I have been a nurse for 15 years and I am beginning to become concerned about the nursing field lately. Presently, I am a traveler on my third assignment and I have begun to notice some disturbing things during my travels:
1. Hospitals are beginning to eliminate travel positions since they are too costly. Many hospitals are losing some of their most talented nurses for this reason and are deciding to put non experienced new grads into acute assignments in which they simply don't belong. For instance, one facility I know of is taking new grads and giving them a three month orientation into the ER and ICU. I believe they are forcing them to sign 2 years contracts stipulating that they stay to recoup their educational expenses. The problem is that the vast majority of experienced nurses are travelers and when they leave they will be left with few experienced RNS in that specialty. I have nothing against new grads but the fact is that the quality of education of our new grads is at best inconsistent. To ensure that RNS know how to operate independently in an acute care setting, they will need far more time than 3 months to possess the skills needed to be assured and confident in critical situations. I have worked in similar situations where I was the one with experience leading several new grads and the results were nothing less than disastrous. The new grads simply could not handle acute patients and I ended up taking most of them and running a 24 bed adult/peds unit. I eventually quit do to burnout.The hospitals which institute such programs can be assured that the quality of care will probably suffer. In addition, most of those who are trained will leave after 2 years since many hospitals are seeking trained nurses thus making the training programs a financial loss in the long run.
2. Salaries are beginning to drop and bonuses are beginning to dry up unless the institution that is offering them is in severe trouble. Travelers have noticed that they can no longer make ends meet with the little amount of money being paid to them . Hospital travel jobs are diminishing in number forcing travel nurses to compete against one another for the few that exist and hospitals are well aware of this negotiating lower and lower salaries and expecting more and more of their travelers including floating, more travel experience, etc. Many of us realize that these diminished salaries don't consider the cost of living increases so many of us are deciding to take ourselves back home where we can at least work another job if needed which can not be done on a travel contract.Many nurses with one to two years training are seeing the dismal conditions associated with travel and are opting to stay home.This means that travelers can expect salaries to stay low for some time until hospitals realize the futility of their efforts as permanent RNS burn out. Many hospitals know that there is quite a few new grads looking for jobs yet the hospitals don't want to hire them due to the educational expense of training them and the lack of retention in this field. Yet, hospitals can drop salaries stating that they will use new nurses if forced to thus making it difficult for us to negotiate. It also means that hospitals have the upper hand stating that that if a person doesn't line their job, they can always quit. Does this mean we can see patient to nurse ratios climb and the work become more difficult as we see hospitals lay off CNAs, Respiratory therapists, phlebotomists etc. much like they did 15 years ago? Does any one remember that nightmare? I know that California has instituted ratios but much of rest of the country has not. Do we honestly think that management will care when money is the bottoms line? i don't mind hard work but I refuse to go back to the days where the RN was forced to clean floors! I would but I think I am getting too old for it...
I know that things will probably turn around at some point but I expect that things will stay pretty much the same for a year or more. I don't want things to return to the way they were 15 years ago. Patient care was dismal and nurses burned out quickly. I love my job but quite frankly, I think I would leave nursing and work a government job for a while if needed. Having a degree in disaster management may help me in the long run. But what about all of the other nurses out there? Do you think things are as bad as I think? What should we do to turn things around? Is there any thing we can do to circumvent mangement's attempts to take advantage of us?
Most of the hospitals here are at a hiring freeze. They over built. Four of the three have cancer centers and two of the four have heart centers. With no jobs or lack of health insurance these are sitting empty. The hospitals in an effort to keep their heads above water increased what they are charging to the insurance companies and are now cutting staff and pay. My wife not only lost her COLA, but also took a 4% pay-cut.
The nursing school I am at is very worried about students leaving the area and state for better job opportunities. They are so worried the Dean sent a message to students. Why they are worried is that it is expected that there will be a large turn over of retiring nurses within the next five to ten years. Many of those nurses were planning to retire sooner, but their husbands who had factory work have been laid off and now the nurses are the sole bread winner.
Squid, I just had a thought: the hospitals that are non-profit have to spend their $$$ somehow, and tend to build/revamp, etc. Think that tax break got them in trouble?
I doubt it. I've never herd of a hospital that was overflowing with cash. The theory of hospitals being non-profit is they would provide care for people who couldn't pay, but clearly that doesn't happen. They cost shifted the cost to the people with insurance or drove those that couldn't pay into bankruptcy.
