Why nurses quit

Ed1937

It's a paywall. https://www.nytimes.com/2022/01/19/opinion/nurses-staffing-hospitals-covid-19.html?  

Jo C.

That is pretty accurate as one of the significant causes for nurses leaving their profession.  The lack of respect for our educated, hard working RNs can be breathtaking.  For the most part, there is very sparse to no autonomy for them.  Many DONs are good at what they do and are proactive as much as can be for their nursing staff, but that being said, there are far too many DONs who are self-serving and they do indeed get very, very generous annual bonuses predicated on keeping their budgets low as possible and even under projection as much as possible.  This of course means skimping on staffing and even unwanted assignment switches.  Some DONs are absolute ogres and one wonders how admin. keeps them except they deliver on budget and cost savings and also keep the staff in line; (often out of fear.) 

And then the poor nursing assistants who we usually call the, "aides."  They are in an even worse situation with no power for very low wages and they are so needed.  Even when unions are involved the issues are often still there and that can be another whole story depending . . . nurses and aides are exhausted. 

I have seen RNs (and aides) who are med/surg nurses, or peds nurses, OB nurses, etc.,someetimes  being relegated to other floors/units with little to no experience in that area just to cover low staffing; often due to not having sufficient backup staff.  Many hospitals must also depend upon registry nurses to backfill staff at a huge increased cost, traveling RNs too are a huge expense but are now used more and more often.

 There are some hospitals where nurses are valued, and the patient is still considered the "customer" to be valued and true quality care is paramount; but in my personal experience, far, far too many are driven by profit without that being primary consideration.  Also just look at the upper tier admin and corporate salaries. Mind boggling comparitively speaking.  Then you get the uber-merging of multiple medical centers into one huge conglomeration; things can and often do get worse.

Medicare went from fee for service to the DRG (diagnosis related group) reimbursement where the hospital is paid one flat fee for the diagnosis that caused the patient's actual hospital admission . . . if  the patient goes home early, the hospital keeps the money as profit not spent from the DRG assigned.  However; if the patient stays longer or develops an increased illness or secondary issue such as pneumonia, infection, etc, and the cost of care exceeds the DRG diagnosis payment, then the hospital loses and must absorb that financial loss out of their own pockets.  This often has patients leaving the hospital, "sicker and quicker."   Medicaid reimbursement is dreadfully low.  Private insurance does not pay big bucks; most insurances contract low rates at hospitals.   (Physicians also have a very difficult tme with contract rates and length of time for reimbursement in their practices.)  These issues affect income and the increasing costs of running med centers, it is all part of the huge problem.

Somewhere in all of this "soup," the floor staff; RNs, Aide, Housekeeping, etc. are where the "snip, snip," is made - the biggest part of costs are wages and benefits . . .  cut wages, benefits and staffing and do more with less seems to be the outcome which of course causes other problems.  Lack of power, lack of autonomy . . . . my heart goes out to the staff.  Sooner or later, every one of us will become dependent on these fine professionals and support staff not only for our LOs, but for ourselves.

Being Administrator of Patient Care Management at various med centers, despite all of my professional staff being RNs, we were not under the Nursing Department which was a blessing, but we too were hit with the cost containment issues; I could really see the dynamics from the top down in all layers of the hospitals.   It is so difficult and no easy answers for what is here to stay.  I do not see it getting alot better soon.  The pandemic certainly has not helped; what a nightmare.  NOTE:  In one of my recent journal readings, it indicated that hospitals are now going out of country or deciding to do so in order to recruit and hire foreign nurses to fill staffing needs.   So much different at so many levels from other countries/cultures, but warm bodies to put into place and hope all works well.

Nurses and other hospital staff are so often exhausted both physically and psychologically. Remember to thank them for their care should you receive services; even "thank you," means so much.

Guess I am through chewing on the door knobs now. 

J.

Ed1937

Jo C. wrote:

 Remember to thank them for their care should you receive services; even "thank you," means so much.

