The Nursing Shortage: A self-inflicted wound?

[dzadzey]

Much is being made of the nursing shortage, but the sad fact of the matter is that much of this shortage is a self-inflicted wound. "30%-50% of all new RN's elect either to change positions or leave nursing completely within the first three years of clinical practice" (MacKusik & Minick, 2010, p. 335). The reasons are many and varied, but a 2010 qualitative study by Carol MacKusik and Ptlene Minick examine these issues and find three major themes, an unfriendly workplace, emotional distress related to patient care and, fatigue and exhaustion (MacKusik & Minick, 2010).

An unfriendly workplace can be one in which the new nurse is simply thrown to the wolves, expected to "toughen up" by more experienced coworkers, women experiencing sexual harassment from male coworkers and physicians, and lack of support from management and/or administration in addressing these issues.

The emotional distress we as nurses experience is, all too often, related to cases of futility of care. This is where, regardless of how many life support systems the patient has attached to them, the result will be the same...the patient will die. The only question being how much suffering they experience as they do so. This occurs at both the beginning of life in neo-natal ICU's to the end one's years in ICU. In either case, physicians may not be entirely honest with patient families, thus giving them false hope regarding the prognosis. The other side of the coin is families, for whatever reason, cling to the hope that their loved one will somehow arise from the bed and leave hale, whole and healthy. This is often due as much to family dynamics involving guilt as it to unrealistic and unreasoning religious views. The toll this takes on the nurses involved in the direct care of these patients is huge.

Fatigue and exhaustion come into play when, for whatever reasons, management and/or administration are more concerned with filling beds than whether or not the staff is available to safely care for these patients. Nurses are asked, then expected, to "flex up" and take more patients it is safe for them to care for, thus putting patient safety and nurses licenses at risk. This creates a fundamental conflict between the core values and terms of licensure for nurses and the values of the organization. Add to that overtime and calls to work on their days off, and the physical and emotional exhaustion simply becomes too much to bear.

So the projected nursing shortage...some 500,000 nurses by 2025 (MacKusik & Minick, 2010)...seems to be as much a result of nurses fleeing the acute care setting as it is with the lack of sufficient new grad nurses to take up the slack.

References

MacKusik, C. I., & Minick, P. (2010). Why Are Nurses Leaving? Findings From an Initial Qualitative Study on Nursing Attrition. MEDSURG Nursing, 19(6), 335-340.

[got2startsomewhere]

" I live in a very large state that is very sporificely populated."

There you have the answer to much of your post. Rural areas have all sorts of healthcare shortages including doctors and nurses.

Even when offering better than local wages rural living isn't for everyone. Even local doctors and nurses often leave their home towns for the bright lights.

I suppose that does make sense. However, more educational facilites/opportunities need to be made available to those who are interested (and meet the pre-reqs for program admission). Two years is a long wait for someone who's ready NOW. And btw- it's not "too rural" around here. I live two blocks from a smaller community hospital (who are looking for 3 RNs), but cannot get into nursing school for another two years. We have all the major fast food joints, Walmart, TJ Maxx, etc about two minutes down the road from my house. It's not Las Vegas or Chicago, but we're not tiny either.

Edit to add: And supposing the assumption that rural areas have shortages more so than more populated areas, wouldn't it make sense that if demand was there, opportunities for education to fill said vacancies me made available? On another note, a VERY large percentage of our state's population is "older". Recent college graduates seem to move out of state for better job opportunities at a staggering rate.

[nursel56]

Something needs to be done for these *surplus* nurses or mark my words there is going to be trouble. Unlike other professions nursing today tends to require recent active experience in order to be considered for most employment. New grads whom have little to nil experience find themselves "aging" out of being considered fast.

That is what's bothered me all along. What a waste of talent and resources. I wish there was a government domestic nursecorps like other programs we've instituted in the past that hook up areas in need with professional health workers. Not everyone would want to go that route, but I'm sure there would be many who would.

got2startsomewhere - if you are interested we have a first job hunt assistance forum with a lot of literally desperate people who would welcome your input.

