by dr_pardee on 4/27/22, 2:54 PM with 1261 comments
by mfer on 4/27/22, 3:27 PM
1. Many new nurses make the same or more and long time nurses. It's frustrating when the nurse in charge with the most experience is making less than new nurses. Some hospitals are even trying to stop nurses from talking about pay.
2. Patients in COVID have become downright mean. Add this to the problems nurses have management and doctors (who are often rude and arrogant) and it's a poor culture. The quality of the environment, from a mental health standpoint, is on the decline.
3. IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them.
This one is big for product designers. Often we listen to the people who pay for it and miss out on the people who actually have to use it.
4. Nurses are the catch all for jobs. Not enough aides? Nurses do the work. Food service workers don't want to take food into a patients room... nurses will do it. Not only do they have higher ratios of patients but they fill in the work when other areas have shortages, too. So, the work per patient goes up. Pay doesn't go up, though.
by pbuzbee on 4/27/22, 7:30 PM
- Demanding work: 12 hour shifts, irregular schedules, night shifts, physically exhausting, limited breaks (including bathroom/water!)
- High responsibility with unsafe conditions. You're literally responsible for people's lives. Poor staffing ratios stretch you thin and make you more likely to make mistakes. And if you make a mistake, you're at huge risk for litigation... and now criminal consequences too. Responsibilities, resources, and staffing stretched even thinner due to the pandemic.
- Administration that treats you as something to be optimized and does the absolute bare minimum to support you. Instead they tack on additional tasks, expectations, and requirements ("no water at a nurse's station!"). They encourage a culture where nurses provide a concierge service to 'guests' instead of critical care to patients.
- Hostile/entitled patients. I'd guess many/most patients are not an issue, but it only takes a couple of difficult/combative patients to really ruin your conditions.
- Low pay given the responsibility and working conditions for non-travel nurses. https://nurseslabs.com/nurse-salary/#nurse_salaries_by_state Like many others pointed out here, in tech I make way more than a nurse for a job that's less demanding, has far lower stakes, and is of far less value to society.
To me the blame lies mainly in middle/upper management, whose role is to build and empower an effective workforce. If 90% of your workers are considering leaving, you blew it.
by germinalphrase on 4/27/22, 3:30 PM
Sometimes, it feels like we’re min-maxing ourselves to death over here.
by oliverafajardo on 4/27/22, 9:08 PM
I feel like a waitress, custodian, social worker, therapist, punching bag and other stuff - It's never ending. This has effected my mental health so much that I am slowly doing my career switch to SWE. While I know every job has it's own difficulties bs/stress/politics, the one's i deal with as a nurse now I can no longer deal with. I don't regret this career path because it has taught me a lot, and their is something better for me out there.
Career: I did consider other areas of nursing, but they didn't satisfy me, ICU is relatively the most enjoyable for me. On a regular hospital floor/intermediate floor, a nurse will be given 4-5 patients and let me tell you its a ZOO! In ICU i only have 2, and those keep you busy the whole shift. They're both different kinds of crazy.
I will say, being a nurse in California is 5x better than anywhere else simply because their are laws that allow us to have uninterrupted breaks!
by sllewe on 4/27/22, 3:41 PM
Outside of the existing issues with Bedside nursing (long days, physically demanding) - the primary issue is staffing. Pre-pandemic the ratios were already bad but now many are leaving for travel contracts which carry significantly better wages. It quickly becomes a loop where employees leave for Travel Contracts, and then can only be backfilled with Travel Contracts. The remaining FT staff nurses are left making much less money, and have to assist "training" with the outside Travel nurses. And while this is nothing against them - The travel RNs also often have a different "vibe" as they are much less focused on long term improvement or problem solving within the Unit.
Also ICU/PCU/ER nursing throughout the pandemic was a terribly depressing place to be. Leaving many of my Wifes colleagues (including herself) with what is essentially PTSD with little or no support from the Hospital System.
by vlunkr on 4/27/22, 5:31 PM
by bkjelden on 4/27/22, 3:30 PM
From my perspective, the entire healthcare industry is set up to treat any frontline worker without an MD after their name as completely expendable, nothing more than a row in a spreadsheet that can be optimized for middle management to hit next quarter's bonus targets.
You can meet all metrics management sets out for you, have amazing patient satisfaction scores, etc, and every 6 months some spreadsheet wielding online MBA graduate is going to show up to turn the screws and tell you you need to work harder for the same pay, and to just be happy you aren't getting laid off.
At some point in time, the workers realize the joke is on them and find another profession.
by pkaye on 4/27/22, 5:06 PM
1. Safe mandated staffing ratios. California is one that does this and many nurses seem happy with the ratios.
2. Safe harbor laws. If the nurse feels they are pushed into a risky situation, they should have a right to notify management which will take on liability if they do not resolve it. A few states have this but hospitals bully nurses not to invoking it.
3. Better pay for the liability they take. Unlike management, they could go to prison for mistakes they make. There was a recent case nurses were outraged about.
