Old Timer's Take on Fixing the Nursing Shortage

Published
by KathyDay KathyDay

Specializes in Patient Safety Advocate; HAI Prevention.

The nursing shortage has been exacerbated and accelerated by the Pandemic, no doubt about that. We need to replace those who have left and educate them even more to fill that gap. I am a firm believer in the "old way" of training, with additional post-training academics.

You are reading page 2 of Old Timer's Take on Fixing the Nursing Shortage. If you want to start from the beginning Go to First Page.

subee, MSN, CRNA

Specializes in CRNA, Finally retired. Has 50 years experience. 4,083 Posts

1 hour ago, CathyGubersky said:

I agree with Kathy Day totally! When I went to the first 2 year RN Diploma program at South Chicago Community Hospital 1972-1974 (Had been a 3 year program up to that point) I had already been working 20 hours per week during high school as a Junior Nurse's Aide. Our first year of school was mornings in class, afternoons on the floor. We put into practice what we learned right away. Yes, by senior year we would go into locker room and change out of our grey pinafores of a student into white of a nurse, and take over for 3-11 shifts, 11-7 on Fridays or Saturdays: as long as we held a B average in class. No instructor on floor, just nursing supervisor or charge nurse. There was a terrible nursing shortage. 72 nurses signed up, 41 graduated 2 years later. Majority passed those awful 3 day boards in June 1974. Majority of the graduates STAYED TO ADEQUATELY STAFF THE HOSPITAL. Yep, it was that bad. But we walked out onto the floor DAY 1 knowing what to do and how to do it. And the State of Illinois paid my tuition and books and fees! 

I retired last year and firmly believe how I was trained is how we need to do it. Team Nursing instead of Primary Care nursing would speed up the patient care, and decrease the workload on the RN. EIGHT HOUR SHIFTS - there were many days I worked eight hour shifts in ICU, ER, Telemetry, O.R., MedSurg where I was exhausted.  Later in life when 12 hour shifts were mandatory there were times I went home and wrapped my legs in a heating pad because of leg cramps. In this day and age of increased acuity just to be admitted, eight hours is long enough to be on high alert. More down time is needed.

Working 8 hours, five days per week, meant you worked with the same people and got to know their strengths and weaknesses so you could work together. True friendships and comradery could develop, and there was time for non-work time activities together such as soft ball games, bowling leagues, etc. With 12 hour shifts you are lucky if you work with the same nurse more than 3x per month. And everyone just wants to finish charting and get home to the 3 hours of "down time" family life before sleep. Actual friendships are rare to develop and I believe this feeling of loneliness leads to burnout. And I would think this is also present among travelers. 

Just my thoughts on the current nursing shortage.

Cathy Gubersky RN, MS

 

"Loneliness" is an astute observation.  CRNA's are always working alone and my personal belief is that this is a factor in our high rate of drug addiction.  12 hour shifts sucked for me.  I had to take NSAIDS just to cover my foot pain so I could sleep!

RN WRITER NC, ADN

Specializes in Nursing challenges, Alzheimer's disease, Dementia. Has 16 years experience. 3 Articles; 20 Posts

Thanks so much for responding! Great to hear how it was back then!

DrNurseCNS

DrNurseCNS

Specializes in Advanced Practice, Critical Care. Has 40 years experience. 17 Posts

9 hours ago, KathyDay said:

... In my article I mentioned some sort of prep courses during high school.  A very basic layer of nurses training could start there...  I know that some high schools offer free CNA training, and that could be the beginning for ongoing nursing education...

Yes indeed. I graduated from nursing school with my BSN in 1982. But I was not as lost as some of my classmates because I had the chance to take a CNA class offered through my high school when I was 17 years old. I went every Saturday morning with my cohort and an instructor, worked an entire shift and then participated in a post shift conference. I was then able to obtain a CNA job at the same hospital where I trained because they knew me and knew I was going to be an RN. I worked there all through nursing school.

