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.

[myoglobin, ASN, BSN, MSN]

My wife has been an PMHNP since 2016 and has a Masters. My friend lives in Arizona and has been an NP since around 2015 also with a Masters. He owns a clinic with four other practitioners on staff and two counselors. My wife works via telemedicine living in Florida, but her patients are in Arizona. My assertion is that to date most studies have shown that NP's provide equal care as measured by outcomes (in primary care) as compared to physicians. I will grant you that MD's will outperform them in "standardized tests", but as you know scores on such tests do not necessarily have a causal relationship with outcomes. Also I would argue that traditional "allopathic medicine" has played a large role in the slide into obesity, and other chronic disease. Conversely, the more "holistic" approach that NP's often take may play a more proactive role in mitigating these conditions. I can tell you that many of the physicians that I work with (Board Certified in Family Medicine and Mental Health) have a blank look on their faces when I refernence the DASH diet for hypertension, or the proven role for exercise in the treatment of anxiety. In addition the "lower cost" at which NP's can be educated can often translate into more time spent with the patient. For example the NP mental health care clinic in Arizona does 30 minute medical management appointments whereas many physician lead offices only allow 15 or 20 minute appointments (for psychiatric medical management). In the final analysis most RN's seeking to improve themselves will not be in a position to "go back to medical school". However, many do find themselves in a position to pursue their Masters or Phd and become an NP. It is not logical to expect them to not take such an opportunity. Also, I would point out that in medicine as in most endeavors people will "tend" to do best when they own there own businesses (as does my Arizona friend) rather than working for someone else.

[nate411]

On 5/28/2019 at 1:24 AM, TheMoonisMyLantern said:

"Nurses are leaving in droves and novice nurses are teaching more novice nurses. According to the RN Work Project, a study performed over 10 years to track career changes among new nurses, 17.5% of new nurses left their position within a YEAR of starting a new job, 33% within two years and 60% within eight years."

I came across this phrase in about 3-4 articles in a 5 minute Google search on nursing retention. Nurses are leaving in droves and have been for quite a while. The sheer copious amount of online colleges that have began NP programs is staggering, the schools aren't doing this out of the kindness of their hearts, they're doing it because people are paying tidy sums of money. Once again, I can appreciate the need and desire for furthering one's education but that doesn't change the plight of needing nurses that have more than 1 year of experience providing care and mentoring new nurses.

https://nhcps.com/the-death-of-bedside-nursing/

https://minoritynurse.com/why-good-nurses-leave-the-profession/

https://journals.lww.com/ajnonline/Fulltext/2018/02000/Nurses_at_the_Bedside_Who_Will_Be_Left_to_Care_.1.aspx

There needs to be more discussion about these online degrees that have no clinical hands on time, face to face, like we had in our undergraduate coursework. Wether its RN-BSN, or some other online accelerated rush program. It's actually frightening to envision a hospital full of NPs with a couple of years of nursing experience in total. I happen to agree with some of the others posts that in 10 years RNs in the hospitals will actually be techs, and the NPs will be assuming the combined role of nurse-doctor, on the floor, with a 6 patient assignment, at RN wages. Sorry, but I just do not see the return on investment here, for the nurse, or for the patient.

Imagine a scenario where you have an electrician come to your house to do wiring, but you didn't know his "credentials" were from an online program, and his only experience in the field was replacing socket plates.

[CharleeFoxtrot, BSN, RN]

26 minutes ago, nate411 said:

Imagine a scenario where you have an electrician come to your house to do wiring, but you didn't know his "credentials" were from an online program, and his only experience in the field was replacing socket plates.

When my patients ask why they need to see a doctor rather than the drug store NP I tell them "If you want a portrait painted you don't ask the guy who painted your living room."

I gotta agree, some of the NPs today are not educated the same as I encountered 10 years ago. The whole idea of NP's solely running the floors scares the bageebus outta me.

[myoglobin, ASN, BSN, MSN]

3 hours ago, CharleeFoxtrot said:

When my patients ask why they need to see a doctor rather than the drug store NP I tell them "If you want a portrait painted you don't ask the guy who painted your living room."

I gotta agree, some of the NPs today are not educated the same as I encountered 10 years ago. The whole idea of NP's solely running the floors scares the bageebus outta me.

I believe that there may be several misconceptions integrated into this post: a. The primary reason to see a physician or NP in a setting other than a drug store is that there is continuity of care and a health care data set developed over time. This is more conducive to better care be it from a physician or an NP.

b. Even if a patient is referred to an MD there is a high likelihood that they will be seen by an NP. In this market (Orlando) at least 50% of the care in outpatient doctor offices if provided by NP's.

c. The concern of "the floor being run by inexperienced NP's" while valid is not likely. Consider, that relatively few NP's would act as "hospitalists" and in most of these cases (if not all) they would be ACNP rather than FNP's. I can attest that even in the 700 bed facility where I work (which is also a level II trauma center, that even the Intensivist who is often on duty for nights couldn't start a central line to save his life (but he could intubate and do a bronchoscopy better than almost anyone).

