Today Kara and Geary talk about staffing shortages affecting bedside nurses. Together with their guest, Nancy, RN who has years of bedside experience in Women's Health and Adult Med Surge.

Any and all information discussed on this podcast or at the goKrazy website are the opinions of the hosts only. Hosts opinions are not meant to serve as medical advice and do not reflect the opinion of any of the hosts' current or past employers.

Hello.

Welcome to go crazy.

We're at the nurses round table.

I'm here with my

co-host

Kara.

Good morning.

And we have a special guest.

Our special guest today is Nancy.

Good morning.

so she has a ton of stories to tell us.

Hi, my name is Nancy.

I have a bachelor's of science and nursing.

I have been a nurse for about 12 years, mostly in women's services.

And in the last few months I've been in, uh, clinical decision unit.

Kara has well between the two of us.

We have over 25 years of experience and Kara has worked all over pediatrics.

seem like that long does it?

No, it just flew by really.

It's what they say in the blink of an eye.

My name's Kara.

I'm a pediatric nurse practitioner.

I started as a bachelor's prepared nurse and got my master's in pediatric nursing.

And I'm an acute care provider in an urgent care.

, . Geary Lynn: Today's topic is

shortages staffing in general.

And that's what we're gonna be talking about.

One of the problems is, how hospitals end up working with their staff

when these staffing shortages occur.

And as they're occurring in, when they're getting worse, how the

hospital manages, their nursing staff can really either make or break.

The staffing So how's it going out there What do you think

I think there's always gonna be fluctuation in staffing and

given what would just happen in the last couple years with COVID.

burnout is at an all time high because there's the constant

sentiment that you have to pick up.

You have to help out cuz you know, not only does your nursing community,

your team need it like right there immediately, but also on a nationwide

level, there's a lot of pressure to perform and be the healer.

Right.

Mm-hmm um, but at the same time, they're not, they're not acknowledg.

our burnout

Right.

And how hard it is to actually show up and continue to go through these processes.

We had talked a little bit earlier about it.

One of your nurse, friends, that was her partner, her husband

said that, she was different.

She's not the same person that she was , you know, six weeks ago, even coming

into her unit, that's really scary.

It's scary.

And it's sad because most people start a new job and they're excited and the

money's great or it's what they expected.

And they're able to separate.

work from home.

Yes.

And for nursing, a lot of times we're not able to do that because

we carry these people with us.

Whenever we go home, we carry these experiences.

I definitely, I agree.

I know, I see my nurses work like that all the time.

. Geary Lynn: that there were plenty of

shift and we would be there, get there at six o'clock in the morning and

then 6 46 45 comes and we get report.

We do our huddle.

Nursing report and then go do bedside report, get our patient assignment, start

working work a 12 hour shift and then give shift report, and then still have

to, for me be there making sure, trying to help the nurses, the rest of the nurses.

do well and help them get caught up right away and be at work until, 8,

9, 10 o'clock at night, just trying to get the next shift settled because

it can be overwhelming when you have four and five patients at a time.

And that's an every day, every shift you work, you're working 12 hours.

You come in, you have four and five patient assignment

and there, if it was just.

Passing meds.

We had to, , hang some antibiotics and general kind of acute care.

That would be one thing, but our patients were very high acuity and we would

have to multiple antibiotics, multiple dressing changes, assisted physician with

procedures at the bedside, all of that.

And then, and that doesn't even include if your patient was

having a bad day, emotionally.

Out of this world or their family was having a bad day.

Yes.

So let's talk about patient assignments, nurse to patient ratios.

So how many patients were your nurses assigned?

for one nurse so each of you took six patients

.But we had the preceptor, so they figure, since the preceptor

was there, we wouldn't handle the.

Patients?

No, it's six patients together, her and the preceptor.

. However, so they basically make the preceptor responsible for

more patients thinking that she's gonna pick up the slack.

That's very common.

. This is a contributing factor to the nursing shortage.

That is, it is a large contributing factor because at, even at five patients, as

a new nurse to the unit, although we don't have, we are not new in healthcare,

but it's still, you're still learning.

You're still learning the critical thinking skills for that particular unit

So when you bombard that nurse with the extra patient load,

You're basically going from task to task, you cannot critically think.

And that's one of the issues that I have brought up to management and

their response is like we are assured you know, if you don't complain

as much, it wouldn't be an issue.

So now you have the two new nurses that hired basically

already burning out, not even.

Get, shortly right off the gate and then you have experienced nurses.

We had one that they lost recently.

She's been on that unit for seven years.

So she just basically said, this is too much for her to take on five patient

and she's experienced in their unit.

