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

#691

Post by divbzero » Wed, Apr 27, 2022, 9:03 PM UTC

germinalphrase wrote: post #55

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…

There seems to be two sides to this.

The first, mentioned already in this thread, is that maximizing profits should not be the ultimate yardstick in all cases.

The second is that we are not setting incentives correctly in healthcare: preventative care still plays second fiddle to curative care. If the healthcare industry were purely free market, this could be attributed to individuals not understanding the long-term benefits of preventative care, or overly discounting the distant future. But the healthcare system is not purely free market. The largest payers, public and private, could do a lot to correct the incentives by setting their reimbursements accordingly.

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

#692

Post by ikiris » Wed, Apr 27, 2022, 9:03 PM UTC

sithlord wrote: post #481

Shuang1 wrote: post #451

Earlier quoted context omitted.

That case goes far beyond med error and I don't understand why people keep bringing it up as an example. She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.

Literally every medication has warnings slapped all over it. My partner worked at Vanderbilt (on a different floor) around this time, and one constant complaint I heard (prior to the incident) was how there was hardly any controls around anything there.

Yeah, there's no doubt that this is a shitshow from how Vandy is described (and nursing in general especially with these automated pharm boxes), but that should be additional consequences, not this nurse avoiding hers.

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

#693

Post by bumby » Wed, Apr 27, 2022, 9:04 PM UTC

coryrc wrote: post #626

tinco wrote: post #580

Earlier quoted context omitted.

> a public scandal will erupt surrounding well-paid medical professionals sitting around doing nothing I don't think that's true. Increasing the amount of nurses means simply increasing the amount of care. If you have twice as many nurses, you'll have twice as much care for your patients. No way nurses would be sitting around doing nothing.

That's not how healthcare works. That it is does not function that way is why free-at-point-of-use public healthcare systems are capable of working.

Not sure why you're being downvoted, but the idea that doubling nurses doubles the amount of patient care shows an ignorance of the healthcare system. "Patient care" is a nebulous term and needs to be further defined in that statement. Do you now get two catheters instead of one? Or get your vitals taken twice as often? Both double patient care but only one is relevant.

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

#694

Post by tetraca » Wed, Apr 27, 2022, 9:04 PM UTC

notch656a wrote: post #593

ayngg wrote: post #577

Earlier quoted context omitted.

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…

I don't disagree nurses DESERVE to be paid more (I'm not sure if the economics bear out but they're certainly as WORTHY as many other professions), but wouldn't the fact that these nurses continue to work in nursing despite considering leaving bolster the argument even further that they are receiving adequate compensation? Staying when you want to leave indicates there's enough compensation to 'make it worth it' at l…

> Staying when you want to leave indicates there's enough compensation to 'make it worth it' at least versus whatever shitty alternatives you have. Leaving when you want to stay, to me, would be a much bigger indicator that nurses who want to stay in the profession can't because of wage/benefits/conditions issues.

I think the conclusion of this sort of economic thinking is basically: Give your employees just enough money that they can keep they keep their head above the water but not enough to flourish, and just enough pressure/responsibility that they don't have energy to do anything else, but not too much that they have a complete mental breakdown that leaves them with the conclusion that they should leave your industry at any cost.

When you spent a lot of time and money into a specialized and demanding career, I imagine it practically very difficult to actually change your career, even if it's killing you. It's probably even worse if you have familial obligations. You likely do not have time or energy to better your situation after hours, and if you quit, you potentially resign yourself (perhaps) to many years of destitution while you accumulate the necessary knowledge to do something else. I would not be surprised if many people just bear bad conditions because the cost to do anything else worth one's time is simply too high.

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

#695

Post by a2tech » Wed, Apr 27, 2022, 9:05 PM UTC

conductr wrote: post #638

tomc1985 wrote: post #585

Earlier quoted context omitted.

At the rate that healthcare charges in the US, hospitals can more than afford to keep X+1 or +2 needed nurses around in three 8-hour shifts. They just don't.

Not even close. Most hospitals have trouble staying afloat as is. And there are disciplines within nursing, so you'd have to overstaff by quite a bit more such that closer to 2x is a backup but leads back to the GP's point. They employ on-call, PRN, contract nurses, etc to fill in the gaps which mostly works in non-pandemic situations.

