You're assuming that hospitals wouldn't rather pay double to have nurses who see themselves as transient cogs in the machine and give few shits about anything beyond hitting the KPIs they need to keep getting paid.
Aren't all workers very quickly becoming transient cogs in the machine?
I don't know a single friend at this point on a fully staffed team in any field anywhere. Whether it be FAANG, startups, or the government, data analytics in retail or lawyers at law firms, there is massive churn everywhere.
Fully staffed or not people who see themselves as long term employees with skin in the game or as providing a service to their community will be resistant to implementing policies that screw the customer and will help customers ask for the things they need to ask for to not get screwed. Employees who see themselves as transient more readily implement whatever management asks without thinking.
I would have thought that transients would be less likely to do that as they could more easily take other roles, while embedded people would have more to lose by opposing management. Why companies hire consultants for unpopular changes, as they will be leaving anyway and thus have less to lose.
Yeah, but that's really where this article should be focusing.
Hospitals are basically at the "We tried nothing and we are out of ideas!"
The solution to a lot of nurse burnout is really pretty simple, increase their wages, hire more than the minimum of travel nurses so they aren't all working overtime.
Imagine being a programmer earning 60k. Now imagine that your company has a time crunch, During that time crunch they are expecting you to work 80+ hours a week.
Now imagine that because of said crunch they say "Hmm, we need some contractors to speed this up." So they hire just enough to reduce your hours from 80 to 75.
Now imagine how you'd feel learning all those contractors are earning $120k and with your skill set, you could to if you left your employer (because there's a high demand for devs everywhere). Not only that, but you have a lot more flexibility in your hours and no longer need to do 80+ hour weeks.
What would you do?
Wage is a huge factor here and the nurses leaving aren't necessarily leaving nursing but instead turning into travel nurses. This creates the vicious cycle the hospitals are currently experiencing.
Hospitals have 2 levers to pull to fix this problem.
1. Increase wages so less nurses feel inclined to leave for more money.
2. Increase the number of travel nurses so current nurses aren't pressured into insane and demanding work hours.
The lever they are pulling instead, is "hire just enough travel nurses for minimal compliance (maybe) and buy little caesars pizza... maybe. Then complain to media outlets about how lazy nurses are."
The reason hospitals aren't fixing this problem is simple. Once they raise their nurses salaries, they will have a HARD time lowering them again.
The capitalist oligarchy will prefer to destroy an industry rather than increase salaries. This is essentially what they did in the US (and around the world) when moving industry to low wage countries.
I do think there is truth in hospital systems slowly eroding the profession of nurse and physician to further cement their control over the future of health care. See traveler nurses and NP/PAs in hospital systems.
> You're assuming that hospitals wouldn't rather pay double to have nurses who see themselves as transient cogs in the machine and give few shits about anything beyond hitting the KPIs they need to keep getting paid.
This is a really great point! I recently read a pretty good true crime book (cheesy, I know, lol!) about the serial killer nurse Charles Cullen who was a nurse in New Jersey and killed his patients via insulin injections. He killed 40 know and up to 400 patients which makes him one of the most prolific serial killers in history.
What I found interesting and ties right into your comment is that before they were onto him and when his patients kept dying, the hospital managers LOVED HIM because he was very efficient, hit all his KPIs and took on a lot of work. He would ask to help out the other nurses and kill their patients so then it wouldn't get on his record that he was killing his own patients.
I don't run a hospital, but know folks who have worked in one. My guess is that paying someone 2x (or many someones) for a short period of time is easier on the long term budget than raising the wages of permanent employees.
Feels similar to how every company seems to want senior developer talent, but few will pay for training new senior talent.
Yeah was reading about this the other day locally.
The inflated cost of traveling nurses is used in negotiating new contracts.
Frankly if American workers want better, they need to realize supply and demand applies to labor.
There’s no reason a surgeon should have a Ferrari while the nursing staff that supports them makes $70k year.
It’s highly skilled labor but also, imo, artificially constrained by our educational funding choices.
All of which is politically babysat to be just so according to well paid economists who are trotted out to tell us inequality is normal because that’s how it’s always been.
Americans made kings and robber barons again and just changed the words. Meanwhile petty crime is high treason.
Human society as we know it was set on this path by forever lifers. The end game is the end times. They don’t care if anyone survives, no one will be around to complain.
