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  #21  
Old 20 November 2018, 21:01
BigNickT BigNickT is offline
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There's a shortage. Look at the jobs on any website for any medical office or facility. Generally, the doctor's office's don't have a staffing problem. That's about it. Everyone else has constant turnover. Some of that is t be expected but some of it is self inflicted. Speaking as an RN, we are losing people to retirement certainly. We are also losing good people at the entry level. Not so much because they showed up with unrealistic expectations, but because they were completely blindsided by the realities of nursing. Like a lot of academia nursing schools teach a set of very high minded ideals. As they should. But they also imply that as and RN you will be treated as a professional and that is often not the case. Add to that the fact that "Nurses eat their young" and you see new nurses throwing in the towel.

Leadership is about people. Management is about assets (which are sometimes people granted). A huge problem in medicine is that there is very little actual leadership and a misunderstanding that teaching someone to be a manager is the same as cultivating them as a leader. In leadership there is an old saw that you can't delegate responsibility. Happens all the time. Nurses are often stuck in a situation where they have no authority to get a task accomplished but bear the responsibility for getting it done.

Part of the issue on the nursing side is that nurses who have risen to management are chronologically far enough away from the actual work of nursing that they think they know what it's like "on the floor" when in fact they can't. That is changing somewhat.

Another part is that there are an awful lot of nurses who don't like getting their hands dirty. The "I didn't go to college so I could wipe someone's ass" mindset. Too many nurses head to a "specialty" or some sort of office gig when they should be getting down and dirty on med/surg or in the ER. Too many nurses are moving into advanced practice without a solid background in plain ol' nursing.

There is also the fact that we have adopted a business model for medicine but we don't want to admit it. Either the practice of medicine/patient care is paramount or the financial bottom line is. Pick one and accept that the other one is secondary. Otherwise both suffer.

The "senior leadership" at our local "big" hospital used to be made up of doctors and very senior nurses. Today there is one doctor and one nurse on that 11 person team. That situation brings with it a certain change in perspective. Go figure.

With 10 years in nursing and having been a CNA before that I can't say I ever felt my job was "cushy". When I started I thought it was manageable. I left work pretty much every day with a sense that I had done a good job and was supported in my efforts. Not so much anymore. I really love the face to face patient care aspect of the profession, but that part of the job is shrinking. Nurses are becoming supervisors for CNAs and techs, and they are doing it with the sum total of one class tucked into nursing school on "delegation" as training for being in charge of people.

Rant off.
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  #22  
Old 20 November 2018, 21:22
RemTech RemTech is offline
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I can say this with true conviction, nurses may have a tough row to hoe but every single one I have come in contact with has been professional, conscientious and attentive. Of course I am a great patient and never bitch or moan:). I've said this previously, the Dr's saved me but the nurses kept me alive - I salute all of them.
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  #23  
Old 20 November 2018, 21:34
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litepath litepath is offline
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Rant or no, that is some astute experience and observation that nails many heads BigNickT!!

Case in point, BSN classes (bout 4 years in as a nurse), instructor says, "As a BSN Nurse you shouldn't be emptying the trash can"

I knew right then she didn't know her Aspen from her Jackson Hole on bedside care in the ICU. And we were only talking trash.. . .LOL

Ageism is alive and well too in nursing. They can least afford it, but it's true.
I've seen them chase off some stellar Diploma nurses who could run circles around many of us. Only because of that greater plan (my words) of "Trying to be SEEN as Professional".

How many facilities have said, "we're going to have BSN's only!" To later have to backtrack on those Only/ever/never statements.

Thing is, it was always professional. And nursing has had high marks as an honorable profession that's well respected by the community it serves.

I used to warn my colleagues that sooner or later that the Doc's were going to get tired of our shit and take it over.. . .As time passed I realized that was simply a pipe dream.