4. Unions are beneficial. In California the nurses union is pretty strong to negotiate better terms and conditions.
by qclibre22 on 4/27/22, 4:19 PM
The nursing crisis is 57 years old now: https://pubmed.ncbi.nlm.nih.gov/14252064/ (1965)
Similar articles
WHY THE NURSING SHORTAGE PERSISTS.
HALE T. N Engl J Med. 1964 May 21;270:1092-7. doi: 10.1056/NEJM196405212702105. PMID: 14121489 No abstract available.
STUDENTS' DISAPPOINTMENTS IN PUBLIC HEALTH NURSING.
HANSEN AC, THOMAS DB. Nurs Outlook. 1965 May;13:68-72. PMID: 14291737 No abstract available.by screye on 4/27/22, 7:14 PM
Nursing is a well paying middle-class job without a lot of transferable skills to other professions. Don't say programming. It isn't the solution to everything. Other low-entry-barrier jobs pay much less and have exploitation problems of their own. For a lot of middle class families, dual income is essential to maintain their lifestyle. So SAHM is not an option. Nursing has clearly gone through a rough 2 years, but I suspect that things are going back to normal now. Why leave now ?
> High patient-to-nurse staffing ratios
This bit is confusing me. If supply-demand is in the Nurse's favor, then don't they get more leverage on what QOL and wages they can demand ? It is not like they can fire a senior nurse on low pay, when new nurses are harder to find and demand higher wages. I know that the nurses refusing work and resulting deaths has bad optics, but it doesn't look like hospitals have a lot of leverage right now.
> Administrative burden and manual tasks
Sounds like an opportunity for a startup to disrupt the space. But, the jaded side of me thinks that the startup will fail due to insufficient political leverage with hospitals/insurance/law-makers.
> health IT
Keep calling it health IT and the problems will never be solved. Solving hard problems needs reframing of the resources dedicated to it. When tech workers are seen as assets and not cost-centers, these problems will solve themselves.
by ryanSrich on 4/27/22, 7:04 PM
I have many friends and relatives that are nurses, MDs, and therapists.
Compensation is about as backwards as you can get. Seniority has no impact on your pay. Once you hit the ceiling you’ll never make more money. This is especially true for Nurses and therapists. Even if you switch jobs. The market rate is what you’re going to get paid (within 10%).
My wife is a PT and made 3x more traveling as a contract therapist than she did as a full time employee. Three times. That’s absolutely absurd.
Benefits are also beyond comical. Healthcare insurance costs for healthcare workers are higher and the benefits are worse than if you just bought Obamacare directly.
Beyond horrible pay with no upward mobility, you’ll also have to deal with completely disconnected management that has never done any clinical work in their lives. They’ll bitch and moan about saving money, and often enforce policies that put clinicians at risk of malpractice. All to save money.
So yeah. If I were to give any young people advice, it would be to stay as far away from healthcare as you can.
by eksx on 4/27/22, 3:30 PM
by quxbar on 4/27/22, 3:22 PM
by tmcw on 4/27/22, 10:28 PM
- "Almost HALF Of San Francisco Residents Considering Leaving City" (according to survey of 500)
- "One in three New Yorkers Considering Leaving The State"
- "Over Half Of Young Lawyers Considering Quitting by 2027, IBA Report."
Look for X people considering Y, and you'll find them. Considering is cheap.
The awful experience of nurses, absolutely, true. But this, like so many others, is a silly poll that doesn't say anything.
by brent_noorda on 4/28/22, 1:29 AM
by mulmen on 4/27/22, 6:08 PM
But this sounds like the employee satisfaction corollary to Sturgeon’s Law [1].
“90% of employed people are considering leaving their profession in the next year.”
This survey would be more compelling if it compared nurses responses with the general employed population over time. I only skimmed so maybe it does and I missed it.
by phil21 on 4/27/22, 3:22 PM
This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems to have broken the few remaining folks who still had hopes and dreams.
How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me.
by FesterCluck on 4/28/22, 5:02 AM
I wish I had more access to nurses during the process. I was always told they were too busy. I just wanted to observe, as I do with any client I write systems for, and was denied. I can say that at least 2 other groups were working on the exact same project as I in the hospital system, and we "won". We all worked in isolation from one another, I discovered the others by accident.
The top of major healthcare systems is wasteful and full of "little kingdoms". The ideas that "AI is going to help" and "nurses need to feel heard" are basically incompatible. Throwing money at artificial brains is always to substitute real ones, and the concept itself is contradictory to employee development. Why train a bunch of nurses endlessly on a subject when you can train an AI once?
We're supposed to be improving & developing people's lives here, not improving a box. For centuries we've found new ways of thinking that have made us better at science and medicine. Computers could do that, but we're not using them to teach each other. We're using them to replace one another.
It may sound silly, but I've reached the point that the theory Dune puts forth seems right.
by jmugan on 4/27/22, 5:36 PM
by monkpit on 4/27/22, 3:16 PM
by jimmar on 4/27/22, 3:27 PM
by r3trohack3r on 4/27/22, 7:02 PM
The deaths were always hard when working with little kids - and there were a couple a month. But towards the end of COVID they were losing 4 kids PER WEEK (anecdote - I have no data other than listening to them vent) that this nurse firmly believed were avoidable had they received appropriate care.