Drop the worker euphemisms and call everyone people. This arbitrary taxonomy to satisfy political sorting is inhuman.
Hospitals are often run inefficiently [1]. This leads to a lot of overhead costs. Many procedures in hospitals loose money for hospitals while others make money. Taking care of COVID patients typically looses a hospital money. So, where does the money come from to pay nurses more when much of their work is on patients they loose money on?
I have never been in management, so maybe I am missing something here. Even from a purely economic perspective, wouldn't it make sense to keep your existing employees happy than having to deal with constant turnover, unhappy workers etc? All I see is constant hiring (even in small teams) and people constantly leaving, to the point that some teams become completely new in just 3-4 years because of attrition.
In my previous job, a lonnnnnnnnnnnnng list of items were pending, because they didn't have enough people to work on them. The mobile app hadn't been updated in 3 years, not even the bugs were fixed. And still the company was one of the most boring places I've worked, with meeting after meeting after meeting...
How hard can it be to have individual conversations with employees once a quarter or something, pay them decent, and at least try to help them do their jobs better? All of which will result in more revenue for the company, no?
I had a chat with a recruiter who argued that remote workers should be paid less. Shouldn't they be paid more (or at least the same as in-office workers for the same work) because the company is saving money on office space, electricity, internet and even stupid coffee and toilet paper? If the recruiter opens the conversation that remote workers are worth less, then how do they expect the candidates to take them seriously? This is just one example.
I just don't get it. Maybe I am not management material/
That’s not how business works in 2021. You hire traveling nurses to suppress wages.
The hospital my wife worked in merged into a big network and gave every RN a 25% haircut, and laid off a few key departments (ER most notably), replacing them with travel nurses and a contracted medical practice. A few exceptions were made in high margin lines if business.
Net result? Care sucks, finances are green. They purged the mid-career people and now have a young and dumb workforce. There was a particular emphasis on hiring military wives as they are transient. The key thing is to stave off unions.
Like any other consulting thing, they eventually purge the hired guns. The traveling nurse boom is a COVID thing. As COVID wanes, these folks will be back in the meatgrinder.
Paying a nurse $125k instead of $80k is not going to appreciably increase the cost of healthcare for any individual patient when the radiologist makes $500k, the surgeon makes $750k, the charge nurse makes $200k, and you get billed $35 for a Tylenol.
Could this also be a result of forced vaccinations on healthcare workers (who were on the front lines for us early in the pandemic) who then move to states without mandates.
Worked in hospitals for years. The day my flu vaccine expired I had to go get another or I would be in violation of my contract. Has been like that for decades.
The number of people who leave because of vaccine mandates are a few percentage points. It's been borne out again and again as mandates are put in effect that the vast majority end up complying and only a few percentage points end up leaving from them. This is a much bigger phenomenon related to how hospital administration cuts nursing to the bone and the lack of organized labor pushing for safer standards of work and better working conditions.
The mandate is Federal - any facility that takes Medicaid or Medicare is subject to it. That's pretty much everything except a few small private practices. Traveling nurses will almost always be required to be vaccinated.
Apparently the mandate is in progress and doesn’t yet exist:
A CMS spokesperson told Fierce Healthcare that the agency is currently in the active rule-making process and cannot comment on any specifics of the pending healthcare provider regulations but did note that there will be a 60-day comment period immediately following its publication in the Federal Register.
One of the issues is that in the USA (as opposed to Europe and other countries that prioritize science over politics) there are no exemptions for people who have recovered from covid and have natural immunity, which has shown to be more effective than the vaccine.
I love how you both acknowledge that health care workers quitting over forced vaccination is an issue while immediately dismissing their actual experience of having worked through both pre and post vaccine covid world and first hand seeing the impact of mass vacination.
If enough health care workers are willing to walk away from their jobs rather than take a vaccine, maybe you should take their observations seriously?
> If enough health care workers are willing to walk away from their jobs rather than take a vaccine, maybe you should take their observations seriously?
If you value their opinions in that way, you should get the vaccine.
"The American Medical Association (AMA) today released a new survey (PDF) among practicing physicians that shows more than 96 percent of surveyed U.S. physicians have been fully vaccinated for COVID-19, with no significant difference in vaccination rates across regions. Of the physicians who are not yet vaccinated, an additional 45 percent do plan to get vaccinated."
