Unfortunately, staffing has been an issue for as long as I can remember. You and I have both been lobbying for safe staffing legislation for years. It started to go south when hospitals became health care systems. COVID-19 just threw it south of the border!
I have been at the bedside for 37 years. I just recently went part- time. We continue to be over ratio, even with union contracted ratio, which are violated daily. I work on a surgical telemetry unit where we take care of fresh transplants and receive patients, often prematurely out of the Trauma and surgical ICU. They expect new nurses fresh off of orientation to navigate these assignments with up to 4 to 5 other patients. They expect senior nurses like myself, to take on the physicality of these assignments with little to no ancillary. But there is a new factor to this equation that has made staffing and health care subpar. The new nurses are not standing for it. They are leaving the bedside, either to travel for more pay and a better work life balance or furthering their education to get away from the bedside. I do not blame them one bit. However, the down side is nurses that have mastered a clinical area, will no longer exist. This leaves many things undone. For instance, many of our colorectal patients are being discharged without any education on ostomy care. This is because traveling nurses as well as the countless number of nurses
pulled to units they are unfamiliar with, do not know how to educate lest take care of an ostomy. When you do not feel a sense of professional growth, satisfaction and appreciation in your work, why stay? This is the general consensus today. It is why I took a step back. I just worry about who will be taking care of me?
Theresa, your message is appropriate. The sky really is falling but hospital administrators aren't interested. As long as hospitals' make decisions based on whether nurse requirements appear to be fiscally realistic to non-nurse administrators, then nurses will be demonized as wrongfully demanding and will not taken seriously by hospital administration. Post-Covid is worse than pre-Covid. Pre-Covid was bad enough, with 17% to 49% of new graduate nurses leaving acute care in their first year, depending on the study and setting. My 2019 acute care ratio of 1:5 felt unsafe already, even more so because we were perpetually short CNAs. I left acute care when they implemented 1:6, 2.5 years after I had graduated from nursing school. Nursing school taught me to think like a nurse, to prioritize based on patient safety in ways that do not make sense to non-nurses. Hospital administration has not been taught to think like a nurse and is not qualified in terms of schooling to prioritize patient safety. Hospitals should be run by people who have been taught to think like a nurse and who have recent acute nursing care experience. Hospitals are so for-profit that I don't understand how they can say that they can't afford to pay nurses for the essential, uniquely skilled patient-safety work that they do and to hire enough nurses to keep patients safe.
Thank you for sharing this article and your thoughts. It is very disconcerting that this problem is neither examined thoroughly nor addressed. It is not new. I graduated in 1968 with a B.S. in nursing. In school we were taught what turned out to be an idealized version of how we would be able to provide care as a hospital bedside nurse. As students, we were assigned just one or two patients to care for. It was indeed a rude awakening when I began to work at the bedside. Several years after graduation, I was working the evening shift in pediatrics. I was responsible for the care of 45 pediatric patients. My only assistance was 2 aides and an LPN. I requested help form the supervisor and was told to do the best I can. It was a holiday weekend, and no one was available. That evening, we had three incident reports. Fortunately, nothing serious occurred. However, I was reprimanded when I wrote on the reports for corrective action, better staffing. Several years later, I got a graduate degree and left the hospital setting. As I look back on my career, I often say that I loved the work but hated the working conditions. It is much worse today. Patient acuity has increased. My daughter and daughter-in-law are nurses. They too, left the bedside for advanced degrees and other settings. My niece, who is three years out of school is considering doing the same thing. Hospital administrators should shadow nurses for a day or two to get an understanding of why more staff is needed. Journalists need to focus on this issue. Studies that show how poor staffing negatively affects patient outcomes need to be publicized. We need better funding for health care so that better staffing can be financed. Poor staffing leads to dissatisfaction and poor retention of those bedside nurses that are the so vital to good care. It just leads to more nurses leaving the hospital setting, and the problem goes on and on. Something needs to be done if patients are to receive appropriate care. Unfortunately, I am afraid that the problem will continue. Health care just does not seem to be a priority in this country.
I love that you got to see the eclipse—with your very own expert too!
Your points about the nursing shortage remind me so much of a similar problem in teaching, a profession that is also seeing a lot of burnout post-Covid. I think a number of measures would help attract more people to both nursing and teaching. More pay, of course, but even more so I think both professions are just too demanding and exhausting. The hours required and the pace of the work (when I was a teacher I literally didn’t have time to go to the bathroom, let alone eat a relaxed lunch) are just inhuman. No one can sustain that for long. And finally, I think both professions have become less attractive because of the growing lack of autonomy. Nurses and teachers are skilled professionals and experts in what they do, but top-down directives by paper-pushers with no relevant experience can make life miserable for us.