What caused them to exit was how the hospital handled COVID: they postponed all elective surgeries. For these children, an elective surgery was anything where they "wouldn't die tomorrow" if the surgery wasn't done (somewhat of an oversimplification - but ballpark correct).
During that time hearts got worse, cancer progressed, bodies shut down until electives became emergencies... Success rates of surgeries dropped. And once restrictions started lifting the staff was underwater, they had a huge backlog of "electives" piled up on top of the normal ingress - kids were dying from waiting.
by sebow on 4/27/22, 3:26 PM
Considering it was bothersome for both healthcare workers and the public, in my opinion the friction is more between the healthcare workers and management/government entities (& their policies) rather than "some patient bothered me" cases.
by mansilladev on 4/27/22, 3:41 PM
by hadlock on 4/27/22, 6:56 PM
I guess my point is, not only is the current healthcare labor market at stake, but hiring/pay/working conditions now are having upstream impacts on the labor pipeline of people coming into the market, or evaluating entering healthcare. Having recently gone to the ER with my toddler, I can tell you this is not an area you want the market going for lowest bidder when you do have to use healthcare services.
by cptaj on 4/27/22, 11:33 PM
They pride themselves in it being so hard instead of realizing that this is glaring problem that needs to be solved instead of nurtured.
This begins from medschool being prohibitively hard, to a lack of global licensing process, to doctors being on duty for 36+hrs when you cant legally drive a truck without stopping after 8hrs.
Its all wrong at every level.
by ryanmarsh on 4/27/22, 3:49 PM
So hospital administration will have a fresh crop of graduates, new to the system, to abuse. The cycle will continue unabated.
by chimprich on 4/27/22, 4:04 PM
I make slight improvements to computer systems. In most of the jobs I've done, despite my best efforts to work for reasonably ethical companies, I've not been convinced I've made anyone's lives better. Yet my salary is 2-3 times hers.
I find it hard to believe there can't be a better way to arrange this kind of stuff.
by honkycat on 4/27/22, 4:34 PM
1. Hire more nurses to spread the load around
2. Pay existing nurses more
3. Incentivize people to get the technical training required to become a nurse.
"But what about my boss's 4th home?" I know. I am worried about that too. i pay 1500/mo to live there, and the costs will probably trickle down to me. we will have to figure something out.
"But we don't have the money! Who is going to pay for it?" Well. Then I guess the goose is cooked. We no longer have the resources to run a functioning society. I want you to think about that, and maybe think if we could get the funding from somewhere.
We are out of trained workers. The money diet our overlords put us on has officially starved us. Welcome to the 3rd world. Hope you saved up enough money for a ticket to Elysium.
Nobody wants to take out student loan debt anymore. If you are over 30, let me fill you in: cost of college has gotten even more insane than when we were in school.
we are seeing the same thing in our courts. Everyone is mad at the PDX DA for turning people loose all the time, but the secret is: there are not enough public defenders, and we can't hold people indefinitely without cause. There are literally not enough lawyers graduating from law school/graduated in the past to fill these spots.
Our society is falling apart and all anyone can talk about is how lazy the homeless are and obsess over what genitals people are born with.
by lucidone on 4/27/22, 3:39 PM
by say_it_as_it_is on 4/27/22, 8:12 PM
by geocrasher on 4/27/22, 7:11 PM
by gjsman-1000 on 4/27/22, 3:15 PM
The reason why, at least for that doctor, wasn't really the stress from patients. It was all the damned paperwork and the stress that created.
by Victerius on 4/27/22, 3:19 PM
So pay isn't the problem.
The U.S. is also above the OECD average for the number of nurses per 1000 population: https://www.researchgate.net/publication/334515420/figure/fi...
So staffing isn't the problem either.
The U.S. is below the OECD average for the number of doctors per 1000 population: https://www.nurses.co.uk/Images/Blog/media/ddad9fa9-b06d-43d...
If nurses could work a regular 40 hours a week and be paid more, as they would like, the additional money and staffing need to come from somewhere. In the United States, we've decided that private hospitals could have the right to exist. Most nurses are thus beholden to a free market. So the question is why other hospitals aren't trying to poach nurses with better wages and schedules. The reason may be that the supply of nurses remains large enough that hospitals don't feel pressured to make these concessions. The business model of hospitals is also drastically different from that of, e.g., tech companies. Tech companies can afford to pay their employees outrageous salaries because it is possible for one software engineer to create a product that will generate $100M in revenue. A nurse's labor has a cap on how much economic value it can generate. Hence why nursing salaries are constrained.
by jrochkind1 on 4/27/22, 5:36 PM
USA healthcare pretty broken, and sliding into catastrophe. Nurse dissatisfaction is just the tip of the iceberg, or the canary in the coalmine.
> Eighty-four percent of emergency room nurses and 96% of intensive care or critical care nurses have a 4:1 ratio, which is double the optimal target of 2:1.
> Thirty-six percent of nurses said they've seen patients with acute health conditions walk out of the ER because of the wait times for an inpatient bed. And 37% said that surgeries had to be rescheduled because of bed shortages.
by civilized on 4/27/22, 7:30 PM
In fact the entire website is probably a PR plant.
by johndhi on 4/27/22, 5:19 PM
It's super, duper complex with lots of paperwork. The complexity is too great to run a small practice, the Medicare/Medicaid fees are too small to make up for it, and it increases the importance of administrators in the hospital system.
