[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