Assuming this is a supply and demand economy why is there a chronic nursing shortage?

Factual Questions
61

Oy. Where to start?

Many good points have already been made. This is a many headed Hydra, for sure.

tomndebb makes several good points in post #17. [QOUTE]The wages at large hospitals can be quite competitive, but they are not sufficient to the responsibility or hassle.
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When I started in nursing, fresh out of my BSN program that took 114 students and graduated 87 (they either dropped or were dropped–nsg school makes basic training look like a tea party in some respects), I started work on Med/Surg, DAY SHIFT for a whopping $7.77/hr. True, this was 1985, but still. My friends who had accounting degrees and other comparable 4 yr undergrad degrees made more than that. Yes,my salary (still an hourly wage–I punch a clock for my pay) has increased dramatically. But so have my pt load and my responsibilities.

I believe we are still underpaid for our job. the bennys are excellent, for the most part, though.

As to the nursing schools–yes, it IS a bottleneck–even with the ADN (associate degree) programs proliferating. When I was in college, the focus (and talk about tunnel vision!) was to make the BSN the entry level degree.

20 years later, it still hasn’t happened and won’t in my lifetime. The demand is too great and added to that, there is the strange in-fighting that comes with the profession. Diploma nurses (3 year hospital based programs-now almost obsolete) get huffy if entry level degree is even mentioned. ADNs take offense that their degree is “inferior” to BSNs. BSNs are often openly mocked and derided for their “ivory tower” outlook and their “book sense, no common sense” approach. Believe me, if we could just get some consensus on this issue alone, nursing would be better off.

[Keep in mind that ultrasound techs (hearsay, no cite) will be required to have a college degree soon–and physical therapists will have to ahve a Master’s. And nursing is still arguing about who makes the “better” nurse? It’s ridiculous! ( to add to that, many don’t consider nsg a true profession because it does not have autonomy–true enough when I have to get an order from an MD just to change a pts diet).]

Oops-forgot to mention that in the clinical aspect of nursing school (the "physical"part)–those students are giving meds, shots, positioning pts etc–ALL under the protection of the instructor’s license. If the student effs up–guess who goes to court? The instructor and the school. It’s alot of responsibility for someone–and since instructors (college professors for the most part) make LESS than your average staff nurse–what is the appeal to go for a PhD and teach?

Men in nursing–worked with many. Liked and respected the vast majority of them. But still, after 20 years of nursing–they still face the stereotype of “gay”/un-manly/couldn’t make it in med school.(one twist on that is that now the women are asked if they couldn’t cut med school as well–see, we have come far, no? :rolleyes: ).

Eating their young. Count me as one of the eaten. I was verbally abused, made fun of, accused of nepotism (supposedly the VP of the hospital was my uncle–wrong)–you name, it happened to me, short of physical hands on abuse (I was threatened with bodily harm)–all from these “angels of mercy”. I swore I would NEVER treat newbies that way, and I haven’t. It’s called being professional–nursing could learn alot from some current business seminars.

Other opportunities: women have by the score, now. Frankly, I myself (if I had had any faith in myself), would most likely have gone to med school, if I could ahve a “do over”–or journalism school (to work at the Reader, of course!). Nursing school instructors tend to berate and humiliate students (akin to law school profs, from all I’ve heard). It is a test of stamina and will and massively dysfunctional.

IMO, nursing has made its bed and is lying in it.

Is there a way out? Sure. Increase the number of slots in the schools. Increase the faculties by allowing Master’s prepared nurses to teach (this is already being done). And allow (or certify somehow) experienced nurses to help lead clinicals. Increase staffing ratios to a safe level–4 pts to 1 nurse on Med/Surg is very safe. Industry average is 8 pts to 1 RN at present–hospitals still haven’t figured out that if they invest in nurses, they might just not have to settle huge lawsuits involving pt safety and errors etc. My salary is waaaay cheaper than a med mal case, hands down. Increase the number of CNA’s–and make sure that they are actually qualified. Accept that nursing is prone to special stressors and support the staff with those (this includes literally mental health days, and grief support groups).

Oh, and some societal recognition that nurses are PEOPLE and not “angels” or “sluts” or “battle-axes” would go far. A higher profile of nurses in the media would also help. I laughed and then cried at how nurses were portrayed on ER, for example–most things done on that show are NOT done by MD’s, nor are they done in the ER. Dont’ even get me started on that.

Lastly, I think a name change is definetly warranted. Someone once told me a good one, but I can’t think of it right now.

sorry this is so long. Phew! I feel better.

