A Nurse with a Gun

Wednesday, May 24, 2006

Nursing Shortage?

I saw on CBS News tonight the same old story about there being a nursing shortage in hospitals across the US, and how patients, you and I, are placed at risk as a result. The risk is real. The reasons presented are fallacy. The health care administration featured in the piece blamed the problem on not enough nursing instructors to man the schools, therefore not enough nurses graduating.

Bullshit.

The problem is that more nurses leave the profession every day for greener pastures than there are nurses to replace them. Why do nurses leave the profession as a whole, and why is there a mass exodus of experience from the hospital floors?

Lack of professional respect.

Lack of professional respect is the number one reason cited over and over again from the nurses who leave nursing. No respect from physicians. No respect from supervisors. No respect from administrators. No respect from patients and their families. There are other reasons, of course, long hours and low pay contrasted with the stress of life and death responsibilities immediately come to mind. Both of these reasons for leaving, however, are simply illustrations of the fundamental and pervasive lack of respect.

If the health care system really wants to change the direction it is going, then there is a huge step that must be taken. There is a huge shift of perception that must be undertaken. Nurses must be given the respect they deserve for the job they do. I am not talking about a basket of candy on Nurses Week either. Failure to give nurses respect will simply have these intelligent and able professionals using nursing as a means of gaining a degree that will accord them better pay and respect in another field.

Labels:

20 Comments:

Anonymous Anonymous said...

Having some experience in a Clinic setting, I can say that nurses do a LOT. Some doctors will give professional respect to doctors but not anyone else (nurses, support staff, etc)who works with them. Some doctors are very good about respect, others are terribble. It seems to be either/or. Salary wise, the nurses recieved a very good salary. Doctors were paid the most, followed by nurses, and the support staff dead last. So at least here nurses get the money, but not always the respect.

6:52 AM  
Blogger garys said...

Nurses are the back bone of the health care system. Every patient in a hospital, be it Emergency Department, OR, or unit will have far more contact with a nurse than a doctor. Chances are the nurse, not the doctor will have the greater impact on the patient's course and outcome.

Interestingly, this same problem plagues EMS where there is an alleged shortage of paramedics. The reasons are amazingly similar.

Gary

8:24 AM  
Blogger Sterno said...

It's not just nurseing. Any field where you have one person making more money doing less work than another person will always be like that. Like attorneys and paralegals.

It's the only way doctors can justify to themselves why they make more money then a nurse who can do the same job and more.

8:28 AM  
Anonymous krin135@aol.com said...

As a physician who 'came up through the ranks' starting as a 'bedpan pusher' myself, I've watched many things change over the years...but the use of foreign born nurses to 'fill slots' in US hospitals is something that has been true ever since the move away from hospital related Diploma schools started in the mid 1970s. Yes, that was still a time of starched caps and 'yes, Doctor' and a hot cup of coffee for the doc as he did his share of the charting...but that was also a time when a wise old nurse often was able to call up even a senior doctor and say, "Dr. Thus and Such, this is Velma...we have a problem here that you need to handle...and here's how it needs to be done..." and have the doctor immediately approve of the suggestion.

One thing that I see as missing now that was present 'back in the day' is the sense of collegiality that nurses used to have...yes, they are more organized, both politically through the ANA and NLN, and often through unions...but as the saying goes "Nurses Eat Their Young"...

Againg, something that started when the academic world overtook the practical world of training nurses.

I have seen many cases where senior nurses have derided and degraded young doctors and worse, young nurses, with equal aplomb...

and in cases where nurses get paid as much as doctors, they are often the ones who 'lead the way' in being abrasive towards other professionals...

As to the comment about 'getting paid for doing less'...I will agree that it's the nurses and nursing assistants who do the job, day in and day out...btdt, washed the bedpans...but when it comes to making tough choices and then defending them...remember whose name will be first in on the listing if a complaint is filed...

To the memory of Velma Schertz, RN, Mennonite Hosptial School of Nursing...who was one of the nurses who set a standard that few nurses can hope to meet.

Charles S. Krin, DO FAAFP

8:40 AM  
Blogger red said...

"Lack of professional respect.

