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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

#651

Post by WalterBright »

ayngg wrote: post #577
cogman10 wrote: post #416

Earlier quoted context omitted.

The one I think you are missing is that nurses are and have been overworked for a WHILE now. (that's what I get from /r/nursing) Hospitals have made sure they hire JUST ENOUGH nurses to cover shifts and no more. With covid hitting, this blew out the number of nurses needed resulting in a lot of "I know you've already worked 60 hours, but can you do another 20? we are short!". Rather than hiring permanent people or up…

I actually think that this is just one example of many across a ton of disciplines where people like Nurses basically are forced to deal with costs and responsibilities offloaded onto them from above the responsibility chain. Resources are eaten up at the top of the chain to their benefit and costs are offloaded down the chain until it reaches people like Nurses at the end of the line who have to deal with it because…

And yet the government budgets rise dramatically year after year.

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

#652

Post by bumby »

cogman10 wrote: post #416
mfer wrote: post #46

I've spent a fair amount of time talking with nurses about the problems. I'm related to a bunch of people who are nurses across disciplines (ER, ICU, med/surg, etc). It's been enlightening hearing them talk about the problems... 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 tryin…

The one I think you are missing is that nurses are and have been overworked for a WHILE now. (that's what I get from /r/nursing) Hospitals have made sure they hire JUST ENOUGH nurses to cover shifts and no more. With covid hitting, this blew out the number of nurses needed resulting in a lot of "I know you've already worked 60 hours, but can you do another 20? we are short!". Rather than hiring permanent people or up…

>The fix is one that Hospital admins don't want. Pay your nurses more and hire more

As someone who worked in hospitals to help redesign their processes, this one piqued my interest.

For every project I worked on (and I mean literally every one), the team lead wanted to jump to the solution that they just need the ability to hire more people. In the rare instances where they were able to convince hospital admins to do so, it never fixed the problem. Not once.

Why? Because it never addressed the root causes. They needed to take a process-oriented approach. There's a saying that adding more people to a broken process makes things worse. You can hide a lot of quality issues with inventory; if you have a requirements for 100 widgets a day and you have a crap process that only makes 10 quality widgets, you can meet your goal by increasing throughput 10x, but nobody thinks that would be a good approach. It's the same with injecting more staff onto a broken system. If the system causes nurses to spend disproportionate amounts of time on admin work and not on direct patient care, it may be better to look at your admin processes rather than just hire more nurses.

It's natural when people to feel overwhelmed to think the solution is to just hire more people, but it's almost always better to hold off on hiring until the system/process is fixed.

Edit: I'm curious about the downvoting. I think it would help illuminate the conversation if you could explain where your disagreement lies. I'm basing my statements on actually tracking when hiring was increased to the levels desired and metrics did not improve.

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

#653

Post by conductr »

robonerd wrote: post #628
conductr wrote: post #609

Earlier quoted context omitted.

Yes and No. On an individual basis, nurses are overworked because they choose to be and their employers allow for it. The standard work week is 3 12 hour shifts, which is much less than most professionals work. Like a retail or warehouse worker, they are expected to clock out as soon as possible and leave when the shift ends. Those of us with salary jobs knows how difficult that can be in our arrangements and how muc…

> Capacity is the problem Capacity is generally limited by staffing, not space or actual beds. When hospitals report how many "beds" they have available, they're generally not talking about the furniture.

They are absolutely talking about actual physical beds. The bed is licensed by the state and inspected by a regulator and is an indication of how many patients can stay in the hospital. As as been shown these years, they can and will pay what is needed, finding qualified people is the hardest part.

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

#654

Post by jodrellblank »

lettergram wrote: post #215
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.

No one wants to hear the truth. There’s near-infinite demand for healthcare and a constrained (mostly artificially) supply. Insurance, people and government can’t solve the problem of the supply and demand by throwing money on it. You either expand supply or remove demand. Given removing demand is... not desirable. The only alternative to fix the issue is remove regulation and expand supply. That’s it. Insurance make…

> "An approach is to deregulate, such as removing government licensing, remove Medicare, etc."

This worked so well for Rosemary Kennedy when she could be prescribed an ice pick lobotomy. And so well for Eben Byers when his doctor prescribed him radioactive water, and he drank so much his jaw rotted off. It works brilliantly for this woman[1] and her cheap Turkish dentist work leaving her in pain. And for, well all of this junk: https://en.wikipedia.org/wiki/List_of_unproven_and_disproven...

