Nurses Are Leaving the Bedside In Droves

[panurse9999]

We can debate the why's, where's, how's, when's of the toxic culture in many hospitals and nursing homes.

More work, less support staff. More work, less pay. Too many patients. Higher acuity, more orders, fewer nurses being hired. My boss is dumb. My boss is toxic. Yes, its a BIG factor in a nurses decision to leave. We hate drama. We want to do our jobs in peace.

But those are just workplace semantics. There is drama in every workplace, wether in nursing, retail, law enforcement, food services, housekeeping, gaming, farming, hospitality, transportation, or basket weaving. Yes, its there now, and yes, it was there 50 years ago.

Truth be told, years ago, before corporate mergers/ takeovers/ acquisitions became as simple as buying pizza, we had hospitals and nursing homes. Today we have hospital systems and nursing home chains. With these corporate conglomerates at the helm, our profession was taken away. We lost our voices. We lost our sanity. We lost our zeal. Same thing happened to the banking system in the 1980s. Local stand alone banks were bought up, one by one, until we had 6 or 7 worldwide megabanks.

Corporate mentality stole the nursing profession and burned it at the stake. What used to be patient focus, is now billing focus. Today we do not have patients, we have inventory. Some generate substantial money, others are a drain. This is why, when and how "staffing to census" began rearing its ugly head. Back in the old days, there was no such thing as staffing to census. Nurses were hired on certain units, and that is where they stayed. Some days were super busy, others were not.

Staffing in hospitals and nursing homes today is soley based upon inventory (patients) and money (acuity). Not enough inventory in the burn unit? Float the nurse. Not enough inventory in L & D? Tell the nurse to stay home. Too many nurses on telemetry? Send 2 home, or let them work as techs on med-surg. And the list goes on.

What used to be paper documentation by exception, became EMR to generate maximum amounts of reimbursements from medicare, medicaid, and insurance. This is why we have box checkers (formerly known as nurses) spending 75% of their time at computer stations, and 25% of their time at the bedside. If you're lucky. So the next time your wife, husband, brother, sister, friend or companion starts mocking you for being a serial job hunter/ hopper, send them to this article.

Spread the word. Nurses didn't leave the bedside, the profession left us.

[Oldmahubbard]

Way back in the day, almost 30 years ago, our nursing professor worked 2 12's on the weekend and then taught full time during the week.

For one thing, a full time instructor did not make a living then or now.

[Horseshoe, BSN, RN]

On 5/26/2019 at 10:16 AM, panurse9999 said:

I went to school 22 years ago as a second career nurse whose job was wiped out due to automation. I knew it was not going to be clean, easy or glamorous. I knew I'd be exposed to vomit, poop, pee, bodily fluids. I knew I'd be on my feet 12 hours at a clip. I knew I'd have to watch people die. I knew I'd be spending my time consoling family of the deceased.

What I didn't know is that I'd be assaulted by patients, thrown under the bus by co-workers, verbally abused by doctors, harassed by my boss

What I didn't know was that I'd be lied to in the hiring process

What I didn't know is that I'd be sent home after 2 hours on the job due to low census

What I didn't know was that I was enrolled in a medical plan, and cancelled the same day, so a card was mailed to me, to dupe me into thinking I had medical insurance

What I didn't know was that while I was out sick 4 days straight with a raging GIvirus, my position was eliminated , and I was replaced by 2 part time LPNs

What I didn't know was that the sorority sisters who were supposed to be training me were partying behind my back, laughing at me, accusing me of wrong doing, and setting me up to fail

What I didn't know was that if you were still on the job at your 90 day mark, you were considered senior staff

What I didn't know was that the $10,000 sign on bonus was a hoax, because no one actually collects it. It is payable after 6 months . On month 5, day 29, I was fired without explanation

What I didn't know was that 99% of nurse job ads are fake

What I didn't know was that my RN job was set to morph into RN, LPN, CNA, Unit clerk, and if I did not like it, I could leave, because HR has 200 fresh resumes on their desks

What I didn't know was to make sure you get your offer of employment in writing, including your rate of pay (especially)

What I didn't know when I went to my interview, was that the job ad was for a job that may exist in the near future, but does not exist now

Should I go on? I could go on. My decision to go into nursing was the worst decision of my life. I wish I could hit the back button.

In 23 years of nursing, I have experienced NONE of those things except for being sent home after 2 hours because of low census. By that time I was working PRN, becoming dissatisfied with hospital nursing, didn't really need the money, so I was sometimes perfectly fine with being cancelled. I acknowledge I would not have felt that way if my circumstances were different.