Having a number of friends that are accountants...non-profits do not have to spend to have a zero balance at the end of the day. The non-profit insurance company in this state has an over $200 million dollar "war chest" and is asking the state that they be allowed to raise their rates.
Cancer and cardiac centers were built to make money for them selves, and since they are relatively empty, they have become a money looser for them. Perhaps the most telling thing is that the cardiac centers aren't the best in the region. 1 hour south is a cardiac center of excellence, which none of the local ones are. But with all the advertising these hospitals have done the majority of the public doesn't know that they would get better care in K-zoo and not GR.
its already affecting my area...the hospital in my town laid off 31 postions. thru out the hospitals 127. the other hospitals not withing the my group had 149 layoffs. I know that some of them were nursing...not clinical nursing but more admistration. But still they were with the company 15 yrs or more. They are on a hiring freeze cut out overtime. So who does this affect the pt of course...:nurse-soapbox:
LivingDeadNurse wrote:its already affecting my area...the hospital in my town laid off 31 postions. thru out the hospitals 127. the other hospitals not withing the my group had 149 layoffs. I know that some of them were nursing...not clinical nursing but more admistration. But still they were with the company 15 yrs or more. They are on a hiring freeze cut out overtime. So who does this affect the pt of course...:nurse-soapbox:
Layoffs here have been admin personel for the most part. However, one hospital nearby laidoff all the LPN's. I guess the LPN's were told a year or so ago that they were going to an all RN nursing staff and those that did not complete thier RN (with tution assistance from the hospital) were fired. However, that hospital did not fill the terminated LPN positions with RN's.
Relevent points, everyone. It will be interesting to see just how things develop. One thing is for sure, it's getting increasingly more difficult for leaders in government, reimbursement and the healthcare delivery system to keep pushing the problems foreward. It's time to deal with the monster before it eats everybody.
R
Ricu wrote:Relevent points, everyone. It will be interesting to see just how things develop. One thing is for sure, it's getting increasingly more difficult for leaders in government, reimbursement and the healthcare delivery system to keep pushing the problems foreward. It's time to deal with the monster before it eats everybody.
R
As I mentioned in another thread, until healthcare costs get under control by using evidenced based practices everything else is pretty much small potatoes.
To add to all of this, I am tired of hearing about the "nursing shortage" when nobody is hiring! I have been unemployed for the first time in my 28yr career (since Dec.08). I bet I have applied for 30 jobs minimum (although it accounts for about every job open in this area). I am lucky if I get a call for an interview and more times than not, I hear absolutely nothing. Yep! There's a shortage but there always will be as long as nobody is hiring!:nurse-rofl:
Welcome, northernbell!
I hear ya. I know I post both the 'good news' about jobs, etc., but also the relevent 'bad side', too. It's a vicious circle.
You think it's getting bad now, wait until the 50,000 new Indian, Chinese, and Philippine nurses get here... then try to find a job.
Congress is working on bringing them over. See:
Search Results - THOMAS (Library of Congress)
If you want to know why you're being sold out, read my satirical rant.
http://www.ultimatenurse.com/forum/f5/congress-plan-end-nursing-shortage-read-act-35992/Personally, I think the only solution is a kind of unionization of nurses. We have to push for staffing ratios (4 on days med/surg 5 on nights, 2 max in ICU).
The problem is there's a lot of nursing schools out there pumping out nurses. That makes competition for any union. I think the amount of nurses is going to have to shrink. If few were becoming nurses, we could demand anything we wanted. So, I welcome hospitals not hiring nurses. In the end, it will dry up the nursing schools, and the supply of nurses.
Right now, every laid off carpenter and auto worker is running to nursing school because it's thought to be so "recession proof." Every nurse who quit to raise a family but kept her license is re-entering the workforce.
I don't mean to be Nurse Doom here, but I try to keep up on economics, and when the lead story is "Homebuilders Confidence is up slightly!" and that causes a spike in the stock market, we're in for a long haul. I read the story: there's no change in the dynamics of the housing market, but homebuilders (out of work carpenters) think there might be in the future. That's it.
Let me ask you this: anyone rushing out to buy a car? Yeah, that's what I thought; me neither. In fact, I have made the decision to keep our 2005 F250 Diesel for 20 years, minimum. I'll simply have done whatever maintenance needs to be done. It's paid off in June. Guess what I'm going to do with the extra 600 dollars a month (plus the extra 1200 we've been putting toward getting it paid off early)? Do you think I'm going to stimulate the economy? Nope, it all goes to the credit card with the lowest balance, and thus it goes until my debts are clear.