I will admit they were a little miffed when I chose a new grad RN program elsewhere. But my point is, I really didn't get a lot of practical experience in my BSN program; my best experiences came from working as a CNA and watching the RNs I worked with. That type of experience also helps people figure out if they are really cut out for this profession before they waste a lot of time, money, and effort.

ThePrincessBride, MSN, RN, NP

Specializes in Med-Surg, NICU. Has 7 years experience. 1 Article; 2,569 Posts

Good points but I will say not all BSN nurses come out clueless and unable to function. I had a preceptorship in my last semester and by the end I was taking full patient load and was able to hit the ground running with less than 6 weeks of orientation. But ymmv. 

I do think that the biggest problem contributing to the shortage isn't the education process but horrible work environment: terrible ratios, crap wages, terrible management,  and being forced to care for out of control, disrespectful patients. And now they are talking about "team nursing" which will make things worse (patient outcomes, workload on RNs).

Until those issues are addressed, it doesn't matter how we educate nurses or how many we churn out if they all leave the bedside in a matter of a couple of years due to poor working conditions.

ThePrincessBride, MSN, RN, NP

Specializes in Med-Surg, NICU. Has 7 years experience. 1 Article; 2,569 Posts

7 hours ago, CathyGubersky said:

I agree with Kathy Day totally! When I went to the first 2 year RN Diploma program at South Chicago Community Hospital 1972-1974 (Had been a 3 year program up to that point) I had already been working 20 hours per week during high school as a Junior Nurse's Aide. Our first year of school was mornings in class, afternoons on the floor. We put into practice what we learned right away. Yes, by senior year we would go into locker room and change out of our grey pinafores of a student into white of a nurse, and take over for 3-11 shifts, 11-7 on Fridays or Saturdays: as long as we held a B average in class. No instructor on floor, just nursing supervisor or charge nurse. There was a terrible nursing shortage. 72 nurses signed up, 41 graduated 2 years later. Majority passed those awful 3 day boards in June 1974. Majority of the graduates STAYED TO ADEQUATELY STAFF THE HOSPITAL. Yep, it was that bad. But we walked out onto the floor DAY 1 knowing what to do and how to do it. And the State of Illinois paid my tuition and books and fees! 

I retired last year and firmly believe how I was trained is how we need to do it. Team Nursing instead of Primary Care nursing would speed up the patient care, and decrease the workload on the RN. EIGHT HOUR SHIFTS - there were many days I worked eight hour shifts in ICU, ER, Telemetry, O.R., MedSurg where I was exhausted.  Later in life when 12 hour shifts were mandatory there were times I went home and wrapped my legs in a heating pad because of leg cramps. In this day and age of increased acuity just to be admitted, eight hours is long enough to be on high alert. More down time is needed.

Working 8 hours, five days per week, meant you worked with the same people and got to know their strengths and weaknesses so you could work together. True friendships and comradery could develop, and there was time for non-work time activities together such as soft ball games, bowling leagues, etc. With 12 hour shifts you are lucky if you work with the same nurse more than 3x per month. And everyone just wants to finish charting and get home to the 3 hours of "down time" family life before sleep. Actual friendships are rare to develop and I believe this feeling of loneliness leads to burnout. And I would think this is also present among travelers. 

Just my thoughts on the current nursing shortage.

Cathy Gubersky RN, MS

 

Team nursing in today's acute care is a horrible idea. My hospital is looking at bringing back team nursing. So instead of being responsible for 5 patients (which I would prefer), the RN will be forced to look after 10 and hope and pray to God they have an LPN that won't kill a patient (because let's face it, if something goes wrong, the RN will be blamed). Plus there are some things LPNs can't do that the RN would have to do on all 10 patients...no thanks!

Many of the patients we are getting in med surg in this day and age would have been PCU patients and many of the PCU patients of today would be in the ICU and the patients of today's ICUs would have died 40 years ago.

