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.
I love my job, but I would love it even more that instead of the "let me tell you what you need to do..." bullsh*t over a phone call, I would like some actual support in certain instances (ie: drug diversion in an unstable home environment with a hospice patient).
I also absolutely detest being on call. I would love an actual dedicated on call staff, instead of just saying they are hiring this one or that one... DO IT! I'm tired after 40-50-60 hour week... I want to rest too.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
I'm a new grad. My biggest concerns R/T work are:
Some veteran nurses do things an improper way. But since they have worked there longer, if I choose to do things correctly, I'll make myself a target. At the same time, I want to protect my license and my integrity (as well as my paycheck) I wish there was a way to change this culture. I'm not saying the vet should be fired, I'm saying that I wish there weren't "social penalties" for making waves if you are indeed doing the right thing.
Another issue that's come up at my job is that they are quick to fire someone who wants to go to school to better themselves in their practice. I wish this weren't so. I wish that if a person agreed to continue working at a facility after obtaining an advanced degree, that the facility would work with their class schedule.
I also think it's unprofessional when a supervisor tells coworkers about a mistake, but doesn't talk directly to the nurse. I love my boss who sits me down and says "I'm gonna tell you want you did wrong." That's how I can do my job better. I used the phrase "unprofessional" but This type of thing actually makes me think I should look for a new job.
In spite of my complaints, I make an active choice every shift to "love my job". I'm hoping having a positive attitude will help me to stay. I can honestly say I love my job--because I choose to be grateful for what it is--a pretty great paycheck doing the work I enjoy.
If I were to leave a job, it would be because I felt unappreciated by admin or coworkers.
I agree that nurses are quick to be told when they did something wrong, but never told "Good job!" when they successfully handle a particularly tough assignment or make a great save.
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.
I can not 'Like' this enough to adequately explain how much I agree with you.
I will add - be supportive regarding my schedule and flexible. My family is important to me too. Sick time should be a benefit - my patients should be protected from me when I'm contagious, it's common sense. There should NOT be write ups for call outs when you have doctor's excuse - like when I got the flu this year despite having the flu vac.
Say thank you.
Don't violate labor laws - meetings that have food served are time on the clock. Working overtime is pay approved or not. Recognise that 'time management' is often an unobtainable goal given staffing.
Recognize that a huge portion of our job is performed ON the computer and directly impacts reimbursement - we need time to do it right, time to read it and time to think about what the chart says in order to care safely for our patients.
Management needs to have our backs when families/patients are rude, unreasonable or dangerous.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
rlerich......I was so hoping that we could have your thoughts, start a dialog, to the information provided here. I know it is the holidays coming up and it is summer. You may be on vacation. However, as nurses we have become far to accustom to silence in response to when we are asked for our input. As nurses we are trained and hard wired to critically think about a situation to get to the critical mass of the issue at hand without a ton superfluous information and deal with the problem immediately at hand. It is what we do.
Nurses have a habit, a job hazard really, to say what is necessary as we cut through the bureaucracy and get the the crux of the matter. We seldom say what someone WANTS to hear. We seldom receive answers for we didn't provide the information that they were seeking. We are thought of as petulant and whiners. This minimizes our concerns and degrades us as a whole. We KNOW that administration is really not interested in what REALLY matters. The silence is always deafening.
Nurses form unions to have a voice. To be heard. To communicate it requires administration to participate. The biggest issue facing nurses right now is staffing, mandatory OT, patient ratios to ensure that staffing is safe. Yes it costs money. But tossing pretty little coolers and cutesie employee of the month parking spots do little to appease the crux of the problem. It is spitting in the wind and frankly it is insulting and demeaning.
I have found those new to healthcare have little REAL knowledge about the REAL issues facing nurses and patients today. When they hear the realities and realize there is little they can do or what will be done. They retreat. I know this as I have worked administration and left because I had to support things that were just not right or safe. I am very poor at giving lip service to real concerns. I have never been able to turn that blind eye.
What can increase satisfaction? Make nurses believe they are being heard and that their concerns will be addressed.
I worked for a multi-system organization in the Atlanta metropolitan area and we were mandated to complete a survey just like this one a few years back. We were at 95% in agreement on what we felt the problem was. When management read and responded, we were met with "you all need to work on your time-management skills". Not one thing changed! Several of us complied with that immediately by 'managing' to take the time to write out and work out the required notice.
Thanks again for all of your input. It is truly appreciated. I apologize for not responding sooner, but I have been kept busy. It is very good to hear the struggles that nurses face. And, if anything, it has only added to the complexity of figuring out how to move forward from here.