The bean counters are in charge.
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  #24  
Old 20 November 2018, 22:07
Jakers Jakers is offline
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I won't fill this with pages of my utter disdain and contempt for the nursing profession (NOT nurse- I like nurses and I love good ones) but there is a lot of good information here for anyone considering a career in medicine at one level or another, or who just wants to know how screwed up it is.

To many people in the various roles (including paramedics) are making a triple mistake by forgetting that, yes, there is a hierarchy in medicine, and no, you can't just add bullshit credits to a curriculum, increase the degree level you get (AS vs BS vs MS vs PhD) and be considered "equal" to those above. Add in that to many are forgetting (or have forgotten in the case of the nursing profession) that their job description actually includes things that are "beneath them" even with how how superdedooper smart, edjumacated and important they are (or are told they are in school) and you have a recipe for disaster.

This isn't even touching on the business side of medicine, just the personal/professional side.

I've seen a change in the last 16 years, and I'm sure others who've been around longer have seen more. But it is rather dramatic. Couple entitlement with unrealistic expectations (and yes, I think to many schools do a good job of blowing up people's heads and poor jobs at showing them what they will really be doing) and an inferiority complex...add in a dash of greed (for more accolades, more respect, more leeway, more independence) and you get people, at all levels, who don't want to perform the function that their profession was created for- they want to do something else. Something more.

Except, there are, without exception, other people who are already doing that more, and almost always doing it just as well, if not better (often better) than the people clamoring for it. And the people behind don't want to do the same things to reach the point that they could perform just as well, but take a shortcut.

If everyone in medicine could just do their job, THEIR job, and focus on being good at their job and leave other's alone we'd be a hell of a lot better off.

That won't ever happen though- the cat is out of the bag in that respect; it's been happening for to long and the lobbying groups are to big at this point.
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  #25  
Old 21 November 2018, 09:33
Devildoc Devildoc is offline
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Originally Posted by Gsniper View Post
I'm a bit apprehensive. She has EXTENSIVE experience as a patient at Duke, which is quite different than any other hospital I've ever been in (with the VA being the other end of the scale). I hope when she lands at Podunk Memorial she can handle the swing.
I have been a RN for almost 17 years. I have been a manager, educator, clinical nurse; now working on my MSN. I may or may not have "EXTENSIVE experience" as a nurse at Duke (ED, ICU, interventional radiology, hyperbarics). I also worked for the "light blue" down the street (ICU, flight); as much as I hate UNC-CH, it is an excellent hospital and I have no issues with having worked there.

If she has any questions or wants any insight--good, bad, and ugly--PM me and I will give you my email.

What @Jakers, said, I also hold disdain for the nursing profession, but have nothing but love and respect for my colleagues at the bedside. Well, most.

What @Litespeed said, is truth. A lot of older nurses, especially those in academia, like to talk the talk about teamwork but won't change a bed or empty a trashcan. Those people can kiss my ass.

What @BigNickT said, a lot of young nurses don't want to get their hands dirty. They have a plan: 1-2 years bedside, grad school, NP or CRNA. And THOSE fields are also undermanned so schools have lowered admission standards, so you are getting gas-passers and script-writers who are dumber than a box of rocks. My local school of higher education has an accelerated BSN program, so you have to have a degree to get in. Once you get in, they talk up the name of the school and tell you why you are the best. They are the worst. Lazy AND snobby. When I precept them I tell them they are already losers: not working in the field for which they already have a BA/BS, and they have to prove themselves to me.
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  #26  
Old 21 November 2018, 13:10
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Expatmedic Expatmedic is offline
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Staffing levels.

IIRC, med/surg floor nurses had a patient load of about 12-14 patients per RN.

Then to help deal with the RN shortage hospitals in my region started hiring a lot more LVN’s, MA’s and CNA’s.

Well, that didn’t work.

Now, I want to say RN’s in CA on the aforementioned floor and similar floors now have a patient load of 2 patients per RN as a matter of law.

