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I've been an RN for almost 34 years and currently do CVOR/General Surgery travel. With the passage of the "Big Beautiful Bill" and the anticipated closure of numerous rural hospitals and 1 in 4 nursing homes due to lost Medicaid revenue, I'm very worried about the future of nursing in general and travel nursing in particular. Although these Medicaid changes aren't slated to go into effect until 2026, UCSD and Sharp Healthcare (two of the biggest hospitals systems in San Diego County) have already announced preemptive layoffs, including nurses-I'm sure many more layoffs are imminent. I also see these changes as potentially drying up the travel industry and available nursing jobs becoming very competitive and difficult to obtain. Thoughts?

Hello Chronicallychanging. I can relate as I am currently struggling with this myself. I am also an older nurse (also 54 yo) and after beginning a new job 4-5 months ago, I am still really feeling like an outsider. I am a career nurse and hav worked in quite a few different hospitals but don't recall ever having had much difficulty in transitioning to a new job before. Not that I don't have faults, but I really don't think it's me in this instance; I am conscientious and try to be pleasant, open and friendly. I'm not wanting to be noticed, liked, or even to make friends...and to be fair, everyone has been generally pleasant and helpful, but I'm a pretty good read of people. I just get this vibe like I'm the odd man out, just don't fit in somehow andm somehow not welcome. Most of the other nurses I work with are younger and I wonder if this is a factor. Anyway, sorry, no real advice, just wanting to commiserate and I also definitely get the part about just being left to figure things out yourself.

Perfect^^^. Me too

You're missing the point-some people (especially older), prefer a more formal greeting-"Mr./Mrs.", some people prefer a middle or a nickname, some people prefer an alternative pronoun. It's professional courtesy to address people in a manner in which they prefer.

Not real sure I'm understanding? Regardless of age, gender, race, rank, social class...a safe, initial introduction would go something like; "Hello, my name is [insert name]. I am a Registered Nurse and I will be caring for you this evening until 11:00 P.M. Could you please tell me your name and how you prefer to be addressed?".

^^^Disagree and I'm siding with Davey on this. First of all, Clark sounds like a complete heel with a serious case of arrested development and I found Davey Do's approach to him entirely appropriate. Having dealt with this personality type before, I know that subtleties are usually ineffective, hence the need for blunt and pointed dialogue. Nursing report is not the time to shoot the bull and talk about the upcoming weekend, it is a time to communicate pertinent patient information and facilitate continuity of care. If Clark was blathering on and a critical bit of report-i.e. a patient's critical lab, consent, unverified order.... was missed, it could potentially have serious consequences. As such, Clark's interference could be viewed as a patient safety concern.

^^^^Completely agree! I have long thought that academia is entirely out of step with nursing practice. At the curricular level, I remember the hours and hours spent in the classroom learning NANDA nursing diagnoses. In the real world, no one give two whits about care planning (other than to check off the mandatory boxes in their documentation). Then, as touched on above, nursing theory-I'm sorry but some of these theories are so arcane and just wacky-really? No practical application whatsoever! Lastly, APA ad nauseum; When what you say (write) means little but the complete preoccupation with capitalization, commas, and citations-give me a break!

Kudos Davy Do and this is also a major pet peeve of mine also. Not that I am prudish or don't use profane words sometimes myself, but never in a professional setting or in the company of someone that I don't well. I guess this reticence stems from my (our) age and upbringing, but to me, regardless of someone's class or status, this kind of talk comes just across as trashy, ignorant, and inarticulate-not cool or hip. I'm going to catch heat for this also, but the same goes for a person's appearance and presence.

Like you, I have been a nurse for a long time and also like you, my employer mandated that all staff RNs attain their BSNs within five years. I did it, graduating at age 50 and when all was said and done, I had spent about $25,000 out of pocket for an online RN-BSN program, not to mention the many hours of study and frustration. Although I graduated with honors from a well respected program, I went right back to doing the same job I had done pre-BSN for all these years and for the exact same pay. Yes, perhaps a BSN may someday open up a career opportunity that I wouldn't have had otherwise, but my experience has been that many hospitals' compensation for this additional credential is negligible. Lastly, I honestly feel like my BSN added very little to my clinical practice; no new skill sets, no real 'must have' information, just a lot of fluff and filler that I could have just read on the side. It's also just laughable to me that the content of those many Blackboard posts and papers didn't matter at all as long as perfect APA formatting was used-unbelievable!

