What would help you love your job?

[rlerich]

This is a question for all nurses - both new and old: What would motivate you to keep working for the same healthcare organization?

I am an analyst for a multi-hospital system and my job is to help reduce employee turnover.

Nearly 1 in 5 nurses leave their job in the first year. Because hiring a new employee can cost almost an entire year's salary (and training takes a significant amount of time), it is in the best interest of hospitals, communities, and patients to have nurses stay around longer.

Of course, many people leave their job within a year because of a lack of connection with the company culture, a dislike for their boss, or another life change. Some of this will never change. However, I believe that many things can change - and I would like to figure out what exactly it is that should be changed.

What are things that you wish your organization, managers, and peers did to help you enjoy your workplace? What makes your job challenging, and what would make it more enjoyable for you?

If you have left a job (particularly after less than 2 years), what was your reason for leaving? Is there anything that could have been done differently that would have motivated you to stay?

Again, thank you for your time and responses! Maybe together we can make the workplace more enjoyable for nurses.

[Esme12, ASN, BSN, RN]

Thank you all for your responses thus far. From the impression I'm getting, it's a feeling of being over worked with a focus on financials, instead of making a difference in people's lives.

What changes would you recommend? It is true that hospitals are trying to save money - there is a lot of uncertainty with new healthcare regulations. However, the focus should still be on serving people. Do you feel that the focus is on making money instead of serving people?

Thanks for the feedback and keep it comming!

It is really very simple.....reasonable nurse patient ratios.

That's it...give a nurse less patients and she/he will be happy. A nurse doesn't need bells and whistle gimmicks. The bottom line is safe patient care and a reasonable patient load. I am talking 1: 5-6 on a med surg unit with 1 aide for every 2-3 nurses.

It's simple...don't spread her so thin that she can't guarantee that patient is getting proper care.

[sistrmoon, BSN, RN]

I left my first job after a year and I've been at my current for 6 years. Part of the first job change was to relocate but the difference between the two floors is night and day. My old place, we'd have up to 8 patients, current place, we never have more than 6, usually 4-5. At my old place, there was very little support staff. No clerk on nights, 1 PCA, no phlebotomy, no clinical support. Current has all these things. Keep ratios sane, provide support staff and actually back your nursing staff up and they will stay. Oh and pay well and be as flexible with scheduling as you can. Easy right?

[Been there,done that, ASN, RN]

It is really very simple.....reasonable nurse patient ratios.

That's it...give a nurse less patients and she/he will be happy. A nurse doesn't need bells and whistle gimmicks. The bottom line is safe patient care and a reasonable patient load. I am talking 1: 5-6 on a med surg unit with 1 aide for every 2-3 nurses.

It's simple...don't spread her so thin that she can't guarantee that patient is getting proper care.

There is your answer . Give us the TIME we need to provide safe patient care... and we will gladly provide it.

Somehow, I feel that is NOT the answer you are looking for.

[RNsRWe, ASN, RN]

The thing is, the only way to have proper (read: safe) staffing ratios means cutting into a facility's profit margin. And we know how likely that is to occur.

There is plenty of lip-service given on billboards and community advertising, showing smiling pretty/handsome nurses lovingly spooning something yummy into a happy patient's face. Here's the reality check: that pretty/handsome nurse is so frazzled that by the end of the shift, s/he is HOPING SOMEONE got that spoon in Mrs. Dorfman's face, because she was just too busy!

Hospitals are very keen on keeping barely enough staff to keep the place afloat; when the census goes down they are happy to send staff home, but when it goes up, where is the extra help? Oh, that's right, those people quit because of the yo-yo effect. And how about when management COULD pull in extra people for extra pay, but REFUSE because "we don't have enough FTEs for that" or some such BS.

When a patient angrily fills out a Customer Service card because "I could never find my nurse", you can bet that nurse is going to hear about it. What, she was in the bathroom at some point? Horrors. Forget an actual MEAL break. Mr. Johnson might just want another blanket, and if he waits five minutes, watch out: Customer Service Card Time!

I feel like I'm ranting a bit; actually, I AM ranting and tensing up as I'm typing this, because it makes me angry to relive this crap. I left floor nursing a few years ago BECAUSE of this kind of behavior: facilities save money by squeezing nurses until they take SO many patients they crack up. Don't worry, they'll hire a shiny new grad to fill their place....or not. The leftover nurses will just HAVE to manage!

