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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

#811
post #702

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…

>It's an interesting problem, because we currently align economic 'productivity' and pay rather than social value and pay How do you define and measure "social value"?

Exactly

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

#812

Earlier quoted context omitted.

Yes, this is probably the bigger impact, to be honest. Teams have limited resources and more and more of it is cannibalized by regulatory compliance work.

We've created so much regulation that no one person can know it all - not the legislators, not the agents/bureaucrats, not the judges, and certainly not the workers or patients who would be most affected by them.

I was just on a 40-person call with Micky Tripathi today. I was on a gov-only call with his minions yesterday. They mean well, but they're policy people, they don't promote by repealing policy (remember, the boss promoting them wrote that policy). No programmer will stoop to a government salary to clean up the mess. Something has to give, and we've decided to break the doctors and nurses until the patients die. Things might change once a few major city trauma systems implode.

Keep in mind, the boomers are retiring and there aren't enough Gen X to replace them. Here's the graph of job postings for my specialty (takes a bit of finagling for it to render, esp. mobile, but suffice to say the system is going bonkers): https://www.pathologyoutlines.com/jobs?jbl=1

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

#813
post #587

Earlier quoted context omitted.

I think this is due to Pournelle's Iron Law of Bureaucracy : https://www.jerrypournelle.com/reports/jerryp/iron.html "In any bureaucratic organization there will be two kinds of people: First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agric…

Nurses, teachers, charity workers, IEPs, game devs. These are all jobs where people sign up for the job . Whether it’s altruism or genuine passion. They’re willing to compromise and put up with less pay and harder working conditions. But because they’re willing to compromise, these people are pushed to their limit . With not only low pay and shit conditions, but higher-ups which actively exploit their altruism and pa…

Yeah - the problem is that "a dream fuffilling job" without major filtering like med or law school effectively has a "virtual compensation" from desirability of the job. We see the reverse for (potentially literally) shit jobs or in ill repute. The economy accounts for your feelings but it cannot care about them.

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

#814
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…

> IT systems that they have to use were designed by people who have not talked with the workers who use them. They may have been designed with laws and compliance in mind. Nurses aren't the people who choose or pay for these systems. But, they use them a lot (maybe the most) and it's obvious they weren't taken into account when designing the UX. It's maddening for them.

I can speak to this a bit. After interviewing lots of hospital workers, I can tell you that the hospital quality people love EHRs because the reporting functions actually work. Previously, it was not possible to measure how well the hospital was doing and convince the doctors to improve practices - think washing hands before doing examinations.

EHRs are shitty because (1) the big players are entrenched - they are already implemented and the cost / disruption to switch to a new EHR is extremely high, and (2) the market isn’t big enough to justify the level of investment it will take to break through - Apple made more money from one product (AirPods) last year than all the EHR vendors combined.

At this point my hope is that mobile devices and meta-EHRs are able to crack this.

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

#815
This isn't just a market failure or some inevitable 'iron law' of bureaucracy taking over management. This is a society wide failure, and we're all complicit. Umpires, cashiers, pilots, referees, doctors, nurses, baristas, accountants, restaurant staff, bank tellers, flight attendants, and teachers are all quitting due to a belligerent, abusive, or violent public, uncaring administration or management, low pay, lacking benefits, unpaid work hours, or reassessed priorities. Little league and high school games don't need parents, players, or the coach smacking or screaming at the ump or ref. Nurses and even doctors don't need one thank-you basket/gift card for one employee per month, empty thank you slogans and parades, lean staffing/six sigma/JIT healthcare staffing bullshit, for-profit, private equity hospitals/clinics, pre-authorization and insurance managing healthcare instead of doctors, pay freezes, legally mandated pay caps, PTSD, or mental trauma from all this steaming pile of nonsense. Violence against medical professionals has gone underreported and grown dramatically over the past few years. Hospitals are allocating significant budget to security. In places where they've never had security. I'm not even going to touch upon all the myriad other issues right now. And, we're/they're not heroes. They're just doing their job, not saving the world as your personal, sacrificial lamb. It's just a job, not a heroic sacrifice. So yeah, we will all quit and play musical chairs with our jobs until things improve.

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

#816

Earlier quoted context omitted.

>> they can 10x their profits by only serving elderly clients. > Soon people stopped coming Ah, yes. Why didn't we think of this before? By increasing the cost of (geriatric) healthcare, we can destroy demand. That's how supply/demand curves work right? In this way the invisible hand delivers unto us a fountain of youth ;)

They may 10x their profit by serving elderly clients but that is assuming x more elderly clients would want to suddenly come. But why? Are elderly clients underserved in that area? Are they going to ditch their original care provider and all come here?

What I was told is that elderly people need more and more frequent care. Additionally, reimbursements tend to be higher for the procedures elderly people need vs children.

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

#817
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…

> There is no shortage of people wanting to be nurses (in some places it is extremely competitive), and there is a huge demand for nurses based on shortages everywhere, but somehow we are in a situation where nurses are overworked because they are short staffed. why is this such a common story across pretty much every single industry? There's more people in the country than 10, 20, 30 years ago. More customers, more…

Because they really can in many cases from more automation, better tools, and better processes and understanding. The demand also doesn't neccessarily increase linearly with the population.

