Nursing shortage? Read this and respond please

[CEN35]

In the recent months our hospital appears to have trouble hiring new nurses, and/or keeping nurses in the hospital. This seems most prvalent on the evening and night shifts. A few thoughts enter my mind right from the start.

#1 - Are there a lack of new grads entering into hospitals?

#2 - Are experienced nurses getting out of the hospital to work with corporate companies, legal nursing, insurance companies, etc?

#3 - Is it d/t pay scales, and shift differentials. I know that in the past shift differentials have decreased. They have decreased to the point, where many nurses working nightshift had their yearly raises (let's say .43 cents an hour), but then the differential was reduced by .50 cents a year for 4-5 years. So they lost .07 cents a year. Currently there is no differential between the evening shift and night shift.

So what is it like at your hospitals? Do they have problems hiring, or keeping the positions filled there? Is there a shortage in your area or part of the country? Any thoughts on this would be appreciated.

Rick RN CEN

[Daisy]

I have worked in hospital nursing for over 22 years. Its just a different world we live and work in than it was 10 or 20 years ago. Anyone remember the last nursing shortage? We got good raises then to keep us in our jobs. Is anyone getting good raises now to keep us? Probably not. Health care institutions just don't have that kind of money now. Instead we work harder with less people. Oh yeah they will pay overtime or bonus dollars when they are desperate but raises are very few and far between. The new grads want their cake and to eat it too. When there is competition to hire they go to the best place for the best money stay awhile and if they don't like it move on. We veterans are committed or maybe stuck in the situations we are in. We are close to retirement age and what else can we do, go to another hospital for the same thing so we stay and put up with the misery of watching people come and go each and every day? New grads don't want the evening and night shift. When we got out of school we were thrilled to get a job in the hospital, now they are picky and want the best. There is no solution just down the road. Is it really money that we want to stay? How about good stable working conditions? How about nurse to patient ratio guidelines to help keep the nurse in the hospital so that he or she knows what they are walking into each and every day? How about better orientation programs? We have big city hospitals one hour away from our little community hospital. We can't compete with the money, maybe we can compete with the quality of the care.

[datbzrn]

[Dear 44 years young,, The so-called dinosaurs that you refer to are the exact nurses that you will look to for help when your first patient goes bad!! Is it so wise to ruffle feathers when there is such a lack of experience in the hospitals now-adays? It seems to me that hospitals would want to find a way to retain experienced RNs. The hospital where I work is 300 beds. My floor is a med-surg floor with the capacity for 53 patients. Split that with 4 RNs,$ LPNs, and 4 nurses aides for day shift and see what kind of care there is. Also, administration doesn't care one lick about the staff, regardless of the many and frequent complaints that they get. Is it any wonder nurses want to unionize? It's only going to get worse. There is no incentive to be hired or to stay. Relocation is a big step in your mid forties. There is no clear answer for the problems that RNs are going through, so the best answer at this time is to up your mal-practice insurance

[bunky, BSN, RN]

Daisy, we were just talking at work about your idea of money not mattering as much as the working conditions. We are in a really desparate situation right now, with nurses quitting left right and center. The mass exodus began with the implementation of a new staffing grid which is a killer. We can sometimes look forward to having 9 patients or more on nights where we have no PCA nor unit secretary currently. The other local hospitals have been working a similar grid for awhile and their nurses have also jumped ship. I don't think it's about the money anymore, or at least the money issue isn't as large as the poor working conditions. As my hospital unveiled it's new grid, other hospitals began recruiting our staff with the promise of better staffing and better pay. Now our hospital realizing the importance of staff retention is planning on a pay raise,(the ER has been shut down twice since Saturday due to lack of staff on the floors) but most of us are of the opinion that they can shove their raise and just give us enough staff and we'd stay. It seems like a vicious circle.

[tweetieRN]

As long as I've been in nursing there has been a push to elevate and promote us to the 'professional level'. Some have suggested that this would be done by obtaining a bachelors degree and some by pursuing advanced certifications. None of which I have a problem with if thats what the individual person wants.

I have an ADN and have worked for years in an ICU. During this time I've had many hours of training and courses to stay educated and current with increased requirements of knowledge. But:

Has anyone ever told a little old lady that she'll have to wait for awhile to go potty? Or stood at bedside for 20 minutes while a patient takes their multiple pills one at a time with a sip of water in between each pill? Or left a GI bleeder lay in a bloody mess in their bed so you could do the paperwork? Of course not!!! And these are just a few of the many things that take so much of our time. I'm supposed to operate all this special equipment, take the readings and interpret them, do frequent physical assessments, interpret lab values, review their meds, recheck orders, review their medical history, report anything unusual to the doc. And in the middle of all this I'm to attend to their physical care - bathe them, feed them if neccessary, ambulate them, etc.

