Amid nurse shortage, hospitals focus on retention

[Akoto]

Source: The Associated Press

MIAMI (AP) — Newly minted nurse Katie O'Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who'd had seizures. She was told he was stable and to check him in a few minutes, but O'Bryan decided not to wait. She found he had stopped breathing and was turning blue.

"If I hadn't gone right away, he probably would have died," O'Bryan said. "I couldn't do it anymore."

Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

Read more: http://www.google.com/hostednews/ap/article/ALeqM5hG3zuxxrx3rMLtoYBarFCD0OZ_DAD96C54580

[knowbody0]

1. my sister, an RN,

worked triage with orders to send away non emergency patients. she sent a woman with tummy cramps home. she died 45 minutes after seeing my sister.

my sister had just transfered from ICU where she had seen too many die.

she is no longer a nurse.

[Ilsa]

2. It's downright dangerous. And asking for help doesn't seem to work

at the time when you need it. A supervisor can run a new nurse hard the whole shift, and then the new nurse catches flack for not getting a menial task done after being busy all night trying to keep her/his patients alive. No wonder there is a shortage.

My brother is an RT in a hospital where every employee is expected to clean and take out their own trash. He said the place is filthy.

[Historic NY]

3. My niece struggled back from being stop lossed to a Critical Care Unit at a trauma center.

She was recruited after returning a couple years back while completing her degree. I feel eventually she will burn out too, but she likes it, its challenging.

[rainbow4321]

4. Until the hospitals are forced to address nurse:patient ratio

These 3 or 4 month orientation for new nurses is not going to do anything to help the nursing shortage.
If they signed something that said they will get a sign on bonus, they will stay long enough to get that and be gone.

From the article abut the "better" new nurse-veteren nurse orientation:
"The new nurses must complete a 60-item checklist"

Checklists mean nothing. They look really good in an employee file but that is about it. Does nothing to prepare a new nurse for when he/she suddenly is cut loose and has 6,7,8+ patients on their own. The list is to only protect the hospital so they can say "see, we showed the nurse the correct way to do something" in case something goes wrong with whatever activity the nurse has problems with.


I left the inpatient setting a few years ago and headed to an outpatient setting. Much better/safer setting.

[Chan790]

7. How would you address this crisis?

I took from your post that you're a nurse (Please correct me if I misread that.) so how would you fix this cluster-problem? Every suggestion I've ever heard is dismissed just as quickly by someone else...but nobody ever asks a nurse, at least that I hear.

Someone says "We need to reduce patient-load by hiring more staff and capping patient:staff ratio.", someone else rebuts "We can't do that, it'll explode the already high cost of health-care."

Someone says "We need to make it easier to become a nurse.", someone else rebuts "We shouldn't, we're talking about patient's lives and it should be difficult." (I'd agree.)

Someone says "The number of nurses isn't the issue, nurses are now being asked to do tasks that typically were done be others (both orderlies and doctors) and those tasks need to be restored to traditional providers.", someone else rebuts "That re-delineation and streamlining in personnel keeps costs down which, in turn, makes it possible to serve the uninsured and poor."

I think we need to remove roadblocks to becoming a nurse. I know several people with non-medical degrees who would gladly go back to school to become a health care professional (either a nurse or a technician/service-provider of some sort) if were accessible to them in terms of being affordable and workable. It seems to me that the best way would be free or extremely-low cost education in exchange for long-term commitments. i.e. We send you to school for free (or create training programs in the hospitals) and you agree to work here after graduation for 5 years. But...everybody seems to oppose that idea for myriad reasons.

[rainbow4321]

9. To start with, hospitals are too top heavy (administrators)

So all the $$ goes to their CEO's and the other top tier employees.
I googled CEO/hospital/profits and the numbers are outrageous. These are just a few of the entries:

http://healthcarefinancials.wordpress.com/2008/02/01/non-profit-hospitals-and-ceo-salary/

Salaries paid to top CEOs at the state’s hospitals grew 95 percent between 2002 and 2006, with some topping $1 million.
Hartford Hospital President and CEO John Meehan made just over $1 million in 2006, up 27 percent from 2002.
The salary of Robert Kiely, CEO of Middlesex Hospital in Middletown, climbed 82 percent, from $511,220 in 2002 to $932,923.