And here's the icing on the cake: patients, and visitors to the hospital, look at the staff running ragged and hear "I'm sorry, we're short on staff tonight".....they THINK they heard "I'm sorry, there's just not enough nurses for our recruitment team to hire, but they're desperate to hire some!!" ROFL...those poor patients and visitors then believe (very wrongly) that there's this desperate nursing shortage, and if ONLY there were some NURSES to HIRE, why....it would be so much better! People go to school (sometimes at great stress and expense) only to find out that they cannot find a job. Shortshrift Hospital just isn't hiring....even though the staff is exhausted. Nope, no jobs to be had. But wait....didn't you know there's a shortage??

Argh. Done.

[chrisrn24]

Safe patient ratios. Proper supplies. Good help. Supportive people around.

I don't need doughnuts for nurses week and a Christmas gift.

[Ayvah, RN]

The thing is, the only way to have proper (read: safe) staffing ratios means cutting into a facility's profit margin.

Does it though? As the OP mentioned, hiring and training replacement nurses costs a LOT of money. So while short staffing saves money in the short term, I'm not convinced it does in the long term.

One of my favorite quotes from my old manager during a department meeting was "We can't afford to hire another nurse when you all have so much overtime!". Its funny because of course having another nurse would mean less overtime... and if we didn't have overtime in the first place, that would mean that another nurse isn't needed.

OP, as you can see from these responses, safe staffing is probably the #1 issue in nursing and reason why nurses leave. It is the reason I left hospital nursing as well.

Of course, while nurses are experts in seeing patient impact, looking at the financial aspect is also very important. Hospitals need to make money as they are a business too, that's just life.

Does anyone have any information regarding California hospital financials? I would be interested in seeing it too. From what I understood, California's mandated staffing levels have not caused financial ruin of the hospitals as was predicted by opponents. Studying California's staffing changes and rates of turnover before and after the change would be good data to use for arguing about staffing changes.

[ICURN3020]

You mentioned (less than 100 words into your post) the exact reason why I want to get out of not only nursing, but healthcare in general:"Because hiring a new employee can cost almost an entire year's salary (and training takes a significant amount of time), it is in the best interest of hospitals..."It seems like every change I've encountered on my unit, in the year that I've been a nurse, has been motivated by some financial incentive. New bathing products that save money, the removal of hazardous waste bins in each patient room that will save money, different staffing patterns that will save money, intentional understaffing/failure to replace resigned nurses in a timely fashion to strategically pad the unit's budget, new approaches to "customer interactions" that will increase patient satisfaction and... improve reimbursement. Yet at the base of all of these business decisions is nursing -- forced to sacrifice personal and patient safety to accommodate their hospital organization's profitability. Then, to continue the quote I took earlier, you hit us with the same horse manure propaganda stanza our managers would supply us with:"...it is in the best interest of ... communities, and patients to have nurses stay around longer."Appealing to the presumed sensitive, caring, martyr-esque nature one finds in the average registered nurse. The same nature that has led us to this crisis point in the nursing profession... where kind, selfless individuals are taken advantage of to fill the pockets of some completely removed CFO's Armani pockets.There is no easy answer to the question you're asking. No quick solution to the problem you're addressing. We are living and working amidst a new culture of healthcare in this country. One that has been shaped and molded over many years, and there is no change of directions in site. There is a shift towards financial gain and extreme oversight in hospital networks and a large portion of this shift is pushing into the realm of nursing. As the government/insurance companies press harder regulations for the same reimbursement, the business sector will make cuts and changes to offset the profit loss. Bottom dollar healthcare. It sickens me.

Well said! Have you ever thought of a career in politics? :) I can imagine that speech being given from behind a podium.

[Oedgar]

Oh wear do I begin? Hmmm... not having a pt scheduled every 15 mins, regardless of if she is a new OB, IUD insertion, biopsy? Having a prn nurse for when we are sick or absolutely have to be out (jury duty). Having a phone nurse would be great, so that we can return calls in a timely manner instead of at the end of the morning... or sometimes the end of the day. A couple of days ago I got a note on my desk that a 4 week postpartum mom had "irregular bleeding" and was concerned about it. So I made note to call her when we finished morning pts. She called back and I was able to speak to her... and found she was having HEAVY bleeding, changing pads Q30 mins. Two entirely different meanings... "irregular" bleeding... geez. Oh and while I am at it, an extra front office person to just answer the phone would be great. Our office manager, who is supposed to handle insurance and is totally overworked, never has time to do her job because she has to answer the phone... a lot.

[Esme12, ASN, BSN, RN]

Thank you all for your responses thus far. From the impression I'm getting, it's a feeling of being over worked with a focus on financials, instead of making a difference in people's lives.

I have thought about this over night. I have been at this game for a LONG time. Nurses are being treated with an ever increasing level of disrespect. I have seen CEO mandates that because they feel the nurses "sit around at the computer all day" had chairs removed from the nurses station. Really? Could that be because they have to look up labs? Could that be because, heaven forbid, they have to chart in the increasingly lengthy, arduous computer process to be sure maximum reimbursement...is required? I have heard the most amazing things come out of corporate administration mouth I am gobsmacked at the lack of insight these administrator seem to possess.