I don't want another nurse - I want more CNA's. I've worked mostly at night, and we never get a CNA or unit clerk - they've talked about it, but it never happens. And at night we get extra duties to do during our 'down time'. Down time? And because its an ICU we often move patients in and out all night long. And guess who gets to clean the room for the next patient?

I've always felt that a nurses' duties end up being what no one else wants to do.

[vicki]

Hi Rick,

I just wanted to respond to the question regarding the nursing shortage. I graduated one year ago. I work in a large teaching hospital in the midwest. My orientation was a farce. On day 8 of my orientation, I was given 8 patients of my own for which I was responsible for their total care. This included assessments, meds, personal care such as bathing and changing beds. This also included taking off my orders (there was no unit secretary), to top it off I was given the narc keys. I believe my preceptor believed that it was a sink or swim situation. I cried daily, and at the end of two weeks truly felt as though I would have a nervous breakdown. All this for 13.85 an hour. A year later, the situation is not much improved. I routinely have 9-11 patients on the day shift. We usually work without CNA's and many times without unit secretaries. In addition, the nursing staff is responsible for patient transport for scheduled tests. Many times there are no techs available for phlebotomy and EKG so the nursing is also responsible for these duties. The hospitals have taken what were previously several different paid positions for different departments and consolidated them under the professional nurses responsibility, and then they wonder why we are stressed. They justify doing this by referring to cutbacks and reduced income as a direct result of insurance companies allowed payables and other government endorsed policies. Ultimately, nurses are unable to keep going under such duress and seek positions outside the hospital setting. Burnout is very real to many nurses. Unfortunately, patients are the ones to suffer the most. Until nurses and other healthcare providers learn to stand together and make one loud voice for the public and government, we can expect no real solutions to this problem. We will continue to have short-term, "bandaid" solutions.

[This message has been edited by vicki (edited July 25, 2000).]

[oramar]

Originally posted by vicki:

Hi Rick,

I just wanted to respond to the question regarding the nursing shortage. I graduated one year ago. I work in a large teaching hospital in the midwest. My orientation was a farce. On day 8 of my orientation, I was given 8 patients of my own for which I was responsible for their total care. This included assessments, meds, personal care such as bathing and changing beds. This also included taking off my orders (there was no unit secretary), to top it off I was given the narc keys. I believe my preceptor believed that it was a sink or swim situation. I cried daily, and at the end of two weeks truly felt as though I would have a nervous breakdown. All this for 13.85 an hour. A year later, the situation is not much improved. I routinely have 9-11 patients on the day shift. We usually work without CNA's and many times without unit secretaries. In addition, the nursing staff is responsible for patient transport for scheduled tests. Many times there are no techs available for phlebotomy and EKG so the nursing is also responsible for these duties. The hospitals have taken what were previously several different paid positions for different departments and consolidated them under the professional nurses responsibility, and then they wonder why we are stressed. They justify doing this by referring to cutbacks and reduced income as a direct result of insurance companies allowed payables and other government endorsed policies. Ultimately, nurses are unable to keep going under such duress and seek positions outside the hospital setting. Burnout is very real to many nurses. Unfortunately, patients are the ones to suffer the most. Until nurses and other healthcare providers learn to stand together and make one loud voice for the public and government, we can expect no real solutions to this problem. We will continue to have short-term, "bandaid" solutions.

[This message has been edited by vicki (edited July 25, 2000).]

One year experiece and you totally got a handle on the situation. No one have given a better description of what is going on, good for you.

[CEN35]

Thank you all for your replies and input so far. I have two questions though? What is a CNA?

One other note, someone mentioned unity? Prrofessionalism etc. One thing for sure, when you look at the medical community, the physicians have the AMA. That's it? What do we have? TheONA, the ANA, the NLN etc. That's one problem r/t nursing unity and professionalism, not to mention the griping, and arguing about BSN vs ADN, what a crock! There needs to be a lot done, before we can get to the same level of proffesionsalism as physicians.

