>This is exacerbated by an aging population and restrictive immigration policies.
Sans the covid anomaly, immigration has never been higher in Western nations. The issue isn't restrictive migration. It's that we're not treating nurses well. That means fewer people pick this career, and more nurses leave prematurely. Suggesting that we need to import more nurses is only admitting that migrant nurses are willing to work for worse pay and worse working conditions, and I don't think that's fair to anyone.
> and today the country has 40,000 nursing vacancies
Mainly because the NHS requires degree-level qualification for UK & EU nurses, but those hired from outside the EU instead have a skills-based assessment. And there just aren't enough UK candidates willing to slog through four years of study and placement for what is a high-stress, manual-labour, high-stakes job with mediocre pay.
I have three friends in the NHS and they are very much in favour of treating nursing as an apprenticeship rather than an academic qualification, so until the rules change they have no sane option but to hire from abroad. But that's a slow process and has lingual and cultural challenges.
>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
> We are going to need thousands and thousands of nurses in the next several decades. They're well-paying jobs that aren't going to be automated away in our lifetimes (a lot of doctors, on the other hand, can probably be replaced by AI). We need nurses, not people with sociology degrees (I say this as someone with a sociology degree).
FWIW a lot of the nurses I know are desperate to get out. One person in particular I know makes ok money but the schedule absolutely destroys them.
> Canada's solution will be to mass-import nurses from the third world
Yes that's basically what Quebec (and probably other provinces) is doing.
> Do twice as much work for half as much money
I might get tomatoes thrown at me for this, but anecdotally "third-world" nurses are usually not as good due to having experience on different equipment, drugs and often languages. It's better than having no one to cover the shift, but it can be seriously dangerous due to lack of training on specific protocols.
They get paid the exact same amount of money and are in the same union, so they absolutely don't do "twice as much work for half as much money".
> 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 money. Why do they think they can handle more work with less workers whose salary is less when adjusting for inflation?
> So we have a natural experiment with older nurses in England. Some are qualified and registered, some are unqualified and registered. We see from research that the qualification helps with patient safety.
As described, you see from research that nurses with the qualification are better than nurses in the same cohort without. This is confounded all kinds of different ways; it doesn't come close to establishing that the qualification helped.
(The most obvious confound, though -- say, do nurses with a bachelor's degree outperform nurses with "some college"? -- does tend to suggest that, in the absence of immigration, overall quality levels will go down if the average quality of immigrants is higher than the average quality of natives.)
> I hope you can see that there are significant differences between learning a language and treating patients.
Of course, but I don't see that those differences are relevant here.
> Then we were told what we really need is nurses. So folks went to nursing school in droves. I'm not sure where we are with that, because it seems like hospitals still never have enough nurses but that those folks that went to nursing school also didn't manage to improve their situation much.
To be fair, we just had a pandemic, and we're still reeling from that. Lots of folks quit because of burn-out.
> We aren't short on 'resources', we are short on doctors and nurses.
When I say "resources", people are included in that. Human resources one might call it.
> Nurses are a little more flexible in that more money might mean more nurses, but only up to a point.
In either case, throwing a ton more people into a long term career to deal with a short term problem (I don't see hospitals needing the same capacity in 3 years that they do for the next wave) will cause other problems down the road.
I understand what you mean but I think you greatly underestimate how many nurses work contract and are not employed by hospitals. Almost all nurses I know, and I know quite a few, are all working as contractors for agencies. The hospital assignments are just almost never worth it.
> The nursing shortage could be solved by hiring more.
At least in Germany, there are massive amounts of open job postings for nursing and other care staff. The problem is that the wages are way too low, as the county/city-owned clinics have to adhere to the budget rule of maximum efficiency and minimum taxpayer subsidies (which led to massive outsourcing and other cost saving efforts in Munich [1]) and private-owned clinics are under financial pressure from their owners (you gotta make those 18% EBIT [2] somehow), while at the same time the amount of money that the public health insurances pay for procedures (fixed rates across the country) is not enough to cover these costs.
> Furthermore Bill 124, introduced in 2019, disincentivizes nurses by limiting wage increases. Many nurses have said repealing the bill would go a long way in retaining nurses. Others say removing barriers for internationally educated nurses would help fill in gaps.
Wow, why is there the wage cap when nursing has long been an issue in Ontario? I wonder who thinks this stuff up and thinks they are somehow saving money by doing this. It just generates inefficiencies and unintended side effects.
Whenever there's problems like this there's always seems to be a long trail of government interference that's counterproductive.
> when Britain's own young people were never going to do that work for the wages offered
Too true. I’m from Canada where we worry nurses will go south of the border, but was recently in London at an NHS hospital and was talking about this with a nurse. Pay for nurses in Canada is on par with a Jr Developer here. (Still low for the hours and effort required!) By comparison, nurses in the UK make about as much as an intern or admin assistant. After all, single payer means there isn’t much pressure to raise wages from other sectors, you’ve a monopoly on nursing so you can set the wages at whatever level keeps staffing adequate, which isn’t the same thing as paying a living wage…
> I can't afford to wait 4 years for someone to train as a nurse to be available for me to hire
From my comment. Nurses require training. I did not assume a finite number of nurses. If I am sick and need a nurse, I need one _right now_. There not being enough of them is a shortage. It may not be a shortage in the future, but right now, it is.
