War on Nurses

Updated | Published

There is a new war raging and it is not Covid. Although the pandemic precipitated our current crisis, the battlefront has now reached our nursing staff.

Specializes in Health Writer, School Nurse, Nurse Practitioner. Has 19 years experience.

Our lifeblood has been drained and nursing shortages have reached critical levels.  We must act now to fight for our survival as nurses before it's too late.  We need to come up with swift and creative alternatives to our present broken healthcare system.  Read on to find out my solution to combat and win back our precious careers and livelihoods. 

For the first time in almost 2 years, I am starting to feel hopeful about the Covid Pandemic.  Although we have not beaten the virus and hospitals are overflowing with Covid patients, we are finally getting the tools and treatments necessary to control it. 

The 4 significant Covid developments that have made me feel optimistic are:

  1. Rapid home tests
  2. Antibody infusions to help give the sick a fighting chance
  3. Anti-viral medications (to be given to those who are mildly ill in the first 5 days of symptoms) from Pfizer and Merck (so far)
  4. Non-vaccine options for those who can’t get the vaccine (due to allergies to ingredients, prior adverse reactions to the vaccine or those on high-dose immunosuppressants).  So far, these non-vaccine alternatives are monoclonal infusion (for protection) and other new prophylactic drugs just coming on the market.

On Dec. 9, 2021, the news outlets, including CNet informed readers that “The drug, called Evusheld (AstraZeneca) is given via two injections to eligible people age 12 and up who aren't sick with COVID-19 and who haven't been recently exposed to the virus.  According to the FDA, it may be effective for six months”.

I followed each of these treatments and tests way before they were approved and am cheering when they have become available to the public.  Every development helps to turn the tide on the pandemic.  I am happy to see the weakening virus trend (so far).  With the above points and the Omicron variant resembling a common cold (for those who have been fully vaccinated), I am heartened that the burden on our nurses may start to ease up soon.

However, it is a little too late for our healthcare system as another crisis is upon us.  This is one emergency that most staff in the medical world and I saw coming. 

Staffing Shortage Crisis

This current calamity is our nursing and provider shortage.  Our medical (mainly hospital and nursing home) staffing is in critical shape and will likely worsen in the next year.  We require “fresh troops,” and we need them fast.  The usual remedy of throwing more money at nurses is not working.  Although generous pay is beneficial, what we really need is more time off, lower nurse-to-patient ratios, and less overcrowding in our hospitals.  In essence, nurses are being worked to death.  Currently, nurses leave the profession altogether or trade jobs to non-clinical environments to lower their stress levels.

Hospitals are left without adequate nursing staff.  I, for one, would not want to be a patient in a hospital at present.  For the most part, it is an unsafe environment.  Even though nurses are doing the best they can, most are already burnt-out and exhausted from overwork.   The ER, in particular, reminds me of the state of medical care in an underdeveloped country.  Long waits in the ER are now up to days to get seen or admitted to a hospital.  Patients who are too sick to sit up in chairs in the waiting area, lie on the floors.  Covid patients mix with the most medically fragile in close quarters for too long.  

Only 2 years ago, we could care for the sick in our community in an organized and efficient manner, and now our medical system has been reduced to inhumane conditions.  In essence, the pandemic has dragged on too long and the already fragile camel’s back has broken beyond repair.

Our hospital systems are aware that our healthcare staffing is a wreck.  Many “acknowledge that there is a problem” but are grappling with solutions.  So far, I have not seen a whole lot of viable remedies being introduced.  Is our government working on helping out in this nursing shortage war?  Truthfully, there appears to be a lack of ideas about how to help our hospitals and nurses get back on their feet.   

Just talking about and telling us there is a problem won’t help.  We have to fight back right now and fast in this battle for our nurses.

There is no time for ponderance when the attack is ongoing and currently waging. We need ACTION now!

This whole healthcare crisis started to make me think about the nurses' training from past generations.

Revisiting the Past for Ideas for Survival

Many of you may not remember the days of “practical nurse training”.  Much of this LPN and RN education was “on the job”.  Due to this "immersion" experience, we could churn out practical nurses quickly. 