62

Bah! It was before lunch. I was hungry. I didn’t get enough sleep last night. I, uh, forgot to take my smart pills today.

There could be a pecking ladder. There probably is a pecking ladder. And if I ever come accross a pecking ladder, I’m almost sure that I’ll want to be at the top of it. :smiley:

63

This is not the first time this has been mentioned in this thread, and I’m kind of surprised that a mainly female population of workers would be so abusive and non-supportive to other (mainly female) nurses. Nursing sounds super tough already, why do they do this to each other?

64

We have had some pretty interesting Pit threads about how harsh mostly female work environments can be. I have done it as a male and the dynamics can be brutal and abusive. This isn’t the Pit so I won’t go into details but many others, especially females, have reported similar things.

65

I find it simply shocking that Wesley can’t see the value of psych and soc and math in the nursing field. I also find it shocking that he finds D GPA’s acceptable for people responsible for other people’s lives. I work in a mostly non life or death field and we had to get C or higher in everything that we wanted to count for our major requirements, including soc and econ and other irrelevant classes. Nobody is dying if I don’t remember how to draw proline, but I was still expect to draw proline proficiently. It sounds to me like he has issues with leaving nursing other than how nursing schools operate. You can’t just turn first semester kids loose on patients without supervision and you want the best of the best doing the supervising. Bad supervisors train students to be bad nurses and bad nurses kill people. I would rather have a competent nurse I can trust or no nurse at all. No nurse can’t put the wrong drug in my IV.

66

I have a mental image of a ladder with a chicken on every step, and each chicken is pecking the back of the head of the chicken just beneath it.

That’s a ladder I want to be at the top of, too!

67

When compaired to other health prodivers, nurses are not as under paid as many believe them to be.

Per this link, which references 2000 stats nurses make $46,000. Becoming a nurse requires an assoicates degree if you attend a community college, a BSN at a 4 year university.

http://www.minoritynurse.com/statistics.html

I’d just like to point out that Paramedics make an average of $32,000. Becoming a paramedic requires atleast two years of school, many programs are assoicates programs. A few BS in paramedicine programs do exist.

http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000189.html

Respiratory Therapists make about $43,000 a year (2003). I cannot comment on the educational requirement for RT’s

http://www.collegeboard.com/csearch/majors_careers/profiles/careers/106312.html

68

Nurses don’t use pharmacology on the job?

Sure, people forget who Beowulf battled and the quadratic formula and whether it was Jung or Skinner who first proposed theory X if they don’t need that in their job. But people don’t forget something when they are using it regularly, even if the class was 15 years ago.

You think there is no correlation between GPA and, say, passing the nursing boards?

While GPA is certainly a direct measure of “how well you do in an academic setting” it is also an indicator (or indirect measure) of other things that may impact future job performance. Frankly, I’d be surprised if student nurses weren’t also graded on the clinical portion of their training. What would a GPA that included clinical training signify to you? Surely more than one’s ability to sit at a desk and learn from a lecture.

69

I worked at a nursing staffing agency for a few months a few years ago.

My general impression is that the nursing shortage exists because nurses aren’t treated very nicely. I will never forget one poor young woman. She came to our office to pick up her pay and was almost exhausted. Apparently the hospital had the legal right right to make her remain at her job past her scheduled twelve hour shift because another nurse did not show up.

She had been legally forced to stay at work for twenty hours. :eek:

The pay was great for agency nurses ($30 an hour and up). Unfortunately the working conditions were awful and there were frequent complaints. Many of the nurses who had a long term employment history with the agency were from foreign countries. I got the impression they found the money great enough to ignore the unpleasant realities the job entailed.

70

Asking only as the spouse of one, which of these epithets is not true?

71

Um–I am going to assume that you are joking, tomndebb. Or you haven’t watched any porn in your lifetime–or seen One Flew Over the Cuckoo’s Nest or seen a get well card that features an ugly woman dressed in an outdated nurses uniform threatening enemas all 'round, or walked by a display from Hallmark depicting nurses with haloes over their heads in “fine” china etc.

Nursing has an image problem–the stereotypes and myths that surround it seem somehow to float above the reality of it all.( Nuns have the same problem–they are rarely seen as whole, flawed people.)

Who do the reporters turn to when following a story? The doctors–look at Katrina stories–do you see nurses quoted, interviewed, cited as sources for quotes? Very, very rarely. But who is at the bedside, 24/7, moving pts, transporting them, reassuring them and their families, advocating for them? Nurses. We are the largest sector in health care–and silenced and unseen. We always seem to get a mention, but the laity really have no good idea just what we do. Nursing is to blame for much of this, but the public and the media (and other HCPs) also shoulder some of it.

