The Death of Bedside Nursing (and why it should matter to everyone…)

The Death of Bedside Nursing (and why it should matter to everyone…)

by Jen Kyer

RN/Blogger/Wife/Mother
On: Purpose Blog

posted on Mar 6, 2017, at 3:51 pm

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THIS PICTURE LOOKS OLD AND GRAINY BECAUSE IT IS. That is me in nursing school, almost ten years ago (I’m screaming internally). Sit down because I am about to get serious with you and let you in on a scary reality that most nurses know but don’t talk about.

The face of nursing is changing. It has been. It is not a good thing.

A family member was recently admitted to the hospital. I accompanied her to get her settled on the floor and in doing so met her nurse, who was being trained by another nurse  (we will call her Mary). Mary and I got chatting and she explained that she trained for a period in my unit during her nursing education. Upon discussing this she mentioned shadowing a nurse that had been on my unit a short period of time and had left. From my calculations she shadowed a nurse who had been working on my unit for 1-2 years (who was already gone) and that had made her a staff nurse for approximately 1 year or so. Subtracting a generous 12 week orientation, Mary (who has been practicing independently for a liberal approximation of 8-10 months) was now in the process of training brand new nurse.

Do you see a problem here?

This revolving door of nursing is creating problems for patients, cost increases (for everyone) and problems for those of us who do decide to stay at the bedside. Nurses are leaving in droves and novice nurses are teaching more novice nurses. According to the RN Work Project, a study performed over 10 years to track career changes among new nurses, 17.5% of new nurses left their position within a YEAR of starting a new job, 33% within two years and 60% within eight years.

What does that mean to you? That means there is a high probability of you getting a pretty “green” nurse when you walk into a hospital. You might notice that half the staff look like they just graduated college, which sometimes is true. (Scary right?)  However, just because you have an older RN it doesn’t mean that they have experience, much of the workforce is second degree nurses and you can’t trust the age to tell you about level of competence.

This matters. Statistically speaking experienced nurses help patient outcomes. This means that there are less hospital acquired pressure ulcers (bed sores), infections, etc. with a staff of experienced nurses. This study concluded that increasing experience (to an average of 5 years) and clinical hours (6 hours a day to 7 hours a day) could lower incidences of hospital acquired pressure ulcers by 11.4%, and falls by 7.7%.

What does that mean? It means $$$$$$. Experienced nurses would save hospitals money because as it stands now, hospitals aren’t being reimbursed by Medicare and Medicaid services (CMS) what they consider “hospital-aquired conditions” like pressure ulcers over a Stage II. To you non-nursing people, this means when you get a bed sore that opens up and becomes difficult to heal, its considered preventable so CMS isn’t paying for it.

Now in ways these things are preventable, just like urinary tract infections from urinary catheters, however the way to prevent those things is to have STAFF. Competent, experienced nursing staff and adequate support staff like nursing assistants to help. Pressure ulcers are preventable if you turn patients, if there aren’t enough staff on hand to do the turning, they become less “preventable”.

This is an issue not because nurses are aging out, not because of “nursing shortages” but because of the hospital environment. Nurses are overworked, understaffed. Units with a high census and acuity take a toll on even the most experienced of nurses. Patients are heavier both literally (in weight) and with more comorbidities. We have modalities to keep the most critically ill patients alive for inordinate amounts of time and these are only small parts of the cause of the bigger problem.

Money is the driver for much of the issue and we are doing more, quicker, with less support than ever before. We are required to work long shifts without breaks, hold our bladders, skip lunches and keep going. We are required to work weekends, holidays, nights, long stretches of 12 hour shifts that become 14 hour shifts. We get berated, verbally and physically assaulted, accused of withholding pain medication, letting food get cold. We are literally breaking our backs- some estimate the average nurse lifts 1.8 tons per shift. Why would you stay at the bedside?

So people leave. They go to a clinic, become visiting nurses, go back to school, pull back their hours or just stop working. Who would blame them? Advanced education means a bigger paycheck and better hours. No double knee replacements at 60 or slipped disks at 35.  Why would you stay?

New nurses look cost-effective initially, lose a nurse with 12 years of seniority to gain someone who will be paid at an entry-level rate sounds like cost savings but unfortunately this isn’t the reality. Once they finish orientation, they stay a short time and then move on to school or burnout and leave the bedside altogether. This is not cheap. According to The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention “Recent studies of the costs of nurse turnover have reported results ranging from about $22,000 to over $64,000 (U.S.) per nurse turnover”.