Theresa, your concerns and perceptions are accurate for the Canadian context as well. I am part of an informal group of Canadian nurse leaders - many of us retired senior executives and academics, but some current leaders as well - who have been raising the alarm about nursing HR issues for almost a decade. We are well connected and meet with executive and professional groups to determine if we are in alignment with their concerns and needs. We produce briefing notes that are evidence informed and share them with decision makers and leaders in political and clinical settings. We get VERY positive feedback on our documents, but NO concrete, coordinated action. We have trouble getting letters to the editor and op eds in the media or any sustained media interest. We cannot apply old thinking about nursing HR planning to future estimates of supply and demand and we are engaging in magical thinking when we do. The nurses who are leaving FT employment in acute care settings are not coming back, because they are finding professional satisfaction and work life balance elsewhere. Most policy makers, decision makers and healthcare leaders are blind to the revolution that is taking place in nursing and what it investment it will attract and keep them. They can't recruit their way out of this problem, but they seem completely unwilling or unable to address the root problems that are driving nurses out of their current employment settings, - problems that have been well articulated by others in this comment string. thank you for keeping the issues up front and alive.
That is an amazing story, Theresa. I wonder how many personal stories like that could come together in one article to make your point? Wouldn't the floor nurse be held responsible for negligence if someone dies unnecessarily? That's why 1:5 and 1:6 felt so untenable to me, because I cannot be in 6 rooms often enough to know how everyone is doing so I felt irresponsible for entire shifts, ended up on light duty because I was so stressed, then found another job.
Theresa ~ again excellent article and appropriate !! I just wish it WAS in the NYtimes or you were on CNN etc. I’m back from a travel position and starting a Baylor shift with Hospice as an admissions nurse. …I cannot comment on the new job yet but personally I continue to witness staffing shortages. I am trying to be hopeful about my new position but I have had an underlying lack of enthusiasm about being a nurse for many years now . Our system remains broken . I am worried about who will care for the sick as time marches forward .
It’s a mourning of sorts of a profession I held to such a high regard .
This is why I try to read everything you write. I love the clarity when you explain what’s going on and it’s like you have been eavesdropping on me and my coworkers! Thank you for validating these truths.
Our colleagues and not just nurses are hurting and because of greed and there is no fix in sight. We have good evidence of what would work to fix things but no support. Lots of support to have meetings and set up committees but don’t dare try and be productive.
The young practitioners understand this and not willing to continue to be a part of it.
If you have been a patient or caregiver for someone with a chronic illness the amount of incompetency and waste of money and time is mind blowing.
Theresa, you are speaking up about what you hear from colleagues all around the country, and it is a message different from that of the report cited. So no, you are not Chicken Little, nor are you reflecting any personal emotion: you are reporting what you are observing, and the reception to those observations is underwhelming, to say the least. That is not a good place to be for nurses, patients, or our healthcare system. Keep witnessing, as yours is at least a voice able to be heard.
Unfortunately, staffing has been an issue for as long as I can remember. You and I have both been lobbying for safe staffing legislation for years. It started to go south when hospitals became health care systems. COVID-19 just threw it south of the border!
I have been at the bedside for 37 years. I just recently went part- time. We continue to be over ratio, even with union contracted ratio, which are violated daily. I work on a surgical telemetry unit where we take care of fresh transplants and receive patients, often prematurely out of the Trauma and surgical ICU. They expect new nurses fresh off of orientation to navigate these assignments with up to 4 to 5 other patients. They expect senior nurses like myself, to take on the physicality of these assignments with little to no ancillary. But there is a new factor to this equation that has made staffing and health care subpar. The new nurses are not standing for it. They are leaving the bedside, either to travel for more pay and a better work life balance or furthering their education to get away from the bedside. I do not blame them one bit. However, the down side is nurses that have mastered a clinical area, will no longer exist. This leaves many things undone. For instance, many of our colorectal patients are being discharged without any education on ostomy care. This is because traveling nurses as well as the countless number of nurses
pulled to units they are unfamiliar with, do not know how to educate lest take care of an ostomy. When you do not feel a sense of professional growth, satisfaction and appreciation in your work, why stay? This is the general consensus today. It is why I took a step back. I just worry about who will be taking care of me?
Theresa, your message is appropriate. The sky really is falling but hospital administrators aren't interested. As long as hospitals' make decisions based on whether nurse requirements appear to be fiscally realistic to non-nurse administrators, then nurses will be demonized as wrongfully demanding and will not taken seriously by hospital administration. Post-Covid is worse than pre-Covid. Pre-Covid was bad enough, with 17% to 49% of new graduate nurses leaving acute care in their first year, depending on the study and setting. My 2019 acute care ratio of 1:5 felt unsafe already, even more so because we were perpetually short CNAs. I left acute care when they implemented 1:6, 2.5 years after I had graduated from nursing school. Nursing school taught me to think like a nurse, to prioritize based on patient safety in ways that do not make sense to non-nurses. Hospital administration has not been taught to think like a nurse and is not qualified in terms of schooling to prioritize patient safety. Hospitals should be run by people who have been taught to think like a nurse and who have recent acute nursing care experience. Hospitals are so for-profit that I don't understand how they can say that they can't afford to pay nurses for the essential, uniquely skilled patient-safety work that they do and to hire enough nurses to keep patients safe.