> Amazing how even raising this as a question gets you downvoted.
That's because it's readily debunked. Nurses largely can't evade the vaccine mandates by moving; virtually all healthcare facilities are subject to the Federal vaccine mandate.
> Yes, I’m sure it’s a factor, and needlessly so considering the vaccine seems to have a negligible effect on transmission.
"Both vaccines reduced transmission, although they were more effective against the alpha variant compared to the delta variant. When infected with the delta variant, a given contact was 65 percent less likely to test positive if the person from whom the exposure occurred was fully vaccinated with two doses of the Pfizer vaccine. With AstraZeneca, a given contact was 36 percent less likely to test positive if the person from whom the exposure occurred was fully vaccinated."
There are plenty of articles from healthcare CEOs complaining about forcing the vaccine mandate. The loss of just a few percent of nursing staff can cause crippling staffing issues.
Sure, why blame yourself when you can blame someone else? It’s a gift for cost-cutting hospital admins who’ve been running understaffed facilities for years.
The ERs in my city have been code red half the time for the last decade.
The vaccine does reduce transmissibility. From the CDC: "Infections with the Delta variant in vaccinated persons potentially have reduced transmissibility than infections in unvaccinated persons, although additional studies are needed."[0] and Delta is more transmissible than "regular" COVID for the vaccinated (and I think in general).
But the primary benefit of the vaccine is to reduce the burden on the healthcare system. The vast majority (mid-to-high-90%s) of hospitalizations are among the unvaccinated. It stands to reason that the more people running around without being vaccinated, the more people will get hospitalized. At a certain point, death is just a percentage of hospitalization, especially as you have places without beds that have to just turn people away. So fewer vaccines directly correlates to more deaths.
Speaking personally now, I don't care if people don't want to get vaccinated. I think it's idiotic, the vaccine is FDA approved now, hundreds of millions of people have gotten it and side effects are as rare or rarer than any other vaccine. But if you work with the public, especially in public health, schools, etc., there is a list of required vaccinations multiple pages long. Adding one more to the list isn't an encroachment on anyone's civil liberties, and you're free to move elsewhere, but that's not what's happening here.
I'm not downvoting you, just pointing out that transmission isn't the only reason to be vaccinated in a hospital setting.
Hospital systems are already overwhelmed, so having vaccinated staff reduces the amount of staff that have to miss shifts because they are dealing with covid symptoms.
Vaccines reduce symptoms, death and hospitalizations from covid complications. It's amazing to me that we have hospital staff that would rather listen to the Joe Rogans of the world than to the science they supposedly learned about in college.
Not only will your comment be downvoted, it will be relentlessly questioned for veracity, as if asking a question required verifiable links from approved sources.
This is a valid question that does appear politically motivated. But, the downvoting does appear politically motivated.
If we look at the from-state/to-state patterns, we may see evidence, one way or the other, that vaccine mandates cause healthcare workers to change jobs. We may see that the mandates do not cause any significant change. Any significant change (15% or more) in the number of healthcare workers can result in a change in healthcare quality from one state to another. If quality of healthcare changes significantly (positively or negatively) in a state, due to vaccine mandates, I want to know: especially if it is in my state.
You are not gonna get this type of data until years later, if ever. We don't have realtime regional data that is comprehensive, we have local anecdotes and then national data without regional breakdowns.
National data with regional breakdowns always lags by quite a bit, and unless there is institutional demand for such data, it just wont be collected at all.
One possibility is to look at BLS employment data by regions, but it's still really tricky to tease these types of effects out of that.
Take it with a grain of salt but I have seen a number of conversations about how hospital groups are applying raises. They take the bottom pay and they apply some dollar amount per year worked/experience. Seems to be wiping out more experienced employees raises.
There are a few things I've learned from the nurses I know...
- Nurses, the primary caregivers in Hospitals, have been treated pretty poorly for a long time. Some of it is pay, some of it is expectations, some of it is just the way the people around them treat them (e.g., the way surgeons often talk to them).
- Some management has gotten down right mean. I know one hospital that has dictated that refusing to work a mandated shift (that's where they keep you longer than your shift to keep working) will cause you to be fired. They've gone through on that already.