Lack of professional respect is the number one reason cited over and over again from the nurses who leave nursing. No respect from physicians. No respect from supervisors. No respect from administrators. No respect from patients and their families. There are other reasons, of course, long hours and low pay contrasted with the stress of life and death responsibilities immediately come to mind. Both of these reasons for leaving, however, are simply illustrations of the fundamental and pervasive lack of respect."


The exact reasons I left EMS.

9:55 AM  
Anonymous Anonymous said...

Xavier, you are right. Healthcare in general is a career with little respect for anyone who does their job. As a lowly CNA trying for 3 years, in vain, to get into any nursing school I have given up. Why do I want to be a nurse anymore? Pay? Nope, not enough for the level of stress and responsibility. Respect? Nope, you are always yelled at for the littlest thing and no one ever seems to notice your hard work. Satifaction? Maybe, but there is a feeling that you are always fighting an uphill battle, one that will never be one. This is one man who's been beaten by a system in dire need of positive change.

12:52 PM  
Blogger alpineman said...

Dang -- I saw that same report. I'm just getting into nursing (I start LPN school in the fall, then on to get my RN).

Thanks for the perspective.

2:41 PM  
Anonymous John from SF said...

Whatever happened to capitalism? If nursing salaries were raised 50% (increase demand), supply should increase. Not overnight, but definitely over the long term. A big fat paycheck is, at some level, a show of respect (or a mitigating factor for stress, long hours, and inadequate respect).

The real mystery is why nurses don't get offered higher salaries.

Tell me, Xavier, why haven't you moved onto "greener pastures"?

2:45 PM  
Blogger Xavier said...

First, alpineman, you are entering a field where you will always be in demand. Do not forget that. Even as a LPN you will have great negotiating power, and especially after you have practiced both in and out of the hospital a few years. I have decided to change jobs at 9AM, found another job by 9:30AM, been interviewd and hired over lunch, and turned in my resignation by 1PM. I advise every young man with the desire to become a nurse. You can't beat it when it comes to the return on your education dollar.

Now, why am I still in nursing? Because I love it. Even during my worst day I can find a way to make somebody's day better. I don't mind the lack of respect, I have been called much worse by much better men than any physician can ever hope to be.

I am actually moving on to greener pastures, within the system. I will never work those hospital floors again though. I'll roof houses in New Orleans in July first.

4:13 PM  
Blogger Jeff B said...

Being the son of, and the fiancee of, a nurse (two seperate people, in case you were wondering!), I'm always holding a large measure of respect for nurses.

However, I will also state that many of the problems faced by nurses are of their own doing, whether intentional or by the Law of Unintended Consequences.

The raising of standards for RN school entry, for example, have resulted in a reduced supply, and thus an increased demand and higher wages (my mother was a night shift ER nurse making $5.00 an hour for years,) but they've also posed a barrier to many quality people.

The other thing I see is many nurses wanting to do things other than "nursing." They want to be department directors, educators, outreach specialists, corporate liasons, consultants, managers, business developers.... the list is endless. Nearly every position in the healthcare system has a nurse in that position somewhere (perhaps not where you live, but elsewhere: The hospital CEO in Padunka, Idaho, may be a nurse, for example.) "Career advancement," while laudable, often gets in the way of having enough people willing to... well, be nurses.

Lots of problems, no easy answers.

6:49 PM  
Anonymous Hyunchback said...

I've written to you before, as well as posted here from time to time.

I'm an RN, too. I've been working in nursing homes for the past few years. Known several Miss Myras.

I started off working a hospital floor and have done other jobs, corrections nursing (through a temp agency, no less), pediatric home health, adult home health.

I'm now on the administrative side organizing paperwork for submission to Medicare and doing managed care. More a case manager.

In a way I enjoy this position more than floor nursing in the nursing home. I get the bigger picture. Not just my shift but an over all picture.

WHO you work for is very much going to determine your job satisfaction. Some people I'd rather cut my throat than work for again. Others I'm tempted to follow when they change jobs.

It's not the company that owns your building. It's the administrator and the Nursing Director who set the tone.

If anything I'd have to say the doctors in my field do give more respect to the nurses. Here they see even less of the patients than in the hospital. They need you to tell them when things aren't what they should be.

Yes, there is burnout. It's gruelling work. I've yet to find any nursing position that isn't gruelling in one way or the other.