If I had a bunch of time I'd love to go through and write up a proposed alternative approach, and congressional bill -- but I have to imagine even if I did that, no one would listen to it.
by formerkrogemp on 4/27/22, 11:52 PM
by weatherlite on 4/27/22, 3:22 PM
by causi on 4/28/22, 1:54 PM
This is an orphan statistic. What percentage of nurses considered leaving every year five years ago? Ten? Twenty?
by nine_zeros on 4/27/22, 3:34 PM
It is also partly because the number of patients is increasing disproportionately, mostly because people are getting older. An individual at the age of 50 needed fewer medical appointments than an individual at the age of 70. That's literally from 2002 to today.
There just aren't enough nurses and doctors to tend to such a large old population.
by thenerdhead on 4/27/22, 5:34 PM
This survey has such a low number of responses to make any meaningful conclusion from. 200 people surveyed. Non surprising stats like 71% of respondents having 15+ years of experience wanting to quit.
What really should be the lesson here is that capitalism does what capitalism does best:
It cuts costs.
- More patients to nurse ratio (Simply unsafe given most medical professionals already lack sleep)
- Little to no compensation relief on the way. (Huge boom of travel nursing during pandemic)
- Excess job responsibilities (More paperwork/aid duties, less actual nursing)
- New talent / old talent challenges (Larger incentive to switch jobs, hard to properly train)
We better figure out something soon. The medical field feels like it's holding on by a thread. Insurance companies run rampant with no end in sight. Health care continues to increase in costs and fail patients to the point of walking out or even dying to get care.
While I think generally speaking, nurses like my sister just want to feel appreciated like other jobs people are burning out in. You can do that in many different ways:
- Don't overwork them.
- Don't underpay them.
- Don't give them unwanted responsibilities.
- Most importantly, listen to them.
I think you may find that people actually do love the profession as it's one of the most noble professions out there, just that they are being forced out of doing something they love because of greed. Greed is not good.
by mikewarot on 4/27/22, 10:22 PM
The tragic insertion of a middle layer, the insurance industry (AKA Death Panels), makes it even more tragic and inefficient.
You can not seek profits in a competitive environment without reducing every cost to the bare minimum. Of course they are going to cut staff costs, and the number of properly staffed beds to the bare minimum, it minimizes costs. If a surge happens, they're happy to pay a little bit of a premium in the cost side for extra staffing. It's more than compensated by the extra billing.
But the recent public health emergency was a seiche, a tsunami, a pulse of unanticipated magnitude. (Unanticipated in the minds of those looking to meet this quarter's numbers, not in the minds of long term strategic thinkers).
The wrong type of people are in charge of health care in the US, and our nation will not be secure until this changes.
by ubermonkey on 4/27/22, 5:22 PM
Her most recent gig was in Antarctica. I mean, cool, right?
by rsanek on 4/28/22, 4:14 AM
And why is it so hard to find the raw data from the actual survey? I'm surprised this is scoring so well on HN.
[0] https://www.hospiq.com/about-us/press-releases/new-hospital-...
by uf00lme on 4/27/22, 3:24 PM
So much sacrifice for the greater good, we the public are not worth it.
Another profession I always think of are math teachers, they are good people.
by bawana on 4/28/22, 2:42 PM
In the same way that national defense has been driven into a profit making venture (and encouraging the support for proxy wars), health care has become a beast beyond monopolistic power, able to drive demand for its own supply. The net result has been to give responsibility without authority to the providers. Nurses are subject to mandatory overtime. Physicians are required to take unreimbursed call. These services were once the hallmark of a devoted provider. Now they are exploited by a corporate profit seeking behemoth.
Patients now have such large deductibles that they prefer to pay me in cash for a negotiated lower price. No longer is health insurance actually insurance. It has become more of a coupon or in the language of today's generation, a groupon.
Even retirees who with Medicare only had to pay 20% of unreimbursed allowable expenses, have increasing burdens. The premium for part B (yes you have to pay for the part of Medicare that does not cover the hospital) has increased 15% this year and the government stated this is largely the result of a single dementia therapy - a pill that costs $56,000.
I think we could fix the problem if we required our lawmakers to actually pay for their healthcare. They get it for free. In addition, each gets a multimillion dollar stipend to run their office, separate and apart from their generous salary. For doing what? pushing emails. And they are so afraid of offending any part of their constituency that they spend most of their time arguing about non-issues. Their ridiculous behavior is creating a fertile environment for the next tyrant who will prromise salvation and deliver true misery.
by bsedlm on 4/27/22, 5:21 PM
the health of the patient became subordinate to the economic incentives of the hospitals and the other involved institutions (insurance providers, pharmaceutical corporations, etc...)
and so I have the hypothesis that this happened because people (young adults) going into medicine because of a vocation to help and heal others become disheartened when they find out it's all about institutional profit; only them who get into this becuase "doctors make good money" really make it to the end (which is not terrible, as they usually do learn the methods and techniques of medicine, but that in the long run prioritize money over health).