Every pt enters the hospital with expectations, whether realized or not, as to how the nurses should care for him/her. I’ve heard just about everything from pts over the years-wonderful accolades and thank yous, propositions, harassment of all kinds, complaints, you name it. We see people at their most vulnerable–and IMO, that is not forgiven easily by most. We are sitting ducks for abuse of all kinds–the doctor may well order X–but we have to inform the pt and we bear the brunt of the pt’s displeasure. It all adds to up to a great deal more stress than your average job.

I don’t have much time this morning, but I want to address the abusive environment mentioned above. There have been any number of studies with this as the focus.

Essentially, nurses have a great deal of responsibility and very little authority–a crucible for frustration and anger. Sadly, there are still many many un-assertive nurses out there who will not call an MD out on his BS*, but will take the stress engendered by that situation and displace it onto their coworkers. That is one scenario.

Another is the passive/aggressiveness that pervades nursing–and I do think that can be attributed to being predominantly female. Women really don’t handle anger head on–we have been socialized not to. Instead, we find fault with a nurse’s care on the previous shift (whether or not there was a lack of care actually present), we spread rumors. Think of the HS cafeteria and you’ll know what I mean.
Enter the newbie–who may have better current knowledge about certain aspects of care, but more likely, has ideals and passion about her job. Ideals are fine things, but if they are too high–that newbie will burn out quicker than Icarus. Some of the old “vets” (IMO) cannot handle the earnestness of the newbie (most likely because it stirs up uncomfortable feelings within themselves), so they marginalize her. Others are hard on the newbie because “she has to learn what it’s like”-it’s baptism by fire. Still others are so overwhelmed with their own assignments that they resent being asked for even minimal help (the “noone helped me when I was new” school of thought).
Throw in some life or death, time crucial tension and add different cultures, ethnicities, races and class to this mix: it can be toxic.

There’s more, but I don’t want to write a book!
*most of the MDs I ahve worked with have been very kind and compassionate people. I can count five over 20 years who were complete dicks. Still, I am assertive, and experienced and MDs trust me. I actively worked to get a good working relationship with docs–that cannot be said of every nurse, nor of every doc.

72

Nurses already make an extremely good income. 50k a year out of college isn’t unheard of, usually only engineering graduates make that kind of money right out of college which makes nursing one of the highest paying college degrees. Also of the nurses I know some talk about becoming traveling nurses and going to places like Alaska, where income is astronaumical.

Besides, people aren’t motivated solely by money. If you work a job that is high stress and makes it hard to enjoy the things money can buy in your leisure time like big TVs or luxury cars you’ll probably quit sooner or later. I once read (don’t know how true it is) that there are over half a million RNs and LPNs who aren’t working as nurses right now. I suppose the job stress was more important than money.

And again, there is still a bottleneck in education. So even if there are 200 applicants who want to try to learn to be a nurse, only 20-30 will be given the chance. Of those 20-30 only about 12-18 will graduate. So it doesn’t matter what you pay people if there aren’t people able to work the job. As I said some hospitals are turning to using paramedics in place of RNs because they can’t find any/enough RNs.

Plus alot of RNs are retiring soon since most are in their 40s or 50s. So there is a legitimate shortage and of the people who are nurses, alot don’t want to be nurses so they quit and alot of people who do want to be nurses aren’t being given the chance.

73

I don’t find getting good grades to be important, no. I find being able to do the job important but I don’t think getting good grades in school relates to that. What is so hard to understand about that? I am saying I would rather have a nurse with 20 years of job experience who got a C in a class a quarter of a century ago than no nurse.

I still think things like electronic communication are more important to avoiding mistakes than good grades in school. Grades are based on endless variables. Maybe the professor is harder, maybe the school is harder, maybe the person had problems at the time, etc. Someone who gets As in a small community college will be lucky to get a C average at MIT. Someone with an easy professor can get an A with the same effort it takes to get a B with a harder professor. maybe the person just doesn’t care about academics but that doesn’t have any impact on their ability to be a nurse. These aren’t good standards to determine what makes a good nurse.

I hope you got a D in psychology because that has nothing to do with it. As I said, I hope someone who was better at the physical component got my slot because the system was screwey. I don’t remember jack shit from my introductory psychology class but I got an A in it when I took it three years ago. How would that make me a good nurse over someone who had been a CNA for a decade but got a C in introductory psychology?

