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Report: 90% of nurses considering leaving the profession in the next year

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Re: Report: 90% of nurses considering leaving the profession in the next year

#161
post #85

Earlier quoted context omitted.

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

The "only physicians should run hospitals" doesn't make that much sense to me. Reminds of the technocratic argument you used to see a lot on the internet that instead of politicians we should have scientists and engineers in legislature.

The issue is if you have someone with a scientific background doing politics, what you have at the end is still a politician. Same thing here. An MD doing hospital administration is an administrator.

Which is not to devalue specialist expertise in these roles. I definitely think you want people with these backgrounds in those roles as well. Just not necessarily exclusively. A career administrator has different skills than a physician, you want people with both, and other, roles working to run a hospital.

The real problem as I see it is probably the incentives, constraints, and pressures they work under, or towards. A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation. The thing is to change the situation, not put different people into that role and expect them to do it dramatically better.

Re: Report: 90% of nurses considering leaving the profession in the next year

#162
I work at a startup* trying to tackle nurse burnout, and two of my family members are nurses. Here are a few things I've learned:

- 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://clipboardhealth.com

* 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)

Re: Report: 90% of nurses considering leaving the profession in the next year

#163
post #94

Earlier quoted context omitted.

Travel nurses are compensated quite a bit more in my understanding. And the travel aspect means they can leave the more toxic locations more easily.

They're paid a shit ton more. And because of that, more nurses are quitting to do the travel thing, which worsens the shortage and increases demand for travel nurses ;-) never seen an industry fuck itself over so bad. That's really the issue - healthcare has become an industry, not a profession.

As you noted at the beginning of your comment, the issue is the pay to quality of life at work ratio being too low.

Re: Report: 90% of nurses considering leaving the profession in the next year

#164
This seems like a world-wide pattern, and it was already an issue even before covid.[1] I'm curious about what alternatives they have, may be joining newer tech-enabled companies with nursing services, or going fully independent and work solely by their own terms with some patreon-like app... ?? Or is it the case that they are really sick of nursing and might prefer changing professions or even unemployment?

[1] https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief...

Re: Report: 90% of nurses considering leaving the profession in the next year

#165
post #17

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

Insurance companies are awful and should not exist, sucking up a lot of doctor time, but when it comes to nursing, hospitals are particularly awful, cutting staffing levels to the bone in order to maximize profit. People die as a result, and nurses are burnt out.

Re: Report: 90% of nurses considering leaving the profession in the next year

#166

I have a close relation that works for one of the oldest pediatric hospitals in the country. It was recently revealed that they will be shuttering almost all pediatric services in the next year because they can 10x their profits by only serving elderly clients. The entire purpose of this organization was to provide pediatric healthcare, and it wasn’t losing money… Sometimes, it feels like we’re min-maxing ourselves t…

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Re: Report: 90% of nurses considering leaving the profession in the next year

#168
post #54

I work in tech with no college degree and about 9 years of programming experience. I make mid 100,000's per year. My S/O has 6 years of Emergency Department experience and a bachelors degree and she made about 65k at our local hospital. I think pay is an enormous factor in this. Her local hospital has nurses with less than 1 year of experience being preceptors to new grads.

She should apply for tele medicine. I knew a few nurses that took this on during the pandemic and were making about $50-60/hr from home. I suspect there are fewer opportunities like this now, but it's worth a shot.

Re: Report: 90% of nurses considering leaving the profession in the next year

#170
post #17

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

Granted, there's a niche for cash pay docs. Example being psychiatry - it's extremely hard to find a psychiatrist who takes insurance, even Medicare. The good ones are all cash pay...
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