- ICU nurses have seen the worst. In places that have had peak COVID it's not unusual for 9/10 people with COVID in the ICU to die. That takes a tole on people.
- Some hospitals are giving huge bonuses to new hires. And better pay. There's nothing like being a senior nurse in an ICU who has more responsibility and higher expectations while having the new person next to them having just gotten a bonus and making more money. You might as well quit and go work at a different nearby hospital to get a bonus and raise.
I wonder what would happen if hospitals starting doing peakon surveys of their people and started working to improve on things.
To be fair, surgeons talk to everyone that way. I haven’t met a surgeon who didn’t talk down to other people. My theory is that you have to have a huge fucking ego to cut someone open and believe you’re going to make them better.
Nurses working 12 hour shifts spend more time around surgeons than most other people do. It takes it's toll.
You can be very good at what you do and confident in it without talking down to others, being arrogant, or treating others poorly. It's a cultural and character thing.
Surgeon here, always try to treat nurses with respect and work with them as a team member to accomplish the best care for the patient. Maybe it’s a midwest thing.
Independent of the medical profession, there is definitely a midwest thing. I have traveled a fair amount, and the culture in the US midwest is infinitely more polite, respectful, and helpful that that of the east or west coasts.
You don’t fully understand Midwest culture then. You never say anything negative to someone’s face. You say it behind their back. Midwesterners are some of the most passive-aggressive people in the country. They’ll help you out of a sense of obligation then resent you for it.
I much prefer the coasts where you know where you stand.
Ego plays a part, but I think med school and residency play a bigger part. Surgery residency is ultra competitive and freaking grueling.
Basically putting 10+ years of your life into being a surgeon ends up playing a big part in your core mindset and approach to life. You don't really end up being a surgeon without being fully committed to it.
> I haven’t met a surgeon who didn’t talk down to other people.
Then they are a shit surgeon.
You can tell really good surgeons. Their nursing staff are on the ball and completely unafraid to call out a doctor and the surgeon has no problem with this.
I went in for wrist surgery. The anesthesiologist was not the surgeon's normal one. He said something slightly off and all 4 nurses immediately stopped him and made him correct himself and repeat the corrected statement 3 times.
Bullshit. Very few doctors behave this way and it's generally any better tolerated in a healthcare workplace than in any other workplace. This is a media construct designed as a scapegoat for the many failures of the american healthcare system. The greatest trick corporate healthcare systems ever played was convincing everyone that physicians are the villains and not the mega-corp that's bleeding every penny out of healthcare.
I don't have any experience with US healthcare but I know this depends a lot on the country.
Large part of this is that much of US healthcare is in the business of earning money or optimizing costs, the care being only side effect. As long as incentives are not right, there exists no practical way to fix the system, only prop it up here and there to eliminate worst offenses.
As to salaries, I just can't imagine how it is even legal for nurses to do same job but being paid more because they just joined. I can sort of understand that you can be paid more if you do same job but have more experience. You get paid for loyalty and for the added value of your knowledge/experience that makes your work potentially higher quality. But being paid less is shady af because it exploits the nurses which have high incentive to stay at one place if only to keep the commute to the hospital. If you have family you can't just move to somewhere else every 2-3 years just to keep your salary competitive.
As to verbal treatment, I understand that the problem is that if you are a good surgeon, you will be hired no matter how mean you are toward your coworkers.
In large companies I have worked for (mainly financial) this is not tolerated (as much). You can be great senior developer or tech lead, but if you are mean to junior developers you are likely going to be reprimanded and then dismissed if you continue.
> Large part of this is that much of US healthcare is in the business of earning money or optimizing costs, the care being only side effect.
ICUs are not optimized. Hospitals in general are not optimized in the US. A lot of the cost issue is in inefficiency. Many ICU patients cause a hospital to loose money.
> As to salaries, I just can't imagine how it is even legal for nurses to do same job but being paid more because they just joined...
Salary is what ever a company decides to pay a person. There are all kinds of ups and downs. If you're running financially inefficiently, as most US hospitals are, then you need to limit when you pay people more.
When US hospitals have seen a majority of their patients as COVID patients the loss they were talking about lead to bankruptcy speculations.
Canadian speaking, wife is ICU RN. Everything you've said is spot on, but there's always more to add. Nurses get assaulted pretty much daily. It's such a problem, management basically said it's not worth reporting because nothing is going to be done.
