War on Nurses

[KalipsoRed21, BSN, RN]

51 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.

 

This was my experience as well. State code of practice is often limited by the facility for litigation fears thus LVN remain under utilized, ratios “look” good but RNs are being burnt to a crisp.

[vintagegal, BSN, DNP, RN, NP]

My viewpoint may be a little different than most…

I think we as a society need to triage patients effectively, and provide them other alternative health care options besides going to the hospital. Home health and hospice needs to be adequately promoted for those patients who qualify. Patients in their late 80s early 90s end up sitting in ICU days/weeks when they should have a dignified passing at home surrounded by loved ones. The issue is precipitated in primary care when providers don’t accurately triage patients to these services and have these tough conversations. Less patients in hospitals burdening nurse equals less nursing shortages. We can continue to pump out new nurses only to burn them out or we can take another approach which is dignified care of those requiring palliative and end of life care vs. artificial prolongation of life in a hospital setting.

[KalipsoRed21, BSN, RN]

5 hours ago, dareese said:

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....  

Also I feel the New Grads RNs being hired are getting shafted due to education needs but lack of personnel to train. We all know a new grad BSN is not floor ready. The last place I worked they tried to give a 3 week old new grad her own team; with a heparin drip, only 3 RNs on the floor (including the new grad) with 6:1 ratio. No charge or resource RN. No way anyone was going to have time to help the new grad. I filled out a safe harbor for before even taking report. Response I got was: “Well the New Grad didn’t complain.” ? Really?! That poor baby is new….if you tell her she should jump infront of a car because it is in her scope of practice and her duty as a nurse; she would probably believe you. That’s why new grads are scary and why we shouldn’t be *** putting them at risk. Because my facility didn’t take that complaint seriously I wrote a letter to state reporting the hospital. I got a message from state basically saying “Thanks for sharing your concern. These complaints are not punitive, nothing is going to happen to the facility, but we will bring this up to them and TJC (who is paid by hospitals to make sure they are safe…tell me how that is effective?). It is all smoke and mirrors and we are the sacrificial lambs. 

[dareese, MSN, RN]

Our local hospital has a 1-year new grad intern program which seemed to be a little long in my opinion but apparently, it is necessary by the comments on this thread.  These newbies are eased into nursing responsibilities very slowly and I would imagine trained well and retained longer than in other "trial by fire" hospitals (which is like the one that I started in).  Perhaps hospitals need to adopt this type of model in order to safely train new nurses into the profession. 

[dareese, MSN, RN]

I agree about utilizing home care more.  I still can't understand why insurance is willing to pay for hospital services but home care reimbursement is very limited.  It seems to be a win-win to be in the comfort of your own home when ill especially for an elderly patient.  It has to be cheaper for the insurance companies and medicare than hospitalization.  We are dealing with this issue right now with 2 of our parents.

[toomuchbaloney]

Interesting fact, more Americans have no health insurance now than in 2019. Also, approximately 80 million Americans are burdened by deep medical debt and avoid further interaction with the industry.  Lots of people have insurance that doesn't cover home care or hospice and junk health insurance policies are a real problem as the ACA has been limited by legislative efforts and court opinions since it was signed into law.   

[Hoosier_RN, MSN]

2 hours ago, vintagegal said:

My viewpoint may be a little different than most…

I think we as a society need to triage patients effectively, and provide them other alternative health care options besides going to the hospital. Home health and hospice needs to be adequately promoted for those patients who qualify. Patients in their late 80s early 90s end up sitting in ICU days/weeks when they should have a dignified passing at home surrounded by loved ones. The issue is precipitated in primary care when providers don’t accurately triage patients to these services and have these tough conversations. Less patients in hospitals burdening nurse equals less nursing shortages. We can continue to pump out new nurses only to burn them out or we can take another approach which is dignified care of those requiring palliative and end of life care vs. artificial prolongation of life in a hospital setting.