As for 8s...honestly if we were forced to go to 8s we would lose a massive amount of nurses. The only reason many of us stay in the bedside is for the 12s...I can't think of a faster way to burn out than being forced to deal with poorly behaved patients and their families 5 days per week.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 30 years experience. 31,606 Posts

8 hours ago, ThePrincessBride said:

Good points but I will say not all BSN nurses come out clueless and unable to function. I had a preceptorship in my last semester and by the end I was taking full patient load and was able to hit the ground running with less than 6 weeks of orientation. But ymmv. 

I do think that the biggest problem contributing to the shortage isn't the education process but horrible work environment: terrible ratios, crap wages, terrible management,  and being forced to care for out of control, disrespectful patients. And now they are talking about "team nursing" which will make things worse (patient outcomes, workload on RNs).

Until those issues are addressed, it doesn't matter how we educate nurses or how many we churn out if they all leave the bedside in a matter of a couple of years due to poor working conditions.

I agree with this.  The BSN program here offer plenty of clinical time.  I think going back to the "40 hours a week, 8 hours a day" way of doing clinicals isn't going to help this situation.  

With an abundance of opportunities, new grads tolerance for such things is not very much.  We're seeing this in other professions during this economy of low unemployment and abundance of jobs in the "great resignation".  This generation of workers are setting boundaries and employers best respond.

It does seem a no-win situation because as soon as we train people and get enough staff, some of them quit and move on, we're short staffed, people are hired, they burn out, on and on.

KathyDay

KathyDay

Specializes in Patient Safety Advocate; HAI Prevention. 5 Articles; 76 Posts

On 5/20/2022 at 2:55 PM, CathyGubersky said:

I agree with Kathy Day totally! When I went to the first 2 year RN Diploma program at South Chicago Community Hospital 1972-1974 (Had been a 3 year program up to that point) I had already been working 20 hours per week during high school as a Junior Nurse's Aide. Our first year of school was mornings in class, afternoons on the floor. We put into practice what we learned right away. Yes, by senior year we would go into locker room and change out of our grey pinafores of a student into white of a nurse, and take over for 3-11 shifts, 11-7 on Fridays or Saturdays: as long as we held a B average in class. No instructor on floor, just nursing supervisor or charge nurse. There was a terrible nursing shortage. 72 nurses signed up, 41 graduated 2 years later. Majority passed those awful 3 day boards in June 1974. Majority of the graduates STAYED TO ADEQUATELY STAFF THE HOSPITAL. Yep, it was that bad. But we walked out onto the floor DAY 1 knowing what to do and how to do it. And the State of Illinois paid my tuition and books and fees! 

I retired last year and firmly believe how I was trained is how we need to do it. Team Nursing instead of Primary Care nursing would speed up the patient care, and decrease the workload on the RN. EIGHT HOUR SHIFTS - there were many days I worked eight hour shifts in ICU, ER, Telemetry, O.R., MedSurg where I was exhausted.  Later in life when 12 hour shifts were mandatory there were times I went home and wrapped my legs in a heating pad because of leg cramps. In this day and age of increased acuity just to be admitted, eight hours is long enough to be on high alert. More down time is needed.

Working 8 hours, five days per week, meant you worked with the same people and got to know their strengths and weaknesses so you could work together. True friendships and comradery could develop, and there was time for non-work time activities together such as soft ball games, bowling leagues, etc. With 12 hour shifts you are lucky if you work with the same nurse more than 3x per month. And everyone just wants to finish charting and get home to the 3 hours of "down time" family life before sleep. Actual friendships are rare to develop and I believe this feeling of loneliness leads to burnout. And I would think this is also present among travelers. 

Just my thoughts on the current nursing shortage. 

Cathy Gubersky RN, MS

Thank you for your comment Cathy.  We are like minded.  I also remember more camaraderie and solidarity in the staff 'back in the day'.  We worked together like a fine tuned instrument and we also socialized outside of work.  There must still be some of that, but by the time I retired there wasn't much...maybe they just thought I was too old!  Anyhow, the old "training'" really should be incorporated into every program. 