74

I never said that. Pharmacology is where most medical mistakes come from.

Again, if someone really, really sucks at learning in the pharmacology class and that inability to learn and remember information about drugs and their side effects also applied to them on the job that is totally different than just not doing well academically.

Nursing, like alot of fields, has a hands on and lecture component. They do grade both.

75

Are you working in a field that requires you to draw on what you learned in Psychology? Perhaps the situation would be different if you were. I continue to think your implication that a nurse would never use pharmacology, either, is flawed, as if your contention that one’s grade in such a class has absolutely no bearing on one’s ability to properly administer and monitor medications.

76

I never said a nurse will never use pharmacology. I said I think work experience is more important than academics.

The vast majority of people who took the pharmacology class passed it. The bottleneck on applications was the bigger problem, not the pharmacology class.

77

I apologize. I misconstrued a series of arguments from an earlier post.

78

I’ve been to two nursing schools and I’ve worked in a number of teaching hospitals where nurses were trained. All of them took past medical experience into account. It wasn’t weighted as heavily as GPAs but looked at, none the less. Having been an Air Force medic, and a CNA prior to nursing school, I can tell you, that past experience was valuble for the first semester, after that, it was much more academic. My school required one carry a B average. My overall GPA at graduation was 3.8. My state board scores were the highest in the state. I don’t think that would have been true had the school been required to take all comers and thus have to teach to the lowest common denominator.
When I was in school there were nursing schools that did accept anyone who applied, up to the point of saturation. However, their graduates tended to fail state boards at a higher rate than those school maintaining a high standard. I’m fairly sure there still are programs like that, they just don’t produce many nurses.
Nursing school does not and can not teach everything you need to know out in the real world. Nursing isn’t a job for stupid, uninspired people. Its hard work, physically, psychologically, and emotionally. If one isn’t motivated by the work itself, he/she will fail, and be scarred in the process. The burnout rate is high. I’ve had 4 friends over the years commit suicide. All four left long, rambling, notes on their self-perceived failures.
Hell, I could go on for pages. I promised myself I wouldn’t respond to this thread. I should never have opened it.

79

picunurse --I hear you. It must be a little like a soldier coming back and tring to explain combat to someone who has no military background. A sense of it can be relayed, but not the whole–not by a long shot.
I have resolved and resigned myself to 3-4 more years at the bedside. I will then be 47–and I hope my back and hips and shoulders last out. I ahve been lucky in that I have only sustained a rotator cuff injury once about 15 years ago–but pts these days are obese–and I mean obese. We used to have a morbidly obese pt every month or so–now it’s several times a month. There just aren’t enough people on the units to truly move these pts as they should be…

While I have never had a colleague commit suicide, I know plenty with substance abuse problems, marital problems, chronic depression–how many nurses are on Paxil and other anti-depressants? And yet the impression is that we are some kind of secretary for the doctor, that we enter nursing to nab a doctor husband, that we sit at the nurse’s station and drink coffee and chat etc.
Christ, this is depressing as hell. I’m getting out of this thread.

I would like to leave the readers of this thread with some advice. If you or your significant other need hospitalizing in future–please treat the nurses with respect and courtesy. If you witness poor care or feel uncared for, please bring to the nurse’s attention in a polite way. Of course go up the ladder if the situation is not resolved (but keep in mind, we might not be able to stop your SO from dying, if that is the case)–but please have patience and look at the big picture. There is a reason why your Mom’s water pitcher isn’t full right now–and it has nothing to do with laziness or malice.

Sorry, ripped the lid off Pandora’s box, this thread did (for me, anyway)…

80

Evidently, they don’t make that great an income, or there wouldn’t be a “shortage.” Let me reiterate that a real shortage is when there is something preventing a willing buyer from doing business with a willing seller, like price controls or a ban on selling things like drugs. Another example is highways. There is an actual shortage of highways in Los Angeles. I would be willing to pay in exchange for a clear highway, but there simply is no such market except for a few toll roads to places I don’t go. So it doesn’t matter how much I offer, I don’t get any road.

Everything is negotiable. Hospitals could let nurses work 30 hours a week for the same pay, or 6-hour shifts, or pay a bigger shift differential.

What’s stopping County General from establishing a nursing school? Continuing the highway example above, I cannot build my own highway, regardless of how much money I have. The government wouldn’t permit it. Hospitals could say, you go to our nursing school, pass all your classes, and when you’re done, we guarantee you a job at $100,000 a year for five years, and reimburse you all your tuition. They’d have to beat people off with a stick.