayshift RN will find themselves around $25.00 per hour. Thus, for this RN going to NP school and earning around $50.00 per hour for a job where they have some hope of things like a lunch break, and actually not facing imminent loss of their license (due to the sorts of things that occur with six, seven, or eight sick medical surgical patients) seems like a bit of a blessing.

[SmilingBluEyes]

2 hours ago, myoglobin said:

Area of the country matters significantly as well. Thus, in Florida, a Med-Surgical nurse might find themselves with, six, seven or even eight sick patients, no lunch (that they can actually take they will still have to clock out and lose the pay or get in trouble), and a starting dayshift RN will find themselves around $25.00 per hour. Thus, for this RN going to NP school and earning around $50.00 per hour for a job where they have some hope of things like a lunch break, and actually not facing imminent loss of their license (due to the sorts of things that occur with six, seven, or eight sick medical surgical patients) seems like a bit of a blessing.

Make sure you really talk to NPs in your area. They make more, but trust me, their scope of responsibility is not something you understand til you are one. They earn EVERY SINGLE PENNY. 12-hour workdays (with all the required charting/billing/yadyada, they are worked and hard.

it depends on what you do. But it's no Holy Grail, like so many think. And the market is increasingly saturated----,meaning your pay may just suck compared to what you expect. Buyer beware.

[myoglobin, ASN, BSN, MSN]

I'm not saying that it is a panacea (my wife works form home earns 85/hr as a PMHNP and hates her job) but what is? Go to studentdoctor.net and one of the common complaints is "why did I work so hard to go to medical school when I see NP's earning almost as much as me". The family practice doctor where I did my medical rotation last summer had a small practice with just himself and four techs/secretary. He had been in practice locally for about 18 months (after completing his residency in New York) and said he was going to be lucky to clear 60K after expenses and he said he was working six days per week and at least 12 hours per day M-F and another 8 on Saturday with administrative stuff (again we are talking Florida).

[SmilingBluEyes]

Understood. You must do what works for you. I am not saying people should not pursue becoming NPs. I am saying a lot go for this, not really researching the market in their area. I suspect within the next 5 years, some markets will be so saturated that in order to pay back the massive debt/school loans, some of these nurses will be forced to either try to get into high-volume, crazy practices or go back to the bedside.

I have seen it here.

[myoglobin, ASN, BSN, MSN]

Here is my "top ten" solutions to both issues (keeping RN's at bedside and optimizing opportunities for NP's".

1. Expand California ratio and overtime laws. If bedside nursing is less miserable and more lucrative people will stay with the job longer.

2. Increase the difficulty in immigrating for "employment visas" in nursing. These H1b visas were intended during a shortage situation that no longer exists and are instead used by large corporations to "hold down wages".

3. NP's need to continue to advocate for an expansion in independent practice. Adding a New York, California, Florida or Texas to the 20 something states already having such practice would provide more opportunities. Adding several would have a truly profound impact.

4. NP's who have their license and credentials need to go to those states that have independent practice and form practice groups with other NP's and PA's. They need to become skilled in maximizing reimbursement and advocating for optimal reimbursement from insurance companies.

5. NP''s should consider forming HMO groups for primary care in independent practice states. They should be able to provide superior care at lower costs than many current HMO's.

6. NP's at these practices need to "do what physicians" have been reticent to do. Specifically, they need to offer expanded evening hours, weekends, and even nights. Home visits for shut ins should be explored. Free "clinic days" once per month for those without insurance or who are financially disadvantaged should be explored both because it is the right thing to do and because it is good PR.

7. NP's need to become expert at offering holistic care. That is to say offering the best in standard of care as defined by evidence based databases such as UpToDate and Cochrane. However, they need to go beyond this and offer the best evidence based complementary and alternative medicine and include aggressive dietary interventions (such as DASH, and MIND, and even Keto) for appropriate patient populations along with strongly encouraging appropriate exercise such as strength training and Tai chi to.

8. They also need to consider "post graduate" certifications that demonstrate additional knowledge and or training (think of CCRN for ICU nurses).

9. They need to be willing to educate and offer opportunities for future RN's to gain clinical experience so that they to can further their education if and when they desire to do so.

[caliotter3]

Agree especially with myoglobin’s fourth point. I distinctly remember our family doctor coming to the house to check my baby brother. Now I work in home care and can’t tell you what a production it is to take patients, some on ventilators, to the doctor. NP’s could go to town with the amount of business they would have by making house calls just to home health clients alone.

[Hoosier_RN, MSN]

17 hours ago, ThePrincessBride said:

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.

The 20 year NPs in my area make about 5,000 a year more than new NPs so I am making about 2000 less is all, and for the comparison in liability and hassle, seems to even out. This pay variance is because of market saturation, and Indiana has a few hospital systems running it, and they own just about every practice through the hospitals. They call the rates-if you don't want the offered salary, go elsewhere, "Susie" is still working at the bedside and wants the chance to work as an NP and will do it for way less. For many, moving isn't an option, as we have family obligations and our spouses may have obligations as well. Market saturation is eventually going to catch up. Me, I am making 6 figures now. Again, it's area dependent.