Nursing First Job Hunt Assistance - Nurses / Nursing Students

[got2startsomewhere]

got2startsomewhere - if you are interested we have a first job hunt assistance forum with a lot of literally desperate people who would welcome your input.

Nursing First Job Hunt Assistance - Nurses / Nursing Students

I'm more than willing to offer words of encouragement to individuals seeking employment, but truthfully, I've been working since I was 15 years old and never went more than two weeks without employment. I always took work that was offered (even fast food) and busted my tail to do it well. I have NEVER had a job that I was not promoted into management. I can't honestly sit back and armchair QB someone else's career other than to say "keep trying". Time spent talking about not finding a job on the internet could be used printing resumes, visiting potential employers, contacting staffing agencies, state job placement services, or speaking to the currently-employed about what openings there are. I don't mean to sound harsh, but in almost 15 years of working, I've NEVER found a job on a message board.

[joanna73, BSN, RN]

It is true that rural areas are always looking for nurses, but many people don't want to go rural. I moved from a large city to a rural area almost 2 years ago, and some days I feel like I could go insane. We have a very hard time recruiting nurses. While I don't regret making the move, I also don't plan to stay much longer. You cannot base the nursing outlook on rural areas. There will always be jobs in rural areas.

[smartnurse1982]

Well,I will say this: there isn't a shortage of nurses in acute care,there IS a shortage in ltc and home health.Why? Because those areas don't pay big bucks.

[nursel56]

I'm more than willing to offer words of encouragement to individuals seeking employment, but truthfully, I've been working since I was 15 years old and never went more than two weeks without employment. I always took work that was offered (even fast food) and busted my tail to do it well. I have NEVER had a job that I was not promoted into management. I can't honestly sit back and armchair QB someone else's career other than to say "keep trying". Time spent talking about not finding a job on the internet could be used printing resumes, visiting potential employers, contacting staffing agencies, state job placement services, or speaking to the currently-employed about what openings there are. I don't mean to sound harsh, but in almost 15 years of working, I've NEVER found a job on a message board.

What I meant was a suggestion about a geographic area that needs nurses might be a lead, however slim, for a nurse who needs a job. It's perfectly understandable if you don't wish to share that due to privacy concerns. For those going on month after month with no job, in some cases we're down to "leave no pebble unturned". Not asking you to QB someone's nursing career.

[DoGoodThenGo]

Well,I will say this: there isn't a shortage of nurses in acute care,there IS a shortage in ltc and home health.Why? Because those areas don't pay big bucks.

Well yes, there is that but also remember many nurses including new grads aren't thrilled with working LTC, period.

One has only to look at various posts to this forum to see that to many nurses LTC is almost like being banished to the woods. Everyone it seems wants the *excitement* and so forth of hospital/acute care duty.

Mind you if current trends hold true there are going to be more positions open in LTC, rehab, and ACS than hospitals. Both insurance companies and the federal government are pushing more "community" healthcare and pushing lower cost alternatives to patients remaining in acute care settings. First we had "drive through" L&D where uncomplicated deliveries were discharged 24 to 48 hours after birth, now they've set their sights on med/surg patients. Not stable enough to go home but not ill enough to occupy that hospital bed? Guess where that patient is heading?

[caroladybelle, BSN, RN]

I believe that the LTC shortage has more to do with conditions than pay.I'm sorry but the ratios found there in most cases and the workloads are completely unacceptable and rightfully so.

[Chiggysmom]

I agree with a lot of the article except for the statement that there is a nursing shortage and that there is a lack of new grad nurses willing to pick up the slack of those nurses fleeing the work place. I also disagree with the idea that this is a "self-inflicted" wound.

There is no nursing shortage and it needs to be repeated and repeated until the media gets it right, otherwise we will continue to have these completely futile discussions about how to create better conditions in nursing, and we will continue to focus on nurses themselves as the guilty party in creating those poor conditions to begin with.

