By Shawn Kennedy, AJN editor-in-chief
Nurses are taking to the picket lines, again. On Sept 22, an estimated 23,000 nurses in California struck at Kaiser Permanente facilities and also at Sutter Health hospitals and Children’s Hospital Oakland. The one-day strike was organized by the California Nurses Association/National Nurses United (CNA/NNU) to protest what they say are unfair rollbacks to nurses’ health coverage and retirement benefits, and was also intended as a show of support for striking coworkers.
But it’s not just U.S. nurses who are engaging in job actions—for example, in the United Kingdom, the 400,000 member Royal College of Nursing is contemplating the first strike in its nearly 100-year history and is soliciting the views of its members as to what action should be taken. The issue is nurses’ pensions and job cuts—according to Nursing Standard, “almost 10,000 NHS
The poor economy is putting pressure on hospitals and health systems everywhere to reduce costs. One way to do this, of course, is to make cuts in what is traditionally the biggest expense in running the hospital—nursing. While this is a quick fix to the bottom line, it’s also one that doesn’t solve the problem. In fact, evidence shows that inadequate nurse staffing is linked to poor outcomes, which ultimately cost more in the long term—for the patients, for the health care system, and for nurses, who must deal with the burden of short staffing.
Let us know—how are things in your workplace?
As a statistic of this current situation, I will tell you that it has diminished my once profound desire to continue on with my nursing career.
For corporate hospitals (which are supposed to be mostly not-for-profit) that answer to their boards for cost-cutting measures, they have taken to the desperate steps of hiring numerous non-licensed employees to replace nurses wherever they can. This concerns me deeply. One of the primary arguments that we have had as professionals is to put patient safety first. Utilization of non-professional unlicensed employees opens up a plethora of patient-related concerns such as patient education, medication reconciliation, the nursing process, etc., all of which they are not certified, trained, or licensed to perform. These unlicensed employees, many with only months of “training” have a very limited, if any, “clinical experience” with the majority of their training in administrative process and certainly no patient care experience.
The very process of patient care in many outpatient settings (doctor’s offices and clinics) has been reduced to a secretarial-like position where data entry is the main task and all patient concerns are relayed to the doctors for review / addressing. This not only causes a road block for the delivery of what used to be excellent patient care by highly trained and knowledgeable nurses, but now puts extra demand on the physicians and leaves many patients waiting for sometimes days to get an answer to a question or concern.
Many of the nurses that remain work long and grueling hours with little staff support whether in the hospital or outpatient arena. The hospitals that apply staffing ratios based on acuity do so to their advantage since there is currently no “standard” definition on how to apply these statistics, so manipulation of the numbers is the rule rather than the exception.
Many hospitals now demand BSN degrees with at least 3-4 years of experience. This is an almost impossible feat in many parts of the country whereas the trend for BSN degrees has only recently caught on and the numbers are just starting to come up. Rather than hire the 20+ year experienced nurse (who would warrant compensation relative to experience), they will go with the new BSN grad. There is no differential in most hospitals between the pay rate of a new grad ADN or BSN; they are all new grads and therefore more new hires without experience are turned out onto the floors and the overworked staff, in many cases, are expected to “train” this new grad. Along with the poor retention rates and the 30% drop out rate of nurses within the first year, the facility is left in a compromising position of needing to constantly train new employees. (The revolving door syndrome)
There still seems to be a lack of understanding that if you hire people at competitive, fair wages and treat them well, they will not only work hard for you, but will stay. The younger generation of new nurses seems more prone to working for short terms and moving on to the next better paying job as soon as one comes up. Gone are the days where one would remain at their place of employment for 20 or more years.
It is sad to me that we are even having this discussion and I do fear that nursing has changed for the worse and can only hope that we will be able to get back to the position that we worked so hard to attain. Nurses are imperative in healthcare, as we ARE the patient advocate and only buffer between the patient and the doctor. If we are no longer there I can only imagine what will become of health care in our county in the future………..
Lulu
Great comments! I don’t think there’s a workplace these days that doesn’t ask more of workers than was previously the case, and nurses can reasonably expect this as well. Which doesn’t make it any easier. Staffing inevitably affects morale, at the very least, especially if it’s already a stressful kind of job. Worker satisfaction matters too, because this influences staff retention. And poor staff retention rates indirectly affect quality of care, or can. But when staffing levels start directly affecting actual quality of care and patient safety, that’s even more a matter of real concern.
It’s good that nurses make the effort to tell their stories, and make the realities known, and fight for their rights. Labor has historically had a voice because no one else will represent such concerns. You have to make noise to be heard, as little as one may want to do so.–JM, AJN senior editor
When I read this post I felt inclined to rant, as my last shift consisted of an unsafe, “tripled” assignment that included vented, isolation patients.…a day when my primary goal was to not make a fatal error, and I wasn’t proud of the care I gave. There’s nothing more frustrating than being placed in an unsafe situation, even if it’s rare (and even if the unit manager comes in on a Sunday, full of apologies and willing to help out, which she did.)
I don’t share Vernon’s pessimism, though. Shawn Kennedy is right; inadequate staffing greatly impacts care and outcome, and at my facility, at least, the linkage of reimbursement and patient satisfaction has resulted in priority shifts. I’m seeing a cost-cutting focus on things like linen use (we’ve apparently blown our washcloth budget) and “incremental overtime”, but nurse staffing, at least for now, has been granted a reprieve.
The major cause of “Discontent Among Nurses” is a culmination of a long historical abuse of nurses by hospitals going back to the Training School days. Unsafe staffing is just the straw that will break the camels back. Hospitals have redefined the function of a bedside hospital nurse and the new role involves little nursing. Unsafe staffing by hospitals has reduced the role of a professional nurse to that of a task oriented time management nightmare. The biggest causality of unsafe staffing has been the integrity of nurses. Nurses now must cut corners that would have been unimaginable in the past.
The list of tools hospitals use to abuse nurses is too long for a discussion here but I would like to mention a tool all hospitals use nation wide to abuse nurses and that is “ACUITY”
No two hospitals use the same formula to arrive at Acuity, which is what hospitals use to justify unsafe staffing. Hospitals have historically manipulated the acuity numbers to match the number of staff. Hospital Acuity is a useless tool of abuse.
The dysfunctional relationship between hospitals and nurses has never been at this low point. Without rapid intervention, the bedside hospital nurse will be a thing of the past, replaced by (hospital workers who will take as many patients as possible, pass medication, chart for reimbursement and run the hospital) – which is the ideal definition of a nurse by most hospitals.
The “Future of Nursing” lies in the hands of Nurse Practitioners and the fate of bedside nurses remaining in hospitals without unions or mandated ratios is sealed.
At several hospitals in my area they have stopped hiring LPN’s for in-patient jobs and using RN’s I often wonder at the cost/benefit of this.