http://www.fiercehealthcare.com/story/upmc-ceo-s-3.95m-pay-draws-attention/2008-05-20
In a world where the bar keeps moving higher, it seems that bar has gone up yet again. It looks like University of Pittsburgh Medical Center CEO Jeffrey Romoff was paid almost $3.95 million in total compensation for fiscal 2007, up 19.7 percent from the year before. This can't feel great to board members who now are looking down the barrel of significant 2008 losses

http://www.usatoday.com/news/health/2006-01-04-hospital-profits-usat_x.htm
The nation's hospitals, boosted by a slowdown in expense growth and continued ability to drive a hard bargain with insurers, posted profit margins that reached a six-year high in 2004 — and indications are that 2005 was just as good.
----------------
So nurses have a hard time falling for that hospital line of "healthcare cost is too expensive to hire more nurses"
Funny how cost doesn't seem to factor in what the CEO salaries/bonuses are increasing every year. The healthcare industry is just as dirty as the auto and bank industry in that respect. Yet when was the last time Congress dragged the hospital CEO's in and questioned them?

The one loophole that has to be addressed is if the nurse/pt ratio is addressed, the hospitals have to be told "and no getting rid of all the respiratory therapists/lab techs/secretaries/nursing aides". Because that would be the hospitals' payback for having to give the nurses a safer workload. As in "you want less patients? Fine, now you get to do everything from answering the phones/drawing ALL bloodwork/respiratory treatments/nursing assistant work". Again, they hide behind the "it's too expensive"..and that is all the public hears til they are convinced that the nurses' patient ratio cost will be passed onto them..we become the bad guys. Meanwhile, CEO fatcat gets a huge increase in his/her salary year after year. THAT doesn't make headlines.

Once the nurse/patient ratio is done is a safe/correct way and there are no loopholes, there is a very good chance (like happened in California per news articles) those nurses that fled the inpatient setting will come back. I think the number I read was a double digit percentage increase in requests for license re-activation per the CA Board of Nursing. People who had let their licenses expire actually WANTED to come back,now that the nurse/patient ratio was safe. Nurses that had kept their licenses but left the inpatient setting also came back.

That return of burnt out nurses would take some of the pressure off of the nursing schools. That is another whole problem in itself. they CAN'T produce new grads because the nursing school instructors have left..they can make a better salary in other fields of nursing. So the second part of fixing the nursing problem is to increase their pay as an incentive to return. They return, the schools get to add classes, more nursing students get to enter nursing school. 2nd biggest problem is then handled.

As far as "we don't want it too easy for people to get in":

They get weeded out pretty quickly once they enter the upper level classes. And if for some reason they don't, remember, nurses have to sit and take the state board test. The slackers that may get thru school, usually don't make it past the board.

-----
How it needs to start is like I said, Congress needs to bring in the CEO's of various hospitals and healthcare companies and put their salaries AND bonuses on a big screen in the room right after the CEO's whine that the healthcare industry is too expensive already..then show another slide that has the HUGE increase in hosptial profit over the last 8-10 years. Once you start examining the top tier of these insitutions you will see layer upon layer of "vice presidents" who make almost as much as the CEO. Whenever they want to create a new position at a hospital, they slap "Vice president of xxxxxxxx" on their badge. I remember one co worker asking "if the United States only has ONE vice president, WHY does our hospital need 20 of them?".

Sorry to ramble on my soap box. I hope I answered some of your questions.....

[Chan790]

10. No apology needed...

thank you for answering my questions. That's exactly the sort of information I was looking for.

I was already aware of the absurd salaries being drawn at Middlesex and Hartford Hospitals by people who provide nothing to patient care...I grew up in suburban Hartford. The only job I've ever turned down was at Hartford Hospital as a grant-writer because they wanted to pay me something absurd like 350% of my then-current salary doing the same job for a NPO and couldn't tell me why I was that valuable or what else wasn't being funded because of it.

I'm sure they turned around and just gave the money to someone else equally being overcompensated.