That's a really good personal decision, but it damns the economy when multiplied by the rest of us.
I looked back to previous recessions: in the 80's credit began to become popular and widespread, and everybody bought things on credit, especially personal computers. This continued, but ultimately didn't keep things up in the 90's, but that's ok. In the 90's there were smaller and better computers, and the internet soared. So that worked to pull us out of a recession. Now, there is nothing. There is no industry. "Green" can't be an industry, because it doesn't generate a profit so long as oil and coal are pleantiful and cheap, and they are.
I've racked my brain, and all I can think of is legalizing marijuana might help the economy. No one needs a better computer. No one could use a smaller phone, even if they combine electric toothbrushes into them.
Where I work, everyone is planning to get out of debt while they can--if they can. Saving money and paying off debt starves the economy. And while the economy starves, houses, cars, refrigerators, ect. don't get bought, and people in those industries get laid off, and they all go to nursing school (it seems).
Bedside nursing is recession proof in that it doesn't stop being utilized in bad economic times. What hurts is when the market gets flooded with nurses. Before this is over, BSN will be the entry level degree for nursing by all state boards of nursing. Maybe that's a good thing. I don't have one. But when all debts are paid off and I finish a writing project I have in mind, I'll go into an RN-MSN program.
Hospital in this area is not hiring quickly either. A freeze or whatever they are calling it is not good at all.
One of my instructors seems to think that going back to 8 hour shifts would help push the issue of increasing staffing while also increasing quality of care. Also with many people turning to nursing perhaps the job to have is in Nursing Ed?
I have a question. When hospitals post their profits, how much of their expenses is clearly stated as bonus or management expenses? I do realize hospitals are a business and that nurses salaries are the biggest expense. Well - duh!!! I suspect part of this so called freeze and cut backs due to financial reasons is an excuse to cut back on nursing salaries. Cut back the staff and force the remaining nurses to pick up the slack.
This leaves the patient with unsafe nurses, bad care, bad outcomes, increased infection, etc, etc. Patients are not safe and new nurses just don't know what they don't know. They are victims as well.
Until the public is aware of this, it will continue.
Pass it on.
I've noticed people are holding onto their jobs. The facility where I work is full of nurses begging to work. Aha, this puts the facility at an advantage, they are holding the reins and calling the shots. I've heard that travel nursing at hospitals is drying up because of nurses there holding their positions. Also, the hospitals here contract out with the nursing schools to get their new grads, they basically do not hire outside the hospitals anymore.
The hospitals cried nursing shortage and schools obliged by churning out nurses by the boatload. Now, the hospitals have their pick. Instead of focusing on increasing enrollment the schools should have raised their standards and decreased enrollment. This wouldn't have helped the hospitals, though.
Jo Dirt wrote:I've noticed people are holding onto their jobs. The facility where I work is full of nurses begging to work. Aha, this puts the facility at an advantage, they are holding the reins and calling the shots. I've heard that travel nursing at hospitals is drying up because of nurses there holding their positions. Also, the hospitals here contract out with the nursing schools to get their new grads, they basically do not hire outside the hospitals anymore.
The hospitals cried nursing shortage and schools obliged by churning out nurses by the boatload. Now, the hospitals have their pick. Instead of focusing on increasing enrollment the schools should have raised their standards and decreased enrollment. This wouldn't have helped the hospitals, though.
I think you're spot on here. I predict the future will see the end of the ADN programs for registered nurses. This economy is not going to suddenly become a boom again for a very long time. My guess is that in order to protect nursing, BONs will start requiring nurses to have a BSN. They may grandfather in ADNs or require that they get a BSN, but it's the only way to protect nursing.
I have a B.Sc. in another field and would love to get a degree in math, but I will probably, eventually, after debts are paid off, go into an RN-MSN program. I don't like doing that, but I think eventually, I will have to to remain competitive.
We'll see.
Was talking to a former LPN teacher of mine, and she'd said we go through 'cycles' of needing nurses and all. I seem to remember her mentioning other times of over-gluts and crises, but can't remember exact time periods.
cougarnurse wrote:Was talking to a former LPN teacher of mine, and she'd said we go through 'cycles' of needing nurses and all. I seem to remember her mentioning other times of over-gluts and crises, but can't remember exact time periods.
