War on Nurses

[dareese]

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. 

[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.