What Nursing Shortage?

SmilingBluEyes · Feb 26, 2003

Originally posted by 3rdShiftGuy
sjoe says it well.

However, we have per diem positions at our hospital where the part-timers make out any schedule they want. I know a woman who works only one 12-hour shift a week. Another works three 4-hour shifts, another 4 8-hour shifts, one 2 12-hour shifts a week, on and on. Is this unusual? I find our hospital extremely accommodating to part-timers.

......and??? I am sorry; I mean no personal disrespect here but I am gonna address this nonetheless. Just what is your problem with that? See, I get burned up when I hear "regulars" complain like that (and I used to be one). You need to remember something here; we do a lot of favors for "regular" staffers, all w/o bennies. (except our differential, I admit).

We don't get guaranteed hours. NO vacation time paid for. No paid sick time. No medical bennies. No tuition assistance. So, I don't see why you are complaining. If you want such a schedule, you always have the option to go perdiem like I AM Or quit your complaining. WE take the shifts no one else will do. So if I make out my schedule to MY convenience, filling in holes left by regulars who get first crack at it, it is my right to. I have no guarantee from my workplace other than that they will call when they need me. I am the first called off for low-census, too. Making out a schedule that works for me is the plus side to be oncall, casual or perdiem, so you need to deal with that and respect it. I COVER YOUR VACATIONS AND ''ME" TIME remember.

And if it seems management is bending over backward to please us, don't believe it. They are just trying to put out fires and fill in holes that regulars cannot or will not fill. (and that management does not want to fill, either). So it's a necessary evil, I suppose. I am sorry this got long. and Again, no disrespect intended, 3rd shift. Just giving a "perdiem" POV here.

llg, PhD, RN · Feb 26, 2003

I've been wanting to join this thread, but can't decide what to say. I am too much "in the middle" to come down totally on one side of the issue or the other.

I believe that some of the "nursing shortage" is a result of poor management practices, underpay, etc. And some particular hospitals are in trouble because of abominable treatment of nurses, etc.

However, I also see that many hospital with reasonable policies, etc. are also having trouble. I believe that even if there were decent management in all hospitals, there would still be a shortage -- just not quite as severe as the one we are currently experiencing. The issues and forces that are producing this shortage are far too complex to explain or solve with the simplistic "If they just treated us better and paid us more, they would have plenty of nurses. Therefore, it is all THEIR fault." reasoning. While that reasoning is part of the overall picture -- it does not explain the entire situation.

I'd be very interested to hear this group address some of the more complex (but yet, very real) dynamics of this shortage situation. Here are just a few examples off the top of my head:

1. As nurses get older, most tend to want to work part-time instead of full-time. Therefore, as the baby-boomers age, their natural desire to want to cut back their hours, decreases the resources available regardless of the pay offered, working conditions, etc. This is a different situation than in the past, during which increasingly larger generations filled the available positions in all segments of the economy -- not just nursing.

2. We need proportionately more RN's per patient than in the past because of increased acuity. We also need more health care workers in general because the aging population increases the overall health care need in society. Combine this with the aging boomers, and we have a demographic problem that we can't deny.

3. As our society has more and increasingly sophisticated health care needs, we run into an economic problem as to where we are going to get the money to pay for it. Is the community going to tolerate big increases in their health insurance premiums? Are we going to raise taxes significantly to cover the health care costs of the poor? etc. etc. etc. It's easy to say, "Give me a big raise," but it's another thing to find the money to pay for big raises for the millions of nurses out there. (And believe me, I would like a raise, too.) Many of the hospitals in the most trouble are the ones heavily supported by tax dollars.

4. Some aspects of the nursing role (e.g. the 24/7 nature of the job, things that smell bad, the stress of life-or-death environments, the "fear of litigation" culture, the inability to say "no" to an emergency or sudden load of extra patients, etc.) make the job difficult and unattractive to many people. Compared with many other possible jobs to choose from, nursing has some undeniable drawbacks. That won't change much even with fantastic management.

I could go on and on. My point is not that some management practices don't need to change. I agree that some changes are much-needed. However, I think those changes alone will not solve all the problems. There are additional, underlying social dynamics going on that we need to take into consideration as well.

llg

arlheart · Feb 26, 2003

Boy, talk about a difference in interpretations! I thought 3rdShiftGuy was just making an observation about how accommadating his facility is, not that he was specifically complaining about it.

Anyways, I think it is very dependent on the area that you live. If one or two facilities start being flexible, than others pretty much have to follow suit or they lose their staff. I know where I live the hospitals are constantly (at least it seems very frequently) doing market analyses to make sure they are all offering the same type of work setting and benefits. Of course, I think less money on outside consultants and more money on staff is the better investment. But what do I know, I just work here.

Tweety, BSN, RN · Feb 26, 2003

SmilingBluEyes & Mattsmom

You've taken my post entirely the wrong way. The original poster was stating that they were having trouble finding places that were accommodating to part timers.

I was merely saying that our hospitals is very accommodating to part timers. I was actually tooting my hospitals horn and wondering if it was unusual to have part-timers.

I was in no way whatsoever complaining about part-timers. I'm sorry if I came across that way.

For all the reasons you stated I love part-timers. Management at our hospital from a scheduling standpoint is good to both part-timers and full-time staff. I have the exact full-time schedule I want.

It's one of those cases where the internet, rather than a face to face discussion, interferes with the true meaning of the post.

