War on Nurses

[dareese, MSN, RN]

I am actually surprised to hear that many nurses do not feel that there is a shortage of nurses in hospitals and nursing homes.  Is it just in my neck of the woods? We were always operating short prior to covid with open positions.  It seems that if there was a set number of nurses for all nursing positions and some left the profession or retired early due to burn-out from the current environment, others were forced to leave due to vaccine mandates, and many shifted to become travel nurses or work in non-inpatient positions, that indeed there is a nursing shortage in our inpatient facilities?  Am I wrong about this?

[Mr. Murse]

2 minutes ago, dareese said:

I am actually surprised to hear that many nurses do not feel that there is a shortage of nurses in hospitals and nursing homes.  Is it just in my neck of the woods? We were always operating short prior to covid with open positions.  It seems that if there was a set number of nurses for all nursing positions and some left the profession or retired early due to burn-out from the current environment, others were forced to leave due to vaccine mandates, and many shifted to become travel nurses or work in non-inpatient positions, that indeed there is a nursing shortage in our inpatient facilities?  Am I wrong about this?

I think what they're saying is that there are not literally too few RNs out there to fill the positions, but rather they are not paid enough or treated well enough to stay in the positions where they're needed. Someone that goes to travel or leave the bedside is still a nurse, they just don't want to work where the shortages are because the pay and conditions aren't right.

[Mr. Murse]

4 hours ago, hppygr8ful said:

Having a BSN does not make one a better nurse.

This is most certainly true. Some of the best nurses I've ever worked with are ASN nurses. BSN really doesn't mean much at all when it comes down to being in the trenches.

[T-Bird78]

LPN’s are vastly underutilized.  We can bridge the gap between CNA and RN, like we’re supposed to do, and take a burden off both those roles. The healthcare system I work for only hires RNs for the hospitals and has some LPNs in the urgent care/ambulatory care/LTC facilities. Last year they redeployed dozens of LPNs from the ambulatory care setting into the hospitals, including me. The coordinator over my hospital was shocked to learn none of us had any hospital experience and I reminded her that they won’t use us. My original assignment was to do med admin while the RNs did their usual duties, but my preceptor had a horrible day and I didn’t get my one day of training (long story) so I wound up being more of a CNA, but it helped. As my time in the hospital (med-surg, postop, telemetry, and COVID pts) was ending, the nurse manager and facility coordinator both agreed they’d love to look into expanding the LPN role so they could properly train one of us for med pass and be in between CNA and RNs. And yes, I got a text from the coordinator asking if I wanted to pick up extra shifts because they’re expecting another surge. 

[dareese, MSN, RN]

This hierarchy of nursing roles had worked for decades.   Smart administration!  And I bet that the RNs appreciate the help.

[dareese, MSN, RN]

I'm not sure if I was unclear.  No, I am not saying that these practical nurses would get their BSN immediately.  It would be more like a practical nurse program for an LPN with additional training over time to build on their education.  The goal would be to get a BSN EVENTUALLY if so desired.  Also to get trained practical nurses in place quickly to help fill slots in the nursing homes and inpatient area.  Maybe some current RNs are too young to remember the hierarchy of nurses in these areas.  BSN nurses at the top with the more complex responsibilities, then AD nurses, with LPN's under the college-educated RNs.  This spread out and alleviated some of the responsibilities for the BSN nurses.

[JBMmom, MSN, NP]

12 hours ago, T-Bird78 said:

LPN’s are vastly underutilized.

My hospital employed LPNs until about 11 years ago when all were given the option of going back to school for their RN to maintain their position or they would be reassigned or offered a retirement/layoff. One of the best nurses I had as a student nurse was one of those LPNs who chose to become a tech in the same day surgery unit. A sad underutilization of her excellent skills, but she said as long as she didn't get a pay cut she was happy enough with it. There should definitely be a place for LPNs in the hospital environment. 

However, as many others have pointed out in this thread, retention is really the key. Until hospitals stop using travelers as a short term band aid for a long term problem, they will not retain the staff they supposedly need and respect- at least according to all those management speak things they say. 