As a BSN student, I remember boarding temporarily at one such “teaching” hospital for my critical care rotation.  The practical nurse’s school had closed long ago, but the “housing” was still in place.  The student nurse accommodations was located on the entire hospital's top floor (attic).  This large, mainly abandoned area that now only housed outdated supplies and furniture was one scary place for 3 young nursing students to reside all by themselves.  The dorm hall was the length of a football field with endless doors and dark corridors atop the hospital.  We BSN candidates huddled together in one room for comfort to sleep each night, hoping to ward off what surely could be many ghosts of the dead in this 200-year-old facility.

Aside from the creepy accommodations, I am sure that there were many, many nursing students who graduated from this practical nurses program of old and became excellent nurses.

As I think back, I am wondering if we currently could revisit this practical nurse education model temporarily to help ease our nursing shortage quickly. 

I know that nursing has come a long way from those "old" days and the ideal for higher educated BSN nurses has taken over.  But once again, we are in crisis, so we may need to think outside of the lines for now.

I began to ponder about WWI and WWII medical staffing.  How did we ramp up our nursing “troops” quickly?  A little research showed that we could meet the nursing needs of our army well.  How did they rapidly accomplish this daunting task?

I found that the US government hired student nurses to start “nursing” almost right off the bat.  After a brief orientation, nurse “cadets” began pitching in as nurses, obtaining nursing skills on the job.  This is a similar model to our practical nursing programs, albeit possibly in a more condensed time frame. 

This blog that I found on the WWII army cadet nursing program is very interesting.  Read here if you want to learn more about the process of nursing education for our war nurses.

I decided to put into words what I was thinking as a possible solution to our war on nursing. 

Here is my proposal to give our current warrior nurses some hope for the future along with a well-needed break by bolstering the nursing ranks quickly.

1. The current US administration should pay for “rapid” nursing education programs to get nurses quickly into the field.  Their wages should start right from the onset of their education.  I’m sure many men and women would love to become nurses but can not afford to give up their current jobs and go without pay as they receive their nursing education.

We have many loan “payback” programs currently but this option would be in effect at the institution of the nursing program.

2. Free child-care for nursing students.

3. Institute ideas and incentives to employ additional nurse educators for these rapid grad nursing programs.

4. Continue paying for nursing education once our ranks are replenished to eventually obtain a BSN degree for those who desire to do so.

5. Encourage our current MAs and CNAs to fast-track into one of these programs

6. Hire more “assistants” for the nurses. This article from MSNBC nicely illustrates how “helpers” for nurses free up RNs to perform adequate assessment and care for their patients.

We will need government buy-in, of course, for the free training.  But we nurses, as one inventive and determined entity, can rise up to meet our current battle with a crusade of our own.  If we just complain, quit and wait for others to find a solution, we, along with our sick loved ones will be the casualties.

I have seen how quickly telemedicine has developed in the past year.   I hope that solutions for the nursing shortage will fall into place just as quickly.   If we can come together as a group to tackle our current war on staffing inadequacy, I am confident that we can overcome this crisis on our own terms.

So, nurse educators, nurses with political influence, administrators, nurses on the front lines and those in the background supporting our troops, let’s put our heads together and beat our common enemy.

I know that we will have to get past what we are accustomed to regarding our current comprehensive BSN model nursing education.  The outcome of my proposition will hopefully produce a similar result eventually.  However, the training process is a new (yet old) concept.  I hope this idea could entice interested potential nurses to enroll and train quickly to fill the immediate gaps before more of our current “soldiers” fall.

What Next?

If this concept is feasible, how can we run this idea “up the pole,” so to speak and get a groundswell going?  I would love for our current government administration to quickly get on board if this proposal is attainable.  As nurses and nurse educators, we have the best insight into this idea.  Can it work?

I would love to hear other nurses’ opinions on this and their ideas. 