> Traveling nurses are definitely part of the problem, (why wouldn't someone go for the much higher salary)
Sounds more like being part of the solution. More traveling nurses equal more pay.
Eventually things will reach an equilibrium where base pay will rise enough to either attract more nurses back to the profession and/or make it profitable to train more nurses.
> I know a lot of nurses. They make decent (not outrageous) money, but their work environment is frequently a shitshow. Many are quitting.
You're conflating recent and broad economic trends with the specific conditions of a specific profession. Millions of Americans all over the country have been quitting and changing careers (it even has a name: "the Great Resignation"). This doesn't mean their conditions are shit, but rather that pandemic-era economic forces have been reshuffling our economy.
Only in a vaccuum. It pays far worse than other jobs at the same rate given the effort and stress the job entails.
> don't they get more leverage on what QOL and wages they can demand ?
Sure, but it needs to get far worse. The hospitals are only going to budge once walkouts are organized. But that can't happen without strong unions, most nurses just need to pay the bills which is why they continue to put up with it.
I'm not sure you understand who has the leverage. The hospitals can let healthcare deteriorate far beyond current expectations. They still get paid in the end. The environment for patients and nurses will only get worse.
>I can’t imagine there’s a lot of well-trained RNs looking to be hired
I think this is an assumption we have to accept. The implication is that there are not enough nurses. Which means we need to protect the ones we have, and incentivize people to join. And we need to be creative / strategic / tactical about it because it is not a problem we can just throw money at (and as you mentioned, the money doesnt exist anyway).
Step 1: protecting the nurses we still have.
a) Increase denial of care. Nursing seems to be in need of triage. Or rather, "the system" needs to bear responsibility for triage instead of putting the weight on nurses and simply forgiving them for reasonable mistakes as a result of being overloaded
b) Reduced workload for nurses. Formalize the maximum acceptable workload for a nurse. Maybe provide compromised solutions that patients can agree to for any work beyond the maximum (less documentation, less liability, etc - an acceptance akin to treating a soldier on the battlefield. ie "do whatever you can, i'd rather something than nothing")
c) Increase usage of care workers (cheaper workers that RN's can delegate some responsibilities to)
d) Make a public awareness of how loaded a healthcare locations workforce is (so patients can self-manage in the moment; ie. my urgent care is very busy right now, let me go a couple towns over)
Step 2: Incentivize new nurses
a) Measure how many RN's exist that are not working as nurses. Do a case study to see what would bring them back
b) promote the profession to the youth like we did for STEM in the 2000's
c) reduce training needs. break apart the responsibilities of an RN and group them by categories that non-RN's / care workers can become certified in. allow RN's to delegate more work to "nursing category specialists" like IV management, medical history relevance, cleaning up shit, covid testing, etc. (whatever categories make sense)
Step 1 will support step 2, as it will be easier to recruit new nurses if nurses are better protected.
the important thing to remember is that we cannot control the demand on the healthcare system. We need to protect that system from collapsing if demand becomes too high. We must also provide a means for providing some treatment instead of no treatment in situations where full treatment is not possible due to excessive demand.
Personally, I think we coddle patients way too much. I understand wanting to protect people from their own stupidity, but we really need to stop trying to make the healthcare system a pleasant customer service experience. Let them be busy level-4 service technicians who do not have time for our bullshit.
Hire a much cheaper dedicated friendly person to provide friendly interaction. have them relay anything medically relevant if it pops up. Let them be the first person to show up to the room and decide if a nurse is really necessary, etc.
Basically, i think we need to evolve / progress RN's to be more like Doctors and prop up a less qualified class of healthcare worker underneath the RN's
At only a bachelor's degree, a nurse gets $70k / year on the average. It is a field that is expected to grow dramatically, even more so than computers.
Outside of Comp. Sci / IT fields, Registered Nurse is one of the most highly paid bachelor's level jobs out there.
If you find a hospital willing to train you up to a Masters Degree to become a Nurse Practitioner, you get well over 100k on the average.
Nursing is a field with immediate job opportunities upon graduation, with the ability to train up to 100k+ jobs if you can find a post-secondary training program.
DESPITE that, Americans don't typically go into nursing school. So we have to import immigrants. Culture is way deeper than just offering a steady job, a good paycheck, and promotion opportunities. The fact of the matter is, we have a nursing shortage despite it being a decent job.
This country needs 15% more Registered Nurses and 30% more Nurse Practitioners over the next decade. And currently, nurses are one of the most overworked jobs because there aren't really enough of them around.
> If illegal immigrants
Illegal immigrants typically don't become nurses. That's totally a different subject. In any case, if there is an illegal immigrant working as a nurse, I'm inclined to say that they should stay, due to our incredible nursing shortage across this country.
Sans the covid anomaly, immigration has never been higher in Western nations. The issue isn't restrictive migration. It's that we're not treating nurses well. That means fewer people pick this career, and more nurses leave prematurely. Suggesting that we need to import more nurses is only admitting that migrant nurses are willing to work for worse pay and worse working conditions, and I don't think that's fair to anyone.
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