Reading threads like this really hammers home most of HN have never worked in health care. Hospitals BARELY make their budget. 1% over cost of doing business is considered a really good year for my institution.

Also if I never have to hear people complain about bloated admin budgets in education and healthcare ever again it’ll be too soon. Those admins aren’t sitting around on their thumbs—they’re dealing with the ridiculous legal and administrative system the insurance companies and government have created. Those people are absolutely critical for the institution to exist.

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

#696

Post by cogman10 » Wed, Apr 27, 2022, 9:05 PM UTC

stdgy wrote: post #607

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…

The rules nurses have to deal with around things as asinine as taking PTO are AMAZING. They’re required to put in PTO requests months in advance and the hospital can and will say “Sorry, denied. We don’t have enough people…” As they are intentionally creating skeleton crews of nurses to wring every ounce of profit out of the business. My mom was a nurse, my aunt was a nurse, my sister is a nurse and my best friend’s…

Yeah, my mom was a small town nurse it was the same even there. I gave them a bit more slack because it was a hospital serving like 2000 people (so not really a high profit place) but even there, there was a lot of last minute "Oh no! People didn't show up for their christmas shifts, could you come in please!"

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

#697

Post by kedean » Wed, Apr 27, 2022, 9:06 PM UTC

bumby wrote: post #652

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…

> 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 d…

You're describing Brook's Law from The Mythical Man-Month. It was an observation of collaboration in software engineering specifically, and it cannot be applied universally to every industry. Really, anything that is highly parallel (medicine, teaching, stocking shelves, waitstaff, deliveries) can benefit from hiring more people until you reach saturation, and medicine isn't there or we wouldn't be having the conversation.

The problems are caused by a "just in time" approach to staffing, where you have exactly enough people to cover the shifts at bare minimum. What solution would you suggest other than more people? They are not saying to throw more nurses at patients simultaneously, they are saying to hire more nurses so existing ones aren't bound to spent the entire week stretching themselves across the hospital.

Also, I think you are being downvoted because you are applying software engineering rules to medicine.

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

#698

Post by dragonwriter » Wed, Apr 27, 2022, 9:06 PM UTC

elhudy wrote: post #408

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…

Don't forget that nurses can now legally be thrown under the bus with criminal charges for malpractice while hospitals walk away scotch-free [1]. This is huge in the nursing community right now. [1] https://www.npr.org/sections/health-shots/2022/03/24/1088397...

> Don't forget that nurses can now legally be thrown under the bus with criminal charges for malpractice while hospitals walk away scotch-free

The nurse in that case was prosecuted for criminal reckless homicide (not malpractice, which is civil negligence.) The characterization of the hospitals direct responsibility is negligence not arising to criminal (gross) negligence (as the principal of respondeat superior doesn't apply in criminal law, the employees recklessness would not be imputed to the employer the way it would in a civil case.)

As for civil liability if the hospital, that was settled out of court with the victims family, the hospital did not get off scot free.

This... isn't a new thing that deserves the “now” label like it is a change. Criminal wrongdoing by employees (including in healthcare) very often does not rise to a level of criminality for the employer, and that's been true for a long time.

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

#699

Post by jeffrallen » Wed, Apr 27, 2022, 9:08 PM UTC

eksx wrote: post #680

jmugan wrote: post #397

A lot of us are saying we need to increase the pay of nurses, but we also believe that medical care is too expensive. So, where is all that money going? There are a lot of flippant answers but they never seem to lead anywhere actionable.

One example is drug waste. Insulin for example is charged per vial to the patient but usually only a minimal fraction is actually used and the remainder is disposed of.

And then the patient is charged a disposal fee.

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

#700

Post by oliverafajardo » Wed, Apr 27, 2022, 9:08 PM UTC

My experience: I'm an icu nurse in the sf bay area. I make a good salary. However, you can make this and more with a job with less physical and emotional stress/abuse. Even the "best" hospitals like kaiser/stanford/ucsf are always short staffed. I considered another area of nursing/hc but it's really all the same BS of being short staffed, constantly being denied vacations, etc.

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!