Old Timer's Take on Fixing the Nursing Shortage

KathyDay

The nursing shortage is starting to hurt, really bad. These past few years have worn down some of the strongest and most talented nurses in the US, and they have either quit nursing or moved to greener Nursing pastures. Sadly, this happened smack in the middle of a horrible pandemic when they were needed the most.

Reasons for Nurses Leaving

Exhaustion
Timely or early retirement
Refusing to get a mandatory COVID vaccine
Going to travel nursing for better pay
Family concerns during COVID
Safer easier assignments elsewhere
Sickness or death
Pursuit of higher education
Violence on the job, or
They were just plain sick of it. Burned out, PTSD, emotionally drained

Too many of them were all wrung out. They didn't have anything left to give. Nurses are human too.

An article in the Bangor Daily News before the pandemic discussed nurse retainment. One hospital spokesperson stated that over half of new graduates left their new jobs before their first year was up. They started replacing nurses with foreign nurses. I wonder what they discussed in their exit interviews. Did they ask WHY they left? If they asked, what were the answers? That was not covered in the newspaper story. It made me wonder what they were doing to address the reasons that new nurses left.

Could it be that they were not staffed well enough? Were they given a long enough training period with a preceptor? Was the pay good? Were they treated with respect and taught the ropes with patience?

I don't pretend to have all the answers, but I am an old nurse, and I have learned a thing or two. Every patient is different, and so is every nurse.

kathy-graduation.jpg.c7ed0572c38b5436f057cec9784af746.jpg.704bce56fc6a7c766a153f732b58db0e.jpg

When I trained in nursing in 1967 (graduated in 1970), we started practicing our book learning in the second half of our first year. I trained in a School of Nursing. It was a 3-year program in a Catholic Hospital school, with rules, lots of rules, and very few vacation breaks. We went to school and trained year-round. Our fees covered books, room, board, schooling, and uniform laundering. If my memory serves me well the cost of our program for 3 years, all year, was around $1500... I had a federal loan that was partially forgiven by my work after graduating. A nursing student couldn't pay for books for that amount these days. I paid the balance of my loan, around $800 several years after I graduated. I was never strapped with student debt and exorbitant monthly payments.

Our first semester gave us all the necessary sciences. The second semester we dove right into actual nursing fundamentals, and beyond that, we learned pharmacology and practiced in all of the specialties. With the supervision of our instructor, we did all of the work of an RN. We passed meds, and took full patient assignments. We work/studied OBS/GYN, Med/Surg, psychiatric nursing, Operating room and recovery, pediatrics, and ICU. We spent a good slug of time (generally a month or more) in each specialty and did our studies and hands-on practice simultaneously at times. We also worked shift work with regular staff and in our senior year, we did Charge Nurse duty (all with instructor supervision).

During our training, no cheating was allowed and we were monitored for it. If you failed a subject, no matter how hard you worked, you were dismissed and had to repeat that entire year. I always thought that was harsh, and that perhaps some tutoring might have been fairer.

My program was very tough. I was never so proud or relieved as the day I graduated from that school. When I left, I felt like I had the world by the tail and I was a fully prepared nurse. I passed my boards with flying colors on the first attempt. And, that was while I was sick with a horrid sore throat and fever!

I sincerely believe that an attempt to "get back to basics" is the way to go. I admire and know many college-educated newer nurses. I also know that they did not start their first jobs with the same confidence that my classmates and I did. We were very confident in our skills because of hands-on training.

A 4-year program is fine, if you want to be a well academically rounded new nurse who will need a lot of nurse training once you start your first job as an RN. Since there are barely enough nurses to go around, is that realistic...to have that expectation of your new employer? Can an already overloaded staff nurse mentor you and still take safe good care of her own patients?

My idea is this:

Go back to the old training, and know that once a student graduates, they are prepared to do the job of a bedside RN from the get-go. Offer these programs free, to anyone who qualifies and find a way to do a lot of the coursework remotely, so a student can do much of their training while at home. Set up satellite classrooms remote from the nursing school. Organize housing for students when they need to be away from home for in-hospital nursing training. Also, attract them with the promise of an excellent position and salary and potential for advancement when they graduate. Employers can then offer tuition reimbursement for nurses who want to work for them while they pursue higher education, like a BSN, MS or PhD. While they continue their nursing education, they can be an already "trained" RN, earning a living in a hospital or LTC. We also need nurse educators, so additional education is necessary for that as well. I know that some of "my" ideas are not original and that some facilities and schools offer a lot of what I suggest. But this has to be widespread and the commonly accepted approach to nursing recruitment, education and retainment. If schools and facilities and other nurses do not make nursing attractive, we will not get new nurses.

The work of an RN should be based on caring, curing, rehabilitating (when possible), educating and prevention. Another very important part of nursing is guiding patients and their families through their last days. None of these things can be done in a hurry, yet every time a nurse goes to work at the bedside, whatever facility they work in, they face a rapid-fire marathon of work. There is little or no time for actual caring....a little hand-holding, a compassionate conversation with a patient or family member, an extra touch, maybe even a little skincare. And, the nurses' basic needs like using the bathroom or having lunch are often not met. That is just not right. The job is just that...a job. We want it to be a calling again.

Nothing has highlighted the short fallings more than the care of Covid patients during an overwhelming pandemic. We can't allow this to continue. Nursing is not the same as a production line, yet nurses are expected to work that way. It is evident by the long-standing understaffing of facilities where physical and mental speed is a constant expectation...and slowing down for caring and compassion is not. Profits are the ruling factor in healthcare facilities and that is just counterintuitive to the calling.

We will never attract young people to nursing if we allow the current pace and disrespect of nursing to stand. There are just too many other attractive professional opportunities that compete with nursing. But we can change. We can change how or if we have to pay for nursing education. We can change nursing education itself....by starting with "training" and continuing with broader advanced education. Perhaps even earlier nurses training prep can start in high school We can change the work of nurses. Most importantly, we can change the quality of the work and patient care and safety if all of these steps are taken.

I don't have a miraculous way to pay for all of this, but we need to find a way. If not, then people like me, a 73-year-old woman, will be hard put to find nursing care for ourselves when we need it.