Rick RN CEN

[vicki]

Rick, first a CNA is a certified nursing assistant. Second, there are enough nurses in this country to bring about real change if they would ever unite for one common goal. We all know there are two ways of changing laws and trends within our government, one is money- lots of it to pay for lobbying, and the other is to have the general public behind you. The only thing that speaks louder than money is votes. The insurance companies will always have more money than any nursing organization we have. We all know that with the current situation patients are suffering because there are not enough nurses to go around, patients are restricted on what health care they are allowed, and oftentimes the hospitals hands are tied because the insurance companies call all the shots. This is why I say this is larger than just a nursing problem. This involves all healthcare workers, including physicians, and this includes anyone who is currently receiving medical care or who's family members are. I think this would encompass most of the United States. Listen to the feedback from patients and friends outside of the medical field. There are many people who are fed up and desire change.We need strong leaders and articulate people to take this to the public, and for nurses to stand together on issues. Change can benefit all of us. I'll get down off my soapbox now. Please respond with opinions.

[This message has been edited by vicki (edited July 26, 2000).]

[mamy]

WOW! After reading all of these posts I am scared! I am in my last year of nursing school and I thought I would have a job for sure! Now I am not so sure. In Texas where I go to school, the shortage is here and in our face! The hospitals where we do clinicals used to be so happy that they had students, well the nurses were, and now they don't even want to be bothered with us. It is very discouraging! I hope that in this time of crisis we can bond together and make something good come out of it! Keep your heads up guys!

[CEN35]

Someone mentioned unity, and that all we have to do is get all the medical personal together (i.e. doctors, nurses, med techs etc).

1st of all, the AMA have always been the biggest crowd against nurse practioners, and PA's functioning independently. They could care less about us.

2nd? Just get one large organization? It is way easier said than done. There is so much confusion among the nursing ranks, on who or which organization you should be with? why should you be with them? LPN vs RN, vs MA vs NP etc. Nurses in general-->>> ICU doesn't like ER nurses, CCU doesn't like SDU nurses, and the RNF staff does not like anybody, cause they get the leftovers? We have all seen it so it can't be denied. Then on top of all that, it goes back to the ADN VS BSN VS MSN etc. They all think they are better than each other. If you are an ADN you HAVE TO HATE the ANA. Why? The ANA is the orginazation that decided, after a certain year an ADN or diploma program RN could not get a specialty certification, like CNS, etc. So they have allienated thousands of nurses with that move. Certainly, not the inteligence of a brain surgeon (as the saying goes).

BOTTOM LINE--->>>> It will be a long, long time before nurses have any kind of bond or unity, to the extent that we will have the leverage to make those changes to benefit us.

Rick RN CEN

[saphie]

I can only speak from my experience. My experience is there is a nursing shortage. I have classmates that got into specialized areas right from graduation. For myself, I landed a 0.6 permenent position before I had technically graduated. One hospital wants to fly me out for an interview. Another is totally willing to work around my schedule and put in the areas that I want to be in. So I would say in Canada there is lots of jobs up here, at least in Calgary. Not a bad place to be either!

[pickledpepperRN]

Originally posted by Mijourney:

Hi Rick,

Got to get my two or more cents in on this topic.

I agree with your summaries and the previous posts. Lesliee is correct in indicating that new grads don't get enough of what they need to practice confidently as a competent nurse. PPL is correct in writing that it is not the pay that is the major problem in nursing.

Since I have been a member of this BB, my review of posts indicates that:

1.There is a problem with intradisciplinary support in nursing. It starts out in nursing school with nursing educators who are not objective, not politically(not to be confused with party affiliation) savvy, and have inadequate people skills.

2.Managed care has disrupted the comfort zones of all health and medical professionals.

3.Demands of the aged along with the aging "me" generation baby boomers and their "no, me" gen-xer children have increased the frustration level of bedside nurses who already are stressed out from all the restructuring going on in the name of "the bottom line."

4.Many nurses are not wholly engaged in formal life long learning activities which is required nowadays to keep up with the increasingly rapid pace of change in health and medical care.

Also experts write that the average age of nurses in practice today is mid 40's. No doubt, this is one reason many experienced nurses are going into nontraditional fields of health and medical care. This along with potential nursing candidates going into other fields that are less challenged than nursing will possibly contribute to a longer than expected shortage. Some experts predict a severe nursing shortage for the next 20 years. Also, need to include the fact that the proliferation of for profit health and medical services in the last decade have probably negatively impacted entry into nursing practice and nurse retention.

Currently, I am in home health(HH). As a former hospital nurse, I feel that in the future, it will become difficult to distinguish between hospital and home nursing practice in terms of frustration levels. In the last several years, increasing pain has been inflicted upon us. With the advent of PPS which is similar in many ways to DRGs, the pain will become unbearable for many nurses, aides, allied health practitioners, and patients. All this in the name of "the bottom line."

With regards to your specialty Rick, I recently read that many ERs are having a time of it with the increased number of nonemergency visits. It seems like the health care delivery system needs a good restructuring. In fact, this problem probably should have been addressed long before the money and power issue.

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