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

#831

Post by scaramanga » Thu, Apr 28, 2022, 12:41 AM UTC

triska wrote: post #587

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 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…

Anyone who has visited planet earth and spent time here is well aware of that. The task is to prevent these people from taking and holding power.

Note that the strict formulation of this law (ie. "in _every_ case..") is profoundly anti-democratic in that it assumes no democracy can ever exist or function. Of course, I hope your household provides a good counter example (if not, then you should seek outside support).

Anyway, for those of us who still believe in democracy, it has long been recognised that the cost of it is that everyone has to be a adult who takes responsibility for basic things in life like maintaining the social fabric of the institutions you belong to in order to prevent them from being taken over by sociopaths.

So the question is, will we support medical professionals in doing this? In the UK, before COVID, when junior doctors went on strike to try and remedy the situation, the media denounced them as enemies of the people and they were completely crushed by the state (with the help of their own professional organisations like the BMJ). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902702/

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

#832

Post by pbuzbee » Thu, Apr 28, 2022, 12:44 AM UTC

tsol wrote: post #782

pbuzbee wrote: post #573

Is this a shock? - Demanding work: 12 hour shifts, irregular schedules, night shifts, physically exhausting, limited breaks (including bathroom/water!) - High responsibility with unsafe conditions. You're literally responsible for people's lives. Poor staffing ratios stretch you thin and make you more likely to make mistakes. And if you make a mistake, you're at huge risk for litigation... and now criminal consequenc…

The pay was good enough last year, what changed? In my opinon nursing has always been a difficult job, yet they've always had people lining up to become nurses. So it must be more than just 'the job is too demanding'.

I think most of what I listed, except pay, has gotten worse since the pandemic started.

- A large fraction of patients see the pandemic as overblown and nurses as perpetuating the myth. It's gotta be hard to care for someone who mistrusts you from the beginning.

- For those nurses taking care of COVID patients, it's probably tough to watch the cycle of death, and moreso when you know many could have taken steps to prevent it.

- The pandemic obviously puts a strain on the healthcare system, including its workers. More patients, longer hours, etc surely gets to be exhausting after doing it for 2 years.

- Administration that says they care but do the bare minimum to boost conditions or morale. A pizza party isn't as meaningful when you're struggling with an unsafe patient load.

- There's a feedback loop. As more nurses quit, the burden gets heavier on those who remain.

So even if pay hasn't dropped, the conditions have gotten worse. It's not a surprise that eventually people decide that it just isn't worth it anymore.

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

#833

Post by bshep » Thu, Apr 28, 2022, 12:45 AM UTC

safdahfslh23s wrote: post #468

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…

My partner is a physician in an ICU and a lot of her colleagues have talked about leaving the field as well. Their complaints are #2 & #3 along with: 5. Pay cuts - Most of the critical doctor specialties (ER, ICU, primary) that were the backbone of the pandemic got "raises" that were less than inflation (hers was 1.5%) while profitable elective specialties got big raises. The root cause is the billing system where el…

In relation to #5 we had to drop pay by ~6-7% due to medicare cuts in 2021. Me and my MDs salaries are paid directly from medicare ( and other insurance companies who peg their compensation to the medicare rates ) so we have no choice but to drop salaries or close up shop.

With the inflation numbers this year I have no idea what we are going to do, since we are already 6-7% in the hole from the 2021 cuts and now inflation is 8-9% ( assuming the economic numbers are correct... )

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

#834

Post by briHass » Thu, Apr 28, 2022, 12:49 AM UTC

gen220 wrote: post #553

ren_engineer wrote: post #343

Earlier quoted context omitted.

capitalism is the reason for hospitals choosing to serve patients covered by Medicare which will give them a blank check with tax payer money?