And she was saying, oh, this is just way too much the workload.

It's not doable.

So she transferred out.

Not only did they lose the new nurses to hire, but they also lost

a seasoned nurse from their unit that was there for seven years.

And she was also one of their charge nurse . So now they're back to the

same situation they started out with.

They didn't improve exactly.

They keep getting, , short staffed, they, and they keep having to go back

to short staffing because they hire.

Two, three new nurses.

They put them with preceptors and, but then they throw everything in the

kitchen sink at them patient wise.

And they, the new nurses get overwhelmed.

And then.

The then they, that load gets transferred on when the new nurses get overwhelmed,

that load gets transferred on right.

To some of their long term season nurses.

But then that gets to be too much for them when they do it for exactly,

for over an extended period of time.

And then all those people leave and they're in the same boat again.

Exactly.

And when you brought it to management instead of management, taking

responsibility or accepting even just accepting, hearing you out

and, and, , saying how much they appreciate you for working saying,

I'm sorry, this happened.

What can we do?

How can we make it better for you trying to listen to you?

I mean would take five minutes for someone to listen to you.

And so I think this is something that we need to be able to convey to management

that, Hey, we are here to help you.

We are your nurses, and we wanna take care of the patients.

We just want.

And we wanna support you.

I always think about pat movie, uh, with Tom cruise, Jerry McGuire, and

that statement help me help you.

Help me help you.

So that's what I wanna say to management.

Sometimes I think nurses are in their head and what they're thinking is help

me help you because I love my job.

I'm a natural nurturer.

I want to take care of the patients and I wanna do a good job, but I wanna be safe.

Also.

I have a license.

I wanna be safe.

And so let's work on this together.

We are not, we don't wanna be in an adversarial position

with management as nurses.

I think generally we wanna come in and do our job and take care of our

patients, cuz that's what we love doing.

But you can only overwhelm somebody.

They can only handle that extra burden for a certain amount of

time before it gets to be too much.

And that's part of what's happening.

okay.

So Kara, why do you think these kinds of these types of things are

happening at this period of time?

It's a very complex situation.

It's a complex, it's a complex answer.

It's not just one facet.

It's not just money, right?

Or personality, or sometimes I think even ethics.

I think it's super complex.

As medicine grows in America, as, things change in our society EV across the.

We are still performing the same job, but we're get, we're not our pay.

Isn't increasing for one, but our load is going up.

The demand for, perfection is higher, right?

Because we live in a customer service based world.

So at any given moment, someone can complain and say I don't

like the way that she looked at.

, I don't think I want her.

And then this nurse who's already struggling.

Who's been working her hardest and who's this is my six day in a row

because I'm trying to help out.

Okay, great.

She doesn't like my face and and that get, doesn't get taken

into consideration either.

So I think it's very multifaceted.

And then you have a huge peak in travel nursing where we're actually

getting paid better to do what we know how to do, but to come in and, be

someone's crutch for a little while.

and then the nurses who are there know, Hey, these guys are making twice as

much as I am doing the exact same job.

If not sometimes less, I'll be it hard because they're in a new environment.

The, there can be personality issues.

There's charting difficulties, cuz they have to learn a whole new system.

Still the person who's there is thinking, I'm not getting paid this much.

And the travel nurse is getting paid this much.

So now I'm forget this.

I'm gonna go travel.

And then people are leaving.

There's no, there isn't any more loyalty.

There's not I need to stay here because of my family and this is where we live and I

need to stay here because of my benefits.

People are thinking to themselves, why would I stay here for this?

When I can make twice, three times as much money traveling and I'll just leave.

I'll just leave.

I'll just go on, leave people in the military, do it all the time.

They go on leave.

They leave for three months.

They leave for six months.

They leave for a year.

They come back with three times as much money in their pocket.

So there's no re they're not able to.

and I think a lot of that is they're not willing to come out of their mold either.

They don't wanna listen to the advice or the constructive criticism that

they're getting from their staff.

, , they're, we're considered very complainant.

Anytime we come and approach management, like even in her

situation, like I'm brand new.

I, I wasn't under the impression that I was gonna have five, five patients today.

I've never handled these kind of patients before.

I thought we were on a rotating basis and for the, for a manager to

be like, why are you complaining?

We all have to go through this instead of taking it as a constructive criticism

or as a cry for help, we are looked at as complainant and then just move

on, suck it up and take it right.

And people are getting tired of it in general.

I think our.

Community of nurses has really gotten tired of it.

Because they're just getting burned out.

Nancy, what did you think the, feeling on the unit was about travel nurses?

Did you guys have any travel nurses come in?

We did.

They are actually not very positive.