Thank you for sharing this article and your thoughts. It is very disconcerting that this problem is neither examined thoroughly nor addressed. It is not new. I graduated in 1968 with a B.S. in nursing. In school we were taught what turned out to be an idealized version of how we would be able to provide care as a hospital bedside nurse. As students, we were assigned just one or two patients to care for. It was indeed a rude awakening when I began to work at the bedside. Several years after graduation, I was working the evening shift in pediatrics. I was responsible for the care of 45 pediatric patients. My only assistance was 2 aides and an LPN. I requested help form the supervisor and was told to do the best I can. It was a holiday weekend, and no one was available. That evening, we had three incident reports. Fortunately, nothing serious occurred. However, I was reprimanded when I wrote on the reports for corrective action, better staffing. Several years later, I got a graduate degree and left the hospital setting. As I look back on my career, I often say that I loved the work but hated the working conditions. It is much worse today. Patient acuity has increased. My daughter and daughter-in-law are nurses. They too, left the bedside for advanced degrees and other settings. My niece, who is three years out of school is considering doing the same thing. Hospital administrators should shadow nurses for a day or two to get an understanding of why more staff is needed. Journalists need to focus on this issue. Studies that show how poor staffing negatively affects patient outcomes need to be publicized. We need better funding for health care so that better staffing can be financed. Poor staffing leads to dissatisfaction and poor retention of those bedside nurses that are the so vital to good care. It just leads to more nurses leaving the hospital setting, and the problem goes on and on. Something needs to be done if patients are to receive appropriate care. Unfortunately, I am afraid that the problem will continue. Health care just does not seem to be a priority in this country.
I love that you got to see the eclipse—with your very own expert too!
Your points about the nursing shortage remind me so much of a similar problem in teaching, a profession that is also seeing a lot of burnout post-Covid. I think a number of measures would help attract more people to both nursing and teaching. More pay, of course, but even more so I think both professions are just too demanding and exhausting. The hours required and the pace of the work (when I was a teacher I literally didn’t have time to go to the bathroom, let alone eat a relaxed lunch) are just inhuman. No one can sustain that for long. And finally, I think both professions have become less attractive because of the growing lack of autonomy. Nurses and teachers are skilled professionals and experts in what they do, but top-down directives by paper-pushers with no relevant experience can make life miserable for us.
Theresa, your concerns and perceptions are accurate for the Canadian context as well. I am part of an informal group of Canadian nurse leaders - many of us retired senior executives and academics, but some current leaders as well - who have been raising the alarm about nursing HR issues for almost a decade. We are well connected and meet with executive and professional groups to determine if we are in alignment with their concerns and needs. We produce briefing notes that are evidence informed and share them with decision makers and leaders in political and clinical settings. We get VERY positive feedback on our documents, but NO concrete, coordinated action. We have trouble getting letters to the editor and op eds in the media or any sustained media interest. We cannot apply old thinking about nursing HR planning to future estimates of supply and demand and we are engaging in magical thinking when we do. The nurses who are leaving FT employment in acute care settings are not coming back, because they are finding professional satisfaction and work life balance elsewhere. Most policy makers, decision makers and healthcare leaders are blind to the revolution that is taking place in nursing and what it investment it will attract and keep them. They can't recruit their way out of this problem, but they seem completely unwilling or unable to address the root problems that are driving nurses out of their current employment settings, - problems that have been well articulated by others in this comment string. thank you for keeping the issues up front and alive.
Thank you so much for the great writing and advocacy.
And hugs to you, Theresa. I feel you. I share your passion to fix this.
That is an amazing story, Theresa. I wonder how many personal stories like that could come together in one article to make your point? Wouldn't the floor nurse be held responsible for negligence if someone dies unnecessarily? That's why 1:5 and 1:6 felt so untenable to me, because I cannot be in 6 rooms often enough to know how everyone is doing so I felt irresponsible for entire shifts, ended up on light duty because I was so stressed, then found another job.
Theresa ~ again excellent article and appropriate !! I just wish it WAS in the NYtimes or you were on CNN etc. I’m back from a travel position and starting a Baylor shift with Hospice as an admissions nurse. …I cannot comment on the new job yet but personally I continue to witness staffing shortages. I am trying to be hopeful about my new position but I have had an underlying lack of enthusiasm about being a nurse for many years now . Our system remains broken . I am worried about who will care for the sick as time marches forward .
It’s a mourning of sorts of a profession I held to such a high regard .
Be well Theresa … so much going on !
This is why I try to read everything you write. I love the clarity when you explain what’s going on and it’s like you have been eavesdropping on me and my coworkers! Thank you for validating these truths.
Our colleagues and not just nurses are hurting and because of greed and there is no fix in sight. We have good evidence of what would work to fix things but no support. Lots of support to have meetings and set up committees but don’t dare try and be productive.
The young practitioners understand this and not willing to continue to be a part of it.
If you have been a patient or caregiver for someone with a chronic illness the amount of incompetency and waste of money and time is mind blowing.
Theresa, you are speaking up about what you hear from colleagues all around the country, and it is a message different from that of the report cited. So no, you are not Chicken Little, nor are you reflecting any personal emotion: you are reporting what you are observing, and the reception to those observations is underwhelming, to say the least. That is not a good place to be for nurses, patients, or our healthcare system. Keep witnessing, as yours is at least a voice able to be heard.