SMILING ON THE OUTSIDE . . .The next time you’re in a hospital – hopefully as a visitor – watch the nurses as they interact with Uncle Stanley, you and his family, the residents and other physicians, the pharmacy, the therapists, housekeeping and dining services. It quickly becomes obvious that it is nurses who make things work.
That makes the crisis in American nursing all the more disturbing.
Unlike the U.S.’s crumbling highway and bridge infrastructure, this crisis gets precious little attention because nurses usually aren’t a complaining sort and few are organized, let alone unionized, and really don’t have a voice. This includes a voice in the ongoing debate about what to do about American’s ailing health-care system. Yes, the one that nurses make work.
The crisis in nursing is playing out one nurse and one hospital at a time, a kind of slow-motion Hurricane Katrina as older and more experienced nurses leave the profession.
A study on nurses in
If "frightening" seems too strong a word, consider the study’s key findings:
* The nursing shortage in
To wit: The average age of a registered nurse in the state is 52, while the general population is living longer and its fastest growing segment is those over the age of 85.
* Nurses are deeply dissatisfied with their jobs and some with nursing in general.
The major reasons are poor or nonexistent retirement benefits, inadequate salaries, lack of job opportunities and oppresive work environments.
* Nurse workload is a crucial factor in driving dissatisfaction.
More than 50 percent of direct-care RNs interviewed for the study said there were too few RNs and support staff to properly do their jobs. Further, almost 40 percent said that because of their workloads, their ability to identify important changes in patients’ conditions was diminished.
This is defined as emotional exhaustion, and these nurses were four times more likely to leave their current positions.
* The shortage is exacerbated by the inability of
The schools lack the resources to hire additional faculty, RNs with graduate degrees are in great demand and some schools have to turn away qualified applicants. This is not merely a lack of funding – there is a major disparity between what schools pay and what the health-care industry pays, as well as what nursing schools pay their professors compared to engineering and other schools.
While there have been incredible advances in treatment, there has been a sea change in health care, which has become an industry in the most literal sense. Today virtually all providers -- whether they are hospital corporations or universities -- are in business to make money.
The major way that these entities have increased their profit margins is to decrease hospital staff, including eliminating license practical nurses and nurses aides, and in many instances housekeeping staff, transport staff and laboratory technicians.
The responsibility for those positions has been shifted to RNs, and while quality of care has not necessary suffered because of this exploitation, the burden on nurses has been awful and the high burnout rate is a consequence.
As a much in demand critical-care nurse of 30 years experience in
"The pool of experienced, street-smart nurses is diminishing and is not being replaced as rapidly as it is being depleted.
"There is a nearly complete disconnect: Nurses cannot survive the hours. They cannot survive their employers. They cannot afford to live in the very communities where many hospitals are located. They are not part of the equation except when it comes to liability. What I mean is that they're liable no matter where the breakdown may be in the treatment chain."
I asked this nurse if there was any hope of things getting better. She replied that:
"I suspect that their pay will go up. But things will not get better insofar as their professional standing, exposure to liability because of screw-ups elsewhere in the system, fringe benefits, eligibility for tax deductions, and so on.
"You'd better believe that we'll still be on the firing line."
And still the ones who make things work.
4 comments:
(sigh)
So true, so true. How to compensate? The pay will go up, she's right. Our contract was finally renewed last summer after suffering four years without one, and there was a retroactive increase of about 11%. Great, except it's already expired and to be honest, the money doesn't help. It really doesn't.
We're still wildly understaffed, stretched too thin, no supplies etc etc.
I've only been a nurse for four years and already I want out. But who will replace me?
This comment was received via email from Alwin Hawkins:
And New Jersey has relatively good Medicare reimbursement rates, allowing them to - at least theoretically - pay more.
Not true in the Northwest, an area long dominated (since WWII, as a matter of fact - think "Kaiser Permanente") by HMO's that drove costs - and reimbursement rates - down. A lot of the economies that are being thrust upon the right half of the US have been a fact of life here for decades.
And I - like so many of my aging colleagues - have left the bedside. After 2.5 decades of night shift in the critical care units, I was unable to make a whole shift - not even a whole hour - on my feet without my legs going numb. Now working at a disability insurance company, who values my experise as much as my colleagues did. Too bad the suits couldn't figure out a way to keep me on, but such is life in the industry of health care today.
And yes, I know - I need to start writing again. I have a marvelous new perch from which to watch the wanderings of the ill and injured now. :-)
It's lucky that I'm a courageous guy, otherwise this sort of stuff could scare me off before I even start! ;)
It may be bad for nurses, but nurses have lots of other career possibilities than bedside nursing. It will be worse for patients...
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