Medicare is not a blank check. It's a standard check (see sibling comment on fee schedules), and each check tends to actually be quite low of an amount. The magnitude of "standard" and "low" are both demonstrated by the fact that when private insurers negotiate pricing contracts (basically, a one-off fee schedule) with hospital groups, they express prices in terms of "medicare multiples". For example, the insurer wil…

Another way to look at that is that Medicare is vastly underpaying for services, as the system is currently run. Basically, private insurers subsidize Medicare/Medicaid, and many providers either refuse to accept Medicare (as allowed by laws) or would go out of business without a sufficient private insurer base.

So, private insurers aren't charities that aim to support 'lucrative' payouts either. The often-huge gulf between MC and private (as you said) means that costs would have to drop massively if we did MC4A. Who's going to tell hospitals/admins, and more importantly, doctors and nurses that they have to take a 30%+ paycut?

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

#835

Post by XorNot » Thu, Apr 28, 2022, 12:53 AM UTC

tetraca wrote: post #694

notch656a wrote: post #593

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…

It also cues your organization up for a failure cascade. You don't have workers who want to stay, you have workers who are forced to stay. As soon as they can leave, you're not going to lose "1 or 2" you're pretty likely to use a substantial plurality since whatever changed probably changed for all of them at the same time. Can your organization survive with 50% of the staff giving 4 weeks notice at the same time?

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

#836

Post by cced » Thu, Apr 28, 2022, 12:55 AM UTC

oliverafajardo wrote: post #700

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, soc…

Happy to hear that you’re progressing towards a career path that sounds like it will be more fulfilling/better conditions.

I just wanted to say that it’s a sad state of affairs when we’re happy to expect uninterrupted breaks. Goes to show just how much we _really_ supported our frontline workers.

Best of luck to you!

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

#837

Post by kerbs » Thu, Apr 28, 2022, 1:02 AM UTC

screye wrote: post #749

kerbs wrote: post #601

Earlier quoted context omitted.

> '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.

> I make $4-500k as a software engineer in the midwest This is a massive outlier though. In your case, the exception proves the rule. The rule: "The 1% of Nurses that found a partner in the US top 1 percentile will be able to quit their job."

OK fair, but let's say that making $250k as a senior/experienced software engineer these days is fairly middle of the road. It's still double.

(I managed a team where post-Covid, 3 left to make >$500k, 2-4 round up the $3250-$425k range. It sure _feels_ average)

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

#838

Post by mdavis6890 » Thu, Apr 28, 2022, 1:08 AM UTC

mumblemumble wrote: post #721

Aperocky wrote: post #392

Earlier quoted context omitted.

> they can 10x their profits by only serving elderly clients. I knew of certain defunct malls that decided to get rid of things that doesn't make money and only keep the high profit inventories. Soon people stopped coming and they went under..

The Invisible Hand works generally fine-ish for non-essential and commodity goods. People might be sad their favorite store went away, but, for the most part, life goes on. It seems to even be the least bad way to handle these sorts of things. It's a bit harder for me to see this as an acceptable approach to health care. Not every segment of the economy needs to be a constant drunkard's walk in search of maximum prof…

Will people pay more for stability and reliability? If so, then that is what businesses will optimize for.

Businesses exist to give us what we want. Those that do it well are profitable, those that don’t aren’t.

Keep in mind that the effort spent to make healthcare more stable could have instead been used to provide more healthcare overall. Or something else entirely, like shoes or haircuts.

All services are not as good as they could be, because the effort beyond “good enough” gets shifted to some other more valuable purpose, where things are not good enough yet.

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

#839

Post by hahajk » Thu, Apr 28, 2022, 1:13 AM UTC

oliverafajardo wrote: post #700

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, soc…

On the plus side, if you are successful switching to software development, having a background as a practicing nurse will allow you to pretty much write your own paycheck if you’re willing to work in medical software.

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

#840

Post by bitsnbytes » Thu, Apr 28, 2022, 1:15 AM UTC

defterGoose wrote: post #307

bitsnbytes wrote: post #245

Earlier quoted context omitted.

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

So...we need to manage that better?

absolutely.We need to look at ways to make monetary compensation more aligned with the best interest of the patient.

Having said that we also need to look at patients taking more accountability for their health and consequences for wasting medical professional times.