There is NO Nursing Shortage – An Open Letter to The New Yorker Magazine
by The New England RN (who prefers to remain anonymous)
November 5, 2015 – James Ledbetter touched on some good points in his recent article, “Why Is The U.S. Perpetually Short On Nurses?”
According to commentary on various nursing boards across the net, it’s clear the article has also triggered some interesting dialogue.
Nurses across the U.S. would like to invite an adventurous journalist to look with a deeper perspective into what is actually happening in the nursing arena!
There is so much more happening alongside the rewarding aspects of being in the Nursing profession. I underscore that it would take a journalist who is adventurous because to cover the terrain of the actual full spectrum truth within nursing will take some courage and stamina.
As an adventurous journalist, you’ll need somewhere in the vicinity of the fortitude required for a nurse to consistently run 8-12 hours on foot, often at a pace of let’s say, running for a bus. Combine this with having to mentally override your bodily functions. There are no pit stops to eat or use a rest room. Instead, add a steady diet of mind numbing bombardment of stimuli from patients, family, machines and phones calling out in constant need. Be sure to keep all those important life saving facts on the top of your gray matter to ensure positive patient outcomes.
Next, you discover there are not enough resources in the way of adequate staffing. By the very nature of the health care construct, adversarial push back from managerial or administration demands often exists.
Last, you would have to be able to be the type of journalist who is able to tolerate having your days garnished with the fear factor (and not the fun entertaining kind) such as all the reasons you need liability insurance, the pervasive hostile incivility and bullying from just about anyone in your environment, the loss of trust with those who vowed to do no harm but found themselves abandoning that idea with the push for profits, physical and emotional violence from patients who strike out, whether intentionally or because of a dementia-ridden mind.
Keep on the top of your brain now that you always have to be “Johnny on the spot” while being in judgment from peers, regulatory agencies and compliance police.
Now, let’s say you’re a pretty savvy and seasoned journalist who has ventured into some war torn areas to cover a story. You are a person who is experienced with life and death up close and are acutely aware of the mortality all around you. With your experience, you’re likely ready to look at some of the environments in which nurses are trying to execute this once sacred profession.
Allow me to demystify a few points for the sake of getting the conversation started. I say a few points because there is an overload, a back breaking mother load of scenarios that still have not been brought to light or resolution. For every nurse, there are stories that would fill volumes more than the size of a few hardcover Physician Desk References (PDR). Presently, there is a general consensus that conveys that nurses love nursing for what it once was, how it was taught and mentored to them and what it could be, but not for what it has become.
So, in order to prevent the piano that I am going to toss out the window from landing on your head, let’s start with only a few points, just as fair warning.
1) THERE IS NO NURSING SHORTAGE
There hasn’t been one for a very long time. Just about the mid 1980’s, “someone said somewhere” that there is an impending nursing shortage. So why, oh why, wouldn’t it be true? You read about it in magazines and saw it on the news…all those trajectory graphs. “It’s been the song that never ends…it goes on and on my friend…” .
Suffice to say, the colleges and universities clearly got this song stuck in their heads and started recruiting from high school shindigs to hospital awareness chats. Students come wielding their tuition and a new sense of purpose and meaning. How can their bright, rose colored futures go wrong? They have been told they will have recession-proof jobs with huge financial rewards in environments full of humanity. So in exchange for their blood, sweat, tears, empty bank account and first born…they launch into their career of ………(crickets)
The reality is, new graduates suffer huge disappointment and confusion by having to explain to everyone from hill to dale why there is difficulty getting a job in nursing. This adds to the confusion of the people to whom they are explaining. After all, there is nursing shortage, right?
The New Hampshire and Massachusetts Boards of Nursing concur. There is NO nursing shortage.
The current trend now is that a new Nurse will have to earn stripes in a proving ground environment, such as a Long Term Care Facility (LTCF) aka Skilled Nursing Facility (SNF) for about a year before being considered for a position in an acute care setting…that’s fancy talk for a hospital. Outside of those who are able to land a position in Long Term care, there are many other nurses scrambling for ‘something…anything…do you know anyone who can get me in?’ Ask any hospital Human Resource department how many applications from Nurses they get in daily. Luckily, only 50 percent of nurses work in hospitals, so there’s still hope yet.
