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  • Shortage of RN

    What can we do to alleviate the shortage of RN ? Can we have medical assistants go through a crash course in 3 months and become ersatz RN ?

  • #2
    There are several options. You can pay more to recruit more people to come back into nursing. Or you can train more nurses. I doubt the nursing lobby is going to let a crash course path move forward.

    It seems like most hospitals were ok paying a bit more for a while but it seems like now they’d rather slowly lower pay back down to previous levels and just wait out the shortage.

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    • #3
      Or universities could be pressured to reinstate actual admissions criteria for NP programs as I suspect that is where a majority of RNs have gone.

      Comment


      • #4
        You’re the problem. Aren’t you smiling and saying good morning behind your mask every day?

        Comment


        • #5
          This is a real problem. The department of defense is sending RN's over to one of the hospital that I round at. I think that this was part of the administrations response to covid, but it really has nothing to do with covid and just to do with an inability to get staff. Supposedly, a few physicians are coming along as well. It is a safety net community hospital that cannot afford to pay staff. The staff they have are quitting only to be rehired at huge rates as traveler RN's. A lot of the safety net hospitals are not sitting on large piles of cash so that that can compete with places which can afford to be in the red in certain departments. Inflationary pressures are taking away all of their low paid techs who can make more working for home improvement stores and nursing homes. Nursing homes have no beds/staff available to take patients so they are causing a backlog in the hospitals who have no staff to take care of them. It's a vicious cycle. Other industries have off ramps they can use- raise prices, limit services, etc. There is no off ramp in medicine.

          The obvious solution is to train more RN's. That's being limited by RN's not wanting to go into teaching because they can make much more money elsewhere. There's only so many people available to go into nursing anyways. I was just listening on a planet money podcast describe how there are some 1.7 job openings for every one applicant right now. We probably need a more aggressive immigration program. It seems silly to have people walking across countries risking their lives to get into the country when we can't find people to drive trucks in our own country. If people want a job and are able to work, they should really look at letting them in. That's why the US previously was doing so much better then Europe or Japan, it has been the influx of immigrants working different jobs that has made the difference. I know that this would be a non-starter for most people, but I do think that they should stop training RN's for advanced degrees. If we need more ER/primary care/anesthesiology/etc providers, we should just train more them as physicians. Either you need a medical degree to do something or you don't. You probably don't need a medical degree for a lot of what we do in medicine, but I think that we end up up with a lot of wasted years in training when you train one person to do one thing and then retrain them to do something else.

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          • #6
            Most young nurses I speak to today all plan to attend NP school (most likely online) or CRNA school. The desire to be a “regular” RN is gone. A good many RNs are going into non direct pt care jobs as well, such as case management. A lot of that probably has to do with the same BS that push docs to become burned out…..EMR (especially this….nursing notes require so much BS documentation), highly demanding pts who treat them like servants, and hospital admin folks who believe they can ask more and more from the RNs without proper backup (or pay).

            A lot of the services provided by RNs could definitely be done by LPNs or MAs……starting IVs, monitoring some pts in postop area (especially outpt), NG tubes, foleys, etc…. RNs are most valuable when it comes to their distribution of meds and assessing pts.

            When I was in med school, we were recruiting RNs from the Philippines. They were well trained and spoke English. It pissed off some of the “American born” RNs……”they are going to take our jobs”…… but it sure did help alleviate regional shortages. We need to reconsider ideas like this.

            Comment


            • #7
              Originally posted by nephron View Post
              This is a real problem. The department of defense is sending RN's over to one of the hospital that I round at. I think that this was part of the administrations response to covid, but it really has nothing to do with covid and just to do with an inability to get staff. Supposedly, a few physicians are coming along as well. It is a safety net community hospital that cannot afford to pay staff. The staff they have are quitting only to be rehired at huge rates as traveler RN's. A lot of the safety net hospitals are not sitting on large piles of cash so that that can compete with places which can afford to be in the red in certain departments. Inflationary pressures are taking away all of their low paid techs who can make more working for home improvement stores and nursing homes. Nursing homes have no beds/staff available to take patients so they are causing a backlog in the hospitals who have no staff to take care of them. It's a vicious cycle. Other industries have off ramps they can use- raise prices, limit services, etc. There is no off ramp in medicine.

              The obvious solution is to train more RN's. That's being limited by RN's not wanting to go into teaching because they can make much more money elsewhere. There's only so many people available to go into nursing anyways. I was just listening on a planet money podcast describe how there are some 1.7 job openings for every one applicant right now. We probably need a more aggressive immigration program. It seems silly to have people walking across countries risking their lives to get into the country when we can't find people to drive trucks in our own country. If people want a job and are able to work, they should really look at letting them in. That's why the US previously was doing so much better then Europe or Japan, it has been the influx of immigrants working different jobs that has made the difference. I know that this would be a non-starter for most people, but I do think that they should stop training RN's for advanced degrees. If we need more ER/primary care/anesthesiology/etc providers, we should just train more them as physicians. Either you need a medical degree to do something or you don't. You probably don't need a medical degree for a lot of what we do in medicine, but I think that we end up up with a lot of wasted years in training when you train one person to do one thing and then retrain them to do something else.
              Depressing but accurate, and it illustrates why we will get zero sympathy when we comment on how much inflation has hurt our compensation over the past 12 months. All of the compensation adjustments are going to go straight to the rank and file. The other obvious solution is to rein in inflation - The Fed is planning to raise rates but IMO is not being aggressive enough.