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

#818
post #769

Earlier quoted context omitted.

While I think SOME longevity in congress/the senate is a good thing (You get more done). I really wish we had something like an age cap. It's really crazy that the only way it seems like we can get these senators/congresspeople out of office is death from old age. The fact is, your mind DOES deteriorate when you get older. That's why so many phone scams are special built to target older people. A change I'd make to t…

Please, don’t spread ageism. Yes, brains perform worse in many kinds of ways when they age. But that’s highly variable. And there are narcissists and sociopaths in every age group.

The kinds of ways matter. A primary way the majority of brains start to show age is in trust and risk assessment. [1] [2]

I agree, someone with a compromised ability to evaluate risk is probably more than capable at doing most desk jobs. However, the last thing we need is politicians who's aging brains have been compromised in evaluating future risks. Putting someone most likely to send scammers gift cards in charge of foreign policy and assessing climate change risks is simply a recipe for disaster.

It doesn't seem all that crazy to demand that the ~300 people running the US not be at an age where mental decline is common.

[1] https://www.scientificamerican.com/article/why-older-adults-... [2] https://neurosciencenews.com/ventromedial-prefrontal-cortex-...

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

#819

Earlier quoted context omitted.

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 m…

That conclusion would be fallacious, although many on both sides believe it. For one it ignores both growth potential and relative costs. High productivity workers can and do utterly dominate in ways which more than make up for it. And miserable employees are mercurial in quality at best relative to happy and motivated ones.

I recall hearing about one desert conflict "gratuitous" allocation of several times the prior typical water per day resulted in outsized military performance. I think it may have been the Six Day War. But Silicon Valley is basically the exemplar of that business model as they specifically go with a very high COL area in the world's richest country instead of mass outsourcing. Even assuming that the actor is a heartless and selfish bastard what truly matters first is net profit.

It is the same fallacious false economy seen both among slaveowners and the Soviet Union. That the labor is free or already paid for so don't worry about its efficiency.

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

#820
This is a topic that I'm pretty close to. After programming for four years in the Bay Area, I decided to become a nurse. I spent three and a half years bedside nursing before returning to coding: two and a half at the Cleveland Clinic (a respected hospital) and another year doing 13-week travel contracts across the US. My goal was to find problems affecting nurses that might be solvable through programming. After my time on the floor, I've come to see that the deeper issues are more structural and organizational in nature.

One fundamental force in nursing is that a nursing shift is unpredictable. Some shifts go very smoothly, some are absolute trainwrecks. Patients are, definitionally, sick enough to be in a hospital, and they can start declining very quickly. This means that whatever you are doing at any given moment is often interrupted by a new priority that must be handled RIGHT NOW. It means that your 'plan of attack' for the day (which patients get [meds | baths | food | mobility | turns | dressing changes] when) is often delayed, sometimes by several hours. Any number of things could push the schedule back - incontinence care, a doctor stopping by to discuss a patient with you, a patient fall, a medical emergency, a lonely patient. A few curveballs can put you way into the weeds.

Consequently, the culture on a floor is key to how good your shift is gonna be. If you help others out when you have some slack and they help you out in turn when you are behind, it really smooths out those rough days. If other nurses let you drown, you drown.

The biggest thing that a hospital can do to help nurses is to adequately staff their floors. If everyone is drowning because the floor is understaffed, no one has time to help each other. If you're caring for six patients instead of four (on a med-surge floor), there are days where there literally isn't enough time to do all the nursing care everyone deserves. Documentation can be, and often is, done after passing off your patients in report. After you've already "dropped" documentation from your during-shift schedule, patient mobility - getting people up and walking, or even just sitting up in a chair for meals - is the usually the next thing go. After that, hygiene. Nobody dies if they don't get a bath, but another patient certainly could die if you don't do X. Next up comes pain medication requests and incontinence care. For me, it was enormously stressful not being able to provide the quality of care that the patients deserve.

This can be a huge factor in burnout. The pandemic made things worse in a bunch of different ways. Besides the stress of caring for patients with a deadly virus, you also now have to add on several minutes to every patient interaction for donning and doffing PPE. That's even less time to do the nursing part of the job while you're dealing with a more critical patient population (who will need more care). Burnout rates increase and nurses leave, either leaving the profession or taking contracts that, even if the conditions are no better or much worse), at least pay a premium. Hospitals that were well-staffed face staffing shortages, and hospitals that were already short on staff are now in a staffing crisis. The hospitals have to spring for travel contracts, and the nurses that did stay are angrier that other nurses are making multiples of their pay for doing the same work.

Given that this thread has some 900+ comments already, this comment will start off pretty far down the list. But I see some people mentioning that you are working on trying to make things better for nurses - I'm guessing that those people will read the thread more thoroughly. I would love to chat with you about whatever it is that your startup / company / weekend hackathon project is doing in this space. I've dedicated five years of my life to the problem space and would happily share my thoughts and experiences.

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