Of course hard work doesn't scare me. If it did I'd never have passed nursing school.

9:27 PM  
Blogger PJ Geraghty said...

I have an unusual perspective in that I'm not a nurse (a paramedic by training, actually) but I have RN employees and routinely work with other ICU nurses. My own experience with nursing has been working almost exclusively with critical care and emergency department nursing staff, with some OR RNs as well.

Many nurses are well-paid; money should not be the issue here. That being said, many nurses seem to be willing to jump ship for a little extra $$$ per hour. We had an experience in my area where a major hospital lost many RNs to a new hospital that was offering a little more money. Many of those RNs have since left the new hospital either to return to the old one (often at higher pay) or to go to another one (again, often at higher pay). As an employer of nurses, I'm forced to compete with hospital salaries, which are approaching exorbitant levels.

As far as respect...give it and get it. I routinely get sh*t on by RNs who have a terrible attitude towards work (the job they agreed to do, mind you), family interaction, standard ICU patient care, etc.

Today, one of my non-RN employees and I spent most of the day trying to calm down a family who had been verbally/emotionally abused by a nurse who just didn't care about what the family (and th dying patient) were going through. By the time we finished, I think we had turned the situation around to the point where the hospital might not get sued. In "appreciation" for our assistance, we were told in no uncertain terms by the RN and her supervisor that our services weren't needed (the family asked us to stay, so we did).

I've known many nuses who got into and stay in nursing for all the right reasons. I've known many others who got into it for the money and stay in it for the money, knowing they can walk off a unit a 0900 and have a new job by 1PM (as someone else described). How can you expect respect when you take that attitude towards a job?

Until nurses (as a whole) act like professionals, they'll continue to be treated like blue-collar workers. Unions are an excellent example of why RNs don't get respect. Auto workers unionize. Highly-skilled clinical professionals do not.

1:33 AM  
Blogger Xavier said...

PJ,
If you want to retain nurses, understand that they are working on a career, not a job. The job you offer may fit well with their career. It may not. You are offering a job. They are in a career. If you think that the entire process of changing a job occurs in the span of a day, you are fooling yourself.

The process of dissatisfaction occurs long before the decision to leave is made. If you want to retain people, you must address their dissatisfaction, not their decision to leave. Otherwise, you are way behind the eight ball. Other workers, who endure months, even years of quiet job dissatisfaction will tend to stay because the job market is difficult for them. Nurses don't have that problem. If you try the same "wait until they are ready to leave to address problems" approach, you will not be able to retain them. How do I know? Because I have worked in the management of nurses. I have hired, retained and fired my own teams of nurses. If you treat a nurse like a maid or a waitress, they will try to find a job where they are not treated that way, and they have the capability of doing so. Quickly. Many nurses have worked jobs like that, and they entered nursing so they would not have to ever again.

RNs work many places other than the hospital. RNs stay in nursing because of the flexibility, and the ability to change job descriptions, to learn new challenges and control their own destiny. Good nurses tend to advance careers. Mediocre nurses tend to look for dollar an hour jobs. Both may be working in a dollar an hour job, but guess which one will be easier to retain with money alone. To retain good nurses, a manager must address their concerns. The first step towards that is to listen, not tell them how unprofessional they are for voicing a concern. Telling them they are unprofessional for not staying in a dead end job will not work either. You will note, I did not say listen to concerns, nor did I say fix concerns, all you need to do is address the concerns. The bottom line is do you want to retain good nurses, or do you just want to bitch about nurses?

I agree that any nurse who walks off a shift should have a license jerked, but that is not what we are talking about here. We are talking about the ability to easily find another job and leave a bad work environment.

As far as the money, money talks, bullshit walks. Money ceases to speak for itself when the bullshit gets to high. You seem to be most familiar with nurses who get paid per hour. I'm talking beyond that. When I first left the hospital in 1996, I immediately began working days vs nights, and my take home pay doubled. Doubled. That difference is huge. It literally meant my wife could chose to work or not. To say that a difference like that does not matter is to try to use bullshit to compete with dollars.