Someone mentioned not getting lunches, since I've changed to this new job, I always get regular breaks. My cousin who is an NP states when she was in independent practice as well as back with MD, lunches are a bite here and there, running past her desk. The NPs that work in my area speak to the same. The ones who have 20 years say years ago, before reimbursements changed, they did take normal breaks. Not now. Again, this is all area dependent. I wish all of you who are pursuing NP luck, but there isn't enough money for me to do that.

[Jedrnurse, BSN, RN]

13 hours ago, myoglobin said:

Here is my "top ten" solutions to both issues (keeping RN's at bedside and optimizing opportunities for NP's".

1. Expand California ratio and overtime laws. If bedside nursing is less miserable and more lucrative people will stay with the job longer.

2. Increase the difficulty in immigrating for "employment visas" in nursing. These H1b visas were intended during a shortage situation that no longer exists and are instead used by large corporations to "hold down wages".

3. NP's need to continue to advocate for an expansion in independent practice. Adding a New York, California, Florida or Texas to the 20 something states already having such practice would provide more opportunities. Adding several would have a truly profound impact.

4. NP's who have their license and credentials need to go to those states that have independent practice and form practice groups with other NP's and PA's. They need to become skilled in maximizing reimbursement and advocating for optimal reimbursement from insurance companies.

5. NP''s should consider forming HMO groups for primary care in independent practice states. They should be able to provide superior care at lower costs than many current HMO's.

6. NP's at these practices need to "do what physicians" have been reticent to do. Specifically, they need to offer expanded evening hours, weekends, and even nights. Home visits for shut ins should be explored. Free "clinic days" once per month for those without insurance or who are financially disadvantaged should be explored both because it is the right thing to do and because it is good PR.

7. NP's need to become expert at offering holistic care. That is to say offering the best in standard of care as defined by evidence based databases such as UpToDate and Cochrane. However, they need to go beyond this and offer the best evidence based complementary and alternative medicine and include aggressive dietary interventions (such as DASH, and MIND, and even Keto) for appropriate patient populations along with strongly encouraging appropriate exercise such as strength training and Tai chi to.

8. They also need to consider "post graduate" certifications that demonstrate additional knowledge and or training (think of CCRN for ICU nurses).

9. They need to be willing to educate and offer opportunities for future RN's to gain clinical experience so that they to can further their education if and when they desire to do so.

A lot of these suggestions will be really difficult to implement unless the NP profession gets their act together and deals with the substandard programs that have sprung up.

[SmilingBluEyes]

I have long held, with many here, RNs/LPNs should charge for skilled services, e.g. IV starts, constant IV titration in ICU, removing sutures, and on and on. If we did this, our value would be truly known. NPs must be the same. Their skills and education are worth a lot more than 55.00 an hour! There are bedside RNs here making more than that already.

Max respect to NPs here, nothing but respect. But they are worth a lot more. Nursing in general, is worth so much more, considering what we bring to the table and the level of skill we have obtained.

[SmilingBluEyes]

OH and don't forget the old "Bait and Switch" pulled by many employers. Offer one thing-----nurse, once hired, finds out it's nothing like what they thought. This leads to disillusionment, naturally. And how many jobs are posted, but the hiring facility will NEVER hire into them! I have personally run across this. Wasted my time perfecting my resume and being interviewed, and told I was "just what they are looking for!"------but we are not hiring "right now".

THIS is really leading to the sense of how employers have no intention of following through on what they lure us into.

I am done trying to reinvent myself. I am just working toward retirement in a specialty I don't love, but don't hate, either. I am sad, 22+ years later, this is what my career has come to.

But I am getting older and no longer want to play games, jump through hoops and be screwed over, anyhow. The Y generation must be beyond frustrated. Don't blame them for looking for a way out, such as the NP or CRNA route. It's sad. "regular RN/LPNs" bring a lot to the table as it is. But increasingly, we are being devalued and demoralized by the constant and increasingly creative abuses of corporate institutions.

[myoglobin, ASN, BSN, MSN]

1 hour ago, Jedrnurse said:

A lot of these suggestions will be really difficult to implement unless the NP profession gets their act together and deals with the substandard programs that have sprung up.

1 hour ago, Jedrnurse said:

A lot of these suggestions will be really difficult to implement unless the NP profession gets their act together and deals with the substandard programs that have sprung up.

I believe that the only solution to evil corporations ( and yes I believe that word is often appropriate) are good ones dedicated to serving others while also staying financially sound. Thus, I believe NP’s and RN’s are uniquely situated to lead such change especially in states that have legally empowered them to do so. Many good hospitals from the past were started for reasons other than profit (Sisters of Charity for example or the Adventist system). There is no reason that dedicated RN’s and NP’s today cannot due the same. First with practices, then with networks and hospitals and perhaps ultimately with a competing “system”. Perhaps to achieve the changes we desire we must create it de novo.