health care should have never been allowed to become a capitalist marketplace.
by dukeofdoom on 4/27/22, 5:06 PM
by giarc on 4/27/22, 3:51 PM
I can't even imagine what nurses have gone through being front line staff interacting with patients (and their families) all day. We need a zero-tolerance policy for families that verbally abuse front line staff, but instead they are often let off due to "stress of a family member in hospital" or the need for "family centered care".
by indymike on 4/27/22, 4:36 PM
by everhard_ on 4/27/22, 3:53 PM
[1] https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief...
by TYPE_FASTER on 4/27/22, 4:48 PM
by kingkawn on 4/27/22, 6:26 PM
by FactualActuals on 4/27/22, 3:20 PM
by nfriedly on 4/27/22, 6:12 PM
Last year she retired from the profession entirely, a few years ahead of "normal retirement age", and now she works part-time at a local farm/fruit stand. The main things that drove her to retire early was management insisting on 12 hour shifts and not hiring enough staff.
by stakkur on 4/27/22, 9:24 PM
And really, this is a red herring; the real problem started long before COVID. This video essay nails it (or so care practitioners at my workplace say, anyway): https://www.nytimes.com/video/opinion/100000008158650/covid-...
by shantnutiwari on 4/27/22, 3:40 PM
Ugggh, maybe it can't? As the main problems seem to be political, not tech related?
You might as well ask how IT can be used to fix homelessness or police brutality?
by dopaminop on 4/28/22, 6:22 AM
by retr0nerd on 4/27/22, 5:05 PM
by bitcurious on 4/27/22, 6:20 PM
Second hand impression from a doctor friend.
by Blackstone4 on 4/27/22, 3:27 PM
by nameless912 on 4/27/22, 6:12 PM
by giantg2 on 4/27/22, 5:38 PM
This is pretty much universal in my experience. As a dev, it always seems to boil down to these. It's amazing how the business doesn't know their processes, can't document them accurately, or simply don't care to analyze and document them. Garbage requirements become a garbage system.
by vmception on 4/27/22, 3:50 PM
by dopaminop on 4/28/22, 6:20 AM
by tomohawk on 4/27/22, 5:09 PM
I have family members in medicine, and they see the same thing. There was a really good opportunity at that time to address some glaring issues with healthcare, and we ended up with this thing that did not address those issues and created a lot more issues.
by mattmaroon on 4/27/22, 3:58 PM
by LatteLazy on 4/27/22, 6:56 PM
by mberning on 4/27/22, 4:18 PM
by nickstewart on 4/27/22, 7:24 PM
The travel nurses make significantly more and now that she has basically hit her cap (after just four years) I've been trying to convince her to move to a different unit or get a different job
by tyrrvk on 4/27/22, 4:57 PM
by yalogin on 4/27/22, 5:15 PM
by springsprint on 4/27/22, 10:10 PM
by mbrodersen on 5/1/22, 1:41 AM
by rdtwo on 4/27/22, 3:47 PM
by t_mann on 4/27/22, 9:26 PM
by slantedview on 4/27/22, 3:51 PM
by susrev on 4/27/22, 10:15 PM
That is 0.00008 % of all RN's in the US.
by crawfordcomeaux on 4/27/22, 8:03 PM
by rel2thr on 4/27/22, 3:32 PM
Kind of weird that the usa prioritizes software developers over healthcare workers in the immigration system .
by AviationAtom on 4/27/22, 9:21 PM
by theguyovrthere on 4/27/22, 3:56 PM
Nursing educators aren't exactly a dime a dozen. The average age of a masters prepared nursing educator in the us ranges between 56-62. Doctorally prepared is higher. The country is facing a nursing shortage, and a nursing educator shortage.
Now my doctor has an interesting theory that some of the pain points for nurses is being created by the hospital systems and industry themselves as an excuse to say we dont have enough nurses and bring in nurses from other countries like the Philippines, as they'll be glad to come to the US and work for less, and will be so grateful for the opportunity that they'll go along with whatever the hospital says they need to do. (This was in the context of vaccines.)
The other thing that has nurses worked up is recently is this case: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty-dea...
by xeornet on 4/27/22, 4:02 PM
by hypertele-Xii on 4/29/22, 2:10 PM
What a shitshow.
by gagan2020 on 4/27/22, 8:58 PM
by ashitlerferad on 4/27/22, 5:17 PM
by slifin on 4/28/22, 9:51 PM
Then if they work for years they might increase in pay band from like 2 to 4 which takes them up to like 20k-22k
Absolute joke for the hard work they do
by Ericson2314 on 4/27/22, 7:56 PM
by pessimizer on 4/27/22, 4:04 PM
Just kidding. Teachers used to almost all be male until public schooling and the resultant budgeting turned them female (to pay them less.) It's like reverse computer-programming where the profession turned male when they started paying more.