2) NURSING GLUT BRINGS LOWER PAY RATES
So where are the big bucks that all of the nurses have been told are out there waiting for them? The pay rates have lowered or have frozen over the past 20 years. With a nursing glut comes lower wages. There is always someone willing to do it for less. So, good bye to nurses of longevity with invaluable skill sets and higher pay rates and hello to new grads who are compelled to take lower paying jobs in order to work in the profession they so rigorously trained for. So who is happy here? Happy are those corporate entities that get to keep more for a very long list of things that don’t include compensating nurses adequately. I think dealing with secretions alone, warrants significantly more than $24/hour. That is what one nurse reported this week as earning in Ohio in an Intensive Care Unit (ICU). To put this in perspective, I was earning $3 more an hour than this as lower-degreed nurse in 1997.
3) THERE ARE AN ABUNDANCE OF NURSES WHO ARE UNWILLING TO WORK WITH UNSAFE NURSE/PATIENT RATIOS
Many things constitute an unsafe environment for both the nurse and patient. It all starts with the basics of available hands to perform the safe, competent care. Lack of staffing is not due to the lack nurses in the U.S. It has to do with keeping costs down for the corporation. There are unsafe nurse/patient ratios everywhere, not just the hospital setting. I have given up working in Long Term Care/Skilled Nursing Facilities where nurses are expected to pass medications, execute wound treatments, breathing treatments, maintain oxygen, prevent falls and other emergencies and much more for an average of 35 patients on day and evening shifts. Once the night shift hits; you are saddled with anywhere from 40-60 patients. But, what about the Certified Nurse Aides that help, you say? They are great if there are any. The last place I worked in gave me a unit 40 patients and a singular CNA who didn’t feel like working that night. Where is the safety or humanity in that?
FEEL THERE ARE QUESTIONABLE ETHICS
Nurses love people. Caring for you is a calling. We really do want to take care of you the way we would want to be cared for. But the corporate structures only understand numbers and profits. They will talk a good game about the rest. All of the suits will be on the heels of the uniforms to this end. The real end result is that it prevents most nurses from providing care in the manner that feels good and rewarding.
It is simply humanly impossible to cover all of the demands. Nurses feel bad when they have to shave off everything but the highest priorities, work off the clock, not take that mandatory half- hour break that you have to say you took because ‘it’s the law” and your employer knowingly docks you for that time. The last place I worked in had a financial incentive for administration to keep costs down. How they decided to do this was what I call “play with the schedule.” The schedule would go up for all to see that all the shifts were covered by so-and-so regular staff and so-and-so agency staff. It’s not before long you realize these agency staff do not exist. So when Jane Doe from the agency doesn’t show up for work; the regular staff has to work short-handed and the corporation keeps those funds. The financial incentives for administration are what keeps this and other creative behaviors continuing. Meanwhile, a lot of smoke and mirrors are held up to the public eye. There are a slew of ways nurses are finding themselves in conflict with ethics and integrity.
WHERE BULLYING, INCIVILITY AND THREATENING EXIST
An employer does not value its nurses if they allow bullying to thrive. It has become the rule rather than the exception to experience bad behavior from other healthcare staff at all levels. It’s a complex issue with those entrusted to keep an even keel are often willing participants. I know, hard to believe.
But some facts and realities, although painful, need to be looked at before it can heal. 1 in 3 nurses are leaving the profession because of bullying according to Claudia Sanborn, RN, author of “Yellow Sick Road.”
Melissa Brown, RN, founder and facilitator of GuerrillaNurse on Facebook (https://www.facebook.com/GuerrillaNurse) was put on probation by her hospital employer two weeks after pressing assault and battery charges against a patient who battered her. Less than three months later, she was fired. The American Nurses Association (ANA) has come out with a statement recognizing this as a real problem that needs serious attention. http://www.nursingworld.org/Bullying-Workplace-Violence
Yes, something has gone horribly awry in our heart centered, caring profession. For anyone experiencing this, consider contacting the go-to guru Renee Thompson: https://rtconnections.com/. She is an expert on this topic from top to bottom and will guide you with her light.
My observations and experience over the past 30 years as well as experiences compiled from others nurses who are either still in the trenches, on the ledge or have run from the profession like their head was on fire tells me it is time. It is time to look deeper at where the system has broken without debate but with a focus on solutions and healing. Nurses were made for this.
Accurate journalism will help. I know there are many amazing Nurses working to facilitate the healing of the wounds within the profession. Please support these efforts. Join initiatives that give support and groups premised on the Golden Rule. Share what brings the best out as we navigate the broken systems. Keep with your heart centered goals in Nursing. No matter what profession you have committed to, please remember to bring compassion, integrity and caring in all that you do.