I believe that rather than "putting the blame" on nurses furthering their education (to become NP's) that the real issue with retention is poor working conditions and stagnant wages. In my opinion the best way to address this issue would be for more states to adopt the California ratio law, and mandatory lunch breaks, along with mandatory overtime pay after eight hours. This would go a long ways toward encouraging RN's to stay in bedside nursing longer.

[Workitinurfava, BSN, RN]

3 hours ago, CharleeFoxtrot said:

When my patients ask why they need to see a doctor rather than the drug store NP I tell them "If you want a portrait painted you don't ask the guy who painted your living room."

I gotta agree, some of the NPs today are not educated the same as I encountered 10 years ago. The whole idea of NP's solely running the floors scares the bageebus outta me.

I had an NP ask me how to fix an order so that it would work for the patient. I literally told her how to do it. She was clueless. I knew based on paying attention to the the changes in doctors order over the years, I worked in med rooms and also because I worked at a teaching hospital so I got to see a lot of new doctors mistakes. I am not knocking her, I am just surprised that one can become an NP and not have solid skills. Doctors and PA's get more training and there are certain levels they have to pass but it is not quite this way for NPs.

[myoglobin, ASN, BSN, MSN]

I have worked with many "clueless" doctors (including many who chart on patients in the ICU with complete accessments, when they never even showed there face in the hospital, in other words complete fraud). I have also seen clueless NP's. In most cases these are issues with "interacting with technology" when the person is new, or the system has changed. If anything the NP's are often more "up to date" on the technology since many of them have worked for years as nurses in hour hospital and thus have interacted with the system over the course of their careers.

[2Ask]

7 hours ago, nate411 said:

. I know NPs who are still working as bedside RNs because they can't find jobs as NPs.

I know numerous NP's who are still at bedside due to not being able to find a suitable NP job (either they will make less with poorer benefits or they will have to move out to a rural area and they can't for some reason). I also know people who went to NP school, have debt for it out the wazoo, and then could not pass the boards. My impression from them is that NP school is more of the BSN fluff and did nothing to educate them for their boards. They take an addition class at their own expense to prepare for boards. Read the NP forum here. You'll see that their schools do not set up clinicals for them. Huge tuition, fluffy classes, and no help with the nitty gritty... what a racket!

I've thought to myself that I would love the chance to skip NP school, take the test prep class, and see if I can pass the NP boards. I bet I could do it!!!

As far as bedside nursing, I think decision makers shot themselves in the foot with eliminationg ADN entry level for bedside AND with moving to a DNP requirement from MSN for NP.

IMO as a second degree nurse, the BSN does absolutely nothing to improve morbidity and mortality. The only reason statitstics showed that patients did better is because the statistics selected for more intelligent people with innately better critical thinking skills who had CHOSEN the BSN route. Forcing everyone to take fluffy expensive BSN school will not transform them into critical thinkers.

Second career nurses who have previous degrees have proven that they have the critical thinking piece and should have the BSN requirement waived. I bet we are less likely to pursue advanced degrees too because of the cost benefit analysis and more life experience (I see the handwriting on the wall. My teenage son considered "becoming a nurse then a CRNA" I said forget that and get a PA. The market is going to be flooded with CRNA's and their wages are going to dip dramatically. I can critically think what all the new CRNA programs popping up all over and churning out grads is going to do to supply and demand in a field that only needs a few thousand new CRNA's annually.

All that said, the thread is really negative about bedside and I want to say I love my bedside job and I'm grateful for the opportunities I have had to earn a decent living as a second career bedside nurse who graduated ADN school well past my prime from a community college debt free and unqualified for financial aid for a grand total of $15K including two years tuition, books, and gas to commute the two hours daily and then got the Mickey Mouse waste of time BSN slowly over 4 years at the expense of hospitals I worked for. Some things about nursing have surprised me compared to my long ago professional career in a different field. It feels more blue collar the way nurses are treated as replaceable cogs in the machine and the big brother is watching you "suspicion" surrounding things like use of sick time, washing of hands, breaks, etc (have to wear a tracker so they know where you are at all times when working).

[nate411]

Poor working conditions and stagnant wages exist across many industries, not just nursing. In my experience, the lack of retention is defacto firing (either outright or forced resignations) on behalf of the corporate hospitals systems and corporate nursing homes that have more to gain by hiring someone new, cheaper, and without benefits.

[2Ask]

40 minutes ago, myoglobin said:

I believe that rather than "putting the blame" on nurses furthering their education (to become NP's) that the real issue with retention is poor working conditions and stagnant wages. In my opinion the best way to address this issue would be for more states to adopt the California ratio law, and mandatory lunch breaks, along with mandatory overtime pay after eight hours. This would go a long ways toward encouraging RN's to stay in bedside nursing longer.

Agree.