That sounds good, but we are the magic pill society. There's a pill to fix everything (at least most patients and families think so). I've seen 90 year olds families refuse hospice/palliative care, despite the patients wishes, because they think the medical team is withholding a magic treatment from their loved one. Or even worse, a miracle is going to occur, just like the movies. Sad to watch. But even worse the threats of lawsuits when told no magic pill or miracle

[Guest 1152923]

5 hours ago, KalipsoRed21 said:

Also I feel the New Grads RNs being hired are getting shafted due to education needs but lack of personnel to train. We all know a new grad BSN is not floor ready. The last place I worked they tried to give a 3 week old new grad her own team; with a heparin drip, only 3 RNs on the floor (including the new grad) with 6:1 ratio. No charge or resource RN. No way anyone was going to have time to help the new grad. I filled out a safe harbor for before even taking report. Response I got was: “Well the New Grad didn’t complain.” ? Really?! That poor baby is new….if you tell her she should jump infront of a car because it is in her scope of practice and her duty as a nurse; she would probably believe you. That’s why new grads are scary and why we shouldn’t be *** putting them at risk. Because my facility didn’t take that complaint seriously I wrote a letter to state reporting the hospital. I got a message from state basically saying “Thanks for sharing your concern. These complaints are not punitive, nothing is going to happen to the facility, but we will bring this up to them and TJC (who is paid by hospitals to make sure they are safe…tell me how that is effective?). It is all smoke and mirrors and we are the sacrificial lambs. 

     Sad!  Just like cannon fodder soldiers, administrators turn a blind eye knowing there will be collateral damage (deaths and permanent disability) due to unsafe practices such as this.  While a new nurse who, due to inexperience, may make a fatal error and whose life will never be the same (PTSD, legal/financial repercussions, loss of job/livelihood), the administrators are unphased.  

[dareese, MSN, RN]

I see that some nursing homes are starting to think outside of the box like the one mentioned in this article.

 https://www.mprnews.org/story/2022/01/10/nursing-home-worker-shortage-ripples-through-communities

Maybe it is a start...

[Susie2310]

On 1/10/2022 at 7:15 AM, vintagegal said:

 

I think we as a society need to triage patients effectively, and provide them other alternative health care options besides going to the hospital. Home health and hospice needs to be adequately promoted for those patients who qualify. Patients in their late 80s early 90s end up sitting in ICU days/weeks when they should have a dignified passing at home surrounded by loved ones. The issue is precipitated in primary care when providers don’t accurately triage patients to these services and have these tough conversations. Less patients in hospitals burdening nurse equals less nursing shortages. We can continue to pump out new nurses only to burn them out or we can take another approach which is dignified care of those requiring palliative and end of life care vs. artificial prolongation of life in a hospital setting.

In my view these decisions should be taken between patients/their family members if the patient wishes to include them, and their health care provider.   I do think, however, that it is important that older patients are given enough information about their medical problems, prognoses, risks and benefits of treatment decisions, and sufficient information about treatment options to enable them to make the best decisions for themselves possible.  The patient and their family should be given sufficient time to consider this information.  I think that these are the conversations that need to take place at a primary care level.  For one elderly patient, a lengthy stay in the ICU may be an acceptable risk; for another elderly patient it may not.  I believe it is very prudent for older patients to have an Advance Directive - a Durable Power of Attorney For Health Care.   I have seen the damaging psychological effect that engaging a patient in "this tough conversation to limit the care they receive" can have, on a well, elderly patient, with chronic conditions, who enjoys their life.  So one needs to tread very carefully and consider individual patient wishes about their care.

[dareese, MSN, RN]

I just read an article called "Medicare Support for NP Training Addresses Nursing Shortage"  https://www.medscape.com/viewarticle/966228  where Medicare is considering support for clinical training for NPs.   Although the title is deceiving (support is for NPs and not nurses), maybe they are starting to think on the right track.

[Guest1030824]

On 1/7/2022 at 6:33 AM, dareese said:

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. 

I’m a BSN nurse with a two year gap and it has been hard for me to return to the bedside because hospital’s are asking for recent experience.  Hospital’s do have programs for new graduates with less than six months experience. I know I am not the only nurse looking to return to bedside. Hospital’s can increase staffing by offering training to nurses looking to return to the bedside.