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. 

[toomuchbaloney]

7 minutes ago, dareese said:

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.

Frankly, it's been a rude backdrop to what otherwise has been a very rewarding 40+ year career in healthcare. I'm glad that I retired when I did. 

[chare]

3 hours 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. 

Are you suggesting that prior to Mr. Nixon,healthcare organizations weren't allowed to make a profit?  Or that he made it easier for them to do so?

[Daisy4RN]

3 hours ago, Hoosier_RN said:

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 

This is most definitely the crux of the matter. Healthcare has been in a downward spiral for many years and admin knew/knows exactly how to fix it but won’t bc the bottom line is the almighty dollar. There is no shortage of nurses in general, just nurses who at some point leave the bedside bc of all the ridiculousness of the hospital environment. This is of course exacerbated by Covid but certainly not the cause.
LPNs could help the current situation if admin allows them to fully work within their scope. I worked with LVN/RN teams but it was extremely difficult bc admin would only allow the LVNs to do certain tasks/skills (even though they were qualified and competent, or at least could have become competent with training) so that left the majority of the work to the RNs who of course could not keep up the workload (bc of the increased number of pts). That unrealistic workload was the straw that broke the camels back for some to leave, so in this particular situation that “solution” did not help. 

[toomuchbaloney]

5 hours ago, chare said:

Are you suggesting that prior to Mr. Nixon,healthcare organizations weren't allowed to make a profit?  Or that he made it easier for them to do so?

No, I'm not suggesting that there was no profit.   I am suggesting that before the 1973 HMO act healthcare in the USA was largely not for profit. After that legislation, with Watergate derailing constructive governance, the possibility of moving toward a single payer system was lost and costs began to rise in an unsustainable fashion.  Nixon was much more progressive in health policy  than is the typical conservative politician of today. 

[KalipsoRed21, BSN, RN]

I don’t believe “fast tracking” nursing programs is a good solution. I graduated 14 years ago and can tell you that my school education was expensive and did not even come close to preparing me to be a competent nurse (I have a BSN). 
My problem with the idea of working with LPN/LVN that I need to “supervise” would be that I have a poor understanding of what those nurses are allowed to do (I would think a lot of hospital RNs would have the same lack of experience). I currently have no time to even supervise the nurse aids that work with me (who are all hauling *** every shift, but frequently do things like turn off my pumps and don’t say anything to me, or do I/Os or weights on my CHF patients….like the aids have time to do vitals, blood sugars, and help with the total cares. No one gets a bath unless they NEED one….no one gets anything unless it has been asked for several times.) So if the idea of adding more people for me to supervise while caring for heavy patients just leads to me having more responsibility but still no better outcomes for the patient, is that going to be on my license too? 

Your concerns are valid. I have been trying to find my way out of healthcare the whole 14 years I’ve been in it. I am almost debt free and once I am I plan to get a job at the gas station down the street from my house making half the pay I do now. Nursing is hopeless. I work my butt off every shift and I can’t keep up. I am terrified of being a patient in a hospital, we are falling apart and the competence is so poor….not because the staff are stupid, but because both staff and providers have no time to think through anything. 

1) I would recommend that all hospitals get rid of the BSN preference and go back to ADNs. 

2) They need to hire AND train nurse aids like crazy. Pay these people what they deserve, we are so short this assistive staff where I work that I’m quasi trying to do direct care for 6 people. 

3) All nursing students should be nurse aids during nursing school. Who the hell ever came up with “let’s make nursing school so hard you can’t even have a job while going” was a retard. I worked part time through school as a nurse aid. My teachers were assholes about my job responsibilities and requirements, my employer was somewhat more understanding of my school requirements but it made the whole experience terrible. I had to work, it wasn’t an option not to, even with student loans. 

4) I believe home health providers are going to be a big part in reducing hospital numbers. But home health is a rough gig too, hard on your car, the charting requirements to get paid by Medicare are outrageous, and the work environment can be scary occasionally. 

5) This is just the tip of the ice burg. There are literally less people in each proceeding generation.(which I think is a good thing.) But you can’t fill staffing gaps with people that aren’t going to exist. 

