Disillusioned RN

I’m currently in school to obtain my Bachelor’s in Nursing and I’m working on a project to “tell the world” about my story and experience as a nurse. Please, Please! Tell your story to the world because it needs to be heard. Compassion, empathy, and caring are absent from healthcare, and nursing is most definitely on its deathbed. So very sad.

I am a believer! I use essential oils and I have experienced benefits. I don't believe anyone is saying they cure diabetes, cancer or other serious diseases. They can be beneficial, cost effective, and even used as an adjunct with other traditional treatment measures, such as medicine, physical therapy, massage, etc. Currently some research is available, but more is needed to fully understand the benefits. And yes, Allison, our patients are using them. Therefore, we need to be aware and informed. I am including 3 articles related to EO research. Also, keep in mind that the FDA receives funding in the form or fees from the pharmaceutical companies they regulate. In addition, the FDA does not do any clinical testing or research. The pharmaceutical companies who will profit from the drugs are expected to do their own research. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-018-2409-0 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606594/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192342/

You make a very good point. Our entire healthcare system and our social support system (or the lack thereof) is in crisis. We have so many changes that need to happen. It is larger than just a nursing issue. Advocate for nurses, educate patients, engage in grass roots lobbying, and vote! I see change in the future.

Excellent! This should go to every hospital CEO throughout the country. We have been asking for 20 years. Now it is time to demand a change. Healthcare is going through a major transition, and I believe that the new generation of nurses will be front and center with changes for the future.

To address the current nursing shortage, we must first address the reason that so many nurses are leaving the profession. Is it stress from witnessing death on a daily basis as was the case during the height of the pandemic, or burnout from working too many shifts during COVID? Everyone seems to think that COVID was the culprit that brought the heroes to the end of the rope. We, as nurses, know better. Could it be the lack of respect and the absence of support that nurses have experienced for the last two decades? Or maybe it is the exhaustive list of demands that are constantly changing but daily expectations in an already chaotic environment? Could it be the realization that neither the nurses nor the patients are safe in the profit-driven, revenue-focused environment that is healthcare today? Or could it be the numerous rules, regulations, unnecessary mandates, and subsequent punitive actions when events happen that are many times, not even within our control? Or could it be the lack of resources and support staff that have eroded steadily over the years, leaving the RN with more responsibility while taking care of higher acuity patients? These circumstances must be addressed by healthcare corporations, otherwise, they will continue to search in vain for adequate, competent staff, and the number of medical mistakes will continue to skyrocket causing patients to suffer more harm. If the previous concerns are not addressed, then nothing will ever change. The nursing profession will continue to erode and patients will continue to endure egregious and preventable medical errors. Our society as a whole will suffer. Focusing on reforming the work environment will go a long way toward improving nurse staffing. Concentrating on exemplifying a just culture, not just discussing the benefits in administrative meetings, will go a long way towards boosting the morale of staff. Either healthcare corporations will begin to attentively listen to the needs of their workers or the workers will be forced to demand change. Collective bargaining is a phrase that brings fear into the heart of every CEO. In a perfect world, leadership will address those concerns and the work environment will become harmonious and organized, and the nursing profession will flourish. Then we can get down to increasing numbers of nurses in the workforce, right? First of all, nursing schools should receive extra funding to ensure an adequate number of instructors, supplies and resources to educate new nurses. Currently, there is a waiting list at many universities and people are being turned away. This doesn’t even make sense when America is in desperate need of nurses. In addition, nurses need scholarships to offset the cost of education. Nurses are offered loan forgiveness when they agree to work in underserved areas, which is a great incentive for the nurse and the healthcare system that will reap the benefits, but there need to be cost incentives for all nursing students, with a particular focus on African, Asian, Hispanic, and Native Americans, as well as recruiting more men into the profession. Currently, the majority of the workforce is white female, but expanding the diversity of the workforce is imperative, especially in light of the increasing diversity of our patients. Furthermore, many times they are the ones who are most in need of quality healthcare. The expectation at schools of nursing is a PhD-prepared instructor. I most certainly think we need PhD level teachers in the academic setting. I also think we need more Master’s prepared instructors primarily to help with clinical instruction. We need a lot of them. Having instructors in the hospitals with nursing students would free up the staff nurse who is acting as preceptor. The staff nurse should not be expected to teach students. She has enough responsibility. Student nurses would have more opportunities for hands-on learning in the clinical setting. Ultimately, more instructors mean more graduate nurses entering the workforce. In addition, more flexibility in the workplace is a must. Nurses need more time off from work, and we need more part-time nurses to fill in the gaps. I personally believe that 8-hour and 12-hour shifts should be offered, but I do understand the potential staffing nightmare that could ensue if everyone is working different hours. Nonetheless, I think there may be semi-retired nurses or nurses who need less work time because of families, who might be amenable to 8-hour shifts. Another necessity is true PRN staff, not just PRN staff that is expected to work 40 hours per week and float. Nurses who want to work occasionally should be available for sickness or vacation or times of high volume. That would help with the workload and the corporation would not have to provide costly benefits. Some nurses might like to have specific extended blocks of time out of work to be with school-age children or care for aging parents. This should be possible. COVID has demonstrated to all of us the importance of work-life balance. To allow nurses to take extended periods of time off, traditional agency nurses could be utilized or large hospital corporations could employ their own group of agency nurses to work all the different facilities within the system. They would have a workforce that is employed by the corporation and not an outside agency, but it would provide flexible staffing throughout the entire system. Correcting the multitude of problems that have contributed to the staffing situation of today will never be easy or quick. Ultimately, every hospital and every healthcare conglomerate will need to address the concerns of nurses in a transparent, forthright, and open manner that will bring some resolution. Otherwise, the safety, quality, and cultural foundation of our entire healthcare system are in peril. References U.S. Nurses in 2020: Who We Are and Where We Work What do nurses want? Why Is There a Nursing Shortage?

