Old Timer's Take on Fixing the Nursing Shortage

[subee, MSN, CRNA]

On 5/22/2022 at 10:41 AM, Tweety said:

The initial idea was that it cut down on incidental overtime.  People that were scheduled to work 40 hours routinely worked over 40 hours just to get things done.  The other thing it was the preference of the majority of the staff.  The problem with offering 8 hours and 12 hours if you have to have someone to match the 8 hour people three times a day and someone to match the 12 hour person.  Otherwise at 3, 7 and 11 you're shuffling assignments around because not enough people want to work 8 hour shifts.  Easier I suppose for administration to have everyone on the same page.  But I can see that in this time of shortage, maybe offering 8 hours would be an incentive.  

 

No, it doesn't work with people on the same floor working differently houred shifts.  Units would have to designated 8 or +12's on inpatient units.

[Tweety, BSN, RN]

4 minutes ago, subee said:

No, it doesn't work with people on the same floor working differently houred shifts.  Units would have to designated 8 or +12's on inpatient units.

Yes.  Back in the day you could work 12 hour shifts if you found a match on the opposite shift to work the same schedule.  

Now if we offered 8 hours you'd have to cover 3 shifts with 8-hour workers and the demand to work 8 hours just isn't there anymore and I would venture a guess staffing a unit with nothing but 8 hour workers would be difficult, but it could be done I suppose and would satisfy a niche for nurses that need to do this for their families, or people whom 12 hours is just too physically grueling.  

Edited May 24 by Tweety

[kbrn2002, ADN, RN]

18 hours ago, subee said:

No, it doesn't work with people on the same floor working differently houred shifts.  Units would have to designated 8 or +12's on inpatient units.

It sort of worked having mixed 8's and 12's at the SNF I worked for. A previous DON came up with the idea to try the 12's for those  that were interested. I'm sure it would have been to their advantage if all the nurses were on board as they could have reduced nursing  staff by 1/3 since it took 2 nurses instead of 3 of cover 24 hours but as it turned out there were not very many interested. Only 6 of us signed up for it and those that did work the 12's had to be super reliable employees, if one half of the 12 hour team called in it was almost impossible to fill the full 12 so my 12's pretty often turned into 16's.

[Michelle K]

You have great perspectives on how we can retain and better prepare future nurses. Nursing is hard work. Even harder with higher patient expectation, more patient focused, incentives for organizations when meeting patient expectations and quality care.  Sometimes I think health care is becoming more health cost. 

[BeatsPerMinute, BSN, RN]

I agree with the majority of what you post. the only bits where I might disagree come with the idea that unless youre “in it” (doing nursing school and figuring out nursing without years of experience here and now) you cannot fully understand what its like to be “in it.” - and tho that is real, you covered so much and much of what you posted makes sense. so focusing on that:  

what would it take to go back to some of the old ways? especially the hands on training?

the restrictions are ridiculous! during my peds rotation, I was not allowed to give many medications and even PO tylenol required supervision at all times. no exceptions. one was very lucky to get exposure to critical care, ED, NICU, L&D etc (basically any specialty areas). far and few got those opportunities even during the last semester of school. if one hoped to see the OR, or any sort of intra procedural area… forget about it. aint gonna happen. I got really frustrated one day, and sternly but respectfully asked a professor once about the restrictions. Summary was: “too much risk.” 

 last year, I was working in IR and was assigned to work intra op, and one of my patients was a retired nurse that graduated from nursing school in the late 1950s. She was an amazing (and hilarious) human with SO many great stories. Learned a lot and got a glimpse of how things once were and how things could be better in the nursing world. she had to work hard in nursing school and really hard being in the workforce, college education, during a time when it was not so popular for women to do so. 

side note: I have my RN, BSN + following certs: BLS, ACLS, PALS, CCRN… and strongly feel that none of the alphabet soup of letters trumps solid training and hands on experience.

other personal thoughts: the more I hear and learn about how things were done before, the more I feel that any nursing programs out there these days are a joke. I learned more in my first year working as a nurse than the entire 4-5 BSN program I spent 50k on “earning” 

Edited May 28 by BeatsPerMinute
NA

[londonflo]

9 minutes ago, BeatsPerMinute said:

if one hoped to see the OR, or any sort of intra procedural area… forget about it. aint gonna happen. I got really frustrated one day, and sternly but respectfully asked a professor once about the restrictions. Summary was: “too much risk.” 

The last hospital I taught at had specific guidelines about what students could do on their own....nothing! Not even an accuchek!  The faculty member had to supervise all medication administration, any urinary catheterization, NG insertion, would dressing care etc. I had 10 students with 10 acutely ill patients with multiple IV medications. There is only so much time..