My main reason for leaving hospital nursing was being able to read the writing on the wall about increasing and INAPPROPRIATE and UNSAFE nurse to patient ratios that were due not to a nursing shortage, but to deliberate understaffing by management.

I have worked for a private elective surgery OR since 2011 and am treated well, paid well, and am quite content. But I'm really lucky because I only work once a week or so as PRN, the doctors are really nice (except for one who I refuse to work with), the patients are pre-screened (therefore pretty healthy), and they are incredibly nice. I know not everyone is in this very lucky situation.

I don't have the doom and gloom outlook as many of these posts, but I am careful when young people ask my opinion of the nursing profession. There are only certain specific areas that I can honestly endorse to them.

[nate411]

I am very sorry I went into this profession

[HomeBound]

4 hours ago, umbdude said:

Depends on where you work. I worked in a community hospital where none of my RN coworkers had any desire to become NP.

On the other hand, when I worked at a research hospital as a psych tech, 80%+ of the techs and many of the RNs are there to become NPs, MDs, PAs, or MSWs.

There is no nursing shortage and competition to work in bedside is fierce at large hospitals. % of NPs currently is still <10% of the entire nursing population. There are plenty of folks working bedside.

Everyone is making the assumption that leaving bedside means going for NP, which is untrue. Plenty of nurses leave bedside to do other things or just retire.

I work currently with a Registered NP--who is still doing her ICU job--because there are no jobs in the entire state for her ONLINE ONLY NP EDUCATION with the "clinical component" being allowed at our hospital.

I like her. I do. As an ICU RN. As an NP? I wouldn't send my dog to her. Because I know the clinical portion of her education was done at the facility in which I work now---which is garbage. It's a "teaching hospital". Residents and interns come first. The only other NP on staff is dayshift---we are nights. This was her education. The tough assignments are rotated---so many, many nights she gets nothing more than a step down patient waiting on discharge the next day.

NP Preceptor? There isn't one. But the facility likes the idea that they're gonna offer her a job at the same salary as she makes now---and nobody else is touching her. She cries the blues. Waaaa waaaa.

Another on this staff is graduating in ~10 months. Same thing. No real experience...nightshift with no "NP preceptor"--the charge will let him do some of the more complicated stuff---but by and large? He's being signed off on procedures and as a preceptee---because the facility will offer him a crap job at crap pay--and if he refuses? He won't get hired anyplace else.

"NP" is the answer to your assertion that since whomever it was challenging the idea that we are leaving in droves---take a look at the entry statistics for these programs. Where do you think these nurses are coming from then? High school?

They come to the ICU for their "one year of critical care" (and that doesn't matter which ICU---it could be po dunk that has 4 beds and sends anything but sniffles out to the bigger hospitals or it could be the 32 bed acuity that you can't even imagine on your worst day ICU) These programs are accepting anybody who is willing to pay the tuition.

The ICUs are complicit because they allow the nurse to remain on staff....getting "clinical time" and signing off on their stuff.

And it's not exclusive to any one facility. Saw this on the east coast at a huge level 1 in the mid atlantic. Crap NPs with barely 1 year of actual nursing experience---"figuring it out along the way".

I have an NP right now as a PCP---and she's a moron. I mean---a complete, utter moron. She has a great bedside manner---but medically? Good gitty ought. I am stuck with her until I can change up---and I will gladly go back to that old codger MD who thinks women should be pregnant and barefoot. At least he'll have some actual medical training and experience.

[nate411]

Oh, I love this thread . Its SUPER! TY HomeBound. Hilarious!

[nate411]

7 minutes ago, HomeBound said:

I work currently with a Registered NP--who is still doing her ICU job--because there are no jobs in the entire state for her ONLINE ONLY NP EDUCATION with the "clinical component" being allowed at our hospital.

I like her. I do. As an ICU RN. As an NP? I wouldn't send my dog to her. Because I know the clinical portion of her education was done at the facility in which I work now---which is garbage. It's a "teaching hospital". Residents and interns come first. The only other NP on staff is dayshift---we are nights. This was her education. The tough assignments are rotated---so many, many nights she gets nothing more than a step down patient waiting on discharge the next day.

NP Preceptor? There isn't one. But the facility likes the idea that they're gonna offer her a job at the same salary as she makes now---and nobody else is touching her. She cries the blues. Waaaa waaaa.

Another on this staff is graduating in ~10 months. Same thing. No real experience...nightshift with no "NP preceptor"--the charge will let him do some of the more complicated stuff---but by and large? He's being signed off on procedures and as a preceptee---because the facility will offer him a crap job at crap pay--and if he refuses? He won't get hired anyplace else.

"NP" is the answer to your assertion that since whomever it was challenging the idea that we are leaving in droves---take a look at the entry statistics for these programs. Where do you think these nurses are coming from then? High school?