think the anger at visitor restrictions/limitations is understandable. I think another fly in the ointment is that some health care workers refused to be vaccinated without true medical contraindications and continued to take care of patients, while patients' family members, who may have been fully vaccinated and fully compliant with mask wearing/social distancing, were prevented from being with their loved one, advocating for them, and providing them with support. This is so true and even though I understand the rationale behind not allowing family visits, I believe it is cruel and unusual punishment. It is wrong to let someone die without family present. If we can allow visitors to MRSA and Cdiff rooms, we can do the same for Covid while following all the necessary precautions.

These articles are great! Our HR had policies and procedures in place that prevented people from getting hired and made the entire hiring process extremely difficult and convoluted. Only a very few made it through. I am now beginning to understand the strategy behind it all. And yes, they will do whatever it takes to destroy unions. It is so sad that our healthcare system has become an indifferent and calculating profit driven monstrosity, even to the point of tolerating preventable errors and death, in some cases, rather than ensure a quality workforce and patient safety. And private equity firms in healthcare! A Catholic healthcare at that! Reprehensible!

That is the tragedy. The patient is most definitely a loser in our current healthcare system. And we will all be patients sooner or later.

I agree. Unless healthcare corporations make significant changes and make them quickly, they will have to deal with nursing unions. They brought it upon themselves.

Capitalist is the key word. Until the entire system is overhauled, there will be no significant change in our healthcare. Making a profit is more important than healing a patient.

I completely agree. A big sign on bonus is a red flag. Most nurses want respect, a voice in planning, and most definitely adequate resources. They don't want more money.

It is very unfortunate that so many nurses are leaving the profession or leaving for higher wages. Why can't hospital systems pay their own nurses the same salary as a contract nurse. Either way I completely understand the exodus. You can only take so much abuse. NormaSaline, you are right! They don't want us old seasoned experienced nurses. That is their loss.