[dana_b]

13. you aren't rambling and

you bring out excellent points. At our hospital, for instance, the RNs get raises due to the union but if you aren't in a union, you got no raises last year nor will you this year UNLESS you are a big wig administrator. They are going to start the layoffs in the nursing dept. (non clinical) but the CNO (chief nursing officer) makes a salary of over $250,000/yr. and got a 33% bonus last year. The CEO and all the others also got bonuses. Does this make ANY sense or are these people just living in la-la land?

[dmr]

22. Top heavy is a huge problem

and after the top, they are heavy with departmental administrators, then middle management, then there are the people who really run the hospitals (with care) the leadworkers or patient care managers or unit care managers, or head nurse/associate head nurse, or whatever name they may give for the various departments.

About ten years ago, I left a 1600-bed teaching hospital that at the time had 15 vice-presidents. The local media ran a series of critical articles effectively saying these costly people have a direct impact on patient care. It's hard to justify budget constraints in hiring or retaining qualified staff when you are incredibly top heavy. Because of the publicity the medical center consolidated those VPs down to 10.

I just checked their web-site and counted 23 VPs/administrators on the Executive Staff! So they are back to their old tricks.

Shameful.

When something goes wrong, it's the lower management and staff who suffer. Painfully tragic errors are made when staff levels are so low, yet the workload is critical. You work as methodically as possible to avoid errors, but not without the Executive Staff interfering through the chain of command myriad they have built to protect themselves.

In my 20 years there I have lived through some tragic, and deadly events my colleagues have endured. They each lost their jobs, rightfully so - (though if you sit on their side of the issue, you know how they are a victim of the system - even though that is not an excuse) - it's heartbreaking to watch all this unfold to someone you respect. The upper echelon should also be held accountable, but they never are. In each case I know of, the documentation was there that staffing was extremely low, the staff was working incredible over-time hours, and upper management's response each time was "do the best you can", while cracking the whip. I always called it 'betting you license', a game I could never play.

I was not in nursing, though I was the liaison between nursing and pharmacy. If there ever was a profession where they are worth and deserve more than they are given, it is hospital nursing. Nurses not only deliver medical care, they advocate for their patient. They are bull that fiercely fights the 'hospital world' for those in their care - I know I've run into many of them!

[Horse with no Name]

23. Texas has what they call "Safe Harbor"

If any nurse at any time feels that she is being asked to do too much or is overloaded--she can file Safe Harbor papers.
You still have to take the assignment, however, if anything untoward happens that can be attributed to the situation the nurse finds him/herself in, then they are not held accountable, the hospital is--these cannot be filled out AFTER the event, must be filled out before.
Our hospital has gotten so bad that there are stacks of Safe Harbor papers on every floor.:(

[w8liftinglady]

26. have you ever filled out one?I (and my co-workers)have.

Needless to say,there was silent retribution for all of us(multiple 12 hr shifts in a row,denied days off,floating).It protects you against a board action,but be aware that things may get unpleasant at work.

[Horse with no Name]

29. I haven't. My coworkers have and most of them got caught in the layoff.

I have no illusions. Doing the right thing, the safe thing, is a death knell.

[tavalon]

21. I'm a nurse

Get the insurance companies out of the system. They are the ones who leached out so much of the money. Get rid of many of the upper level managers of managers of managers, hire more ancillary staff so that nurses can be nurses instead of secretaries and janitorial staff, get computer charting so that misplaced papers don't happen anymore and get rock solid national protocols so rogue stupid care doesn't happen anymore and then let nurses be nurses with mandatory reasonable staff ratios so that we can go back to providing care for our patients instead of the charts. Tolerate no further abuse within the workplace from fellow staff. Zero tolerance, in fact.

Get rid of JCHCO or at least require any reviewer to be a current floor nurse. They live in ivory towers and make proclamations that are difficult to implement and therefore often get circumvented. Same with the Magnet company - get rid of them, they are leeches on the system. Force Big Pharma to stop leeching off of the system. The money was there before they ate it all.

First and foremost, let the government take over the system. I know there is plenty about government being inefficient, but the current system is beyond inefficient. The private sector wants good profit, not good care. Government hopefully will focus on good care and not necessarily on good profit.

That's probably only half of my complaints.