This year I have been in the hospital a lot. I noticed Kaiser nursing staff has a lot of nurses willing to help their co-workers as needed with care.

Healthcare is very litigious profession for the tiniest of errors. That scares people away as well.

That’s my take on it.
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  #27  
Old 21 November 2018, 13:58
Devildoc Devildoc is offline
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Originally Posted by Expatmedic View Post
Staffing levels.

IIRC, med/surg floor nurses had a patient load of about 12-14 patients per RN.

Then to help deal with the RN shortage hospitals in my region started hiring a lot more LVN’s, MA’s and CNA’s.
Generally, though states do vary, the profession's standards are 1-2 critical care, 4 or less ED, 3-5 stepdown, and 4-6 "floor." Most states mandate these via the boards of nursing, which of course is influenced by regulatory/accreditation agencies.

When I first started in the ED, I could have 3, I could have 9. Nothing like dealing with a STEMI when another one of your patients pops their head in the room bitching about needing their discharge instruction. No longer.

CNAs are still widely used to assist nursing, but most (not all) hospitals have gotten away from LPNs/LVNs outside of clinics.

One of the many things I miss about EMS and flight medicine: one patient at a time (99% of the time), and only for a time-specific amount of time.
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  #28  
Old 21 November 2018, 17:58
justamedic justamedic is offline
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I think it’s been said before, but where you are has a lot to do with it.

IMO, I have seen no shortage in student applicants for any nursing program, NP program, or PA program I’ve been around (in 4 states over my 10 years in EMS/healthcare). The shortage of physicians is more noticeable as more and more career minded people are choosing to be mid-level providers instead of going for MD/DO. There is a separate thread on that, and it is for a multitude of reasons.

I’m aware nationally there is “a shortage,” and that has a lot to do with turnover, retirement, and the caliber of some people entering the field. However, as more positions become vacant, the bean counters will have no choice but to increase the salaries and perks to bring in the talent. Healthcare is still a very good career and a popular field for those entering the workforce or moving up from within. Although, like everything else, each med field/profession has their own gripes and share of complaints.

Nursing is sort of a different animal- the whole “certificate nurses who could run circles around BSN nurses being chased out” is a real thing, I have seen that first hand. Additionally, many nurses are now using the RN profession as a stepping stone to NP, as has been said also. It is becoming common place, and for some schools you can proceed direct to MSN with little to no real bedside patient experience. My wife had 5 1/2 years experience in one of the cities busiest ERs prior to becoming an NP. She had people in her program that worked at Botox clinics, spa clinics, outpatient facilities, med-surg floors, etc for like 12 months in her cohort with her... in a Family Nurse Practitioner program designed to teach primary care throughout the lifespan. There were other from ERs, ICUs, but the point is the majority had no real experience to be out there in 2 years practicing medicine at the provider level. The nursing machine seems to have shifted its focus as the others have said.
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  #29  
Old 21 November 2018, 17:59
justamedic justamedic is offline
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Originally Posted by Devildoc View Post

One of the many things I miss about EMS and flight medicine: one patient at a time (99% of the time), and only for a time-specific amount of time.
Isnít that the truth.
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  #30  
Old 23 November 2018, 20:36
IronErik IronErik is offline
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Just finished three 12 hour night shifts in the ER. So let me throw a few thoughts out there.

First, there is no nursing shortage. There are plenty of nurses. They just don't want to work. We currently have 58 nurses employed by our ER. Only 29 work regular scheduled shifts. The rest work when it is convenient for them, or when they are mandated to such as their required holidays, like Thanksgiving. However, on thanksgiving this year, the regular employees worked a 12 hour shift. The non-regulars were just required to work 4 hour shifts. The result? We were short staffed. Happens all the time. We could hire more full timers, we have 6 openings, but upper administration won't let us right now, because our "productivity" is low. Or in plain English, we aren't bringing in enough $$$, so profits are down. Which brings us to the real problem, our Docs.