Nursing shortage has reached critical levels. That alarming iconic statement is a sign of the times, and it is broadcast daily in the media. Of course, the crisis is blamed on the Coronavirus. Assuredly, everyone in healthcare at this moment in history, nurses specifically, is overwhelmed, overworked, overpowered, and overcome with exhaustion to the point of being totally over it. Yet this nursing crisis did not start with the first COVID case in the United States or even after the first 39 million patients diagnosed with COVID. It has been a slow, relentless, insidious scheme occurring over decades. Do you remember the nursing shortage of the 1970’s? That’s when nurses first began to work 12 hour shifts. Was that because nurses were demanding 12 hour shifts? No, there were not enough nurses to staff three shifts. In addition, hospital administration was in favor for obvious reasons. Less staff meant less salaries and benefits, and therefore, more revenue. About the same time period, hospital and healthcare organizations began to merge. Originally, the intention was to decrease costs and standardize care through electronic medical records, joint purchasing options, and more efficient coordination of patient care. Unfortunately, studies have shown that hospital mergers only increase costs. Huge healthcare conglomerates mean costly administrative bureaucracies, enormous marketing expenditures, and decreased competition. Decreased competition is the gold standard for business models today. When a hospital system controls the market, they can exercise their leverage to negotiate higher prices with insurance companies. As a result, Insurance companies raise rates to cover the hospital expenses, and the patient is the one who suffers due to inflated insurance premiums. Furthermore, there are fewer diverse employment opportunities for nurses and hospital consolidations slow wage growth. How have hospital acquisitions affected nurses? Nursing satisfaction scores have decreased with hospital mergers. Nurses have more responsibility and less support staff. Not surprisingly, an increase in musculoskeletal injuries has also been reported. Twelve hour days that are consistently fourteen hour days lead to emotional fatigue and physical exhaustion. Turnover rates are high. Nurses leave, either for a change of venue in the clinical realm, which can be difficult since there is very little choice among the corporate monopolies, or sometimes to find a completely new profession. New people are hired and an already frustrated, overworked, mentally strained staff is expected to mentor new hires. It is a continuous vicious cycle. All of this results in mistrust of administrators and the organization as a whole. Obviously, this type of work environment is less than optimal. Furthermore, multiple studies over the last two decades have demonstrated that nursing satisfaction scores demonstrate a positive correlation with patient outcomes. Aiken and associates demonstrated that hospitals with higher ratios of patients per nurse were more likely to increase the odds of nurses reporting poor quality of care and patients were less likely to rate them highly or recommend the hospital. Research studies by Perry and associates demonstrated similar results. Units with less than satisfied nurses have more medical errors, falls, nosocomial infections, and poorer patient outcomes. Over the last 4 decades, nurses have been bombarded with overwhelming demands, increased liability, an upsurge in negative workplace experiences, even to the point of physical violence, increased work injuries, and less support and empathy from leadership. Policies and protocols dictate tedious documentation. Hospital policies, federal and state regulations, and joint commission requirements are lengthy and arduous. Provider organizations and private insurance have adversely impacted the delivery of nursing care. Who has time to care for patients when the list of duties and requirements grows exponentially? In truth, nursing care is no longer meeting the physical and emotional needs of the patient, instead we cater to the demands of an indifferent corporate system that monitors profit margins and struggles to constrain litigation. A prime example of corporate disregard for nurse demands is being expected to go to other units to work, units we have not been trained on, units that have certain responsibilities we cannot perform due to lack of training or certification. What does that mean? Another nurse has to help the nurse who has been pulled to the unit, performing various tasks such as administering chemotherapy, explaining orthopedic medical devices, or just helping her find the correct supplies. This situation only increases the workload for both nurses, which means increased anxiety and emotional stress. What is the likelihood that nurses will give a positive rating to those types of work environments? As previously stated, a dissatisfied nurse is a dissatisfied patient. Another flagrant disregard for nurses is the lack of representation on hospital boards. There are 3.8 million registered nurses compared to approximately 1 million medical doctors in the United States, but what is the composition of the hospital board? It is very disappointing to discover that hospital boards are made up of doctors and business leaders. Nurses are front line caregivers and should be included in developing patient care policy. Nurses are essential to everyday patient care and they understand better than anyone the daily operation of a hospital, but there is an obvious lack of nurses on hospital boards across the country. In fact, there is a definite scarcity of nurses, pharmacists, respiratory therapists, and physical therapists, the staff that are the matrix of the hospital environment. Surprisingly, the hospital workforce has grown by nearly 75% between 1990 and 2012, according to an article in the Harvard Business Review, but for every sixteen non-doctor workers, ten of those are management and administrative roles. At first glance, one would assume the remaining six are nurses, which is still a negative percentage, but the real facts are even worse. The remaining six are the entire clinical staff, including nurses, allied health professionals, medical assistants, and care coordinators. Is it safe to say there are too many captains and not enough crew? Sadly, nurses have been advocating for safe staffing guidelines for over 20 years without any meaningful change, but the non-clinical workforce has increased significantly. Not only do the executive positions multiply, but corporate salaries continue to skyrocket. Still hospitals choose to understaff frontline workers and demand unrealistic expectations at the expense of the staff and the patient. Nursing is a call to care. It is a passionate commitment to care for those who are sick, injured, disabled, or dying, as well as offer support to their family members. Unfortunately, the healthcare model of today does not feel that same level of responsibility. The idea that caring for patients is a selfless, noble profession dictated by a higher calling no longer exists. Healthcare is defined by a business model, governed by corporate executives that have never even had an opportunity to see a patient much less observe the daily workings of a hospital. Our healthcare system, in the name of progress, quality patient care, and strategic cost reduction, has exploited nurses and left patients without adequate resources to obtain satisfactory healthcare or even maintain a healthy lifestyle. Nurses are required to work long hours, they are expected to work in areas in which they are not adequately trained, and there is never enough staff to physically care for patients much less educate them regarding a diagnosis, prescribed medications, or discharge instructions. The end result is that patients suffer harm due to hospital medical errors, and patients are discharged without necessary education or supplies. Changes are long overdue. Just as Nightingale commanded a new dialogue around nursing and patient care 150 years ago, today’s nurses must come to the forefront of designing safe patient care strategies. We must demand access to equitable healthcare for everyone, we must demand a seat at the table of corporate boardrooms, we must demand a safe supportive work environment for ourselves which ultimately delivers safe and supportive care for all patients. To achieve our goals, nurses must stand united as a powerful voice and advocate in our workplace, our schools, and our communities, and petition our state and federal legislatures to advance the cause of safety for nurses and patients. Time is of the essence. References/Resources Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States Changes in quality of care after hospital mergers and acquisitions. The impact of workplace violence on medical-surgical nurses’ health outcome: A moderated mediation model of work environment conditions and burnout using secondary data. Chapter 24: Restructuring and mergers. Patient Safety and Quality: An  evidence-based handbook for nurses. The downside of health care job growth. Nurses on Boards Coalition. Nurses on Boards: The time for change is now. The effects of nursing satisfaction and turnover cognitions on patient attitudes and outcomes: A three-level multisource study.

Good for you! You are very brave!

C-Suite compensation has got to change. I believe non-profit status is only a way to pay less tax and increase profits. The worker, the system, and the patient do not benefit. Only certain individuals. CEO compensation and huge hospital mergers should be regulated.