I agree, the nursing profession has always gone in cycles of plenty, then shortage often times in parallel with the state of the economy.
BTW, IMHO we will always have ADN programs just as we will always have LPN programs. I'm all for furthering one's nursing education but seriously doubt the ADN will ever cease to exist.
... my 2 cents
SoldierNurse wrote:I agree, the nursing profession has always gone in cycles of plenty, then shortage often times in parallel with the state of the economy.
BTW, IMHO we will always have ADN programs just as we will always have LPN programs. I'm all for furthering one's nursing education but seriously doubt the ADN will ever cease to exist.
... my 2 cents
Out of curiosity, why do you think the ADN programs will always continue? Apparently, they are all that's needed to make a capable RN, but look at social work, and physical therapy and pharmacy. See how their educational requirements have become inflated? Why not the same thing in nursing?
Last Nurse Standing wrote:Out of curiosity, why do you think the ADN programs will always continue? Apparently, they are all that's needed to make a capable RN, but look at social work, and physical therapy and pharmacy. See how their educational requirements have become inflated? Why not the same thing in nursing?
My daughter is a junior in pre-physical therapy, which some day [God willing] when she finishes will be a doctorate degree PT. So, no need in trying to cite examples to change my mind... it won't work. You will fail. :p
I've heard this
no more ADN rumor ever since the early 90's. The same rumor has been around longer than the 90's, I'm sure. I've also heard throughout the years about no more LPN programs. Look, we have several educational levels of nursing from ADN to PhD. IMHO, LVN's & ADN's can be outstanding clinical nurses. My wife has been an RN [ADN] for over 15 years and I'd bet she can provide the best cardiac bedside care and even better than most BSN nurses. LOL, she is far more than just
capable.
Please, don't misunderstand me. I tell all young folks interested in nursing to go straight for their BSN. Yet, some financially are not able to do so. They instead pursue the LPN or ADN route, which I completely understand. I went from AAS in Surgical Tech [CST] - ADN - BSN. Now, the Army Medical Dept wants me to apply for a Masters program on their dime. I'm nearing the big
50 and not sure I want the stress of assignments, test, etc.
Not sure what else I can say. ;)
I know... I just read your Bio and you have an ADN with BSc in something else? Yet, you want the ADN programs to cease?
I've always been an advocate for higher education and like Cary, encourage nursing students to complete a BSN. My reason has nothing to do with the belief that baccelaureate or masters prepared RNs are better bedside nurses, it's just for job security. There is enough volatility in the healthcare industry to make anyone wonder if now will be the time that reform will start to happen and job requirements will change. It's best to be ready.
That said, for more than twenty-five years, I've been doing hospital based patient care and have witnessed the ups and downs and heard and read the studies touting the importance of higher nursing education. Despite all of that, I've never seen a distinquishing characteristic at the staff level, in direct nursing care to enable me to determine who had the higher degree. In that same setting, I haven't seen a difference in earning potential, either. Where clinical differentiation occurs, a specialty training and a certification exam is available to the RN, regardless of degree. The point I want to make here is that currently, the clinical education is the same regardless of degree. The only areas where I see differentiation in job description and pay rate is in nursing administration(sometimes),nursing education and advanced practice.
Don't get me wrong, I'm on my own higher education track for advanced practice but I understand the reason for that additional training is because there will be significantly more to the work. What I have yet to see is a valid reason for the individual to incur the additional time and expense for no higher pay or position.
This leads me to pose a question. Other than for job security, what would be the incentive for an individual who wants to be a bedside nurse, to get higher than an associate or nursing diploma training?
Just my opinion,
R
I think that this depression might be the time of getting rid of ADN programs, which would be ashame. The ADN program I am in typically produces students ready to hit the ground running clinically and has higher NCLEX percent passing than most of the four year progams. A couple of the four year schools typically only have their students do one task while on a unit. They might do an assessment OR pass meds, but typically not both. While I understand that this isn't every four year program it seems to be more the rule and not the exception. Also we are required to have an 80% passing grade for our courses with no rounding. I have had friends that were failed with a 79.99%. My wife, a BSN, is amazed at the amount of work we do in our seven week long courses.
I assumed that the major difference between a BSN and a ADN RN was the public health aspect. However, my program provides a 1.5 credit community health class each semester.
Also it is my understanding that hospitals trying to obtain magnet status are required to have a certain percent of nursing staff at the BSN level.
