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 agree with Esme12 about the unlicensed personnel. I get nervous when I hear talk about increasing there presence. As far as digitizing things, computers are a mixed blessing. I spend far more time charting ever since we switched to computer charting.
"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?"
If you mean to simply hire more CNAs to do the jobs that were placed on RNs to alleviate their (CNAs') complaints, that will help. In my experience, even as recently as two weeks ago, as soon as another department OR unlicensed staff within the nursing department, begins to complain, the task that they are complaining about is taken from them and assigned to licensed nurses. There is nothing that can be taken from us in exchange. Our workload constantly increases as those of non-licensed persons receive lighter loads by the minute. We are called upon to troubleshoot EVERYTHING: phones, televisions, you name it. I can't even fix those things at my home. Does donning a set of scrubs make me more proficient in it afterwards? But, in order to cut back on engineering or maintenance hours, they want us to 'see if we can fix the problem' before entering in a call for maintenance. I'm 5'2"...I can't even reach the TV.
We need the help of CNAs, but if we are doing more and more of their work for them just to keep the peace, there's a cut right there. It appears that hiring more staff does us no good when nurses are called off on a daily basis due to the 'current' census and are then forced to work short-staffed when the admits come pouring in. Situations like that lead to errors, patient injuries, and ultimately decreased satisfaction scores, not to mention a lack of caring for a system's employees.
Case in point, I was sent home at 2am due to a change in the census. (I guess one person too many died because we surely don't discharge at that hour due to safety concerns for the patient with transportation, prescriptions, etc.). I live 3 1/2 hours from my job. Even if I lived an hour away, who wants to be out and about at that hour of the morning? But the facility's bottom line meant more than a potential safety issue for one of its nurses, apparently.
Ok, that's my vent....not intending on shooting the messenger.
As a disclaimer OP, I don't have any gripe with you or your agenda. I think it's admirable that you're partially trying to help nurses. I don't mean any offense to you personally if my posts are heated or opinionated.
That said... I think maybe the execs should focus more on getting the sick and injured the care they deserve instead of increasing their goal profit margin from 2% to 4%. Instead they invest money into running business diagnostics on hours of care per patient day, then make cuts and indirectly victimize the infirm. I wonder if any of them picture their mothers and fathers being taken care of by an overworked nurse who is probably actively looking for a new job while struggling to adjust to the never-ending changes enacted by profit-driven machine. Oh wait, these are the individuals admitted with a special call from bedboard to be treated as "VIPs" (ie. bottle service and a private booth in the back of the hospital). Hah! Here's an example. I had a "VIP" admission who I later learned was a marketing manager for our healthcare network and was friends with the CEO. I got a call that the patient was to be treated as VIP, which I don't understand. Nobody has ever explained what I'm supposed to do differently. Literally kiss their ass? Later that week I took care of retired nurse who was a 30 year veteran of the liver floor, which I personally opine is one of the toughest disease pathologies to handle as a nurse. No call. They were both treated the same.
Look I understand that a hospital requires money to run. Business personnel are essential for this function. This might sound crazy but, in my opinion, what is not fundamental to a hospital's operation is corporate conquest and profit demands. Like Esme pointed out, there are CEOs making $1-7 million. This is surprising to me, as the last time I looked up average hospital org. CEO compensation (including "not-for-profits") it was something like $400-600 thousand. Even this is outrageous. This is just yet another real world manifestation of the growing income gap in the United States. Here's an interesting tidbit of income tax history. Adjusted for inflation, an individual bringing in $465,000 in 1974 paid a rate of 70% in income tax. In 2013, that guy paid 39.6%. And that's just on income, not counting the separate tax laws for corporations or the tax breaks the rich exploit through capital gains.
On a more abstract note, capitalism in America has led to a great many freedoms and pleasures for we as Americans. I now sincerely believe that it has gotten out of hand. With business expanding into healthcare conglomerates and using the treatment of the ill as a scheme to generate capital, I'm sort of ashamed to be an American. The stars in my eyes have faded as I witness firsthand the erosion of the image I created for healthcare. I realize now that virtue, Christian morality, and beneficence to other humans are values of naïveté that have led to burnout in myself and countless others.
Specializes in Acute care, Community Med, SANE, ASC.
As nearly everyone has said, better pay. The responsibility and liability we have is, in my opinion, not commensurate with the pay.
Better staffing. For me this actually is a lot about unlicensed personnel. I think my hospital staffs nurses pretty well but the unit clerks and techs/nursing assistants are fewer and fewer. The nurses can do their jobs better, more safely and more thoroughly if we're not doing everyone else's job. Would you rather the nurse have time to really review the chart and the patient's various test results or do you want us answering the phone, putting in orders, delivering food trays, finding an O2 tank for transport or can someone else more appropriate be doing these things? Staffing nurses appropriately is huge too. If you staff appropriately and people actually get breaks and lunch and can take good care of their patients, I believe you would have nearly absolute loyalty of the staff, probably far better care, and eventually more market share simply by word of mouth based on the good experiences of your patients.
I left my last two jobs (both outpatient positions not hospital but still relevant) because of my managers. I need to know I can trust my manager and that he/she has my back. Both of my last managers blatantly threw people under the bus without cause, thinking we wouldn't know it. I can't work for someone I don't trust--I value my hard-earned license too much.
