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

#241

Post by woah » Wed, Apr 27, 2022, 4:23 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…

Works pretty well for lawyers. It's not perfect, but lawyers have to adhere to a code of legal ethics, and only lawyers can have equity in law firms. Seems like this model could be transferred directly to the medical industry. It would not solve every problem ever, but it is an interesting thing to look into.

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

#242

Post by bkjelden » Wed, Apr 27, 2022, 4:24 PM UTC

UnpossibleJim wrote: post #189

bkjelden wrote: post #56

Not surprising. My partner is a DNP and has pretty strongly considered leaving the entire profession. 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 fo…

This is totally anecdotal, so take it for what it's worth, but in addition to nurses leaving the profession I've seen quite a few doctors in my area leaving the profession as well. Relatively young men and women retiring the profession completely post pandemic, though I haven't had an opportunity, nor would I, to ask them why they left the position. I have no idea if it has anything to do with the pandemic or the adm…

I have no doubt that MDs are leaving as well - but, at least from my perspective, in any large healthcare system, there is a drastic difference between the way middle management treats MDs and the way they treat everyone else. The latter is completely expendable, whereas the MDs do have a fair amount of negotiating leverage around their working conditions.

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

#243

Post by mikkergp » Wed, Apr 27, 2022, 4:25 PM UTC

PragmaticPulp wrote: post #77

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…

> 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…

I get what you're saying, but the promise of the medical system and the implementation of the medical system aren't really aligned. Sure 50% of problems are naive patients, but the other 50% are doctors or a system that doesn't know how to talk to you or treat you, or there's just an ocean of uncertainty in how to operate. You show the negative side from the doctor perspective, but on the other hand. Doctor's aren't really trained in 'health' they're trained in pathology. If you're really sick they can provide help, but if you want to optimize or you're kind of sick, or your numbers are borderline. Medicine is just sort of not a hard science, there's way too much uncertainty. You mention people demanding antibiotics, but the doctor's are just as bad -- last time I tried to have a nuanced discussion about it with a practitioner, the answer was a simple "x days is the standard of care". Not to mention that the doctors would have to be up to date on the latest versions of research in a ton of different areas to have some of those answers anyway. I'm not going to leave terrible reviews about it, but I rarely leave a medical office feeling satisfied that there are firm answers on anything.

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

#244

Post by shadowofneptune » Wed, Apr 27, 2022, 4:25 PM UTC

fitba72 wrote: post #108

In my experience, most nurses come in, socialise and cheer you up, take your blood pressure and temperature with automated devices, that one can buy for home use, and give you medicines that a doctor has prescribed (someone can also can do at home if they are feeling up to it). This is a wonderful profession and they should be highly paid but do they really need a bachelor's degree or master's degree to do this job?…

Where a less credentialed person can do the job it has already been done. Here's how it breaks down:

Registered Nurse (RN): The 'specialized nurses' you talk of, and what this article is mainly about. Requires at least an associate's degree to be licensed, but increasingly an bachelor's is expected. Only they can administer any medication a doctor prescribes, and only they can assess your condition.

Licensed Practical Nurse (LPN): If they are certified they can also do blood draws. Requires graduation from an LPN program (usually about one year) to be licensed. They perform easily predicted tasks like a dressing change that do not require assessment. They can also administer some drugs based on the situation.

Unlicensed Assistive Personnel (UAP): In a big hospital, these are who are checking your temperature most of the time. They can only do basic tasks that do not require any medical training, even if their experience is larger than the RNs and LPNs they're under.

There are also many different technicians. In a big hospital, an RN acts as a middle manager delegating their work to these many different tiers. In an ICU, or in a small hospital, it will be done much more by themselves.

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

#245

Post by bitsnbytes » Wed, Apr 27, 2022, 4:26 PM UTC

salt-thrower wrote: post #28

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…

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling The profit model of the U.S. healthcare industry might have something to do with it. The fact that hospitals are run like businesses and have shareholders is insane to me. I know other countries' healthcare systems got hit hard by the pandemic too, but it seems like the uniquely capitalis…

profit model is not the issue. How the compensation and rewards are structured is the issue.

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

#246

Post by legitster » Wed, Apr 27, 2022, 4:27 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…

> after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc

This actually isn't necessarily true when you learn how billing codes work. Most insurance companies pay out at a fixed rate per billing code based on your plan. That doesn't change. What does change is that hospitals can retroactively apply new additional billing codes.

This happened to us once for an ER visit where we got 3 additional surprise bills over 6 months because the hospital retroactively applied new billing codes to our visit.

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

#247

Post by jonshariat » Wed, Apr 27, 2022, 4:27 PM UTC

tqi wrote: post #221

PheonixPharts wrote: post #58

Earlier quoted context omitted.

Standard error in this case, assuming the 200 are randomly sampled is: sqrt((p*(1-p)/n) sqrt((0.9*0.1)/200) = 0.021 So 95% confidence interval for this ~ 0.86 - 0.94 Does that radically change the message of this article?

That also assumes there is no response bias. The linked article doesn't seem to go too deep on methods but the source is a content marketing piece for Hospital IQ, so I'd take it with a grain of salt.

Also my first thought when I saw n was 200, lots of surveys make mistakes in sample selection or question writing but it seems with the responses here and my own observations being close to nursing, the main point checks out. Lots of burn out and leaving the profession.

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

#248

Post by xkbarkar » Wed, Apr 27, 2022, 4:27 PM UTC

Find it a bit amazing that so many here act as if the past two years are the sole reason.

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.

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

#249

Post by LewisVerstappen » Wed, Apr 27, 2022, 4:27 PM UTC

yhoneycomb wrote: post #234

LewisVerstappen wrote: post #207

Earlier quoted context omitted.

The healthcare system in the US clearly has nothing to do with free markets considering how unbelievably opaque and regulated everything is.

Actually, that’s exactly how unfettered “free market” capitalism operates. The end game is big companies end up controlling everything, including the regulations in order to tip the scales in their favor.

Regulatory capture is the issue that needs to be solved. Not free markets.

Free markets are the most efficient way for information to be transferred throughout the system.

Stricter campaign finance laws, ending revolving-door politics, etc.

But putting the blame on free markets seems like a mistake.

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

#250

Post by JackFr » Wed, Apr 27, 2022, 4:28 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. Certainly not administrators whose only education is an MHA and only experience is working for for-profit health companies.

The skills need to run a hospital are quite different than those required to be a doctor. I'm not saying hospitals aren't unique - I believe they are and their adminstration is highly specialized. Doctors should inform the administration at every level but it would be a waste of their training and a bad idea for doctors to run everything.

> Medical decisions need to be made outside of cost considerations. The only factors should be medical science, quality of life, and patient wishes (in that order).

Would you be as quick to say "Doctors should work without pay." ?