Nurses have no control over the way the medical industry works. There are a lot of powerful people and corporations, big Pharma, for-profit organizations, the insurance industry, the media, lobbyists, and politicians who work together to create the current system. Nurses are just cogs in the wheel.

And I hate it when I have to read yet another article about how we have done this to ourselves because....well, I'm not sure what the because is.

Because apparently it's not enough that we have gotten through one more day of 10/10 stress, taken ourselves home, cried, tried to find some quality time with our families, paid our bills with a diminishing income, struggled to hold onto our homes and our pensions, struggled to find some joy in life, to take care of our kids, to continue our education so we can be better nurses, looked for some outlet for spiritual support, tried to eat or exercise, deal with our own health issues, and slept.

And then after trying to do all of that we haven't picked ourselves up and taken to the board rooms and the streets to go head to head with the power structure to change the medical industry, because somehow, the onus for change lies squarely on our shoulders and no body else's.

I'm just tired of the structure of this dialogue. To accomplish change, we need to first address the flawed foundations of the debate. Meaning that there is NO nursing shortage and there is NO shortage of new grads and the health care industry has no real impetus to change the way they treat nurses.

Very Well said!

[Chiggysmom]

Actually, it IS nursing fault that this has occurred. For YEARS, nursing has refused the ONLY solution to the problem-to unionize, en masse, and take control of our professsion.

Without a union to protect you, it is impossible to, "take to the streeets", like other professions, like teaching has. Teachers go right to the parents, when their profession is under fire, and cuts are made to the classroom. The are out in numbers, in the streets to protect their classrooms. Yet, no one has ever died because they could not do long division, or diagram a sentence. How many have died in the hospital because of deliberate short staffing?

The, "martry marys", of the nursing profession, "have nailed us to the cross", to prevent us from being the power we should be with out numbers. They use terms like, "unethical", not fair to our patients if we have to strike", or, my personal favorite, " I could never leave, MY PATIENTS", and walk out on strike.

In the first place, they are NOT, "YOUR PATIENTS". They have not contracted with you for care, they way they do with the hospital or doctors. It is the hospitals' responsibility to provide staff to care for them. Get over it.

It continually amazes me, that nurses have not figured out what is going on. The PTB, terrorize us, to prevent us from taking control, not unlike the slave owners of past centuries. As long as they have the power to control us, the problem remains. If and when we finally decide to take control of nursing, they will not longer have that power over us.

Doctors contract with the hospital to admit patients to the hospital. They have their lawyer, who are on their side, negotiate their services to the hospital, and have legally signed contracts, to uphold them.

Why can't nursing do the same? Because there are TOO many who are afraid to have control over anything. Let alone their practice of nursing.

Make it a priority to change the way you think. Call the NNOC to start an organizing campaign in your hospital. Just say no, to too many patients. Get together in groups on non work hours, and plan the takeover of your profession in your hospital.

Work with the members of NNOC, to make it happen. Remember, no one can take advantage of you without your permission. You can do it.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

Linda you are so-o right in your synopsis of the situation. The teachers are an excellent example! Look at the benefit packagages they have. Most nurses have nil when we retire after working so hard for so many years, week-ends, holidays, summers (which the teachers don't!). This is exactly what needs to be done. Maybe the next generation of nurses will get some balls and act on this? I'm 52 y/o and I'll be out of the field in another 8-10 years but the kids of today . . . I'm not sure they'll put up with what our generation puts up with? Maybe they'll demand to be treated better? We can only hope? I don't think I'll see any changes in my generation/career. Everyone is too afraid to stand up to them.

[Chiggysmom]

Problem for nursing is that the profession tends to react rather than act, and this comes across on both ends (employers and nursing).

Aside from a few brief periods in the history of modern nursing there has never been *enough* qualified and well trained nurses. This is one of the reasons behind the creation of various UAPs such as NAs, scrub assistants, OR techs and so forth.