Nurses are being given an ever increasing work load. My generation for FOR YEARS to improve staffing ratios. I started nursing many years ago you had one 2 RN's, 2 LPN's and 2 CNA's for 35 patients. It was called team leading...LPN's had a larger scope of practice in those days and were a vital part of acute care nursing.

We then shifted to (fought for) primary care. One RN for every 5-6 patients. There were fewer LPN's (they were not hired for acute care any longer in favor of ALL RN care) but we still had adequate CNA's. The patients became sicker. More things became outpatient. Technology advanced

But there weren't enough RN's to fill those spots. We worked OT up the wazoo, there were HUGE recruitment/retention bonuses, tuition forgiveness....hundreds of job openings. AMAZING benefits! I remember one prominent facility...Lahey Clinic having 5... count them five...3 inch 3 ring binders FULL of open RN positions.

Hospitals were still being run by experienced MEDICAL professional that were promoted from being leaders and not by degree. Physicians still ran the facility from a medical/patient standpoint. I realize that an overwhelming majority were poor business men...the patients were well cared for and the nurses were heard.

Then the Government stepped in. They reeked havoc.

Profits plummeted...physician reimbursement was also in the bucket. It caused fear. Who was successful? Corporate America. I know...lets get corporate America in here to run this business right. Unfortunately corporate America isn't a good model for us. It removes that human...something... from the bedside.

Patients don't code on time. They code at shift change. How do you charge for compassion? How do you charge for the time spent holding a patients hand while they grieve over their cancer diagnosis? How do you charge for the little things that count...like compassion. A clean bed. A fresh shave. Clean teeth. A back rub. While they make a patient feel cared for it is NOT billable time.

So what did the corporate executives (with their million dollar salaries and six figure bonuses) think? Nurses are a debit. Nurses became un-billable, non reimbursable time. We were/are only looked at as a debit. A big fat RED withdrawal off the account. A burden on the budget. We became a loud, educated, disgruntled workforce advocating for our patients. We were looked at as an over compensated petulant employee. You can't bill for our time. You can't bill for that hug or back rub. We bring no revenue...we don't have a patient following that bring new insured population for the facility. We only generate withdrawals off the corporate budget.

So how do you fix this? You do more with less. Right? Lets cut staff...I mean who really needs one nurse for every 5 patients...that seems excessive. They have 20 to 30 patients in a nursing home. They did it that way in the old days. Benefits....lets cut benefits...so good bye non contributory pension...to a contributory retirement to a 401K with contribution to you are on your own.

Well...in medicine...Less nurses means less patient care. Can you imagine being in a five star resort and have the concierge tell you that they cannot fulfill your every wish because there isn't enough staff? You'd be outraged! Try that on for size from a patients stand point who is in pain, can't go to the bathroom because you can't get there by yourself because there just not enough staff to go around.

Add that to these surveys and patient satisfaction...connect that with reimbursement/revenue and you have a calamity.

Patient are not always going to be happy. The are ill, frightened, and down right angry. Each and every patient believes they are THE MOST IMPORTANT...along with the other eight patients in my care. Patient really don't give a donkey's behind that there are other sick patients. THEY have needs. Then you give them a piece of paper and ask them what they were unhappy about?

The nurse.

The nurse who is blamed for lab, the nurse who is blamed for CT, the nurse who is blamed for the MD who cannot be found, the nurse who is blamed for the 6 hour stint in the ED on an uncomfortable stretcher with an attending who can't be found to admit and an ED doc who has 2 speeds...stop and reverse. The nurse becasue the bed isn't ready because she is discharging her 3rd patient in 2 hours, receiving her 2nd post op, transferring another to the ICU, transporting another for a stat CT while her "stable" patient is having chest pain...then her first patient a fresh post op wants something for pain and that little old lady who believes she is at home crawls out of bed AGAIN and falls.

Who does this nurse see first?

How to make nurses happy? How do you keep them? Give them a reasonable patient load. You are demanding an ever increasing level of education...then pay us appropriately.

And..... Yes that will cut into the budget.

Thank you at least I feel better.

[TheCommuter, BSN, RN]

Thanks for the feedback and keep it comming!

No problem! We do hope you return soon because a couple more pages of feedback has accumulated since you last visited.

[BSNbeauty, BSN, RN]

I love my job now. However, it would be so much better if the CNA's weren't as lazy. Most of the time I find them lounging around talking when patients are ringing their call lights.

[emtb2rn, BSN, RN, EMT-B]

Preach it brothers and sisters!