Thank you for your work.  Kathy

 

CathyGubersky

CathyGubersky

6 Posts

15 hours ago, Tweety said:

I agree with this.  The BSN program here offer plenty of clinical time.  I think going back to the "40 hours a week, 8 hours a day" way of doing clinicals isn't going to help this situation.  

With an abundance of opportunities, new grads tolerance for such things is not very much.  We're seeing this in other professions during this economy of low unemployment and abundance of jobs in the "great resignation".  This generation of workers are setting boundaries and employers best respond.

It does seem a no-win situation because as soon as we train people and get enough staff, some of them quit and move on, we're short staffed, people are hired, they burn out, on and on.

Tweety, Your last paragraph says it all, so why not try 8 hour shifts again????

 

CathyGubersky

CathyGubersky

6 Posts

Team Nursing "back in the day" was made up of RN Team Lead, LPN, 2 or 3 CNA's. The team assignment was based on acuity of patients on the floor.  Today's patients ARE much higher acuity, so that would be factored in to the assignment and safety ratio. The hospitals need to suck it up and hire more supporting staff. The RN can not do it all! If more hospitals paid off the school debt of the nurse as part of the hiring contract, and a good wage with at least 4 weeks mandatory PTO, and a lot of "support" staff There would be less burnout. I am still a firm believer in 8 hours a day on high alert is enough. 

Thanks for being a nurse, and for the work you do!

Cathy

JKL33

6,269 Posts

On 5/19/2022 at 5:45 PM, KathyDay said:
 
  1. Exhaustion
  2. Timely or early retirement        
  3. Refusing to get a mandatory COVID vaccine
  4. Going to travel nursing for better pay
  5. Family concerns during COVID
  6. Safer easier assignments elsewhere
  7. Sickness or death
  8. Pursuit of higher education
  9. Violence on the job, or 
  10. They were just plain sick of it. Burned out, PTSD, emotionally drained 

Remember that #s 4 and 6 do not represent anyone leaving nursing and are not contributing to a nursing shortage--to whatever extent one might exist.

The problems are so large-scale; their origin is with our health system itself; our politics, the scheming, the profiteering, all of it. Having nurses expose themselves to the toxicity 5 days a week instead of 3 is not a solution that is going to have a positive effect on nurses' tolerance for mean-spirited disregard and constant toxic chaos. What people are tired of is the constant messaging of how they are not good enough or have failed in some way or have done yet another dozen things "wrong," day in and day out, while trying to do their work the best that they can given the ridiculous circumstances. They have grown intolerant of the gaslighting (being made to feel that there is no problem or that their attitude is the only problem). They are tired of being called upon to be ethical, angelic, heroic in some way, while their employer spends big money to try not to be fair or ethical and will plainly tell you that they would cut off their nose to spite their face.

Nurses are tired of poor treatment, period.

I feel no pressure to try to figure out how nurses can get themselves back in line so that huge corporations can keep churning the way they prefer to.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 30 years experience. 31,606 Posts

10 hours ago, CathyGubersky said:

Tweety, Your last paragraph says it all, so why not try 8 hour shifts again????

We were mandated 12 hour shifts years ago and a few people left then that couldn't fit it in with their family's schedule, but 12 hour shifts and 4 days off are wildly popular and if they brought them back my guess is that not many people would take them up on it.  Personally, I'd rather get the torture done in 3 days. LOL

subee, MSN, CRNA

Specializes in CRNA, Finally retired. Has 50 years experience. 4,083 Posts

46 minutes ago, Tweety said:

We were mandated 12 hour shifts years ago and a few people left then that couldn't fit it in with their family's schedule, but 12 hour shifts and 4 days off are wildly popular and if they brought them back my guess is that not many people would take them up on it.  Personally, I'd rather get the torture done in 3 days. LOL

Isn't is silly of hospitals not o offer a choice?  I did work one place where both options are offered.