[pbuzbee]

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 consequences too. Responsibilities, resources, and staffing stretched even thinner due to the pandemic.

- Administration that treats you as something to be optimized and does the absolute bare minimum to support you. Instead they tack on additional tasks, expectations, and requirements ("no water at a nurse's station!"). They encourage a culture where nurses provide a concierge service to 'guests' instead of critical care to patients.

- Hostile/entitled patients. I'd guess many/most patients are not an issue, but it only takes a couple of difficult/combative patients to really ruin your conditions.

- Low pay given the responsibility and working conditions for non-travel nurses. https://nurseslabs.com/nurse-salary/#nurse_salaries_by_state Like many others pointed out here, in tech I make way more than a nurse for a job that's less demanding, has far lower stakes, and is of far less value to society.

To me the blame lies mainly in middle/upper management, whose role is to build and empower an effective workforce. If 90% of your workers are considering leaving, you blew it.

[dguest]

The traveling nurse phenomenon is exemplary bureaucratic absurdity. To paraphrase a conversation with a nurse friend:

Nurse: It's really hard for us to hold on to our good nurses, we can't afford support staff so they get stressed out and leave for traveling gigs.

Me: Why can't you afford support staff?

Nurse: The traveling nurses cost 3x more. We have to hire traveling nurses to replace the ones that left for traveling gigs.

Me: ...

Nurse: I know...

Me: Can't we just... pretend they are all traveling nurses?

Nurse: I know...

I'm not a big fan of defrauding your employer, but sort of hope that some of these "traveling nurses" are somehow swapping gigs secretly and subletting their temporary housing to college students.

[SamuelAdams]

Part of it is that travelers are contractors. Management only has to pay for that contract for 3-6 months, then technically that cost is no longer an issue.

Whereas an FTE nurse is a recurring annual expense, so higher wages will lead to higher long-term costs.

Everyone in hospital administration is expecting demand to die down once COVID surges die down, so they don’t want to make any long-term financial changes.

[hackernewds]

Some of these conditions have always existed. But I can't imagine 90% have wanted to quit in the last decade. The most important factor thus is most likely COVID

[atoav]

Like with many jobs Covid revealed what society truly values and what not. Sure clapping for nurses, nice. But these people should have propper working conditions and wages, otherwise nobody will want to do the job.

Covid just gave the realization that even if we face a global crisis where nurses are dying on the front, the rest of society is not willing to provide the bare minimum these people deserve.

[cupofpython]

Exactly this. The nursing profession has been accumulating empathetic debt for probably decades. By empathetic debt I mean nurses taking on more work and responsibility beyond personal rational choice because if they fall short then patients suffer.

the truly tragic part of all of this is that as much as we would like to imagine these nurses confidently walking away from a bad situation like some sort of power move.. a lot of them are not. A lot are finally leaving because they are broken and feel broken enough that they dont feel capable of being responsible for patients anymore.

To reiterate- many (most?) nurses that quit still want to help people, but no longer feel capable of helping. That is a level of trauma that can be passed down to the next generation. It might take effort to let the gravity of this reality sink in.

Anecdotally, my mom is a nurse and she has come home and cried due to sheer helplessness to her work problems on more than one occasion. Shes near retirement age and switched careers into this late in life to help people so this is pretty much it for her. If the system does not show mercy and continues to grind her out then she leaves the workforce feeling helpless and broken.

It goes beyond payment. better pay will go a LONG way, and is absolutely necessary.. but it is not enough. There needs to be more redundancy, because 100% utilization of that kind of resource in that kind of system is something that would get you a failing grade in system design.

[kulahan]

I honestly have no clue how we fix this problem. Our healthcare costs are already out of control, COVID showed our systems can’t handle large numbers of patients, and we’re finally nearing the point where we get healthcare out there to all the people who need it.

Who’s going to care for all of them? Do we just make healthcare even more expensive, raise everyone’s pay, and hire a fuckload of new nurses? I’ve never heard of an RN being out of work for very long; I can’t imagine there’s a lot of well-trained RNs looking to be hired. Seems like we’ve backed ourselves into a corner we’re about to wall off.

Does anyone know how we fix this? I’m very interested in hearing ideas.

[cupofpython]

>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

[jjice]

> Low pay given the responsibility and working conditions

The pay to responsibility ratio for nurses is absurdly low. So unfortunate given the difficulty of the profession. I guess we'll see if anything changes over the next handful of years.

[tsol]

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'.

[anonporridge]

Pure speculation, but if I had to hazard a guess, it's because the job is becoming increasingly inhumane.

More and more, nurses have to act like robots to remain in compliance, and that's not what any of them signed up for, and the increasing lack of intangible reward that comes from caring for people and creating a human connection, means they demand more explicit monetary reward for temporarily suppressing their humanity to do the job.

[pbuzbee]

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.

[lupire]

COVID protocols and protestors, combined with the decay of the ongoing K-12 and college education system, Great Resignation, and general economic malaise of Millennials and Zoomers.