At the hospital I don't feel like my management team even knows who I am. Stop by every now and then and see how I'm doing. Incidentally, this would probably also make the evaluation process seem more realistic. It's hard to swallow an eval from a manager who I literally see about twice a year.
As others have said, please stop spending hospital money on mugs and bags and other silly holiday or nurse's week gifts. I'm guessing they aren't spending a lot on these judging by the quality by it's almost insulting. If you want to recognize us, give us a card for a free beverage/meal in the cafeteria or something we can actually use.
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.
Per your original post "I am an analyst for a multi-hospital system and my job is to help reduce employee turnover".
"I make significantly less than most of you nurses do" Therein lies the problem."You nurses".??
I feel you are not interested in supporting the nurse role, rather.. pick our brains to do your job.
"We nurses "already do that ... in every discipline, let alone add another ( well paid) level of bureaucracy to analyze the obvious issues.
Been there, done that does have a point. I know for a fact that at my hospital, we've voiced our concerns long before things got as bad as it has. We were required to attend this mandatory meeting and bring suggestions, only to have them all tossed out the window. Should you relay our thoughts/comments to your superiors, it is possible that YOU yourself may become the subject of scrutiny, thereby justifying your replacement in the hopes of finding someone who can convince us that there really is no problem. This is just my opinion, but upper level management really does not want to hear what the problem is. If they did, they would brave the cold (or the heat) and come into the conference room with us instead of hiring a decoy (no offense or direction to you, specifically).
Many of us have completed surveys like this one on numerous occasions, or attended 'retreats' to brainstorm for solutions to the problems. We keep having to do them because the results of said surveys/retreats are repeatedly ignored. Sadly, this is the norm for nurses all over because, as you can see, you're in California, I'm across country in Georgia, and there are more than enough representatives here to fill all the space in between who share similar experiences.
Specializes in Med/surg, ER/ED,rehab ,nursing home.
I spent nearly 20 yrs at one hospital on the med-surg floor. My biggest complaint is that the hospital started punishing nurses for issues that patients got upset with. One had her hair with a different tint in it. Not ugly or anything. But this idea of the patient and his family being always right. that has to go. I used to make sure that a family member who complained that rounds were not made , was awakened every hour. I would turn full lights on, bump into their cot accidently, etc. Hourly. All it took was one night and they quit their complaining. They knew they had lied. But when you are not backed up by the supervisors, it makes it hard to do your best or stay at a hospital. Where I worker, they had a really cool Christmas/ Holiday party , a company picnic in the summer, and used to make it mandatory for you to attend an off site inservice of your choice, which was paid for in full. All of that went by the way side. When I left 6 years ago due to health issues, we were lucky to get pizza, of sub shop sandwiches. Gifts of items that are used for advertising instead of a real item that has not marks on it. A gift that you can write off as advertising sucks. Some of the items have use, but most do not. I would rather you hand me the $5 or so in cash. Also do not treat an assult on staff as something that can be brushed off. I am still suffering from mouth damage of 6 yrs ago when I was hit by a patient. Never hit before in all my years. This patient was known to be roaming and being inapproiate. But physical attack was new. I was told that I should know that my job is dangerous. If so then I need a body guard.
Anyway, the over work, never enough time to really be with your patient. One that I had promised to return and sit with,died alone during that short time I was away from him giving a medication. It bothers me. I did return to do the post care. Would have rather been there in his time of need.
More staff. Not just bodies in the ER But people that know what they are doing. It is fine to hire some with no experience but not every single one!! And lower pt nurse ratios. It is getting more and more dangerous in the ER where I work. I use to enjoy going in there. Now I dread it. They think we are machines and not humans
First I must say thank you and God bless to all of you who care for awake patients. I work in surgery for majority of past 20 years. I've experienced what you do daily.
To answer the question, I agree with equitable pay, and improved health insurance, an end to call,or improve call pay...$2.00 an hour really? Myhospital just rolled out a very inflexible gestapesqe time and attendance policy to include clocking errors that count as absences. I'm a degrees professional. I shouldn't have to clock in at all.
An environment free from verbally abusive surgeons, a manager that followed thru with anything at all. Administrators to visit the unit and staff and hmmm how about an hourly wage for executive leadership oh but that's my masters degree track, let me think about that one...lol
A real financial incentive for being in charge would be a welcome change. Manager who holds each staff member to the same standards and expectations, oh okay I'll just go ahead and add the welcome departure of the manager onto someplace else.
Best of luck with your poll and the intent behind it. Would be nice to see some improvements in regards to workplace conditions, salary, ratios and the likes that have been discussed so far.
I'm thinking about changing my graduate studies to something other than nursing. I'm in my fifties, borderline burn out, tired of increasing penalties for the likes of forgetting to clock in, or approve my timecard...absurd. Best of wishes too my colleagues, May you be blessed with an abundance of peace love and laughter
RNperdiem, RN
4,592 Posts
I agree with Esme12 about the unlicensed personnel. I get nervous when I hear talk about increasing there presence. As far as digitizing things, computers are a mixed blessing. I spend far more time charting ever since we switched to computer charting.