Someone here asked about California hospital profit margins. I work for a west coast system and, I can tell you, our profit margin is about 2% a year. Our goal is to get it up to 4% a year. With salaries and wages accounting for half of our costs, if we bumped everyone's salaries up 5%, we would be going in debt. And, of course, occassional new buildings, equipment, and other costs come up - and we need to have money on hand to cover these costs (in addition to preparing for baby-boomers hitting the hospital seen over the several decades).
Just recently (and again, I am very new at this job), I have been working on evaluating how many hours of work we spend for every patient day. And it averages over 30! In other words, for every day that a patient is in the hospital, four employees are working an entire work-day. That ends up being a lot of money. And where is it going to come from? It either has to come from the patient, the government (our tax dollars), or the hospital staff. Generally, it is a combination of all three. And sadly, nurses are one of the groups that gets hit the hardest. I would love to change this.
Using the money that we currently have, what can we do to change this?
Regardless of whether or not any of us like it, hospitals won't be receiving much additional funding in the forseeable future, therefore, we must learn to find a way to intelligently save more - in a way that eliminates stress and the need for overtime/overwork.
I have many friends who went through nursing school, and I know it is not easy. Becoming a nurse requires a lot of hard work and an incredibly intelligent person. Thus, it is right that a nurse should get paid well for this work. However, as I've mentioned, there is not a lot of extra money sitting around. And yes, we could cap a CEOs salary at $100,000 - but, for most facilities, that change would only make a difference of another $1-$2 a week per employee (at least, in my system - although our CEOs get paid less than the average).
So, a question I have, that I believe could help nurses and hospitals, is this: What aspects of your work could be digitized or given to someone with less knowledge and experience - such as a CNA? Nurses are highly educated - do we need you running to pick up someone's meal? (Not to mention this turns you into a $35/hr delivery person). I am wondering if there are routine, monotonous tasks that nurses do that could be given to someone else, or even digitaized - giving you more time for work that you are educated to do. I know that many current technological "tools" seem to cause more hassle than help (we need to get Apple and Google making these products).
Essentially, I am low on the totem pole, I make significantly less than most of you nurses do, and I am just now learning about the intricacies of the healthcare system. However, I believe that win-win outcomes are ALWAYS possible (with a bit of creativity). And I would love to find a way to help nurses, hospitals, and patients from where we're at right now.
So again, than you for your input, and I'll keep listening.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thanks again for all of your input. It is truly appreciated. I apologize for not responding sooner, but I have been kept busy. It is very good to hear the struggles that nurses face. And, if anything, it has only added to the complexity of figuring out how to move forward from here.
Someone here asked about California hospital profit margins. I work for a west coast system and, I can tell you, our profit margin is about 2% a year. Our goal is to get it up to 4% a year. With salaries and wages accounting for half of our costs, if we bumped everyone's salaries up 5%, we would be going in debt. And, of course, occassional new buildings, equipment, and other costs come up - and we need to have money on hand to cover these costs (in addition to preparing for baby-boomers hitting the hospital seen over the several decades).
Just recently (and again, I am very new at this job), I have been working on evaluating how many hours of work we spend for every patient day. And it averages over 30! In other words, for every day that a patient is in the hospital, four employees are working an entire work-day. That ends up being a lot of money. And where is it going to come from? It either has to come from the patient, the government (our tax dollars), or the hospital staff. Generally, it is a combination of all three. And sadly, nurses are one of the groups that gets hit the hardest. I would love to change this.
Using the money that we currently have, what can we do to change this?
Regardless of whether or not any of us like it, hospitals won't be receiving much additional funding in the forseeable future, therefore, we must learn to find a way to intelligently save more - in a way that eliminates stress and the need for overtime/overwork.
I have many friends who went through nursing school, and I know it is not easy. Becoming a nurse requires a lot of hard work and an incredibly intelligent person. Thus, it is right that a nurse should get paid well for this work. However, as I've mentioned, there is not a lot of extra money sitting around. And yes, we could cap a CEOs salary at $100,000 - but, for most facilities, that change would only make a difference of another $1-$2 a week per employee (at least, in my system - although our CEOs get paid less than the average).
So, a question I have, that I believe could help nurses and hospitals, is this: What aspects of your work could be digitized or given to someone with less knowledge and experience - such as a CNA? Nurses are highly educated - do we need you running to pick up someone's meal? (Not to mention this turns you into a $35/hr delivery person). I am wondering if there are routine, monotonous tasks that nurses do that could be given to someone else, or even digitaized - giving you more time for work that you are educated to do. I know that many current technological "tools" seem to cause more hassle than help (we need to get Apple and Google making these products).