My wife was in the ER, night before last. The RN who took care of us went overboard to make us both as comfortable as possible. She did not know my wife was an RN until she was released. I thanked her for making things as easy as possible. I'll also be calling DON to put in a good word for her. 

Joydean

Most nurses are in my opinion the life of the hospital. They work their tails off and do it with a smile for patient. They seldom have time to go to restroom, lunch that’s a bite here and maybe there, not a sit down prop your feet up 30 minutes! That doesn’t happen. My daughter is children trauma RN, also has to fill in in the ER. I have seen her cry and be so angry because of the conditions of some of the little babies that are brought in and even the police know the damage done to some of those babies was done by family members . And yet they keep on working because when they can help save some it is so rewarding. That’s why nurses work their tails off!  My opinion.

Ed1937

Ed1937 wrote:

I'll also be calling DON to put in a good word for her. 

Got that done this morning. I don't think we see as much compassion as we used to, and when we do, it should be acknowledged.

DrinaJGB

I was an RN for over 20 years. I quit to take care of my DH because I had no other choice

 That being said-- I would not be working in this politically charged covid environment now, anyway. The politicians have caused too many unnecessary deaths . Just saying. My paltry 2 cents' worth.

sandwichone123

When we went to a model of "health care should run like a business" things changed in nursing. We used to have busy days and slow days, where we could reconnect with our passion and our coworkers. Now we have busy days and days where someone got sent home so we're still busy. I know of a nursing program that has had a waitlist for entry for decades--their current admissions cycle isn't even full. Nursing has gotten such bad press lately that people don't even want to go to nursing school.

Travel nurses are another huge blow to morale: they don't have the same demands as staff but are paid much more.

When you get your hospital bill, there is no line item for nursing services, so there is no perceived profit in having nurses there--nursing service isn't a billable item, so it's not valued administratively.

I also read that US healthcare is recruiting internationally, decimating the health care systems of developing nations.

JDancer

Many facilities have a (very) special award called the Daisy Award. Nurses are nominated by patients, family  or coworkers. It's special honor to receive the award or even a nomination. If a nurse does something special or you are especially grateful for the care received, ask if they can be nominated for a Daisy Award.

Crushed

DW was a physician but when she was developing hospital information systems she "weighted" the feedback committees by the time various professionals spent with the patients relying on the information system and the consequences of errors. Nurses ended up with  about 60 % of the input, physicians 25 %  and everybody else 15 %.  So the systems were designed to make it easy for nurses to input and output the information they needed.  a two finger code (NM for nursing management, N and M are next to one another on the keyboard ) instantly brought up all the current vital information needed for care

The nurses loved her.  

 

Jo C.

Oh my goodness; I was just reading the latest online issue from the Family Caregiver Alliance, and in it was a link regarding just this theme and in it was outlined much of what we had discussed here.  Link:

https://www.medpagetoday.com/opinion/second-opinions/96135

Sadly true per the writing about what is happening to society as a whole . . . .

J.

Iris L.

CNAs provide the non-skilled personal care to patients.  Many are minimum wage earners.  I just read that many can get the same pay without the stresses by working at Amazon-type warehouses and distribution centers.  Fewer CNAs, more demand on nurses.

Iris

garrybort

It’s not fair how nurses are treated at all. I have seen people calling nurses names and using aggressive language towards them several times. There should definitely be legislation to protect them from abuse from the side of the patient and the hospital administration. The hospital bosses know they will have to work a lot and spend a lot of money if such a law is implemented, and that’s why they create lobbies against it.
I really want to become a doctor, and I’ve even done some reading on https://www.exploremedicalcareers.com/ about the most relevant medical fields now. But I don’t want to work in an aggressive environment where I would not be appreciated and paid well.

Ed1937

Garry, welcome to the forum. Sorry you have a need for it. I just want to say thank you for bringing this thread to life again. My wife passed away five months ago, and because you brought this thread back up, I sat down to write a letter to the nursing staff in the ER where my wife was. I think I'll hand deliver it today, along with a box of chocolates.