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 10 years experience. 4 Articles; 1,931 Posts

This is an interesting concept. I think that one particular barrier would be who would be educating the nurses in these new programs? Right now it's hard enough to find nurse educators in established nursing programs, especially since I've heard anecdotally that some are returning to the bedside where they can make more money in the short term. If the hospitals would be providing the education themselves, I can almost guarantee that it would be inadequate for the people training and would be an additional burden on current staff that they could not undertake. My own hospital can barely meet the education needs of the nurse residents that are hired on a quarterly basis with our educator staff. 

This is certainly a challenging time and it's going to require some out of the box thinking, so I appreciate your concept. As you mentioned, even money isn't bringing people in as much. I know my hospital is offering double time for any extra shifts worked and still nurses aren't picking up because the workload is just too much while at work. Something has to give. 

Mr. Murse

Specializes in Critical Care/Vascular Access. Has 11 years experience. 384 Posts

I have a little bit of an issue with the concept of "rapid nursing education". I understand and don't disagree with the rationale for proposing it, of course, but I feel like (on top of short staffing) we already have an issue of poorly educated nurses with bad critical thinking skills. I often come across nurses about whom I ask myself "how did you get through nursing school?" I'm not sure where the blame lies, exactly, but I fear that fast-tracking nurses into the field would create a generation of even more poorly educated nurses and in turn a more dangerous and litigious healthcare setting than we already have. So ultimately the question would lie in what is more dangerous: short-staffed hospitals with better trained nurses? or well-staffed hospitals with questionably trained nurses?

dareese, MSN, RN

Specializes in Health Writer, School Nurse, Nurse Practitioner. Has 19 years experience. 4 Articles; 32 Posts

I agree that a shorter education may be a problem.  But what other options are there?  Maybe it can be a stepped approach like LPN where the responsibility is less.  Certainly, a BSN nurse would have more responsibility.  Yes, I think it will take buy-in and a concerted effort for all parties to get this idea up and running.  Including incentives for nurse educators and schools.  Thanks for the input.  I just hope that everyone does not drag their feet which could lead to more staffing issues.

Edited by dareese

morelostthanfound, BSN

Specializes in CVOR/General/Transplant Surgery, and cat herding. Has 30 years experience. 276 Posts

On 1/7/2022 at 7:33 AM, dareese said:
Our hospital systems are aware that our healthcare staffing is a wreck.  Many “acknowledge1. The current US administration should pay for “rapid” nursing education programs to get nurses quickly into the field.  Their wages should start right from the onset of their education.  I’m sure many men and women would love to become nurses but can not afford to give up their current jobs and go without pay as they receive their nursing education.

   dareese, thank you for your thought-provoking article.  While I agree with most of your ideas, I and many other nurses, take exception to the notion of a "nursing shortage".  There is always attrition in any profession but as a career RN, I don't believe there is truly a lack of well-qualified nurses able to care for our nation's sick patients.  There is however, a shortage of nurses willing to continue to practice in dangerously understaffed units, poorly resourced units while being given more and more redundant hyperregulation and redundant tasks.  I don't feel the answer is to further glut the profession (more cannon fodder) with rapidly trained and poorly equipped new nurses.  Rather, the answers are in; 1) mandating non-negotiable and safe nurse/patient ratios, 2) providing adequate resources to our health care providers (especially PPEs), 3) offering fair and commensurate compensation and benefits, and 4) giving respect in words and ACTIONS-ie, NOT treating nurses as if they are an expendable commodity.  

JBMmom, MSN, NP

Specializes in Long term care; med-surg; critical care. Has 10 years experience. 4 Articles; 1,931 Posts

39 minutes ago, morelostthanfound said:

There is however, a shortage of nurses willing to continue to practice in dangerously understaffed units, poorly resourced units while being given more and more redundant hyperregulation and redundant tasks.