The largest issue is the chronically understaffed units. The burnout that results from having double the normal patient load makes everyone cranky and the team atmosphere breaks down. In better managed units the nurses are all willing to pitch in, help with workload or take over so you can have a break. In units that are suffering, everyone starts looking out for #1 and that whole system breaks down. People start scheming and creating cliques among themselves so if you're not with the "in" crowd on a shift you can get royally screwed... the animosity just grows.
My wife has had coworkers commit suicide. There's been countless nurses straight up quitting, whether to retire or to take up contract work south of the border (the stories of how much they're making filter back through and more nurses start going that direction). Personally, my wife was forced to go on early mat leave because when she told management she will not be able to be primary on COVID patients. Management said goodbye... My assumption is the union would not allow nurses to create such demands (even with proper doctors notes and accommodation) but they would rather lose a nurse entirely than deal with accommodations in an unprecedented time.
I've spoken with her multiple times and ultimately I think a lot of their issues stem from being unable to shift their hiring/onboarding practices. As an Engineer, I start as Junior. I get jobs designated for Junior Engineers, and I work alongside the Seniors to pick up skills and craft.
As an RN she's fighting with people 25 years her senior for a position. She was out of school working casual shifts for 5 years before getting a temporary position, and longer after to get the permanent job. But even then, she's competing with the senior nurses for the same shifts. They aren't equal in skill, but they're treated that way, and the seniors gobble up everything they can until they run out and crash.
> > management basically said it's not worth reporting because nothing is going to be done.
> Just call the police directly.
If you call the police to tell them that a 78 year old man with dementia grabbed your boob while you were trying to fix his nasal canula they are gonna laugh at you and say there's nothing to be done.
For the patients who are chronic assaulters, MAYBE if you are lucky they will get transferred to another unit or another hospital. But it will take a LOT of really bad instances to make this happen... and all it does is turf out the issue somewhere else.
We once transferred and old man who masturbated and threw his semen on the nurse in the room. Buried in his paperwork about 180 pages back was a big note "DO NOT LET THIS PATIENT BE ATTENDED BY FEMALE STAFF." But nobody saw that until the incident already happened.
edit: Also, it's not that there are too many nurses on the market. It's the places only want to hire ones with floor experience. Nobody is willing to train new grads. A few places have new-grad specific programs, but they don't move fast enough or take enough new grads to help with the problem.
>Sounds like there's too much nurses on the market if that's what the job market looks like.
Uhhh... that's a weird take. I already talked about the chronically understaffed units.
The issue is the system doesn't hire enough nurses to cover the needs of our healthcare system. They'd prefer to run understaffed and burn out their workers than hire more nurses and overstaff the units so there's some cushion
> Some of it is pay, some of it is expectations, some of it is just the way the people around them treat them (e.g., the way surgeons often talk to them).
Not to mention the patients! I'm not a nurse but have worked with patients on a few hospital units and I have been groped by old male patients several times. Also patient's families can be incredibly rude, mean and demanding to nurses. They're trained for it and you do kind of get used to it, but it does wear you down after a while.
Vaccines as a job requirement are nothing new and I have no pity for people who have been fired as a result. Cry me a fucking river, you’ve had to have them for decades to send your kid to public school.
Honestly if they don’t believe in vaccines, I question their competency as a nurse and do not want them touching me. I as a patient should have the choice to manage my own risk level. These nurses can go find another job where they’re not exposing already sick patients to a deadly virus, because IMO they’re not qualified to be nurses.
It’s not an individual vaccine; there are dozens of individual vaccines across the world and they have all been proven safe. People are just scared of a needle and the sniffles (if your body reacts to the vaccine by getting sick, congrats! You probably avoided a trip to the ICU).
"free market exists for employees as well as businesses, businesses concerned"
I found myself recently listening to a podcast about the teacher shortage. Something like 20% of first year teachers leave the profession. It costs around $20k to replace a teacher. The average teacher starting salary is $41k. If you could get teachers to stay by (1) treating them with respect, (2) administrators having their back, and (3) raising that to $46k, more than 10% of pay, how many would stay for at least five years? The first two cost nothing, and if they stay more than 4 years you have entirely recouped the cost of replacing them every year.
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