So our ER Physicians group has contracted annually with the hospital for almost 40 years. However, this year the hospital severely lowballed them during contract negotiations. The docs counter offered, but the hospital refused to budge. So 5 of our 10 docs quit. Left the group. The hospital then entered individual negotiations with the remaining five, and continued to lowball, and two more left. As of today, we have no docs scheduled to work Jan 1 2019, because none have accepted the hospital contract. As of today, 38 days out, We have no plan, not even a tentative one for staffing. All to save a handful of dollars. But management assures us "it will be all right."

In the past two years, our hospital has laid off Nurse managers, case managers, social workers, infection control nurses, lab techs,and respiratory therapists. We've short staffed our nursing units, so we then have had to transfer patient's to other hospitals, because we didn't have nurses to care for them ourselves. We fired one of the most loved oncologists in the area, because he wasn't seeing enough patient's on a daily basis, and therefore, not bringing in enough revenue. So he then took his business, and his patients, to our competitor across town. And it came out in the media, and created a shitstorm of bad publicity. So now we are seeing about 25% fewer patient's than we did last year, because they are going to the hospital across town.

So, while the higher national "ministry" is paying the CEO $13 million annually, and our state "ministry" is buying property in the most expensive part of the state, to "develop in the future" we are forcing our local hospital to work harder, cheaper, and with less.

My impression, is that healthcare has too many administrators and executives, and not enough leaders. My ER manager hasn't had a face to face conversation with my in over a year. Zero feedback on my job performance. The manager before her was 6 months out of nursing school when she was hired for the job. Almost no floor experience, and had absolutely wretched leadership ability. Most directors of nursing haven't been at bedside for years, they are desk drivers, detached from the people they are responsible for. And even with bedside nurses, there is no process for leadership development or mentoring. The result is that we have people in positions of authority, who can manage reports, spreadsheets, and budgets, but can't manage people. And in a profession that deals exclusively with people, that is a severe handicap.
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  #31  
Old 24 November 2018, 10:26
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Gray Rhyno Gray Rhyno is offline
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My impression, is that healthcare has too many administrators and executives, and not enough leaders.
This isn't just a problem in healthcare.
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  #32  
Old 24 November 2018, 11:53
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litepath litepath is offline
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Originally Posted by Gray Rhyno View Post
This isn't just a problem in healthcare.
No. It's not.

IronErik's post is sage.
Per the nursing shortage that we've all been reading about for a better part of two decades, When I wrote a paper on it in BS classes, it was deemed the "Volunteer Nursing Shortage."

I forget the numbers but they were fairly stout.

Still the number one reason nurses leave their job, or the profession is Management, or lack there-of.

At the cost to replace a nurse; A new hire, training the same with the facility you'd think they'd have figured it out that it's cheaper to retain them.

"The RN Work Project cites the average cost to replace an RN who leaves the bedside ranges from $10,098 to $88,000 per nurse. Whatís more astonishing is total RN turnover costs range from approximately $5.9 million to $6.4 million per year at an acute care hospital with more than 600 beds"

The answer isn't higher pay. It's Workplace satisfaction *Assholes!*

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  #33  
Old 24 November 2018, 12:03
8654maine 8654maine is offline
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Quote:
Originally Posted by IronErik View Post
Just finished three 12 hour night shifts in the ER. So let me throw a few thoughts out there.

First, there is no nursing shortage. There are plenty of nurses. They just don't want to work. We currently have 58 nurses employed by our ER. Only 29 work regular scheduled shifts. The rest work when it is convenient for them, or when they are mandated to such as their required holidays, like Thanksgiving. However, on thanksgiving this year, the regular employees worked a 12 hour shift. The non-regulars were just required to work 4 hour shifts. The result? We were short staffed. Happens all the time. We could hire more full timers, we have 6 openings, but upper administration won't let us right now, because our "productivity" is low. Or in plain English, we aren't bringing in enough $$$, so profits are down. Which brings us to the real problem, our Docs.

