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. 

[jeron]

Australia is now using EN = LPN in a full-time 18 month course to cover all the basics in wards freeing up RN's for assisting doctors on rounds,wound care etc etc. Due to Covid-19 vaccination mandate hundreds of nurses have walked away and still are leaving big holes in all facilities. Until March 2022 all elective surgery in Australia has been cancelled to combat staff shortages around the country. Many Nurses are taking less stressful positions after being over-worked 16+hr shifts and still can't keep up. Ambulances ramping for 6 hours plus and emergency calls taking upwards of 1-3hr response time due to people ringing up with symptoms of covid clogging the system.All Education facilities here are profit run for training Nurses on all levels and accepting 15 students of which 50% actually pass and either continue onto Higher Education levels not interested in working long demanding shifts for low pay. Our system has crumbled yet we have only just surpassed 1 million Omicron cases here in Australia out of a 29 million population so our system is only just as strong as the number of Nurses,Doctors available to run all departments who aren't being infected with covid-19.Burnt out or won't get vaccinated so left. I started out as an EN before becoming an RN Student so I'm doing an extra 18 months of learning to make me the best Nurse I can be as I love working in Hospitals and the more challeging the day is the better I love it. 

[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. 

[Terri Holland RN]

Perseverance  will get you through and best of luck in your studies. Can tell you have realistic  understanding of what to expect. 

[jeron]

Thanks ? Looking forward to getting out there. 

[cgw5364, ADN]

I have 30 years nursing experience. I worked with some wonderful LPN's in my career including one that showed me how to be a nurse as a new grad. I have also experienced being the only RN on a floor with LPN's. I was not only responsible for my patient's I was responsible for the LPN's patient's IV meds and assessments and being in charge. This was on a mother baby unit and we had a lot of fresh C/S that required PCA's and IV pushes. The LPN's I worked with were in ADN school and they were wonderful to work with. It was just a lot for me to be responsible for. I am sure there are some older nurses that can relate with this situation. 

 

[VolkRN]

On 1/9/2022 at 3:57 PM, 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.

https://wtfhappenedin1971.com/
 

The ramifications from that time period have dramatically changed this country and mostly in a bad way

[Terri Holland RN]

Thank you for sharing. This is a very interesting article and sequence of events. Embarrassing for our profession and country. We need to do our part to make things better for the generation. 

 

[Terri Holland RN]

Agree and have been in the same situation. Enjoyed and respected all the LVN’s, but didn’t like the extra stress of responsibility. Ends up being more work and feeling like you can’t keep up. Have also worked in larger teaching hospitals where they utilize LVN’s, ADN’s and BSN’s but each Nurse is responsible for their on group of patients. This seems to work well verses team Nursing think it was called. RN in Charge, takes less or no patients & is able to assist with skills an LVN can not administer. 

[CKPM2RN, ASN, EMT-P]

On 1/7/2022 at 7:24 AM, dareese said:

I agree that a shorter education may be a problem.  But what other options are there?  Maybe it can be a stepped approach like LPN where the responsibility is less.

From how I read the article this old-time approach created LPN-type nurses. Could one of these licensed nurses not take supplemental education down the line to become RN, or more? And it would be my personal dream to have a bunch of LPNs working alongside the RNs in every unit. The work with each patient could be assigned accordingly but the complete workload would be broken up into manageable partitions.  

[dareese, MSN, RN]

Sure.  I believe that there are LPN to RN programs.  I enjoyed working with LPNs at the beginning of my nursing career.  I was the charge nurse and the LPNs worked under me.  I did not have to spend time directly supervising them as they were competent and had their own duties.  We each had divided tasks among us and the system worked well.  Fast-forward to now and my last inpatient employer did not hire LPN's.  I enjoyed taking care of my own patients but it was not in entirety as I still had CNA's working on my team.  However, there were times that I felt like I was drowning in nursing responsibility with nobody to help me.  Especially regarding phone triage as our phones rang continuously and the CNAs could not answer any of the calls or questions from family members, etc.  Between charting and answering the phone, my time was pretty well taken up with these tasks.  It was discouraging and frustrating.  If I could have shared nurisng duties, it would have taken the pressure off of my shoulders somewhat.

 

[guest1143647]

On 1/10/2022 at 11:17 AM, dareese said:

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.

Homecare has an even more severe shortage of nurses than hospitals. Home care is brutal and low paying. My gosh the paperwork alone is painful. Oasis

[Terri Holland RN]

OMG…yes yes yes! Home care paperwork is brutal and basically no training. Just started with home care Company and only training is some online tutorials. Appreciate recommendations on favorite home care charting books and Medical Coding too. Hard to know when ordering online except by reading a lot of reviews.