[likesmountains 52]

25. You said it sister! JCAHO is mostly a dog and pony show...some of the crap that comes from them

is unbelievable..get rid of insurance companies with their coding rules and 15 added steps to getting paid for a procedure. I could go on and on but I'm too tired after my 12 hour shift which afforded me one pee break for the whole day.

[rainbow4321]

28. The floor I used to work on gave us cell phones to carry with us

And like clockwork, soon as I was on a pee break, the damn phone would ring. Not that I would answer it, but it would ring. Then you'd get to go back to the floor and hear people bitching cuz you didn't answer your phone..GEE, I'm sorry, do YOU want to be the one who gets my phone to use after I answered it with pee residue on my hand???
Then I left there and went to work in an outpatient clinic, I was in awe of going into the bathroom and NOT HAVING A PHONE RING. Ditto for going on my lunchbreak..NO PHONE. I sit outside the building in peace and quiet on the back steps, soaking up the nice weather for 20 minutes or so after eating, no one calling me or expecting me to be back early from my lunch. It was such an amazing, relaxing feeling.

[GinaMaria]

24. Actually I worked at a hospital that did just what you suggested

We hired Student Nurse interns. They were paid to partner with RNs and learn patient care and the hospital offered to pay the rest of their tuition if they stayed three years. Almost all took them up on the deal and then... they had too many nurses. So these new nurses who thought they had such a great deal, were told we don't need you. We release you of your contract with us. We cannot promise you employment. It's messed up. If I had had a deal like that, I would have gone to a better school, one I couldn't afford on my own.

Water under the bridge. If I lost my job tomorrow, I would go back to nursing just to keep a paycheck and health insurance coming in, but I would spend every free moment looking for another job. 10 years took it's toll and we had relatively good nurse/patient ratio for our acuity.

[tavalon]

32. Here's the thing for me

I'm disgusted with what has happened to the system, but nursing is, for me, a calling and how many people are lucky enough to have a calling? I can't imagine not taking care of my tiny charges (I'm a NICU nurse). I keep trying to think of a backup plan if I can't take it anymore, but nothing comes.

[dana_b]

5. it can get very scary

I work in a "top ten hospital" (according to USA today) and we have similar problem although nursing ratios cuts down on this problem. However then administration decides that you have less patients to take care pf so then you don't need the help of the nursing assistants. Go figure.

We train many traveling nurses every month because we there aren't enough areer nurses to hire and then we have a hard time retaining them. Burnout is high. It's scary to be a nurse and definitely scarier to be a patient.

[mucifer]

6. I am an RN and not the most organized person. I have found that working in

peds home health and hospice is much better for me. I can't imagine working in a hospital these days. I haven't worked in a hospital for 12 years. Thank G-d for those who do.

[NC_Nurse]

8. I haven't seen them trying to retain us where I work. They have stopped hiring

and made those of us left do more and more call time at night to cover the shifts that people left.
It's considered good for some reason that they don't expect us to work more than 16 out of 24 hours in a day.
Great.

That 15th hour it's hard for me to think straight. And I am an experienced nurse.

I'm leaving as soon as possible. If I could get out of nursing now, I would. The best thing about it is the guarantee of a job. The problem is the quality of that job. The
lower stress, better hour jobs are usually filled and those people aren't moving on. The best paying jobs are the long hour, high stress jobs and
the unattractive weekends, nights and holiday shifts.

The article makes a great point about the internship of RN's vs. physicians. What always strikes me is how clueless the public is about what that means for them. The RN is the person who is there when you need them, not the MD. If they don't know what they are doing, you are screwed. The MD's leave after they see you for a short visit or finish your surgery. It's not like House, where the docs do all your tests and happen to be there when you code. Utter fantasy. The nurses are the ones who have to pick up on it when someone's going downhill. It's a skill set that requires a LOT of critical thinking and some actual TIME to assess the situation.

From what I've heard, one in five nurses plans to leave the field within 5 years. And that's not just retirees. It's sad because most of us are dedicated and good at what we do. We just don't want to be worked to death and frustrated all the time.

