The Future of Nursing Retention

[JBMmom, MSN, NP]

It is an interesting approach to getting nurses to return. I wonder whether they will explore similar options to retain nurses already employed in more traditional positions if and when they consider leaving due to things like schedule changes, having children, etc.

[HomeBound]

"The RetuRN nurse does not have to twelve-hour shifts or work the weekends, some of the deterrents that kept them away. They can self-schedule in order to fit the job to their life schedule, creating a balanced work to life ratio."

This is the problem in nursing---and it's the result of the unrealistic expectations of the units/facilities.

If the expectations are crushing---a nurse that is required to work 14-15 hour shifts--because they are rarely (and yeah...c'mon all you ambulatory contrarians and jump in to say YOU just ALWAYS get out on time. whatever.) out on time--and ergo, have no "balanced work to life ratios" and are experiencing moral injury/illness because of the crushing expectations of short staffing, unrealistic RN to PT ratios, etc.

How about offering all nurses---across the board---the OPTION of 8, 10 or 12 hour shifts? How about going back to the Baylor weekend option offering? Those nurses who want to work 36 hours in a weekend? Go for it. Those nurses who happen to like going home after an 8, having dinner every single night with their family and then having a good nights' sleep? I would work there probably forever.

I worked at a place that had almost complete freedom of shifts. I mean--if the schedule was open to it--and there were people to fill them---shifts started and ended almost every hour. And there were "princess shifts"--although we were made to feel like absolute crap for choosing to do them. Nurses really can be jerks....for absolutely no reason at all...why would you have a problem with me coming in and breaking YOU so that you can have lunch...yet I get to go home in a reasonable timeframe? Jealousy is an ugly thing. But I digress.

I loved it. I worked noon-midnight. I didn't like 12 hour shifts, but this fit my sleeping schedule. Had I been offered 4 10s? or 5 8s like my partner's schedule? I would most likely still be working there.

This isn't a hard thing. It's not rocket science. Give people true flexibility with the schedule (yeah yeah. poor schedulers. poor RN Mgrs just have to do all that work to figure out coverage) This pilot is showing that if you build it, they will come.

The biggest thing that drove me out of that place? New director who had never been bedside---that super special "RN to PhD and never touched a patient since nursing school"---iron fisted and micromanager saying---now everybody is 7-7. Nights or days. And it goes by seniority.

Buh bye.

I like the pilot that AGH is putting forth. I lived in that area for a very, very long time. It's a great system. I'm glad that they have finally gotten it through their minds that this isn't about "burnout" or disloyalty. This is about treating nurses like human beings, and not machines that you can just put into service and push "go".

[MedicRU, RN]

It seems as though what is being done is a band aid approach. The problem is much deeper than just scheduling.

To me the biggest issue is that nurses are EXPECTED to do more than ever before. Many of the tasks that were routinely performed by doctors are now supposed to be done by RN's.

I left ICU because I was tired of scrambling to catch up to more and more demands every effing day, all the while watching MD residents sitting at computer stations and having a good time. Not one would get up and d/c a chest tube or a PICC line - why bother, let nurses carry on the load of everything along with ensuing responsibility. Not to mention wild census rides, administration BS and other crap that invariably sucks the life out of a nurse.

Similarly, NP's are expected to run most things on the unit where as MD's would not even bother come to an ICU unit unless a patient is crashing and even MD's would be standing around issuing orders and not doing much. Mid-levels folks and RN's are filling in every hole in the torn healthcare fabric.

There is not a single reason why I would leave my home based UR/UM position to go back to hell of hospital shenanigans.

That being said, the whole system needs overhaul, and joggling with schedules alone will just not cut it.

[HomeBound]

7 minutes ago, MedicRU said:

It seems as though what is being done is a band aid approach. The problem is much deeper than just scheduling.

To me the biggest issue is that nurses are EXPECTED to do more than ever before. Many of the tasks that were routinely performed by doctors are now supposed to be done by RN's.

I left ICU because I was tired of scrambling to catch up to more and more demands every effing day, all the while watching MD residents sitting at computer stations and having a good time. Not one would get up and d/c a chest tube or a PICC line - why bother, let nurses carry on the load of everything along with ensuing responsibility. Not to mention wild census rides, administration BS and other crap that invariably sucks the life out of a nurse.

Similarly, NP's are expected to run most things on the unit where as MD's would not even bother come to an ICU unit unless a patient is crashing and even MD's would be standing around issuing orders and not doing much. Mid-levels folks and RN's are filling in every hole in the torn healthcare fabric.

There is not a single reason why I would leave my home based UR/UM position to go back to hell of hospital shenanigans.

That being said, the whole system needs overhaul, and joggling with schedules alone will just not cut it.

ALL. OF. THIS. ^^^^^

It's the unrealistic expectations and the ridiculous liability.

I have to carry professional Liability Insurance? WHY?