An excellent point. If the working conditions were such that nurses felt they could provide quality nursing care without constantly being forced to put patient safety below other responsibilities, many people would not leave, or would return to primary and acute care nursing positions. 

dareese, MSN, RN

Specializes in Health Writer, School Nurse, Nurse Practitioner. Has 19 years experience. 4 Articles; 32 Posts

Great ideas!  I would love to figure out a way to consolidate all of our collaboration and somehow get it to land on the desks of those who make decisions regarding our hospital systems.  Are there any administrators or nurse recruiters out there who can lend their knowledge regarding actual nursing shortages and solutions (especially for long-term care facilities and inpatient hospitals systems)?

toomuchbaloney

Has 44 years experience. 7,959 Posts

Practical nursing can relieve the task burden on Registered nurses at the bedside.  Most of those programs can be completed in 12 months, I think.  However, that is just a bandaid. Flooding a labor market with lots of less expensive bedside workers won't fix the toxic environment that for-profit health care creates in the USA for nurses.

HGRN

Specializes in Critical Care. 6 Posts

Great idea! Lets  oversaturate market with less educated nurses, lower testing standards, and worsen already unsafe environment for patients. Problem is that nursing is not attractive carrier as it used to be. For example, couple decades ago nursing starting pay was 4-5 times higher than minimum wage.

Susie2310

2,041 Posts

3 hours ago, dareese said:

I agree that a shorter education may be a problem.  But what other options are there?  Maybe it can be a stepped approach like LPN where the responsibility is less.  Certainly, a BSN nurse would have more responsibility.  Yes, I think it will take buy-in and a concerted effort for all parties to get this idea up and running.  Including incentives for nurse educators and schools.  Thanks for the input.  I just hope that everyone does not drag their feet which could lead to more staffing issues.

Others, including myself, have asked questions about the "shortage of nurses."  Nurses with various training/experience have posted here about their applications for RN positions being ignored when facilities are advertising their need for nurses and are lamenting the nursing shortage.  A "shortage of nurses" seems to mean different things to different people.

We already have large numbers of ADN programs that are producing large numbers of nursing students regularly at significantly less expense and less time to completion than the BSN programs, with, at least when I was a student, graduates who are competent to start their first jobs providing bedside care as new nurses in hospitals.  

I'm not sure if I'm misunderstanding you, but it seems that you are suggesting that the BSN trained nurse is the ideal solution to the problem minus the time factor to train, and that a program that produces essentially a BSN trained nurse that is structured like an LPN program time wise could be a solution.  If  this is what you are suggesting, I disagree.  I don't see an actual shortage of ADN programs or BSN programs.  While there is always a need for competent, well trained, bedside nurses, in order to produce a properly prepared nurse with a good clinical foundation I can't see the training being accomplished on a lesser time scale than an ADN program, two years, after completing pre-requisites.  The infrastructure is already there; I don't see a lack of supply of new nurses as the problem.

I think the problems are much wider.  It seems to me that facilities are generally not really interested in hiring nurses who don't have very specific experience and training, both of which can take years to accomplish, and are also often reluctant to hire new graduates without conditions for new grad programs, regardless of their advertising their need for nurses.  In my area there is great competition for new graduate positions.   That leaves a lot of licensed nurses who are not competitive candidates for open positions.

I see a mixed desire on the part of employers to invest in nurses, hence the use of temporary staff.  I don't see the industry changing unless the entire model of healthcare in the US changes.

I also think that some health care workers who are well paid and are quite comfortable in their positions are not particularly interested in any changes in health care that could affect their level of comfort.

Edited by Susie2310

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,877 Posts

Here's what  may help: RETENTION efforts. In other words, work hard to keep those nurses already here. Better pay and working conditions would help ease the revolving door that is hospital and LTC nursing today. What about us (those of us still here)??????

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 20 years experience. 2 Articles; 4,273 Posts

I have noticed in my local area of Southern California that many hospital systems have dropped the BSN requirement from their job descriptions. While I believe people can learn many things from a BSN program, this extended course of education does not necessarily make one a better nurse. 

I know many fine nurses who were squeezed out of nursing because they either did not want to spend the time or money (Often upwards of #30,000.00) when they were doing OK at the ASN level and were in fact precepting BSN grads.

Having a BSN does not make one a better nurse. I did start a BSN program some years ago through a highly rated Evangelical Christian school which intoduced me to nursing theories and hatred of non-Christians. So I dropped it an went backto making money instead of spending it