I have also taken pay cuts to advance my career in the direction I want it to go. When I began surgery this week, I took a 26% overall pay cut so that I could be working in an environment where I could advance my career in the direction I want it to go. In the end, it's not always about the money. It's about what you have to offer as an employer. If you, as an employer, have nothing to offer but money, then it cannot be about anything but the money.

5:00 AM  
Anonymous Charles S. Krin, DO said...

I've taken the liberty of posting this blog page to the SNurse-L mailing group, as this thread is an excellent discussion of why we are having a nursing shortage. I'm hoping that some of the students and nurses on the group will contribute.

>If you want to retain nurses, understand that they are working on a career, not a job. The job you offer may fit well with their career. It may not. You are offering a job. They are in a career. If you think that the entire process of changing a job occurs in the span of a day, you are fooling yourself. <

yep...careerists...which is a step up from being ROAD...

Sometimes, you have to look at your career and ask, "Am I doing what I really wanted to do in the first place?"...I don't know about alot of mid career docs now a days, but I do know that the older ones, and most of the younger ones look at medicine as a calling... not just a career. It used to be that nurses looked at their profession as a calling as well...dating back to when it *literally was* a calling, as most nurses took some form of religious orders while they were at it.


>The process of dissatisfaction occurs long before the decision to leave is made. If you want to retain people, you must address their dissatisfaction, not their decision to leave. Otherwise, you are way behind the eight ball. Other workers, who endure months, even years of quiet job dissatisfaction will tend to stay because the job market is difficult for them. Nurses don't have that problem. If you try the same "wait until they are ready to leave to address problems" approach, you will not be able to retain them. How do I know? Because I have worked in the management of nurses. I have hired, retained and fired my own teams of nurses. If you treat a nurse like a maid or a waitress, they will try to find a job where they are not treated that way, and they have the capability of doing so. Quickly. Many nurses have worked jobs like that, and they entered nursing so they would not have to ever again.<

agreed. And I've seen some good nurses leave the field because they burned out on trying to cope with the competing demands of profit based hospitals and needs of patient care.

>RNs work many places other than the hospital. RNs stay in nursing because of the flexibility, and the ability to change job descriptions, to learn new challenges and control their own destiny. Good nurses tend to advance careers. Mediocre nurses tend to look for dollar an hour jobs. Both may be working in a dollar an hour job, but guess which one will be easier to retain with money alone. To retain good nurses, a manager must address their concerns. The first step towards that is to listen, not tell them how unprofessional they are for voicing a concern. Telling them they are unprofessional for not staying in a dead end job will not work either. You will note, I did not say listen to concerns, nor did I say fix concerns, all you need to do is address the concerns. The bottom line is do you want to retain good nurses, or do you just want to bitch about nurses?<

I don't want to bitch about them or at them...I have spent time trying to help 'grow' good nurses at various levels over the years...including time spent poring over journal articles to help students and nurses better understand what the patient needs. Part of the problem I have noticed over a 30+ year 'career' in the medical field is that we no longer have 'patients' who are sick and need our help...we have 'customers' and 'clients' who have to be 'serviced.' That alone takes some of the old job satisfaction out of the equation.

>I agree that any nurse who walks off a shift should have a license jerked, but that is not what we are talking about here. We are talking about the ability to easily find another job and leave a bad work environment.

As far as the money, money talks, bullshit walks. Money ceases to speak for itself when the bullshit gets to high. You seem to be most familiar with nurses who get paid per hour. I'm talking beyond that. When I first left the hospital in 1996, I immediately began working days vs nights, and my take home pay doubled. Doubled. That difference is huge. It literally meant my wife could chose to work or not. To say that a difference like that does not matter is to try to use bullshit to compete with dollars. <

Odd...I found it interesting that you were able to double your salary moving from nights to days...most places pay a fairly substantial shift differential for nights, weekends and holidays.

I will admit that I know of too many facilities where long term staffers do not do anywhere near as well financially, even if they are more qualified, than new hires.

>I have also taken pay cuts to advance my career in the direction I want it to go. When I began surgery this week, I took a 26% overall pay cut so that I could be working in an environment where I could advance my career in the direction I want it to go. In the end, it's not always about the money. It's about what you have to offer as an employer. If you, as an employer, have nothing to offer but money, then it cannot be about anything but the money.<

If an employer of nurses can 'only' offer money, then they need to take a good look at what they are doing... There should *ALWAYS* be at least the job satisfaction of helping our patients feel better...even if it "just" means holding a little old lady's hand in the deep dark recesses of the night as she mourns for her lost husband... or as she herself slips into that final sleep.

ck

11:15 AM  
Blogger Xavier said...