And there are no hard metrics in floor nursing. None. Not like in UR/UM or even other technical jobs in the hospital that don't require >2yrs training and yet MAKE MORE MONEY and have better hours, better staffing, hard metrics when you're evaluated.

Shenanigans. I love that word.

So Medic...if the scheduling would change to where people could have some sort of control over their lives---and some sleep---I think that the culture of being able to push nurses around at will may recede somewhat.

My reasoning is this---the nursing staff increases automatically. If you have 3 shifts instead of 2? You can't just keep whittling down staffing. You have to cover all shifts. The rules are that you can't work a certain number of hours as a nurse consecutively.

But if I worked an 8? If I need to---I can stay another 6 hours and cover if someone calls out.

It's all about the bottom line with these places. How can we do more with less? 12 hour shifts are NOT about "continuity of care". It's an accounting trick.

It's why the travel companies tried to cheat travelers out of overtime after 8 in California--while the state law said anything after 8 is overtime. They claimed that the hospitals "required" this caveat---that the travel nurses worked 12 at straight time and then overtime only after FORTY (not 36)---and then banned overtime for travelers.

Finally a few bright sparks sued a certain well known travel company---and won. I received a nice fat check for all of the overtime I was cheated out of.

It's not continuity of care---or the hospitals would never have "required" travelers to do this. It was a money thing.

I feel your pain. ICU is one of the most dangerous jobs I've held. Just the other day---a code happened that I am scared out of my wits that I will be included in a lawsuit by the family. Because the facility has a truly horrendous policy on MTP as well as other things---and the attendings didn't show up until well after the patient exsanguinated. There were other things---but these were the main two reasons.

Now it's a race to point fingers. Well ultimately, says one MD who made the most horrible choices ever--it's the NURSE that didn't realize why this patient was tanking. (even though this attending had done a procedure on this pt where the pt was literally...bullied...into choosing it...because the attending wanted to give his resident "practice" on this particular procedure. the procedure was literally contraindicated for this pt's history).

But we'll get blamed. Because the MDs bring in dollars. Residencies make money for the hospital. Research brings in dollars. Nurses are a "liability on the balance sheet". We have to justify our very existence by writing our own reviews and begging for our positions.

Want to know why nurses leave? This is why.

If you have a greater pool of nurses that are needed....as in...8 hour shifts...and those nurses are well rested and there is a large workforce, lots of eyes on what's going on....it's a way to have a louder voice in the way departments are run.

[OUxPhys, BSN, RN]

This really isnt that hard. Staff appropriately, factor acuity into staffing (acuity based on what the floor staff says, not what the supervisor/staffing office says). Bring back weekender programs. If you do this Id be willing to bet you see a decrease in turnover.

The patient workload today, on top of what we are expected to do, requires a change in the way we staff the floors. Sure, you will always have turnover based on bad management and if thats the case then the hospital should look into why people are that particular floor.

[panurse9999]

4 hours ago, OUxPhys said:

The patient workload today, on top of what we are expected to do, requires a change in the way we staff the floors. Sure, you will always have turnover based on bad management and if thats the case then the hospital should look into why people are that particular floor.

Have you ever heard the term "People do not leave jobs, they leave managers?" Its true.

Programs like this would not be necessary if hospitals would take on the pro-active role of nurse retention policies, that either are non-existent , or never followed. On the top of that policy should be a requirement to have a retention conference for every single nurse who submits a resignation, followed by a written letter from the highest level of hospital management , providing a chance to detail, why the nurse is leaving. The retention conference would then be attended by the nurse, a manager, an HR rep, an a person at the highest level of corporate.

Programs like this would not be necessary if hospitals would stop firing their nursing staff for any reason or no reason

Programs like this would not be necessary if hospitals would finally realize that treating their nursing staff like robotic machines who will churn out more medication, answer more calls, process more orders, take on more roles, be pulled from one floor to the next, will be cancelled on a moments notice, will never get a break, etc...is a guarantee for nurse burnout in 1 year or less

Programs like this would not be necessary if hospitals would get rid of their charting systems which require the nurse to check off all tasks, wether completed or not completed.

Programs like this would not be necessary if hospitals would return to traditional staffing of units where a nurse does not report to central staffing at beginning of shift, rather is hired for, and works on the unit where she was trained.

Programs like this would not be necessary if nurses were appreciated for their skill and education, without being forced into expensive, useless, online degree mill programs for the sole purpose of enriching higher education

[OUxPhys, BSN, RN]

1000% True

[panurse9999]

I would also like to add that the Allegheny health system offering this program is also pushing a useless and expensive "refresher program" for old nurses to come back to the bedside. I have heard of these "programs" offered at community colleges. This is nothing new. Problem is, other than a few clinical classes that teach the old nurses how to make beds and hand lunch trays out to patients, clean bed pans, do a bed bath, etc, there is no value to the returning nurse. I knew a few nurses that were suckered into this at their own cost, and have confirmed they are a waste of time and money.