              Comment


              • #8
                A RN was in my office as a patient to get a Tdap or something before taking a travel job in the south. She was friends with one of the LPNs and was giving her the details. 4500 a week plus a housing stipend for 3 12hour shifts.

                It almost makes sense for me to take that job!

                Comment


                • #9
                  Originally posted by CordMcNally View Post
                  There are several options. You can pay more to recruit more people to come back into nursing. Or you can train more nurses. I doubt the nursing lobby is going to let a crash course path move forward.

                  It seems like most hospitals were ok paying a bit more for a while but it seems like now they’d rather slowly lower pay back down to previous levels and just wait out the shortage.
                  How is the nursing lobby more powerful than doctor lobby ?

                  Comment


                  • #10
                    Originally posted by nastle View Post

                    How is the nursing lobby more powerful than doctor lobby ?
                    They are, and I don’t think it’s even close.

                    Comment


                    • #11
                      Originally posted by nastle View Post

                      How is the nursing lobby more powerful than doctor lobby ?
                      They're willing to unionize

                      Comment


                      • #12
                        The labor capital seesaw has swung radically toward labor especially in health care but really everywhere. What's unique in health care are the weird distorting externalities around COVID incentives and emergency pay and travelers etc. Add to that the NP route, "NP compensation equity" in some states including mine, and folks are now using RN only as a pit stop. All my experienced senior RNs have retired, if it wasn't plain out health care that wore them out, COVID did them in. The young ones stay for two years then go to NP then open up a shop down the street selling TMS and getting $500 per pop. I can't think of a single RN who become an RN between 5 and 15 years ago. They all are either old lifers, or young NP-to-bes.

                        Comment


                        • #13
                          This will fall flat or raise contempt.
                          Computers and tech.
                          Why? Computers are so much faster than any humans. Computers have created a productivity circular process that creates imbalances. An imbalance creates an opportunity to exploit the imbalance for the benefit of one and the detriment of another.

                          Education in general:
                          High school education at one point had value.
                          Bachelors degree at one point had value.
                          Masters degree at one point had value.
                          Doctoral degree at one point had value.
                          Well, a pen and paper, reading a text book, a university needed an infrastructure and multiple colleges to do “research”, prestige! And large specialized hard copy libraries. State governments and federal governments funded “needs” for “progress”. What was needed once computers came into existence?
                          A data center, data entry “clerks”, keypunching skills, compilers for program debugging, computer programmers, systems analysts, computer operators, larger high volume printers.
                          The infrastructure was the gating point. The “teacher” had subject knowledge and guided students through the process of acquiring skills and knowledge. Supercomputers were rare.

                          A product to be sold? Take away the infrastructure requirements and opportunities exist. State U was actually a two path choice. A&M (agriculture and mechanics) land and improvements (engineering) and all others (business, sciences, liberal arts, education).
                          NP is a small subset. The learning process is much more intuitive and the infrastructure is minimal.
                          A BSN vs a NP is the same as MS students no longer needing to attend lectures in person or spend hours in a library to have access to hard copy material needed to learn.
                          I have never heard a physician ask, should I get a bachelor of business degree?
                          Why would a nurse want a bachelors of nursing?
                          No longer really needed because the more valuable certifications and education are available with minimal infrastructure. And the university systems have a product to sell cheaply. A universities status is determined by the graduate programs and research. Not teaching lowly undergraduates. Computers and tech have made it possible, no longer need large infrastructure nor undergraduate degrees. Many have asked, is a college degree worth it? Most engineering and accounting programs are designed now for a master’s degree path. It doesn’t take much to add on a year of classes.
                          If NP training required infrastructure and libraries and in person classes, you would see many less NP’s. Computers and tech made it easy.

                          Just a note: our society is struggling with regulation of changes caused because computers and technology are so much faster than human capacity and how it can exploit. Crypto is an example. $5billon theft, but infrastructure to benefit from the theft was a problem. The regulations make it difficult to prosecute.
                          https://www.newyorker.com/business/c...en-bitcoin/amp
                          Society as a whole is being disrupted. Tremendous benefits, but it changes the incentives.




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                          • #14
                            Currently the head ache factor associated with working as a nurse is not worth the pay

                            Anything that fixes the above statement wins...

                            Comment


                            • #15
                              Originally posted by nastle View Post

                              How is the nursing lobby more powerful than doctor lobby ?
                              Are you actually asking how or are you asking that because you don't think it's true? Physician lobbying power is weak because physicians are generally weak as a group. The nursing lobby has more pull because they aren't weak. Case in point: remember during the first wave of COVID in New York when nurses were getting paid 4-5x their normal rates to go work there while physicians were being asked to volunteer? Everybody knows we're softer than nurses.

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