With regards to the OR:  There were 3 pages of guidelines. I had to walk the 2 students allowed that day at a designated time ( one hour before the clinical start time) to outside the OR and wait for the appointed person to appear and steer the 2 students to their cases. The guidelines were specific about NO jewelry but I missed one student out of 20. The OR appointed person  made sure to pull me out of a patient room later to show me my transgression (with cheap costume jewelry in her hand). But there you go....gatekeepers to learning. This has changed in my nursing education role from 1979 to now....

[subee, MSN, CRNA]

1 hour ago, londonflo said:

The last hospital I taught at had specific guidelines about what students could do on their own....nothing! Not even an accuchek!  The faculty member had to supervise all medication administration, any urinary catheterization, NG insertion, would dressing care etc. I had 10 students with 10 acutely ill patients with multiple IV medications. There is only so much time..

With regards to the OR:  There were 3 pages of guidelines. I had to walk the 2 students allowed that day at a designated time ( one hour before the clinical start time) to outside the OR and wait for the appointed person to appear and steer the 2 students to their cases. The guidelines were specific about NO jewelry but I missed one student out of 20. The OR appointed person  made sure to pull me out of a patient room later to show me my transgression (with cheap costume jewelry in her hand). But there you go....gatekeepers to learning. This has changed in my nursing education role from 1979 to now....

If hospitals don't re-dedicate themselves to institutions of learning for nurses (do they restrict medical students in this manner?), then they are NEVER going to have enough staff because they are already missing the big picture of what's going wrong.

[CathyGubersky]

I really enjoyed my job when there were Jr and Sr nursing students, LPNs, LPN students, CNAs, Jr CNAs, RT + students, PT + students, OT + students, Med students, interns, residents, fellows who all worked together and were not afraid to ask for help lifting, moving a patient ... etc., etc..... 

[No Stars In My Eyes]

2 hours ago, CathyGubersky said:

I really enjoyed my job when there were Jr and Sr nursing students, LPNs, LPN students, CNAs, Jr CNAs, RT + students, PT + students, OT + students, Med students, interns, residents, fellows who all worked together and were not afraid to ask for help lifting, moving a patient ... etc., etc..... 

That's the way to do things! We had sufficient staffing, and there was always someone to help out if needed. They divvied up the patient assignments so that no one ended up with the all the hard/difficult patients and no one refused to help out for a few minutes with certain procedures. I was the med nurse on 3-11, and the charge nurse and I would take up to 4 patients between us. There were 3 CNA's who split up the rest of the patients, some who they doubled up on, and some they each worked alone.  

[CathyGubersky]

As a diploma student we did 8 week rotations, into the OR and on day one were taught to scrub, sterile technique, worked in sterile supply (back in the day we double-cloth wrapped items for sterilization), learned what was in simple packs. Then we went into pre-op and then post-op. Finally got to scrub and became 2nd and then 1st assist during surgery.  In my senior year I was allowed to work weekends as part of the skeleton crew that staffed for emergencies. We were not a trauma center. This was an excellent experience on my part! Never had a problem gowning, gloving correctly and maintaining sterile protocol.

[KathyDay]

I had several weeks of OR training as well, Pre and post op, and scrubbing in.  And like you we learned to clean and repack instrument packs.  My first job as an RN was in the OR/ER/sterile supplies department of my small hometown hospital.  I had all of the basics on board to do that job and the many aspects of it.  This was in the days of sterilizing and centrifuging glass/mercury thermometers!  So much has changed, that is for certain.  But, the need for scrupulous sterile technique will never change, and those basics were given to me and my classmates in an excellent 3 year nursing diploma program. 

[AnneD.RN]

These are great ideas, Kathy! I agree that going back to the "old training" or fundamentals of nursing is important. I feel that there was a great emphasis on nursing theory, micro pharmacology (the level of detail that is more useful to a Pharmacist that a Nurse) and other areas of study in nursing school, that are not as useful in the day to day of being a nurse. Although these other topics are important, they do not need to be at the forefront of nursing education. It would be better to prioritize nursing and clinical skills. These are the tools needed for safe practice and to increase the best outcome for your patient. Developing these skills will develop confident nurses.

Today in healthcare, there is a significant emphasis on charting for the sake of meeting Medicare standards and to avoid liability. Unfortunately, this often takes away from patient care. Some of my colleagues who started working as a nurse in the 1970's and 80's have shared with me that they felt that they had the ability to practice actual nursing care during that time compared to today.

I agree that Nurse Educators are also necessary. I worked with two wonderful Nurse Educators in my first four years of nursing. They provided education to oncology patients who were receiving chemo for the first time. However, they also provided education to the nursing staff. 

Definitely appreciate your insights!