Pay them and they won't leave. Pay them a lot, and dudes will start writing essays about how the reason women aren't being hired and are leaving the profession is because they naturally have less of an interest and aptitude for nursing than males.
by sytelus on 4/28/22, 7:38 AM
by next_xibalba on 4/27/22, 7:18 PM
(I have a nurse in my family)
by andrewclunn on 4/27/22, 3:54 PM
by namecheapTA on 4/27/22, 11:35 PM
by gigel82 on 4/27/22, 8:29 PM
by maerF0x0 on 4/27/22, 3:48 PM
Lots of considering leaving a profession, also considering losing fat on Jan 1, and saving for retirement.
When people are surveyed there is a big difference between why they say and why they actually are doing the action. For example "Yeah, covid has been tough... and those insurance companies though... And doctors really dont respect my profession... Oh my [pregnancy/parental leave/dream of being a DJ]? yeah that has nothing to do with it."
These kinds of opinion surveys are just barely "science" .
by tedmcory77 on 4/27/22, 8:24 PM
by Tozen on 4/28/22, 9:14 AM
by agumonkey on 4/27/22, 6:09 PM
by vonnik on 4/27/22, 3:53 PM
- Nurses were getting burned out before the pandemic, and the US has a nursing shortage that's been going on for about 90 years (it started with an infrastructure buildout in the 1930s).* So it's a secular problem, with chronic as well as acute causal factors.
- There is a ladder of nursing credentials, and the shortage effects them differently. Hiring for roles like CNA and LPN/LVN has exploded because of the shortage of RNs and above. CNAs get trained in 4-12 weeks to do the heavy lifting of care; RNs get ~3 year degrees to perform much more complicated tasks.
- Burnout, and the nursing shortage, are in a positive feedback loop/downward spiral. That is, the more nurses burn out, the more they cause other nurses to burn out. Short-staffed facilities have a very hard time pulling back to normal staffing, because nobody wants to join a skeleton crew. (I know of long-term care facilities where the scheduling nurses (the bosses) are working the graveyard shift because they can't fill it.)
- Many nurses work rigid schedules on 12-14 shifts, and a lot of medical errors happen at the end of those shifts. **
- The hot US job market (Great resignation, great reshuffle) is hitting nursing especially hard; it is very sensitive to external shocks. There are paths to easier work and higher pay.
- Many healthcare facilities and systems don't give nurses flexibility or the possibility of advancement. (One family member will need to quit her current job and come back in a year or two to her current employer if she wants to move up a pay grade -- which is like some tech companies -- but slower moving and lower paying.)
- Many facilities are run entirely on foreign staff (the H2-B visa allows that). And many nurses are imported from the Philippines.
* https://www.nursing.upenn.edu/nhhc/workforce-issues/where-di...
** https://www.nytimes.com/video/opinion/100000008158650/covid-...
(plug: if you're interested in this problem, we're hiring: https://culture.clipboardhealth.com)
by Copenjin on 4/27/22, 4:05 PM
by hereme888 on 4/28/22, 12:16 AM
by airstrike on 4/27/22, 5:06 PM
by dollyworld on 4/28/22, 1:34 AM
small sample size but agree on most points
by saos on 4/27/22, 6:17 PM
by xkbarkar on 4/27/22, 4:27 PM
Few people have been as relentlessly toxic and unforgiving on social media as nurses.
As a child of a nurse, that job has sucked for at least the past 40 years. The pay is average. Workplace is a cesspool of gossip and toxic work culture. Management is generally terrible. Also, the pandemic has exposed how many in the profession really are just narcissists.
The amount of facebook posts from indignant nurses spreading the most horrible comments , just to receive likes and be perceived as heroes, these past two years have made my stomach turn.
Its about time we cleaned up in healthcare. Not just aduquate pay, making sure we properly manage healthcare professionals and evolve healthcare management to grow where its needed.
I am 100% positive a flexible healthcare system that expands and shrinks after societal need is possible.
Not this crazy old fashioned fixed set of beds for x or y, that gets cut in some wave when they are needed less. Only to cause havoc in years when they are needed more.
Make sure the good nurses dont burn out and quit leaving the narcissist and ego maniacs behind.
There are amazing nurses out there, but we need to face that many of them are absolute shit at their jobs. And should seek other venues. This exodus may be a good thing in the end.
by gentryb on 4/28/22, 6:05 PM
Saddest thing is that I really felt I was helping, but have to admit I've become burnt out in the healthcare field - Just have $500 or so in scrubs invested...
Taking the time has hurt my career in many ways, I do believe. I have a ton of respect for many nurses, but many travelers are worse than you might imagine. Over-extended, far over-paid for their work. And really don't care about the facility they are working with (or throwing others under the bus to cover up their own mistakes)...
It was a valuable thing to experience, and I do believe I helped many people, but it's a very different thing to be at the bottom rung than the one designing and implementing various systems. God forbid someone can see a workflow issue, propose multiple solutions, and have travelers ignore it because the workflow issue makes them more money.