I'm not entirely sure why you are angry with contingent nurses This is your nurse manager's attempt to control costs and maintain staff nurses in difficult to fill positions (night shift). Also, although per diem nurses are paid a higher hourly rate, they typically don't receive benefits (insurance, 401K, paid holidays...) and as such, are a big cost savings for the hospital. Fair practice? no. Commonplace practice? Yes, sorry

Said well-thank you. The most disturbing part of this post was the OP's cavalier attitude and his inability to appreciate the gravity and possible patient harm that can result from unsafe staffing ratios.

Agreed! Malpractice insurance is cheap too, like $.50/day! Even defending a bogus/unfounded claim could costs thousand in legal fees and lost work.

Bad advice!^^^^ In a court of law, if it came down to paying out a multi-million dollar lawsuit or implicating a staff nurse on even a small technicality or deviation from established policy, it would be an easy decision for the legal department. Protect your interests and livelihood because while the probability of ever needing malpractice insurance is slim, we all have far too much at stake.

Wow! Unless I'm mistaken, you weren't drafted into military service but are voluntarily serving. Also, your immature, over the top machismo is only surpassed by your ignorance of the subject matter and quite frankly, I'm embarrassed for you:(

Without imposed governmental regulations, do you think the labor bosses of old would have voluntarily stopped the systematic exploitation of children in mines? What about the other innumerous, inhumane, and dangerous labor practices commonplace in our country during and following the Great Depression. While at work, when you enjoy your 30 minute lunch and 15 minute breaks, be grateful for governmental regulations!

I'm a very sensitive person also so I totally understand and can relate. Unfortunately, people are people and in almost every job that I have ever held (outside of nursing and within), there always seems to be the same personality types including the toxic coworker(s). Also, like you, I also prefer workplaces that are organized and the expectations of the role are clear. Personally, I would focus on finding as low stress a job as possible and as nursy above suggested, focus on some 'you time', including therapy. Take care of yourself first and foremost!

I’ve worked in California and its staffing model works well. As such, it could serve as a template for other states until the current system can be overhauled or drastically revamped. Other states’ experiences with the flexible model (as advocated by the ANA), prove that it is ineffective and untenable!

Like Tenebrae, RN, BSN, I too am completely gobsmacked that any nurse involved in direct patient care would not immediately support rigid staffing mandates akin to California's. I guess it all comes down to being a matter of perspective. Maybe when you in academia or seated in a comfortable administrative office, removed from the immediacy and necessity of the matter, can it then be a matter of debate.

This^^^ Having worked all over the US as a travel nurse, I can assure you that many of these flexible staffing models consistently fail to capture an inpatient unit's true acuity and staffing needs. I favor California's approach where subjectivity is removed and grids, graphs and matrices can't be skewed by management to cover up a flawed, ineffective and danger staffing model.

These flexible staffing models sound good in theory but unfortunately, in the real world they have no teeth and are often disregarded by many hospitals. Sadly, with these mandates, there is much room for interpretation, and that is often an open door for manipulation which tips in favor of management and results in higher acuity/patient loads for nurses.

Don’t be fooled; the ANA is plenty cozy with HCA and other large heath system conglomerates. Their advocacy and alliance for rank and file RNs is always trumped by its support for those who profit the most from corporate healthcare:(

Having worked at hospitals that have outsourced nutrition and housekeeping services along with security, I would say the answer to that question is a resounding 'yes'. If those shortsighted approaches don't appease the MBA numbers crunchers, then there's always the implementation of skeleton staffing, the slashing of employee benefits and wage stagnation to fall back on.

Agree with Jedrnurse here. Sorry to say, but the American Nurses Association is in bed with corporate health care and as such, any position that they endorse is spurious to me and likely taken for political gain, not advocacy! A closer examination of the issue would show that while CA N/P mandates were somewhat responsible for hospitals' "cut funding for supplies, upgrades and education and holding patients longer in the ER", the CEOs and senior management continued to enjoy exorbitant salaries, company benefits, perks, and golden parachutes-odd, no cuts there. It is 'all about the money'.

I'm a Gen X (33 years in healthcare and almost 28 as an RN) but have never agreed more with a Millenial nurse-spot on! In my tenure as a nurse, every year it seems, hospital benefits are cut just a little more (increased insurance copays/deductibles, lowered cafeteria discount, call and call back pay...) and wages fail to keep pace with the cost of living. All the while, CEOs and senior management entitle themselves to very comfortable salaries, benefits, perks, and golden parachutes. I think we as nurses have every right to job hop and have little loyalty to anyone other than our patients, peers, and ourselves.

This post hit home for me-thank you! As an RN for almost 28 years, I am still shocked at the unprofessionalism that is rife in nursing, especially the petty rivalries, cliques, passive-aggresive behaviors, and the shear number of toxic personalities. Lastly, when did it become the trend for 'professionals' to pepper nearly every sentence with the 'F' word? Unbelievable and very unprofessional IMHO!