Thursday, June 09, 2005

For my nice pal from Digitalstakeholders-dot-org...

I cannot fathom the rationale for a so-called "critical nursing shortage" in light of your postings.

God love him or her; s/he's brought out my soapbox.

I paint a really rosy picture of being a nurse. Most of the nurse bloggers I know do; it's because we have the time and energy to blog because we work in good facilities. But there *is* a critical nursing shortage--and don't let the word "critical" make you think that everything that follows it is hyperbole. It's not.

The facility where I work is private. It's famous all over the South for the work that its surgeons do. It's one of those places where you meet doctors from all over the world who've competed hard to gain fellowships. We recruit nurses from all over the country, from some of the finest nursing schools around (both two- and four-year; we're not snobby that way).

As much as I bitch about the administration, there are certain things that are unique--and wonderful--about the place where I work. The attending physicians have nicknames. Nobody is verbally or physically abusive. The patient-to-nurse ratio is quite low. The pay is good, the support staff is smart and competent, and teamwork is emphasized.

I've heard stories from non-nurse friends that chill me. One woman told me about going to visit her mother in the hospital and seeing a nurse punched by another patient's family member. I've been told about doctors screaming obscenities at nurses in a patient's room. And I've heard one story from a pal about the hospital her father was in--the place was so badly controlled that he was beaten up by his roommate.

The stories from nurses are even worse. One woman I precepted as a student nurse accepted a job with a fairly prestigious hospital and got a three-week orientation (ours is twelve). On her first day as a brand-new nurse, she got nine patients. Nine. With no practical nurse to work with, no patient care aide, nobody. I hear stories from colleagues of sixteen or more hours of mandatory overtime a week, or worse, of being so overwhelmed that your charting isn't done until three hours after your shift ends.

No wonder there's a nursing shortage. You know the shortage is bad when Our Beloved Governator, Arnold, calls nurses a "special interest group" because the unions had the temerity to fight for safe nurse-to-patient ratios.

We're at about a ten percent vacancy rate across the country right now when it comes to floor nurses. Critical care and specialty vacancy rates are even higher. (Don't even ask about rural and deep-urban shortages.) We just aren't graduating or keeping enough nurses to staff the hospitals we've got; at the same time, we're having to build new hospitals to keep up with demand.

Part of the problem is in nursing schools. Teaching positions pay shit, compared to working on the floor, and the hours are even longer than those of floor RNs. There aren't enough teachers to go 'round, so there aren't enough spaces in nursing schools. My class started with thirty (out of 228 applicants) and ended with 21--not a bad attrition rate, if you think about it, but a horrible acceptance rate.

Part of the problem is with nursing curriculum. Especially in two-year programs, the workload is insane and the competition horrendous. Medical residents go through an eight-year weeding process to cut out the dead wood; we get two years. A couple of my colleagues graduated with less than a third of the classmates they started with. This is one of those necessary evils: if you're not quick enough, smart enough, and strong enough to handle the schooling, you're not going to be able to handle nursing.

But the main problem--the thing that is solvable but unsolved--is the fact that hospital administrations see nurses as a homogenous group of masochistic machines who'll do anything for a three-thousand dollar signing bonus. Money rarely gets put aside for continuing education, cost-of-living increases, or special awards. Nurses are unrecognized, on the whole, and expected to take on ever-more-critical patients with ever-less-available resources.

And hospital CEO's, like CEOs all over the country, make gazillions of bucks. Consultants get hired to tell hospitals how to improve customer service (ignoring the best way to have happy patients--have happy nurses). New hospitals get built with all the latest bells and whistles, then offer only 80% of market rate, thinking that nurses will be happy to get taken for a ride, as long as they get all the greatest technology.

So yeah, beloved DSH, there is a rationale there. And the shortage is critical *right now*--maybe not across the entire country, but it's certainly dangerous in spots. (One of our sister hospitals has *two* nighttime RNs for its orthopedic unit.)

Now I'm going to put the soapbox away, thank heaven for my job, and go get some coffee.


EmJC said...

I like your brand of soap(box). It's always amazing to consider the disconnect between the needs of nurses and decision-makers. The 9:1 ratios and the like chill me to the bone.

Kelly said...

Good lord; come forth ye nurses to Minnesota, home of the 6:1 ratio on nights and 4:1 on days for my neurology floor (same ratio at all the hospitals I've seen). Some of the smaller hospitals have higher ratios, but less paperwork, so I've heard...We also have good pay. We'll be happy to have ya!!

Kit Is Knitting said...

Oh hell yes. Not that I've ever felt like I've been overworked, but it was beaten into me that nursing is a hellish task where you will have six or more patients in a day to care for and you'd best not let anyone slip through the cracks before you do.

When I went to nursing school, we didn't have people drop out because the work was too hard, however. We had nursing students failed due to a personality conflict between the student and the teacher. A teacher has a problem with a student and that's one less nurse out there to help fill up the shortage. Great, huh? I was threatened in this manner as well.

And yet, I would not want a different occupation because I know that I can make a difference, even if it's a small one.

I just wish I didn't have to work like a dog for peanuts. I don't even *like* peanuts.

Ron Sullivan said...

I got on my soapbox about this subject in another nursing blog's comments... Good thing it's a portable soapbox.

Nurse training and its various deficits make one part of the problem. Nurse retention is just as bad. Do you know how many ex-nurses there are in this country? When I burned out and started training for my second career, I found that about 10% of the students in my fairly large community college were ex-medical pros, must of them nurses. And that was 20 years ago, when things were less dire all 'round.

I'm 55 years old. I have been hearing about "critical nursing shortages" all my adult life. I'm not sure whether it comes in waves or whether I just turn my ear to it periodically. Importing nurses is nothing new. It's funny, isn't it, that the Almighty Free Market somehow hasn't solved the whole problem by now, that nurses aren't either making large fortunes or hugely oversupplied.

Maybe some of it is because we're still mostly women, and there's a funny thing that happens when anything female-related is perceived to be in short supply. Think about childbearing rates in much of Europe, for example, and how governments are reacting. (I personally think it's a crock. There are six billion humans on the planet and that's enough!) But it's all stopgaps and guilt-trips; nothing that would actually make what they want us to do any more rewarding or less onerous.

We're a "renewable resource" -- just like old-growth forests. And you can see what's being done to them.