[toomuchbaloney]

3 hours ago, dareese said:

I'm not sure if I was unclear.  No, I am not saying that these practical nurses would get their BSN immediately.  It would be more like a practical nurse program for an LPN with additional training over time to build on their education.  The goal would be to get a BSN EVENTUALLY if so desired.  Also to get trained practical nurses in place quickly to help fill slots in the nursing homes and inpatient area.  Maybe some current RNs are too young to remember the hierarchy of nurses in these areas.  BSN nurses at the top with the more complex responsibilities, then AD nurses, with LPN's under the college-educated RNs.  This spread out and alleviated some of the responsibilities for the BSN nurses.

When and where I began my nursing career BSN or higher education was not the standard.  The community in the 1970s was home to two hospitals of with high level trauma, burn, and maternal health facilities. There was a large state mental health hospital with acute care and custodial care beds.  The medical hospitals provided NICU, PICU, CCU and neurological intensive care.  One of them was/is still a level 1 trauma center.  

There was a private religious college in the area which provided BSN and MSN degrees.  The classes were small.  The local public university did not include either colleges of medicine or nursing. (That's different today) The hospital's diploma nursing program graduated it's last candidate by the time I was licensed.  That program was eventually the basis and the namesake for the university program.   The vast majority of the nurses practicing in that region were ADN prepared nurses working in teams with LPNs and CNAs. They were educated in one of the half dozen community college programs which could be completed in about 24-30 months full time. 

The BSN and MSN prepared nurses typically gravitated quickly to education or other roles away from the bedside.  Much has changed since then and a good bit of the change has not been that great for nursing as a profession. Reagan essentially closed down public mental health funding and Nixon allowed profit into healthcare. Lots of where we are today cascades from those type political decisions. 

[Susie2310]

20 hours ago, dareese said:

I am actually surprised to hear that many nurses do not feel that there is a shortage of nurses in hospitals and nursing homes.  Is it just in my neck of the woods? We were always operating short prior to covid with open positions.  It seems that if there was a set number of nurses for all nursing positions and some left the profession or retired early due to burn-out from the current environment, others were forced to leave due to vaccine mandates, and many shifted to become travel nurses or work in non-inpatient positions, that indeed there is a nursing shortage in our inpatient facilities?  Am I wrong about this?

I see it this way:  An actual shortage of nurses due to under-supply e.g. not enough nurses being produced by the nursing schools (which I don't see overall) would be one situation.  For areas in the country that experience a true shortage of nurses due to a lack of production of new nurses in those areas, I agree that increased production of new nurses in those areas would be helpful.  However, in my view, a shortage of nurses in hospitals and nursing homes (which I recognize is a problem in some areas of the country), if it comes as a result of nurses choosing not to work for some facilities or due to some facilities not actively recruiting licensed nurses who don't meet specific training and experience criteria, is a different situation.  As I see it, the latter situation won't be helped by simply increasing the supply of new nurses.  Other posters mentioned the issue of retaining nurses also.  I think it's necessary to closely examine what the causes of the shortages are in each geographic area in order to determine what specific remedies are needed.

 

[Hoosier_RN, MSN]

On 1/7/2022 at 12:01 PM, dareese said:

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)?

The admins and upper management in hospitals and LTC groups know the issues, they just don't care about retention efforts. They are unwilling to lose pay and bonuses, to the detriment of staff and patients/residents 

[Hoosier_RN, MSN]

1 hour ago, toomuchbaloney said:

Reagan essentially closed down public mental health funding and Nixon allowed profit into healthcare. Lots of where we are today cascades from those type political decisions. 

And thus began the downfall of healthcare, according to my mom. She got her RN in 1966, and says the change was pretty immediate after the law in 1972 or 1973 (she can't rememberexact year). She says her hospital system changed overnight, with greedy little bean counters ready to put it to whoever they could, just to get a nickel. Sad...

[dareese, MSN, RN]

This is a very interesting thread regarding the downfall of healthcare in the  70s which I was unaware of.  Who would have ever thought that it would come to this, our current state of affairs.