Then there is the fact the profession being a mainly female occupation it is very responsive to changes in the world of women.

Up until rather recently there was always a need for new grads because so many experienced nurses for various reasons such as marriage and or having babies, left their jobs or went to part-time status.

However as one has said often on this forum the nursing profession in both the United States and other developed western nations has never recovered from various laws/schemes meant to end employment discrimination against women.

While it may seem a joke to young girls today life before Title IX was *very* hard for women, especially those seeking to enter the medical professions. By *medical* I mean just that, doctors, dentists, etc..., for back in the day you would have had your head handed to you on a plate by including "nursing" under the same heading.

In order to gain entry into med schools one has to lay down educational chops starting almost in high school. Many girls simply were told flat out they couldn't take the required math and science classes because it would displace boys. If a girl wanted to do something in the healthcare field she was directed you know were; nursing. While this was on paper great for the profession as it produced vast numbers of new grads, many of those new nurses hated every minute of their job and quickly found a way out (marriage for instance). Of those that remained provided some of the most passive aggressive care one could imagine.

Once the educational and employment landscape opened up for women enrollment in nursing programs began a slow but steady decline. That coupled with changes in the healthcare system lead to many nursing schools closing. One other nail in the coffin was when the *managed care* craze swept though the USA in the 1980's and 1990's. Hospitals looking to cut budgets began getting shot of experienced senior nurses by the dozens. This despite warnings that from those ranks clinical instructors and professors were drawn. So what many in the profession predicted would happen came to pass. There was suddenly a "nursing shortage" but too few programs and worse instructors/professors as well.

Now things have come full circle as everyone and their mother ran to staff up and or create new programs churning out scores of new grads every six months. However as there always seems to be something, no one could have foreseen the economic meltdown of the past several years and how it would affect healthcare.

Another problem for nursing is what began during the managed care era; hospitals have been examining their business model and determining anything not central to that core has to go or at least be reduced.

Using the popular college class excercise, ask yourself what is the function of a hospital? This is not a purely academic query as the replies have a direct impact on the nursing profession.

Time was most all functions not falling under medicine fell under nursing. Licensed professional nurses did everything from clerical work to running CSS. Hospitals via their schools of nursing were also very involved in the education and training of nurses as well. But over the years for various reasons all that has changed.

I've said this before and though it pains many of you all to hear it am saying it yet again, nurses are labour for hospitals. Labour is a cost that all businesses seek to control. As the cost of providing nursing service (wages, benefits, etc..) increase hospitals are using them only for what is required; direct and or perhaps some indirect patient care. Up and down this country hospitals and their consultants are taking apart the role of a professional nurse to see what is the best use of her/him for their money. What can be done by UAPs for less cost is being farmed out to them. If you examine those rosy predictions about employment growth in healthcare you'll see CNAs, techs, and home healthcare aides make-up a large precentage of those numbers, indeed in some areas outpacing the hiring of nurses.

Patients by and large aren't that aware of whom is providing care at the bedside, and many probably do not care long as they are treated properly. Now that nurses by and large no longer wear caps and whites, but dress in most cases like everyone else from housekeeping to techs it is kind of hard to tell whom is doing what. This of course is not lost on hospitals and "patient care" then becomes a very large umbrella and not just restricted to "nursing services" provided by RNs and LPNs.

You're right about so much you write about. In our hospital though, the patients definitely know who their nurses are because we have to wear hideous and boring (part of the total mind controll programming of nurses-also functions to let us know we have no autonomy and are completely controlled down to the very clothing and shoes we wear!) ALL WHITE!!!

[joanna73, BSN, RN]

Speaking from a union-oriented perspective, I would agree with some of the points raised above. However, in practice, unionized environments still present many challenges. While you may be perfectly within your rights to enlist the help of the union, there is a fine balance....because you still have to show up for work every day, and you still need those references. Employers still try to mess around sometimes, despite the fact that the contract says otherwise. Union or not, nurses still get shafted.