So our ER Physicians group has contracted annually with the hospital for almost 40 years. However, this year the hospital severely lowballed them during contract negotiations. The docs counter offered, but the hospital refused to budge. So 5 of our 10 docs quit. Left the group. The hospital then entered individual negotiations with the remaining five, and continued to lowball, and two more left. As of today, we have no docs scheduled to work Jan 1 2019, because none have accepted the hospital contract. As of today, 38 days out, We have no plan, not even a tentative one for staffing. All to save a handful of dollars. But management assures us "it will be all right."

In the past two years, our hospital has laid off Nurse managers, case managers, social workers, infection control nurses, lab techs,and respiratory therapists. We've short staffed our nursing units, so we then have had to transfer patient's to other hospitals, because we didn't have nurses to care for them ourselves. We fired one of the most loved oncologists in the area, because he wasn't seeing enough patient's on a daily basis, and therefore, not bringing in enough revenue. So he then took his business, and his patients, to our competitor across town. And it came out in the media, and created a shitstorm of bad publicity. So now we are seeing about 25% fewer patient's than we did last year, because they are going to the hospital across town.

So, while the higher national "ministry" is paying the CEO $13 million annually, and our state "ministry" is buying property in the most expensive part of the state, to "develop in the future" we are forcing our local hospital to work harder, cheaper, and with less.

My impression, is that healthcare has too many administrators and executives, and not enough leaders. My ER manager hasn't had a face to face conversation with my in over a year. Zero feedback on my job performance. The manager before her was 6 months out of nursing school when she was hired for the job. Almost no floor experience, and had absolutely wretched leadership ability. Most directors of nursing haven't been at bedside for years, they are desk drivers, detached from the people they are responsible for. And even with bedside nurses, there is no process for leadership development or mentoring. The result is that we have people in positions of authority, who can manage reports, spreadsheets, and budgets, but can't manage people. And in a profession that deals exclusively with people, that is a severe handicap.
Lots of truth here.

You could be describing my ER.

"Quality" is another term for a shit sandwich.
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  #34  
Old 24 November 2018, 13:18
Devildoc Devildoc is offline
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The data are clear, just been several studies on this. The nursing shortage would be ameliorated if not for the proliferation of all these administrative, research, leadership, and ancillary role. Many of which do not need nurses, but we did that to ourselves as a profession an effort to be "as good as". Eliminate those, and there's no nursing shortage.

The data also points to leadership and management as the significant reason a nurse stays or leaves a job. You can throw all the benefits and bonuses and stuff but they will only work so much.

When I started an hour emergency department we were at about 50% capacity, not uncommon for one nurse to have seven or eight patients. Now the ratio is 4 to 1 and is staffed at about 80%. We are billeted for almost 130 nurses, but never have had more than probably 110 at any point.

While leadership and management is certainly a factor, and our particular slice of heaven, ER nurses do not want to be ICU or floor nurses, but we have a 50% admission rate and given the paucity of discharges it is not uncommon to hold on to an admitted patient in the emergency department for 24 or 36 hours.

It is a real problem, but we'll never be fixed in our institution. if a hospital had its way it would get rid of emergency and its trauma center designation all together because it's not sexy and it does not bring in big revenue.
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  #35  
Old 24 November 2018, 13:23
Agoge Agoge is offline
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And yet...after reading through this thread several times, if I had it to do all over again, I would still choose out of the medical field or teaching. More than likely, the medical field would win out.

IMO, it's one of the only fields that have "true" continued growth mechanisms set into it. I love fields that have a continuing growth model based on "new" knowledge.

You all serving in the medical industry have my utmost respect! Regardless of the hardships, I suspect that *most* of y'all would consider it a calling rather than a *job*. Thanks for all you do!
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