They come to the ICU for their "one year of critical care" (and that doesn't matter which ICU---it could be po dunk that has 4 beds and sends anything but sniffles out to the bigger hospitals or it could be the 32 bed acuity that you can't even imagine on your worst day ICU) These programs are accepting anybody who is willing to pay the tuition.

The ICUs are complicit because they allow the nurse to remain on staff....getting "clinical time" and signing off on their stuff.

And it's not exclusive to any one facility. Saw this on the east coast at a huge level 1 in the mid atlantic. Crap NPs with barely 1 year of actual nursing experience---"figuring it out along the way".

I have an NP right now as a PCP---and she's a moron. I mean---a complete, utter moron. She has a great bedside manner---but medically? Good gitty ought. I am stuck with her until I can change up---and I will gladly go back to that old codger MD who thinks women should be pregnant and barefoot. At least he'll have some actual medical training and experience.

I cannot figure out why people are stockpiling their money...and I mean thousands and thousands of dollars into becoming another kind of a nurse...just go to medical school. These advanced nurse degrees are worthless. Honey roasted peanuts (more expensive, but still a peanut) . Honey roasted nurse (more expensive , but still a nurse) .

[kbrn2002, ADN, RN]

22 minutes ago, nate411 said:

I cannot figure out why people are stockpiling their money...and I mean thousands and thousands of dollars into becoming another kind of a nurse...just go to medical school. These advanced nurse degrees are worthless. Honey roasted peanuts (more expensive, but still a peanut) . Honey roasted nurse (more expensive , but still a nurse) .

Now that's funny! Sadly our old rounding NP left her position to go somewhere else so I can't call her a honey roasted nurse to see her reaction. I don't know the new one yet well enough to risk it.

Seriously though, we have a rounding NP from one of our healthcare systems and a PA from the other. Of the two I much prefer the PA, she seems to generally make medical care decisions that make more sense.

[nate411]

2 minutes ago, kbrn2002 said:

Now that's funny! Sadly our old rounding NP left her position to go somewhere else so I can't call her a honey roasted nurse to see her reaction. I don't know the new one yet well enough to risk it.

Seriously though, we have a rounding NP from one of our healthcare systems and a PA from the other. Of the two I much prefer the PA, she seems to generally make medical care decisions that make more sense.

I thought NPs needed a full 2 years of clinical NP hours working for a physician, before they become a CRNP? No?...like a residency. which then brings me back to my last comment. Go to med school.

[Susie2310]

34 minutes ago, HomeBound said:

I remember playing "Doctors and Nurses" when I was a child.

[OUxPhys, BSN, RN]

1 hour ago, nate411 said:

I thought NPs needed a full 2 years of clinical NP hours working for a physician, before they become a CRNP? No?...like a residency. which then brings me back to my last comment. Go to med school.

Nope, some programs have really lowered their standards.

[myoglobin, ASN, BSN, MSN]

You say these advanced 'NP degrees are worthless", but you fail to acknowledge that in over 20 states with independent practice that with one of these degrees you can "open your own office" and do it "your way". While I will concede that MD providers usually have superior understanding of pathophysiology, chemistry, and basic sciences (although here in Florida where it seems 50% or more MD's are foreign educated with marginal English at best even this may not be certain). NP's are often more inclined to utilize evidence based complementary and alternative medicine, diets (such as DASH and keto, and MIND in appropriate populations) and to prescribe less potentially addictive medicines such as benzodiazapines and also in my experience to stick closer to UptoDate and Cochrane Collaboration guidelines. Also, as someone who received "the online" education you seem to disparage, I have already received no less than three job offers with only minimal applications and don't even graduate until late July (granted in Psych). Indeed, those studies that have been done in the past have indicated that NP's are "at least" as safe as MD's when it comes to primary care. If you don't like the currently established national guidelines for certification, then I would encourage you to lobby for their change rather than disparaging those who seek to better themselves and or their career via additional education.

Also, with regard to the advice of "going to med-school". Most RN's would need to go back and complete three to four years of prerequisites, take the MCAT, after which time they would face approximately 5 to 6 years of medical school with residency and perhaps more with fellowship. That is on top of the less than 10%-15% acceptance rate that they would face in getting accepted into medical school after completing those prerequisites. All so they could enter a profession where they work 100 hour weeks and many physicians decry "isn't nearly worth the effort". As a 50 year old RN as I am (or even as a 30 year old RN with a family) what rational, logical, person would really pursue that option when another option to independent practice exists?

[Roy Hanson]

no surprise! With management changing for the sake of the $$$$. wE SEE on this side of the border. Many supers & general management have no idea HOW to manage.