Not a rant against nurses at all - As someone with over 20 years in various roles of engineering, it was quite an eye opener to me.
by smm11 on 4/27/22, 8:50 PM
by acchow on 4/27/22, 7:49 PM
by ed_balls on 4/27/22, 6:33 PM
by fumeux_fume on 4/27/22, 4:13 PM
by dcchambers on 4/27/22, 7:17 PM
by poorbutdebtfree on 4/27/22, 9:34 PM
by bezospen15 on 4/27/22, 5:02 PM
by Kharvok on 4/27/22, 5:25 PM
by davesque on 4/28/22, 3:39 AM
The issue with entitled, mean patients strikes me. While I'm sure a fair bit of this is due to the way in which misinformation about COVID and other health issues spreads on social media, I have a hard time believing this is the primary cause of this grumpiness. It seems more likely that the average person is just fed up being taken to town by a completely inhumane system that really ought to be the most humane of systems. Nurses are the front line representatives of a system that exploits people when they are most vulnerable.
Now, I'm not saying nurses deserve this at all. They're not to blame for the state of things. But the observation might go some ways in explaining the psychology of the phenomenon.
by xyzzy123 on 4/27/22, 4:34 PM
by failuser on 4/28/22, 2:27 AM
by Footkerchief on 4/27/22, 8:18 PM
by Zeetah on 4/27/22, 4:46 PM
by artur_makly on 4/27/22, 10:12 PM
by sumanmd on 4/27/22, 9:31 PM
In my opinion nurse should have shorter 8 hrs shifts and 4 per week . In this capitalistic driven health care system, where being a patient and health care provider comes with a cost.
by fallingfrog on 4/27/22, 4:47 PM
by dijonman2 on 4/27/22, 5:24 PM
by mugivarra69 on 4/27/22, 11:02 PM
by bob_neumann on 4/28/22, 3:25 AM
It cost something like 15% of the nursing workforce, people who were already Covid immune, since they had worked the Covid front lines from day one.
But we pretended the vaccine helped stop the spread of Covid. It doesn't. And we pretended the vaccine had no meaningful risks. It does. And we pretended that natural (recovery) immunity didn't exist. It not only exists, but it's far stronger than anything a vaccine can do.
And yet we pretended anyway. And now we're paying the price. Pretending makes for bad public policy.
There are a lot of things we need to stop pretending about.
by adventured on 4/27/22, 6:11 PM
by gsatic on 4/27/22, 3:48 PM
by lexwraith on 4/27/22, 4:12 PM
1. Everyone pays lip service. People stand at airports and say thank you for your service the same way they open their windows at 7PM and start clapping and cheering during shift turnover. Sometimes they'll say they know people who are veterans or 'frontline healthcare workers' as a sign of solidarity
2. Nobody actually wants to hear what you went through. Hearing people die or knowing people are about to die in sometimes painful, unfortunate ways is too raw for people to try to seek out and understand, despite the fact that for a significant portion of the population that's how we're going to go out, in a hospital with all sorts of drugs pumped into our system
3. There's a constant barrage of emotional/mental harm. Believe it or not, you don't magically 'harden up' immediately. Absorbing/witnessing drastic outcomes gets easier, but the burden doesn't get lighter. This isn't to mention physical harm. People do all sorts of things out of desperation and frustration.
4. The systems that manage you are byzantine if not kafkaesque. You're never sure how the decisions are made, yet you're the one that will be paying the most for it. You know deep down that you're just a number on a spreadsheet, and the only reason that keeps you going is internal motivation to do what you think is right, so you push on
5. The people who can help rarely think about you. Very few politicians will mention your name or your union that is doing its best to get some kind of safe nurse:patient ratios or even get the hospital to pay for your scrubs that they mandate. Very few billionaires have mentioned healthcare workers or veterans at all. As a whole, until someone has an emergency that threatens their physical or financial status, healthcare and security is treated as a black box with unreal expectations and extra sensitivity to deviations from said expectations, despite a complete lack of introspection and information on how those expectations came to be
I don't know what the solution is. In healthcare, every system is so deeply connected to the rest that destroying one or even refactoring takes down everything else, and we need it to stay online. The same applies to the continuation of geopolitics by other means. You can give every IC the best EMR system, the best rifle and radio, the best monitor/laptop/keyboard, but it's all for nothing if the system as a whole is a dumpster fire. Her frustration is palpable every time she finishes a rough shift (probably 2 out of 3), and the best I can do is lend my ear and pour a glass of wine.
That being said, I am grateful that she is continuing on the path. Our shared experiences have brought us closer than ever.
by badtoro on 4/27/22, 6:01 PM
by kxyvr on 4/27/22, 4:35 PM
https://www.beckershospitalreview.com/workforce/if-1-in-5-he...
Now, the problem is that when people started quitting, there were fewer nurses to take care of the patients and their ratios went up. During normal times, a floor nurse might be 6-8 patients to one nurse, a step down unit might be 4-1, and an ICU might be 1-1 or 1-2. It depends on the level of care required. Now, they're doing more than double this on a regular basis. And, frankly, they can't do it, at least safely. There's a number that a nurse can call if they believe they have an unsafe number of patients in order to get some kind of legal protection, but they still have to see that number of patients. And, frankly, it's incredibly stressful because they really, truly can't take care of that many patients, so they quit. A friend of my wife is a nurse trainer at a large hospital. They're having 80% of new nurses quit during their onboarding process because the ratios are absurd. A good portion of my wife's time is spent figuring out who's the least sick patient to discharge from the ICU because they don't have the staff.