[w8liftinglady]

11. I don't know if you live in a "Right-to-work" state.I do.

Conditions for RNs are deplorable.And,yes-I hold administration responsible for this.My hospital made a $4 million profit last year-by cutting nurse:patient ratios.We have gone from 1:4 to 1:6 and they are trying to push that.Not to mention the fact that we are doing maNY medications/procedures that used to be done in the ICU.Most of the nurses I work with have 20+ years experience.That's the only way we pull it off.God bless the people 20 years from now,when we are all gone.

[NC_Nurse]

14. Of course. The Southeast has the lowest wages in the country - and probably

the highest ratios. GA is worse than NC was. Sigh.

[rainbow4321]

16. Hospitals go with the "a nurse is a nurse is a nurse" policy

The hospital I used to work at would pull nurses from the maternity floor or the orthopedic floor to work on our always short staffed cardiac step down unit. Don't get me wrong..these were wonderful nurses...wonderful nurses when they were working in the field of nursing that they were trained for..and that was not cardiac stepdown.
The patients didn't know that their nurse was not trained in cardiac...all they knew was that they had a nurse taking care of them.
So the hospitals get away with shuffling nurses around the hospital and the patients have no clue that they are at risk.
Of course, this was the same cardiac step down floor that tried to push our nurse/patient ratio up to 1:6..that was the same as a med surg floor, even those the step down patients were more critical/had higher needs. I had had enough and I called the State on them for putting the patients at risk. I honestly didn't expect much to happen, maybe a stern letter or phone call from the State, if that.
A few weeks later I heard that the State did a surprise visit to our facility..specifically because of our floor and it's ratio. One of the supervisors let the info slip when she did rounds one night. They dropped our ratio back down to 1:5. Still not great, 1 to 4 was ideal, but it was still better than 1:6.

And wouldn't it be wonderful if the hospitals did staffing like they do when Joint Commission is coming to inspect the hospital?? That is the ONE week that you get to enjoy a safe nurse:patient ratio, great staffing. Then Joint Commission goes and so does the safe staffing. You wonder JACHO goes back and looks at OLD staffing sheets to get a dose of reality..or do they just go along with the charade? My experience is that they go along with the staffing/safety charade.

[Horse with no Name]

17. I'm a former ICU/ER/Trauma nurse

I chose to move to maternal/child because that is what I like to do.
However, I keep getting pulled back during periods of low census. I'd rather stay home unpaid than to float.
Administrators don't understand that when you work in high stress areas such as the former--that some of us OPT to go to different areas to prevent ourselves from burning out.
Nor do they care.
Personally?
I've started using sick time when I have to float. I'm just not gonna do it.:(

[rainbow4321]

27. Yep..I had a co worker who transferred to another floor...

They couldn't pull her back right away because some hospital policy says that a "new nurse" can't be the one floated for a month or 2 so they can get adjusted to their own floor, etc...
But as soon as that time frame was up, we saw her back on our floor pretty much every night I was there...she was frustrated, like you. Especially since she was now working on our floor and NOT getting the extra pay one got for working on a specialty floor because they were paying her the lesser hourly pay she got on her NEW floor. She was pissed. Rightfully so.

[Horse with no Name]

19. Absolutely.

Conditions are deplorable. Even at hospitals where you think they are not. They just hide it better.

[midnight]

12. Please beware that this nursing shortage will be used to usher

in more foreign nurses, and not fix the long term problem.

[NC_Nurse]

15. As well as many LPN's and techs who have less training and have to be overseen

by RN's. That's what happens usually.

[Horse with no Name]

18. I haven't seen a hospital concerned with retention in many years

the ones I have seen would rather use you up and throw you out than to fix the problems that would encourage nurses to stay.
For those who don't visit the health forum--this particular OP is "must see".
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x52466

[Enthusiast]

20. 'For profit' healthcare just doesn't work. nt

[ChoralScholar]

30. Agreed

It's the common thread in all health care.

I believe it should be illegal to profit off the basic goddamn human right to be healthy.

I'm not against healthcare organizations paying people what they are worth, and owning the finest equipment you can buy... but to be in the business to PROFIT from people's MISFORTUNE/BAD HEALTH - is the lowest form of unethical.

[Enthusiast]

31. I wish everyone felt your way.

Actually nurses could have a healthy raise, if we took the unnecessary profits out of the equation. :fistbump:

[ChoralScholar]

33. Don't I know it. I'm married to a NICU RN.