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]

Wow-what a shame!  Hospitals are missing out on great nurses if this is a trend nationwide.  Are other hospitals across the country similar in this practice?

[Jralax]

Coming from an existing health care worker shortage previous to covid was already a problem we had from the start. We then proceeded to burn our candle from both ends with government planned health care worker shortages. Our situation feels somewhat deserved. 

[159Nursesrule, ADN, BSN, CNA, EMT-B]

I am Faculty at a private-for-profit college; I teach in the LVN program, either 12 months full-time or 15 months part-time nights.  Both programs are fast-paced.   Students are actively engaged in Theory/ Clinical Learning Lab, Simulation Lab, and Clinical sites.  We encourage our students to stay actively involved in all aspects of their education, and one focus is critical thinking versus task performance.  The college also has an LVN-ADN program, BSN and MSN programs.  The college is rapidly expanding to different states/locations.   Due to a faculty shortage, we have students waiting to attend; the pay isn't competitive with PRN positions in the industry, so many candidates walk away.     So how about improving our income also.  

Another aspect would be recruiting from the high schools; many districts already have agreements with local colleges for students to attend college-level courses and receive credit.  Make it mandatory for colleges to accept those courses if they meet the state accreditation standards.

[dareese, MSN, RN]

Appreciate your weighing in from an educational perspective.  Excellent points!

[Guest1030824]

On 1/10/2022 at 9:17 AM, 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. 

I started out in Med/Surg as a new grad and there were not enough staff to train me. I followed a nurse around for 2-3 weeks and learned very little hands on skills. She had 7-9 patients and had zero time to really train me.  I started out with 3 patients which was nice, but I got a lot of pressure to increase my patient load every day. I basically had to teach myself when I started out as a new grad. I got bullied a lot because of being new as well. I really believe the toxic worked environment is fueled by the already overly stressed out staff. I got burned out after 2 years and left in 2017. Took two years off which I regret. I didn't feel confident enough to look for another job. I finally applied again in 2019, and it was the same old stuff. The training was awful, and I was bullied so bad. I only lasted four months this time. Two years later, I'm now sitting at home unemployed and lacking the confidence to interview. I am so sad because I love bedside nursing. I know I am not the only nurse that wants to return to bedside after time away. It's not that we don't have enough new grads to train, but we are lacking the staff that can train them in the hospital setting. Hospitals are losing their current experienced staff which further adds to the shortage. New grads are getting burned out quicker because of their training , and leaving the bedside within a 1-2 year time period. The nursing shortage is coming from various avenues. Pouring in new grads will further add burden to experienced nurses burning them out faster because of the already high to nurse patient ratio. The hospital I was at got rid of their nurse educators which was not a good idea in my opinion. Instead of utilizing them, they let them go. Why not use nurse educators to train nurses while they are on the floor? I have had plenty of classroom educational opportunities but little hand on training on the floor. I know we are supposed to get this while in school, but the teacher was so stretched that many of us fell through cracks. They did not have simulation labs while I was in school either. I can go on and on, but it basically comes down to funding. Hospitals don't want to spend the money to train new grads, and schools don't want to hire enough teachers. It starts at the top. 

 

 

[toomuchbaloney]

1 hour ago, CinLeo42 said:

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. 

Hospitals have long been willing to sacrifice that promised training and support because other concerns take priority. 

[Gratefulbutnotstupid, ASN, LPN, RN]

As a nurse who started as an aide, then a LPN through a hospital based LPN program before becoming a RN I can see your ideas clearly.

LPN school required me to do intense academic classes followed by intense hands on practice.  The program was one year Sept 8 to Sept 8.  We went through the Summer and days were 8-9 hours.  5 days for vacation at Christmas and part of New Year day off.  My practicum was in hospital and with the hospital staff.  Our help was enormous.  We passed po meds, gave injections and hung IVs ( First antibiotic had to be hung by the RN. No IV pushes or other meds).  The IVs the LPN couldn’t give could be monitored by them and reported to the RN if needed.  As a LPN I also started IVs, gave daily hygiene care, ambulated patients etc.

Turn the coin.  As a RN, I usually got 14 to 15 patients with a LPN to assist.  The LPN took vitals, passed linens, ice water, assisted the patient bathing and passed the medications they were permitted to pass.  They also did ambulating etc.  As a RN, I did the assessments, IV pushes, and all other RN duties including overseeing the LPN.  It was doable.

My mother went to a three year diploma school (through all summers) for her RN.  The students eventually were staff as they continued to learn.  She had to go through all departments and specialties, be the Supervising nurse for a certain time period, scrub in to 25 minor and 25 major surgeries and so on.  They were integral in the functioning of the hospital.

Starting these kind of programs with immediate pay while learning would be a win win.  Students get training, hospitals get staff.

Enjoyed your article, good ideas.  Sometimes you have to go back to move forward.

[Guest1030824]

1 hour ago, 159Nursesrule said:

I am Faculty at a private-for-profit college; I teach in the LVN program, either 12 months full-time or 15 months part-time nights.  Both programs are fast-paced.   Students are actively engaged in Theory/ Clinical Learning Lab, Simulation Lab, and Clinical sites.  We encourage our students to stay actively involved in all aspects of their education, and one focus is critical thinking versus task performance.  The college also has an LVN-ADN program, BSN and MSN programs.  The college is rapidly expanding to different states/locations.   Due to a faculty shortage, we have students waiting to attend; the pay isn't competitive with PRN positions in the industry, so many candidates walk away.     So how about improving our income also.  