Deregulation is what we had when things were terrible. Regulation and licensing is what we use to block the most obvious junk 'treatments' and the worst con artists.

> "Given removing demand is... not desirable."

Removing demand is enormously desirable. Regulate the shit out of CocaCola, Marlboro, and all the other health destroying parasites and their advertising, tax them, rework town and city planning to remove driving as the primary transport in life and all the associated exhaust fumes, rework public schooling and rebuild trust in the government and medics so people aren't anti-health-advice on principle, rework employment so that employees have some rights and aren't stressed out all the time with no sick breaks. Rework medical access so people can see medical professionals, and sickness can be caught and treated early, which reduces demand on seeing much sicker people later.

> "Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures."

Insurance makes the issue worse by driving up costs to patients and at the same time driving down pay to medical staff, by insurance taking as much as possible. Without insurance, supply and demand could remain the same, medical staff earn more, patients pay less, and services be more efficient with less time wasted fighting insurance companies and filling in insurance paperwork.

[1] https://old.reddit.com/r/northernireland/comments/ua9me9/eas...

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

#655

Post by dragonwriter »

JaimeThompson wrote: post #447
tristor wrote: post #219

Earlier quoted context omitted.

> This one is big for product designers. You're right that there are definitely opportunities for improvement here. As a Product person that has worked in EMR/Healthcare IT systems, I can tell you the biggest challenge is most of the decisions are driven by legally-required compliance. In many cases, you literally cannot make it better because the brokenness is /by design/ to comply with the law. Nearly across the bo…

Doctors and hospitals control some of the more powerful lobbying groups in the United States making it a bit strange they haven't worked on those issues.

> Doctors and hospitals control some of the more powerful lobbying groups in the United States making it a bit strange they haven't worked on those issues.

Doctors and hospitals are not necessarily aligned groups (either with each other or with nurses) on the issues, and private insurers, state governments (as market participants themselves, via operating public insurers such as Medicaid agencies), and other players are also very powerful lobbies.

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

#656

Post by conductr »

landemva wrote: post #618
conductr wrote: post #609

Earlier quoted context omitted.

Yes and No. On an individual basis, nurses are overworked because they choose to be and their employers allow for it. The standard work week is 3 12 hour shifts, which is much less than most professionals work. Like a retail or warehouse worker, they are expected to clock out as soon as possible and leave when the shift ends. Those of us with salary jobs knows how difficult that can be in our arrangements and how muc…

It makes sense to the $250k/year hospital chief bureaucrat (not a medical person) and the Pres. and board accept that the extra contractor pay is just short term.

So are pandemics if you look at it that way

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

#657

Post by karmelapple »

ISL wrote: post #541
hedora wrote: post #235

Earlier quoted context omitted.

We’re facing some massive generational crises at this point, and it feels like the only solution is to wait for the current leadership to die off, and hope the gen x’ers fix it. The WWII generation fixed the ozone hole, but their kids didn’t lift a finger for global warming. Subsequent generations are scrambling to pick up the pieces for our kids, while crap like this, and our rapidly collapsing democracy keep sabota…

The WWII generation may have worked to fix the ozone hole, but they also unknowingly created it: https://en.wikipedia.org/wiki/Chlorofluorocarbon#History

And all of the generations helped create climate change, yet we're not doing all that much to comprehensively combat it at a government level.

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

#658

Post by jewayne »

kerbs wrote: post #601
screye wrote: post #550

Not to be mean, but 'leave nursing' and then what ? 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. Nur…

> 'leave nursing' and then what When we got married, my wife (Physicians Assistant) made handily more than I did. $140k to my $82k midwest, software development job. 10 years later, she makes $130k (after cutting hours back) and I make $4-500k as a software engineer in the midwest. The two markets crossed drastically Where are they going? For us, home.

$500K as a software engineer? That's the very tip of the unicorn's horn. My friend works as a CEO of a (smallish) software company and makes half that.

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

#660

Post by mikkergp »

dudul wrote: post #589
mikkergp wrote: post #291

Earlier quoted context omitted.

It's an interesting problem, because we currently align economic 'productivity' and pay rather than social value and pay, which is efficient since we don't have to redistribute resources between industries or roles, and resource redistribution is a dirty word, at least in America. My wife is a doctor and I make significantly more than her working as an SRE, when her job is significantly more difficult (particularly e…

We do not align productivity and pay, we simply align pay and how difficult it is to find someone to do the job.

Not directly, but indirectly, this is one reason why bigger companies can pay more than small companies, more efficiencies, automations, and economies of scale means the output per employee is higher.
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