But myoglobin, the days of making bank as an NP are fading because the market is flooded. Doctor salaries remain high because doctors can't get a degree online and there are not new programs opening up everywhere. Their professional association has the critical thinking skills to protect the VALUE of an MD degree by limiting ACCESS to it and guarding the QUALITY.

[nate411]

12 minutes ago, 2Ask said:

I know numerous NP's who are still at bedside due to not being able to find a suitable NP job (either they will make less with poorer benefits or they will have to move out to a rural area and they can't for some reason). I also know people who went to NP school, have debt for it out the wazoo, and then could not pass the boards. My impression from them is that NP school is more of the BSN fluff and did nothing to educate them for their boards. They take an addition class at their own expense to prepare for boards. Read the NP forum here. You'll see that their schools do not set up clinicals for them. Huge tuition, fluffy classes, and no help with the nitty gritty... what a racket!

I've thought to myself that I would love the chance to skip NP school, take the test prep class, and see if I can pass the NP boards. I bet I could do it!!!

As far as bedside nursing, I think decision makers shot themselves in the foot with eliminationg ADN entry level for bedside AND with moving to a DNP requirement from MSN for NP.

IMO as a second degree nurse, the BSN does absolutely nothing to improve morbidity and mortality. The only reason statitstics showed that patients did better is because the statistics selected for more intelligent people with innately better critical thinking skills who had CHOSEN the BSN route. Forcing everyone to take fluffy expensive BSN school will not transform them into critical thinkers.

Second career nurses who have previous degrees have proven that they have the critical thinking piece and should have the BSN requirement waived. I bet we are less likely to pursue advanced degrees too because of the cost benefit analysis and more life experience (I see the handwriting on the wall. My teenage son considered "becoming a nurse then a CRNA" I said forget that and get a PA. The market is going to be flooded with CRNA's and their wages are going to dip dramatically. I can critically think what all the new CRNA programs popping up all over and churning out grads is going to do to supply and demand in a field that only needs a few thousand new CRNA's annually.

All that said, the thread is really negative about bedside and I want to say I love my bedside job and I'm grateful for the opportunities I have had to earn a decent living as a second career bedside nurse who graduated ADN school well past my prime from a community college debt free and unqualified for financial aid for a grand total of $15K including two years tuition, books, and gas to commute the two hours daily and then got the Mickey Mouse waste of time BSN slowly over 4 years at the expense of hospitals I worked for. Some things about nursing have surprised me compared to my long ago professional career in a different field. It feels more blue collar the way nurses are treated as replaceable cogs in the machine and the big brother is watching you "suspicion" surrounding things like use of sick time, washing of hands, breaks, etc (have to wear a tracker so they know where you are at all times when working).

I agree. In skilled trades..take welding or tool/ die, since its a hands on learned skill, there are few classes, its an apprenticeship route to becoming credentialed. I think ADN needs to be the entry level at hospitals. I also think that the ADN should be an apprenticeship , rather than classroom (or with minimal classroom). Much of what I did in clinicals in nursing school did not prepare me for bedside, because we made beds and did bed baths. Each bedside nurse would have an apprentice (that is not paid for 2 years) with them at all times, 8 hr shift, 40 hours a week. At the end of those 2 years, the hours convert to credits, and that is the ADN. There would be a huge improvement in quality , for the nurse, and for the patients, and for the hospital/ nursing home

[Workitinurfava, BSN, RN]

9 minutes ago, nate411 said:

I agree. In skilled trades..take welding or tool/ die, since its a hands on learned skill, there are few classes, its an apprenticeship route to becoming credentialed. I think ADN needs to be the entry level at hospitals. I also think that the ADN should be an apprenticeship , rather than classroom (or with minimal classroom). Much of what I did in clinicals in nursing school did not prepare me for bedside, because we made beds and did bed baths. Each bedside nurse would have an apprentice (that is not paid for 2 years) with them at all times, 8 hr shift, 40 hours a week. At the end of those 2 years, the hours convert to credits, and that is the ADN. There would be a huge improvement in quality , for the nurse, and for the patients, and for the hospital/ nursing home

I agree. I posted about nurses needing more clinical skills but this is what I meant. It should be like how it used to be a long time ago.

[myoglobin, ASN, BSN, MSN]

15 minutes ago, 2Ask said:

Agree.

But myoglobin, the days of making bank as an NP are fading because the market is flooded. Doctor salaries remain high because doctors can't get a degree online and there are not new programs opening up everywhere. Their professional association has the critical thinking skills to protect the VALUE of an MD degree by limiting ACCESS to it and guarding the QUALITY.

I'm not sure about "making bank", but you can earn a reasonable living as an NP especially if you are willing to move where they are most needed. In addition, if you are willing to open your own practice in an independent practice state (there are over 20 now) you can do even better. This is especially the case if you are willing to offer office hours (Sat, Sunday, and evenings) that many MD's have been unwilling to do in the past. If you also offer evidenced based complementary and alternative medicine in addition to the best standard of care when it comes to traditional medicine all the better. I would argue that there is now more opportunity for NP's than there has ever been in the past.