Odd...I found it interesting that you were able to double your salary moving from nights to days...most places pay a fairly substantial shift differential for nights, weekends and holidays.

When I left the hospital, I began to work in the private sector. I no longer worked for the hospital. I worked for myself. Instead of being paid per hour I was paid per visit.

Shift diffs and weekend premiums could not keep me working the hospital floor, and the hospital was phasing them out anyway. I had night shift diffs in the hospital, and my take home pay, once the hours were tabulated on one side and the dollars on the other, were better than double immediately once I began nursing outside the hospital. Once I had a couple of capable nurses working for me, my time investment vs dollars gained again increased.

I do not even want to contemplate the beating I no doubt took when time/dollars is taken into account by re-entering the hospital to learn surgery. The one thing that the hospital setting does have to offer nurses is the ability to learn. The financial gain may be less but the opportunity to learn and grow are much greater. I simply had reached a point where I no longer needed nursing so much financially, but still wanted it for personal and professional growth.

The shift diffs I walked away from 10 years ago have now been dissolved. There are no shift diffs or weekend premiums anymore in North Louisiana. Just time and a half for holidays. Floor nurses work every other weekend, and are not compensated for it. The time of 32 for 40 is over as well. 16 hour shifts are no more. 8 hour turnarounds are history.

1:42 PM  
Anonymous Hyunchback said...

One factor I think I see appearing in posts by those outside our field is the lack of knowledge about how our employers screw us over.

In most OTHER fields I've worked you won't be in a position where you are training someone who is "under" you who is taking home a higher base pay than you.

In nursing, because of the demand, the starting pay for new hires is often higher than that of nurses who have been with the company for a few months.

You put someone in the position of being told that they are only worth 27.00 an hour but they have to train and be in charge of someone that is making over 30.00 per hour.

That's a major factor that can really open up wounds in the workplace. Why on earth would one want to keep working for the same employer if they can quit and go to work at the same type of position for hundreds more per month?

Employers don't reward the faithful, they reward the job jumpers. The failthful have to work harder to compensate for those who are always changing jobs.

If an employer is going to be unfair with wages paid then what intangible could the nurse have to keep her with an employer? The answer there is that the intangibles are often missing.

The lack of unions in nursing is one reason employers get away with this. The bosses at the car companies always complain it's the unions that are killing them but in our field they don't have that excuse. The management isn't seeing value in the employee until the employee isn't there anymore.

Two autoworkers on the same line, doing the same job would not be paid the same if one was new and the other had been there for three years. The longer tenured employee would be paid more. That encourages the newer worker to stay in place, knowing that he'll take a cut by trying to move from Chevy to Ford. The nurse, however, usually gets a raise by going from hospital 1 to hospital 2. Then a few months later get another raise by going to hospital 3. Then she can go back to hospital 1 again and get yet another raise she'd never have gotten by staying with hospital 1.

That's stupidity in the marketplace and it is the fault of management.

9:36 AM  
Blogger Corsair, The Mostly Harmless said...

"No respect from patients and their families."

Xavier,

My wife and I had the unfortunate experience of having both of our children in pediatric ICU on different occasions. I can BARELY remember who their M.D.'s were, but am still on good terms with the truly outstanding Nurses that attended our kids. They were there 24/7, and were our rock when we thought we were going to loose my 2 month old daughter. THey get a HELL of a lot of respect from me..

9:07 AM  
Blogger Xavier said...

Corsair,
It's patients and families like you and your's that keep nurses like me nursing. Thank you.
XB

4:16 PM  
Blogger Nurse Jenny said...

Try to visit this site starting a nursing home its a nursing guide.. And its a solution to the nursing shortage crisis.

11:16 PM  
Blogger Nurse Jenny said...

Try to visit this site starting a nursing home its a nursing guide.. And its a solution to the nursing shortage crisis.

11:17 PM  

Post a Comment

<< Home

Links to this post:

Create a Link