In fact, they're very negative about the travel nurses.

They, the general consensus is that.

they're getting paid two or three times more than the actual staff nurses, but

their workload is the same or sometimes less because they're not, , upheld to

the same standards that we do as a staff nurse, charting is very bare, minimal.

, they basically do whatever they can and whatever, they don't know, they

don't, someone else picks it up.

Exactly.

Or they don't do it at all.

So that that's why the, a lot of the nurses were very upset when we had,

we, when we had the travel nurses.

And I.

Feel I feel for the travel nurse too, in the sense that, , they're

coming into a new environment, but at the same time, I think that when

nurses on a unit find out that the hospital is willing to pay so much for

somebody to come in from the outside.

I think that's part of the, I think that's also part of the problem, cuz

I think if the hospital or wherever you're working, if they consider.

the nurses, their staff that they have and say, you know what, let's sit down

with the nurses and talk about, Hey, we, instead of what would you like us to do?

We can bring in a traveler and to provide the actual physical support

so that you guys don't get burned out.

But this is how that process works.

you guys wanna do something else?

Is there another way that we can work this to where we can have the patients

and the shifts covered, not burn you guys out, or, give us some input,

work with us, help us figure this out.

Let's all figure this out together.

And that way you'll have more of a cohesive and a friendly,

cordial, not necessarily friendly, but a cordial environment between

management and nursing staff.

And let's talk about that.

Management's approach to some of these nursing concerns.

How does management respond when nurses voice are concerns, whether it's about

staffing or appropriate assignments or any other nursing concerns?

What does management have to say?

Nurses are not a dime a dozen.

Yes.

Some director can come to you and say, you wanna leave?

Leave.

I have a stack of resumes on my desk.

I'll hire the next person on the stack.

And at this point, the nurses are in the position to say, you know what?

You go ahead and do that because that's gonna cost you $46,000.

Just like you said, in training that nurse.

and when you get her, you don't know, you know what you're getting,

she's gonna be that's right.

You don't know what you're getting.

Is she gonna know what she's doing?

And even when you do spend another $46,000 training, this nurse that you just hired

that's Thursday, is she gonna stay?

Once you get her trained, she may not like you

and that's flight that they're in right now.

Yes, because they kept telling us that we're gonna replace you.

You're all replaceable.

You're warm.

So now people just walk.

All right.

My warm body is taken off to California.

That's right.

That's right.

You.

And then they're like, wait a second now, instead of paying, an now instead

of paying $40 an hour, because that was great five years ago, instead of

paying $40 an hour for a travel nurse, they're like, oh my God, we, our own

nurses won't come in for a $50 bonus.

Okay.

Maybe they'll come in for a hundred.

Nope.

Sorry.

Not gonna do it.

Oh, shoot.

Now we're paying 500 and they're still trying to get away with

gas, lighting you and telling you.

Here's your you're still replaceable.

I can go get someone else.

You're still replaceable.

They're still doing the old thing and where they're not getting

the effects that they want

so that those words need to leave.

Management's vocabulary.

100% a director, a coordinator, , middle manager management.

There's a base median and, , high pay average rate, and they give it to

you every year for your evaluation.

This is what you're making.

You're making 26 45 an hour, and we're willing to give you a 3% pay increase,

and then they show you, this is the me, the base median and high end you're right

there, like in between base and median.

And you can say every year, you know what, I've worked really hard.

I've done all these things.

I got a masters I've oriented five people to the unit, and I'm still here.

I want you to raise me to the median pay rate.

That's maybe a dollar, $2 more an.

That's it.

And I'll be content to continue to put up with this BS for another year.

And they're like, you know what?

No, sorry, I can't do that, but you still need your job.

Yeah.

So now you know that they're willing to pay someone else more because

they just showed it to you on paper.

They're giving them bonuses and giving them increase.

But the thing is, they're saying, okay, in order for us to give it to you, you have

to work at least one or two shifts extra.

But rather than if I think you would, they would attract more or actually

have more people volunteer to sign up.

They had said, Hey, you know what, because they're paying

that for the travelers anyways.

And just say, Hey, you know what.

This is out of our own pocket.

We are gonna give this to you without expecting anything from

you, . Return, because we respect you.

We appreciate all your help.

If you can sign up, that's fine.

But if you don't sign up, we are not gonna hold that against you.

I would think that people, They will attract more people to say, okay, you

know what, I'll help the unit out.

all right.

That's all the time we have for today.

We'll continue to have our discussions here at the round table with Karen, Gary.

Catch us next time.

. And remember whatever life

So email us, drop us a line at gokrazy@thenursesroundtable.com.

That's go krazy and remember crazy with a k@.