Another aspect would be recruiting from the high schools; many districts already have agreements with local colleges for students to attend college-level courses and receive credit.  Make it mandatory for colleges to accept those courses if they meet the state accreditation standards.

Why are they recruiting from high schools when there is a shortage of faculty staff already? You are right, teachers need to be paid more and the student to teacher ratio needs to be ideal. Schools are giving teachers way too many students to teach especially at the bedside. 

The list of students waiting for the nursing program will increase, and students may walk away because of this long wait which is counterproductive. Correct me if I am missing something.  It all boils down to funding. Where can schools and hospitals getting the money? The higher ups are not willing to adjust their pay. How is the government helping?  This is where the focus needs to be. Hospitals say they don't have enough nurses but there are enough. It's just there way of trying to take the focus off the real problem. Schools use this tactic as well to increase their bottom line. The healthcare system is in trouble because nurses are leaving the bedside due to various reasons caused by the system. Mainly, it is a shortage of unfair allocation of funds.

[DallasRN]

I've only scanned most of the replies so my thoughts may be redundant.  Nonetheless, so many of the comments are similar to those made back in the early 80's when I started nursing.  However, things are different now.  Two years ago, nurses all over the US (and world) were thrown into situations they were totally unprepared for yet most stood shoulder to shoulder attempting to provide care for people dropping like flies all around them.  Retired nurses re-joined the work-force - maybe just to provide "clinic" relief for those more up-to-date on clinical skills.  I knew several of those nurses myself.  Nurses were called heros.  Given standing ovations.  Offered free pizza.  Everywhere I went, I saw signs posted across lawns of nursing home facilities - Heros Work Here.  And two years later?  For those nurses who oppose vaccines?  They are shown the door.  After working through the worst of the pandemic.  (and no, I'm not an anti-vaxxer but I do appreciate others opinions and concerns).

In the interim, nurses have found they can leave the dangers (yes, dangers) and frustration and sheer exhaustion of the hospital environment and go to work in a big box store and make almost as much per hour in some locations.  Leave hospitals where they are often treated like the proverbial "hand-maiden" by patients and some physicians. No night shift, no holidays, no 12 hour exhausting shifts. Here in my area - Amazon (a job for young/strong people) pays up to $23/hour, EXCELLENT benefits (insurance and PTO), lots of available OT if one chooses, double time on holidays...and little health risks.  Certainly no legal risk as those nurses face every shift - in great part due to staffing issues coupled with increased accuity.

Finally.  Go back and read so many posts from newer nurses just now entering the work-force.  Complaining about having to work holidays, nights, w/e's.  I read these comments and just shake my head...what did you think you were getting into?  How did you get through school not knowing you were entering a 24/7 profession?  

By fast-tracking/doing the things you mentioned the profession will be diluted.  As it stands, there are abundant opportunities for would-be nurses to go into other fields - law, engineering, IT, even medicine - opportunities not available 30-40 years ago.  We need to clean up the profession from the inside.

[Terri Holland RN]

Sounds like a wonderful detailed plan to current staffing solutions. Would only add one very important other point. The option for 8 hour shifts. This would allow for Nurses raising kids to work and balance family life which makes for happier and more pleasant team and staff. The goal here should be options for better life balance.  The best quality of care for patients is having a range of talented Nurses of all age range verses relying on constant change of travel Nurses. Fast track training, hiring LVN’s and more ADN’s is an excellent goal but also creating better life balance and work flexibility is crucial.  

[jeron]

I'm in Australia and were already at breaking point in our Health System since Delta arrived. I'm ex-military and became a student nurse now aged 47 and as USA,Canada,UK,Australia all share covid-19 discoveries and seeing how detrimental to all Nurses,Doctors etc has taken it's toll they continue to ignore any pleas for help or to change the system to ramp up extra Nurses,Assistants to combat this. RN Training can be done as a 2 part system taking your model of Hands on Practicle Learning with the theory being done via online from the Universities which would inject thousands of Students into Hospitals, Aged Care and Residential to alleviate the crisis. Paying students,Supplying the tools of the Nursing Trade free to students also would see larger number of intakes.The amount of experience a student would receive is 100% more than they we do only completing set amounts of hours to pass a particular practicle module.I learnt in 2 hours Manual BP Taking Accurately and Nurse planning within 2 weeks from RN's. I've spent on my own time 1 month purely observation in ED with special premission and I now have far greater knowledge,understanding and less hesitation once I complete my training to be able to hit the ground running faster than my other student classmates so I believe your method can be put in place without too much complication at all. Will they do this or even consider it "NO" as there are too many Lawyers and people ready to sue the Government,Hospitals and facilities at the slightest chance that someone fails in the position causing serious injury / death. Our societies have become corrupt where governments and Lawyers,Big Pharma are making money and not caring about the consequences of the people and the dire need for change are just continuing to band-aid the situation in the hope getting everyone vaccinated who can be and everyone complying to make our communities as safe as possible and ride out the pandemic just like the days of Spanish Flu as an example. I hope someone listens and adapts but until then many doctors,Nurses will either change positions to less stressful positions or leave the profession as they are now placing everyone else in harms way and not enough experienced people to help Students who do Graduate able to forget half of what you learn in University only to be replaced with actual ways and proceedures used in a real working hospital and not just in the classroom. Can't wait to graduate and get the opportunity to come to the US and learn more... 

[Terri Holland RN]

Australia I’ve read and watched on documentaries is suppose to have the most efficient healthcare system.  How do you think that will compare to US systems which is still for  profit? Most hospitals even teaching facilities have to make a profit and staffing shortages are not always priority.