Report: 90% of nurses considering leaving the profession in the next year • Hacker News Board

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

#171

Post by soco » Wed, Apr 27, 2022, 3:55 PM UTC

polskibus wrote: post #128

brightball wrote: post #39

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.

It’s like that in many countries, also in EU. Average age of a nurse is rising, richer countries rescue themselves by importing workforce, because they can’t find workers for the rates they have budgeted at home. It’s is like that in other professions too if it’s only the tech that gets compensated well. There is a shortage of skilled labour.

Errata: there's a shortage of skilled labour for these working conditions. Said budgeting is not set in stone, and as long nurses and whatever else professions can vote with their feet (by leaving the profession) no amount of politics-led finger-pointing can replace a real-world change in the healthcare policies.

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

#172

Post by pc86 » Wed, Apr 27, 2022, 3:56 PM UTC

CityOfThrowaway wrote: post #119

PragmaticPulp wrote: post #77

Earlier quoted context omitted.

> 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. I have a lot of friends at various levels of healthcare, from nursing up through low and mid-level administrative positions. The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare. Once the emphasis shifte…

Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patient…

Patients have always been entitled to make decisions about their bodies. You can decline procedures, and treatment, and you can get second, third, fourth, fifth opinions. Satisfaction surveys do nothing to increase that autonomy. The dystopian world you speak of is a straw man.

The problems stems from people believing they are consumers of healthcare, on equal footing with the practitioner they are seeing. They're not, objectively. A 45 minute Google search doesn't equal 4 years of college (usually in something like biochem but not always), 4 years of medical school, 3-7 years of residency training and potentially another 1-4 years of fellowship training. If you're seeing anyone above a family doctor/PCP, they 100% know more about your condition than you do, whether you've been living with it for a decade or not.

That doesn't mean you don't have autonomy, or that you shouldn't question your doctor's decisions and ask for explanations, but it does mean you should err on the side of thinking the person whose spent at least a decade, but probably closer to two, educating themselves to get where they are probably knows what they're talking about.

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

#173

Post by theguyovrthere » Wed, Apr 27, 2022, 3:56 PM UTC

Nurses leaving the field is only part of the larger problem.

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...

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

#174

Post by TrispusAttucks » Wed, Apr 27, 2022, 3:56 PM UTC

rjbwork wrote: post #86

JaimeThompson wrote: post #9

Perhaps allowing modern MBAs to cost optimize most every single thing we do isn't the best way to assure mid and long term security and profitability.

Efficient systems are brittle systems. You wring all the slack out of it and any shock is going to cause failure. In this case, the slack is the nurses and other healthcare workers' mental health and burnout limits and pay and culture etc. etc. The slack is being pulled to lower costs and increase insurance/hospital profits. It's unsurprising that what has happened in the past couple of years is putting stress on a s…

You're spot on. This pattern is emerging across many structures. Efficiency is inverse correlated with resiliency. JIT systems have spread over the globe but they don't handle shocks in the pipeline very well.

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

#175

Post by slantedview » Wed, Apr 27, 2022, 3:57 PM UTC

pc86 wrote: post #85

brightball wrote: post #39

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…

> I strongly believe that only physicians should be running hospitals.

More than that - hands on healthcare should not be a for profit industry. The need to make profit is fundamentally opposed to providing the best care. As the push for profit increases, more people get sick and die. This goes for long term care as well, which is facing a similar staffing crisis for similar reasons.

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

#176

Post by omginternets » Wed, Apr 27, 2022, 3:57 PM UTC

duxup wrote: post #41

FactualActuals wrote: post #7

High stress environment, stagnant wages unless you're a travel nurse, underappreciated during the pandemic, and having friends turn on you because they associate you with some crazy conspiracy theory. These are all reasons I've heard of career nurses quitting and going into other industries.

I was under the impression that nurses were paid pretty well (generally speaking).

I went to an undergraduate school with a fairly large nursing program, and interacted with a fair number of nursing students. One thing I noted was that a large proportion of nursing students were first-generation college students from lower-middle-class and working class backgrounds. I suspect that the meme of nursing being "well paid" stems from the fact that it is a step-up in that context.

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

#177

Post by belval » Wed, Apr 27, 2022, 3:57 PM UTC

alexashka wrote: post #124

belval wrote: post #52

Earlier quoted context omitted.

I doubt that it's as simple as that. Nurses are also leaving in Canada and we don't have insurance breathing down their neck.

Are they? Leaving to do what, exactly? For every story of 'X leaves to do Y', there are a thousand people claiming they'll leave, that never do.

Some just leave to stay-at-home, some go back to school and a lot will take early retirement.

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

#178

Post by durrden » Wed, Apr 27, 2022, 3:58 PM UTC

sllewe wrote: post #114

Using an anecdotal source - My Wife (ICU RN) this is sounds right. 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…

My wife (ER/Trauma RN) feels the same way. They will need to double the pay of non-travel nurses to get through this.

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

#179

Post by hedora » Wed, Apr 27, 2022, 3:58 PM UTC

api wrote: post #87

phil21 wrote: 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…

> lost their professional agency to do-nothing administrators You just summarized the decline of Western civilization in one phrase. This has happened almost everywhere and efforts to push back have proven extremely difficult. I personally place a lot of the blame on the educational system for overproducing administrative skill sets and underproducing practical skill sets. There is some role for those things of cours…

See also: California’s plan to eliminate algebra 2 and calculus from the highschool curriculum. It is being spearheaded by someone without a math degree, in the name of improving marketability of the kids for data science positions, or something.

See also (2): Monty Python’s bicycle repairman sketch.

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

#180

Post by caycep » Wed, Apr 27, 2022, 3:58 PM UTC

giraffe_lady wrote: post #161

pc86 wrote: post #85

Earlier quoted context omitted.

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…

The problem with this is that the MBA programs that churn out hospital administrators tend not to be very good...focus on mergers, cost cutting, not so much on optimizing care. The pendulum has swung too much onto the MBA for MBA's sake hospital administrators and less so on actual medicine.