Essentially, I am low on the totem pole, I make significantly less than most of you nurses do, and I am just now learning about the intricacies of the healthcare system. However, I believe that win-win outcomes are ALWAYS possible (with a bit of creativity). And I would love to find a way to help nurses, hospitals, and patients from where we're at right now.
So again, than you for your input, and I'll keep listening.
Thank you for your thoughtful response. You have opened a can of worms...get your seat belt on.
What aspects of your work could be digitized or given to someone with less knowledge and experience - such as a CNA? Nurses are highly educated - do we need you running to pick up someone's meal? (Not to mention this turns you into a $35/hr delivery person). I am wondering if there are routine, monotonous tasks that nurses do that could be given to someone else, or even digitaized - giving you more time for work that you are educated to do.
Hiring non licensed personnel in place of nurses is going to set a dangerous precedent. Sure there are tasks that CAN be done by lesser trained/non licensed personnel but is that going to improve the overall patient outcome/morbidity and satisfaction? When it has been CLEARLY documented that it is the presence of LICENSED personnel, with attention to the BSN prepared nurse specifically, that have a direct correlation on patient outcome and care. That is what the whole push for BSN prepared nurses is ALL about.
Better patient outcomes comes with higher education.
There is an ever increasing push for nurses to obtain their BSN. Many facilities in acute care are only hiring BSN new grads stating it is directly tied to better patient care and outcomes. The suggestion that to hire less trained and educated personnel is in conflict with all of the studies out there today. So to make a nurse happy is not to replace her with non licensed assistive personnel.
Case in point...finger stick blood sugars can easily be done by non licensed personnel. However, there have been some sentinel event regarding finger stick glucose reading and patient death recently the FDA (check out this thread RNs to do glucose checks on patients without DM) has sent an alert that for non diabetic patient that this task should not be done by non licensed personnel. This applies to many aspect of nursing. Our responsibility is broad and encompassing yet cannot be measured until something goes wrong.
So the answer is not hiring non licensed personnel to use less nurses. That will not make the nurse happy. What makes nurses happy is patient safety and patient safety is tied, by numerous studies, directly to staffing and education. This is a complex and convoluted issue. I see little ability to change for you can't make quality and cut costs. Because nursing is a non billable expense we are seen as burdens and not assets....when the very reason a patient makes it out of the hospital alive most of the time is because of good nursing care.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Looking at this....it really isn't difficult or hard to believe.....actually I thought the number would be higher
Just recently (and again, I am very new at this job), I have been working on evaluating how many hours of work we spend for every patient day. And it averages over 30! In other words, for every day that a patient is in the hospital, four employees are working an entire work-day. That ends up being a lot of money. And where is it going to come from? It either has to come from the patient, the government (our tax dollars), or the hospital staff. Generally, it is a combination of all three. And sadly, nurses are one of the groups that gets hit the hardest. I would love to change this.
In a an average patient day it takes an entire village to care for that ONE patient. From housekeeping, to maintenance, to lab, to x-ray, to PT/OT, respiratory, physicians, the kitchen, diet aides, CNA's, surgery, social services, pharmacy, IT, educators, and RN's. No small feat.
George Halvorson, CEO Kaiser Permanente: $7,861,915
Lloyd Dean, CEO Dignity Health: $3,907,346
Patrick Fry, CEO Sutter Health: $3,045,216
James Brewster, VP Adventist Health of Roseville: $2,010,040
Robert Carmen, CEO Adventist Health Roseville: $1,741,988
Stanley Adams, VP Adventist Health: $1,563,496
Thomas Gagen, CEO Sutter Medical Center Sacramento: $1,391,316
Patrick Brady. CEO Sutter Roseville Medical Center: $1,059,659
Seven count them Seven! figures. It is difficult for me to understand the need to cut the bottom line when they are in the top 1%. and these figure are from 2010.
At Kaiser Permanente, the California-based insurer and hospital chain, CEO George Halvorson’s pay of $7.9 million included a $5 million bonus -- the largest of any that KHN looked at. (KHN is not affiliated with Kaiser Permanente.)
Kaiser Permanente's IRS filing says that the bonus came from the achievement of goals to "support the organization's mission to provide high-quality, affordable care and improve the health of its members and the communities it serves."
IN MA my state we are asking for transparency for the corporations compensation.
Fact Sheet on Hospital CEO Compensation - Patient Safetey
jschut, BSN, RN
2,743 Posts
I love my job, but I would love it even more that instead of the "let me tell you what you need to do..." bullsh*t over a phone call, I would like some actual support in certain instances (ie: drug diversion in an unstable home environment with a hospice patient).
I also absolutely detest being on call. I would love an actual dedicated on call staff, instead of just saying they are hiring this one or that one... DO IT! I'm tired after 40-50-60 hour week... I want to rest too.