Unfortunately, I don't think we're even close for this to being over either. The constant refrain is that COVID is the new normal and we need to adjust. I would contend that a new normal would imply a stable operating point and I do not believe this to be the case. It's going to take a really long time to restaff appropriately where the patient ratios and stress level manageable. Long time means years because, really, hospitals want and need BSNs and not just associates level training. In the mean time, every time we have a COVID surge, the hospital gets flooded, everyone gets overworked and abused, and more people quit.
by detcader on 4/27/22, 3:25 PM
by jgalecki on 4/28/22, 12:10 AM
One fundamental force in nursing is that a nursing shift is unpredictable. Some shifts go very smoothly, some are absolute trainwrecks. Patients are, definitionally, sick enough to be in a hospital, and they can start declining very quickly. This means that whatever you are doing at any given moment is often interrupted by a new priority that must be handled RIGHT NOW. It means that your 'plan of attack' for the day (which patients get [meds | baths | food | mobility | turns | dressing changes] when) is often delayed, sometimes by several hours. Any number of things could push the schedule back - incontinence care, a doctor stopping by to discuss a patient with you, a patient fall, a medical emergency, a lonely patient. A few curveballs can put you way into the weeds.
Consequently, the culture on a floor is key to how good your shift is gonna be. If you help others out when you have some slack and they help you out in turn when you are behind, it really smooths out those rough days. If other nurses let you drown, you drown.
The biggest thing that a hospital can do to help nurses is to adequately staff their floors. If everyone is drowning because the floor is understaffed, no one has time to help each other. If you're caring for six patients instead of four (on a med-surge floor), there are days where there literally isn't enough time to do all the nursing care everyone deserves. Documentation can be, and often is, done after passing off your patients in report. After you've already "dropped" documentation from your during-shift schedule, patient mobility - getting people up and walking, or even just sitting up in a chair for meals - is the usually the next thing go. After that, hygiene. Nobody dies if they don't get a bath, but another patient certainly could die if you don't do X. Next up comes pain medication requests and incontinence care. For me, it was enormously stressful not being able to provide the quality of care that the patients deserve.
This can be a huge factor in burnout. The pandemic made things worse in a bunch of different ways. Besides the stress of caring for patients with a deadly virus, you also now have to add on several minutes to every patient interaction for donning and doffing PPE. That's even less time to do the nursing part of the job while you're dealing with a more critical patient population (who will need more care). Burnout rates increase and nurses leave, either leaving the profession or taking contracts that, even if the conditions are no better or much worse), at least pay a premium. Hospitals that were well-staffed face staffing shortages, and hospitals that were already short on staff are now in a staffing crisis. The hospitals have to spring for travel contracts, and the nurses that did stay are angrier that other nurses are making multiples of their pay for doing the same work.
Given that this thread has some 900+ comments already, this comment will start off pretty far down the list. But I see some people mentioning that you are working on trying to make things better for nurses - I'm guessing that those people will read the thread more thoroughly. I would love to chat with you about whatever it is that your startup / company / weekend hackathon project is doing in this space. I've dedicated five years of my life to the problem space and would happily share my thoughts and experiences.
by faangiq on 4/28/22, 1:38 AM
by JaimeThompson on 4/27/22, 3:21 PM
by nomoreusernames on 4/27/22, 10:04 PM
by sujitjadhav on 4/27/22, 3:26 PM
by goodpoint on 4/27/22, 3:39 PM
by jmyeet on 4/27/22, 4:13 PM
What's worse is it belies an ugly aspect of human nature (particularly pervasive in the US IME) that people absolutely do not give a fuck about anyone else when it comes down to it. As long as someone is fortunate enough to have decent health insurance through their job, people who don't are lazy.
The big picture here is that the wealthy want people dependent on jobs and to be in debt (eg student debt) because it makes them compliant.
So I'm not surprised nurses are leaving. Insurance companies make providing healthcare an absolutely miserable business and deliberately killing people ("prior authorizations", "pre-existing conditions", etc) should not be the basis for commercial enterprise. Denying someone life-saving or life-changing care should not be a profit motive.
What's worse is that a lot of the burnout is effectively caused by people who are profoundly selfish and are voluntarily choosing to get sick and die of what is now a highly preventible disease.
It's a hard situation because people depend on nurses so collectively they're torn. Teachers OTOH aren't life-critical (but still obviously important) so I'd actually like to see them make a mass exodus over all the right-wing censorship they're facing in most states.
by petermcneeley on 4/27/22, 3:22 PM
by throw8383833jj on 4/27/22, 4:49 PM
It sounds like they're just being overworked. So, just have the nurses take a 20 minute break every 2 hours, to go out and take a walk. The hospital can require it if it comes to that but why wouldn't they just want to do it? and if the hospital doesn't want to do it, then the nurses should insist on it and walk off the job if not given their breaks. I would imagine the hospital would rather agree to 20 min breaks every 2 hours rather than loosing 90% of their workforce forever: they don't have a choice, they have to agree.
by fitba72 on 4/27/22, 3:40 PM
by sonicggg on 4/27/22, 3:26 PM
There's just something masochist about their profession.