6) Immigrants are going to continue to be a large part of our staffing gap. It would be beneficial for us as a society to quit fighting that and become more language diverse and have better technology to translate between patients, staff, and among colleagues. I work at a very diverse institution, and I do believe diversity is better, but there are many shifts I go in not knowing a damn thing about a few of my patients even after I get report because I didn’t understand what the other nurse was saying.

7) if you want more nurses, you need more teachers. I never became one because most educators make what I make working med surg 3 days a week. Why would I spend more money for school to make about the same as I do now?

[Hoosier_RN, MSN]

6 hours ago, toomuchbaloney said:

Frankly, it's been a rude backdrop to what otherwise has been a very rewarding 40+ year career in healthcare. I'm glad that I retired when I did. 

Mom retired in 2014. Says it wasn't a moment too soon. She says she doesn't know how anyone does it nowadays. At the same time, she was a dept manager who enjoyed nice bonuses, although surgery is run in a way you can't short staff, at least not that I'm aware of

[Hoosier_RN, MSN]

4 hours ago, Daisy4RN said:

This is most definitely the crux of the matter. Healthcare has been in a downward spiral for many years and admin knew/knows exactly how to fix it but won’t bc the bottom line is the almighty dollar. There is no shortage of nurses in general, just nurses who at some point leave the bedside bc of all the ridiculousness of the hospital environment. This is of course exacerbated by Covid but certainly not the cause.
LPNs could help the current situation if admin allows them to fully work within their scope. I worked with LVN/RN teams but it was extremely difficult bc admin would only allow the LVNs to do certain tasks/skills (even though they were qualified and competent, or at least could have become competent with training) so that left the majority of the work to the RNs who of course could not keep up the workload 

It's not admins that determine the job scope for LPNs, it's the state BONs. If a facility chooses to ignore those scopes, forfeiture of reimbursement or closure of facility are amongst possible punishments. If a nurse chooses to ignore scope, lawsuit or loss of licensure could occur

[guest1171208]

I applied to every  acute hospital in my area. I have a BSN. I  been a nurse 15+ years. I just got the BSN in September. I could never get a call back from recruiters in the hospitals. One recruiter wanted me to call her. When I did,she did not answer.  I am experienced,with the BSN. So what Is the problem? I figured it might be that I do not have the right experience. I worked in private duty with peds and adult patients. Maybe hospitals think it would be hard to train me,who knows. It could be that many nurses and recruiters do not know that private duty work is still working in nursing.

[dareese, MSN, RN]

Well, that's a shame!

[Daisy4RN]

10 hours ago, Hoosier_RN said:

It's not admins that determine the job scope for LPNs, it's the state BONs. If a facility chooses to ignore those scopes, forfeiture of reimbursement or closure of facility are amongst possible punishments. If a nurse chooses to ignore scope, lawsuit or loss of licensure could occur

Allow me to clarify…..

The hospital was not allowing LVNs to perform tasks/skills that were most definitely within their scope of practice. Therefore, the work of the LVNs on the RN/LVN “team” needed to be done by the RN. The hospital did this (teams) to bypass mandated ratios ((Calif) but it did nothing for pts (or RNs) because the RN was more busy than ever and pts were getting worse care. But, hey the hospital was saving money so for them all was good.

 

[Hoosier_RN, MSN]

25 minutes ago, Daisy4RN said:

Allow me to clarify…..

The hospital was not allowing LVNs to perform tasks/skills that were most definitely within their scope of practice. Therefore, the work of the LVNs on the RN/LVN “team” needed to be done by the RN. The hospital did this (teams) to bypass mandated ratios ((Calif) but it did nothing for pts (or RNs) because the RN was more busy than ever and pts were getting worse care. But, hey the hospital was saving money so for them all was good.

 

Gotcha! I occasionally see some nurses talking about "the nurse" who wouldn't, or couldn't do "x", not understanding said nurse is an LPN and may be limited by scope. While it's nice to assume that everyone knows each other's scope and boundaries, it's not always the case. Sorry that I misunderstood 

[dareese, MSN, RN]

Well, that's a shame if hospitals are not hiring new grads or utilizing LPNs as they should.   I am starting to see a common thread here....