Tweety, BSN, RN · Feb 26, 2003

Originally posted by arlheart
Boy, talk about a difference in interpretations! I thought 3rdShiftGuy was just making an observation about how accommadating his facility is, not that he was specifically complaining about it.

Anyways, I think it is very dependent on the area that you live. If one or two facilities start being flexible, than others pretty much have to follow suit or they lose their staff. I know where I live the hospitals are constantly (at least it seems very frequently) doing market analyses to make sure they are all offering the same type of work setting and benefits. Of course, I think less money on outside consultants and more money on staff is the better investment. But what do I know, I just work here.

Hey we were posting at the same time. You're right. That's what I meant.

I'm a little shocked that the original poster was having trouble finding part-time work. Per diem staff where I work make up their own schedules in anyway they choose. Seems like part-time would be easy to get.

nrsjo · Feb 26, 2003

I also believe there are plenty of nurses out there who just got tired of putting up with all the crap and got out of the field because they could.

Management and administration has done more to destroy hospitals and jepordize patient care than I can ever remember happening. Since my hospital seems to feel it is "bleeding" money, we no longer have nursing assistants, or unit secretaries, and nursing staff in the ICU is cut to the bare minimum. All one-to-one assignments have to first be approved by the department director. Like she would have any clue? So, now in addition to running around like a maniac all day, you also now get to do all your own orders, and take care of the phones, and since the unit is locked--you get to answer the visitor door.

And now, all education that you have had to come in on your day off for, is no longer going to be paid for. So, they expect you to give up a day off for free. But yet, they have tons of agency help in other units because no one will come work there. Fat chance of getting anyone to come to this place now with these new policies.

If I could turn in my license today, I would.....

oceanlover · Feb 26, 2003

A lot of good points being brought up here. But the fact remains there is a huge turnover of nurses. The job is so mentally and physically demanding that some cannot or will not keep up the pace.

I've been saying it's a good time to be a nurse lately because there is such a demand for nurses in this area. I get calls from agencies at least twice a month. But I'm wrong to say this.

It's not about the availability of a job or the compensation, it's about the extraordinary demands placed on the individual nurse.

llg, PhD, RN · Feb 26, 2003

Originally posted by oceanlover
I've been saying it's a good time to be a nurse lately because there is such a demand for nurses in this area. I get calls from agencies at least twice a month. But I'm wrong to say this.

I used to say the same things, too. But, like you, I don't anymore. However, I still hold out hope that things can improve -- and that individual nurses can still make a good life for themselves. Of course, that might mean changing jobs ... getting more education ... switching specialties ... or something.

llg

-jt · Feb 26, 2003

And what if you just stop doing all those things & just take care of the pts? We have to just stop trying to do it all & let administration deal with the backlash. Like when the phone rings & rings & all the doctors & managers are complaining that they cant thru to the ICU, youll get your secretary back. If you do her job too, the powers that be wont notice that a secretary is even needed. BTW its against the law to work overtime & not be paid If youre being called in on your day off, thats Overtime and overtime has to be paid or they get reported to the feds & can be fined. Overtime pay is usally Time & a half - we can take it in extra days off or in money.

J-RN student · Feb 26, 2003

Originally posted by Susy K
Why recruit more nursing students when you don't have enough nursing faculty to begin with?

I agree 100%. The wait time for clinicals in some areas are 2-3 years.

Dr. Kate, BSN, RN · Feb 26, 2003

One thing I don't recall being addressed in this or the previous threads on the nursing shortage is what increasingly seems to me to be a curious way of thinking about nurses. That is that there are enough nurses if they were all working. That coupled with the assumption that nurses aren't working because of the conditions in hospitals. Both seem a bit off to me.

In truth, with respect to the nursing shortage, if nurses with active licenses are not working as nurses then they are not part of the available pool of working nurses. There are a multitude of reasons why they aren't working, but they aren't. I suspect there is very little that would convince most of them to return to nursing. So to say they are available just isn't a practical solution to the current shortage of working nurses.

Hospital working conditions leave a great deal to be desired, no surprises there. But those are system problems, similar in all hospitals and at the same time unique to each facility. System problems do not always lend themselves to quick and easy fixes. And what appears to fix one problem can generate more problems and make the situation worse in the long run.

But, that's just my opinion.

llg, PhD, RN · Feb 26, 2003

AAAhhhh.... Welcome to this thread, Dr. Kate. It's so nice to read your thoughts. Most of what you said is similar to what I was trying to say.

Many people with RN licenses are not working as hospital nurses for many reasons that improved pay and working conditions will not change. Some are married to people who make lots of money, have kids, and want to stay home with them. Others are over 50 and are simply retired, period. Many nurses maintain their licenses until death simply because they are proud to be a nurse and don't want to give up that part of their identity. I know of one man who maintained his wife's RN license for many years after she died!

The stats show declining enrollments and increasing average age of both students and practicing nurses. That translates into an older workforce who will work for fewer years -- and a larger percentage who will want only part time employment and/or jobs that don't require nights, weekends, on-your-feet, etc. THAT is a fact that can not be ignored. Those demographic trends are real.

Also, as you say ... any one "fix" causes a lot of problems down the road. It just isn't all as simple as some people seem to think. If it were that simple, it would have been solved already. Yes, there are some evil people out there -- but there are also a lot of good, intelligent, compassionate people out there working on this problem. Believe me, if the answers were simple to find, they would have already found them.

These are tough problems, not simple ones!

llg