The course offered by AHN,

"The AHN RetuRN to Practice Program offers a 12 week refresher course in collaboration with the University of Delaware. The didactic portion is completely online with an 80 hour clinical portion provided in AHN facilities."

appears to be a laughable online / scam waste of money as well. Do ADNs get hired? I doubt that. So, its basically just another "pay to work" scheme, that supposedly gets the old nurse in the door, where she will then be told in short order, than the goal post has been moved to the right...and now its BSN time, or be fired. The AHN is a "BSN only" hospital system, and this is well known by all nurses in PA.

[panurse9999]

20 hours ago, HomeBound said:

But we'll get blamed. Because the MDs bring in dollars. Residencies make money for the hospital. Research brings in dollars. Nurses are a "liability on the balance sheet". We have to justify our very existence by writing our own reviews and begging for our positions.

Its ironic that, yes, nurses are seen as a liability. We are not revenue producing. We are an expense. Just like housekeeping staff. Just like laundry staff. Just like maintenance staff. Just like cafeteria staff. I have seen hospitals wipe out these entire departments because someone at the top decided it was worth it to save another few thousand dollars a year, by outsourcing, saving some money on benes, workers comp, and administrative savings in not having to cut a payroll check and keep track of days off, FMLA, etc.

If a hospital could wipe out its nursing department entirely, they would do it in a heart beat. Its all about the $$$. We are not regarded in a professional role, as are the revenue producing MDs, residents, etc. This is why its always more and more and more, with less and less, and less. Every accounting trick in the book to save a few bucks.

A large hospital near me had a lawsuit from nurses, who were prevented from punching a clock, and forced to submit timesheets, where overtime hours were never recorded as overtime on the clock, because they were paid 40 hours a week, over time not approved, no matter if they worked it or not, with a break automatically deducted, even if the break was never taken. The nurses won.

The only real difference between nursing and the other non revenue producing departments listed above is that we are required to have a license to practice, which makes us the most expensive department of the non-revenue producing departments. So , guess what that means? The ones who are always going to be spread the thinnest, cut the most, understaffed the most, etc. So while all of this is constant , we have the added stress of the education goal post being continually moved to the right...and I wrote another whole topic on this one (Nursing school to welfare).

The hospitals know this. They are not dumb. They know exactly why nurses leave. They do not bother to have retention , because retention would mean they actually have to make the work conditions less toxic. Less toxic means more $$$, and they don't want that. There's always a fresh pile of nurse resumes in HR, so if we don't like it, its "hit the road jack". Nothing is ever going to change until nurses ultimately refuse to work under these conditions, and that is never going to happen, because we are lucky to have a job.

[panurse9999]

On 5/21/2019 at 2:34 PM, JBMmom said:

It is an interesting approach to getting nurses to return. I wonder whether they will explore similar options to retain nurses already employed in more traditional positions if and when they consider leaving due to things like schedule changes, having children, etc.

I think hospitals need to focus more on retention, than recruitment, and they can start by taking some responsibility for the toxic workplaces many of them are. A really great article comes to mind:

https://www.forbes.com/sites/amymorin/2017/01/15/study-reveals-how-damaging-a-toxic-boss-really-can-be/#3607ea656249

[RLoya]

There's also the complicated issue of the healthcare system as a whole. I don't understand it completely but this is what I gather. Health insurance costs used to be pushed off onto employers. It became too expensive for employers to handle as more Americans became more unhealthy (diabetes, hypertension, etc). Now the cost of insurance are pushed onto the hospitals. So maybe one solution - which won't happen overnight - is that we nurses need to get more into public health. We need to help people learn how to live with these chronic conditions so that they don't deteriorate to the point that they have to be admitted to the hospital in the first place. I left the hospital and now work at the county health dept. I get to actually learn more about the illnesses I'm treating and then better educate my patients about how to deal with them. I don't want to be part of the current healthcare method of just running from one crisis to another. I want to prevent these crises all together.

The other issue is Medicaid/Medicare reimbursement. Again just what I've gathered, I'm probably off. A patient with illness X is expected to recover in Y amount of days. The government will reimburse the hospital but only if patient is discharged on time and does not have any complications that require a longer stay. A lot of these patients are sick with chronic diseases and will realistically have to stay longer because the expected recovery time is based on healthy, uncomplicated patient cases. So now hospitals are feeling the squeeze and looking for any way possible to offset the cost of not being reimbursed as easily as they once were. Plus the hospital execs don't want to stop living their comfy lifestyles. So they push the burden onto everyone below them.

I have no idea if any of this will ever improve. I do hope that we nurses will at least go down with a fight, however. Nurses should continue leaving the hospital in droves and even strike. Get America to pay attention to our plight and then pull back the curtain so that they can see for themselves the horror that is the hospital system