War on Nurses

[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....