More importantly,  more than cost, there is something to be lost when good, experienced nurses leave the bedside. Institutional knowledge, experience gained from years within an organization are lost and with it the patient experience suffers, or worse. In a study done of Pediatric Cardiac Intensive care unit patients (discussed here), that included 38 hospitals and 20,407 patients, they concluded that “the odds of death significantly increased when the percentage of RNs with two or fewer years of clinical experience was 20 percent or more” and going further to recommend that “pediatric ICUs should have no more than 20 percent of their staff with less than two years’ experience.”

Layman’s terms, patient mortality and outcomes have a lot to do with how long your nurse has been doing his or her job.

Nursing is a lot more than bedpans and med passes, there is a lot more that goes into the minute-to-minute decisions that aren’t taught in a classroom  or on orientation. In teaching hospitals this is even more important. Residents coming onto the floor are fresh out of med school and honestly depend on experienced nurses to be their double-check at times, nursing being the last line of protection to the patients. If the nurses are new and the prescribers are new, it can spell disaster for people in the beds. You’ve all seen the Scrubs meme where the nurse speaks to the more experienced physician saying “Doug wanted me to give this patient five hundred thousand milligrams of morphine. I thought I’d check with you before I kill a man.” This is funny because its true. Mistakes happen, you want the person giving you or your husband or wife or child to recognise the error before giving the medication.

There are so many of us devoted to this career. Who want to see it succeed. I want to work alongside a staff of experienced, dedicated staff whose priority is the patient above all. I have had the pleasure of working with some phenomenal experienced nurses throughout my career and have seen newbies blossom into some of the most amazing nurses I know. I want people to stay and for patients to get the care they expect to in the hospital (minus the expectation of dinners for their extended families and five extra pillows- I don’t work at the Hilton).

Retention is key, I want to stay at the bedside and I know many that do. The face of the bedside doesn’t need to keep changing. Management and hospital administrations need to play a more active role. Hospital administrators need to address this hemorrhaging of experienced staff, through better ratios, staffing, schedules for better work-life balance, and retention projects.  Spend the money allocated for hiring bonuses on your experienced staff and you won’t need to keep hiring. It will be more cost effective and more importantly, patient outcomes depend on it.

About Guest Blogger Jen Kyer

My name is Jennifer. I am a twenty-something (I hate that term) wife, mother and RN from Connecticut. I have never lived anywhere else, traveled or done anything to make myself cultured or well-read. I’m not all that interesting. I have no freaking clue what I am doing or talking about. I’m doing things- aimlessly and without any sense of if I am doing them right/well. FYI: you probably are too. This blog is a collection of essays of my thoughts, opinions, trials and experiences figuring out how to be a fully functional adult. Trying to find my purpose in the chaos. Read at your own risk and enjoy!

21
Comments
  1. Sonya Mooney, RN says:

    Wow, you have capsulized perfectly a lot of what and why there is loss of bedside nurses – without sounding angry and crazy. I’ve been a nurse since ’84 and find myself more and more frustrated with the course health care and bedside nursing practice is taking. CEOs, administrators, managers, and the public need to read your article. I am retiring in the next 5 years and coming to realize I haven’t been able to help “heal” what’s wrong with “the system”. You are doing a great service promoting the cause and respect for “in the trenches” nursing. Thanks.

  2. B Hager, RN, BSN says:

    I enjoyed your post. I left bedside nursing many years ago due to meeting the needs of my family. I have this “pull” to return. I’m currently working as educator in LTC. I’m considering a position in pediatrics and neonatal abstinence syndrome (have worked per diem in this role recently). Am I crazy to leave M-F position to go back to “being a nurse”??

  3. Outstanding portrayal of the critical situation we find ourselves in. Many leave disenchanted with bedside nursing because they find the reality of their jobs very different from the roles they had envisiones upon entering the profession. This leaves most feeling betrayed and frustrated. Unfortunately, the vacancies theubleave are filled by persons with far less education and training.
    I worry that even our professinna associations are blind to this problem (either purposefully or very uninformed). These associations often focus on the advanced practice roles and neglect the foundation of our profession – direct care nursing.

    Thank you so much for your blog and insight!

  4. Joel Waddy says:

    This read is so accurate and defined the ills of Nursing today. In essence, there are instances where those that make decisions, have no to very little insight into the reality of performing safe patient care. Financial viability is the ultimate goal, but at times to the detriment of patients, care personnel and the entity in the whole. Short term gains of investing in newer nurses, while pushing the higher paid ( more experienced) nurses out of the work force leads to a lose….lose situation for all. Let’s galvanize to enforce patient care and protect all variables that enable nurses to provide quality Nursing Care.
    Thank you for your post.
    Joel Waddy RN MHA CNN..

    1. Manuel says:

      Thank you for your feedback, Joel! Keep saving lives!

  5. Jan Gurule says:

    The focus here is hospital nursing. I have absolutely no desire to return there after many years of working long hours, many days and declining respect and an exponential increase in unrealistic expectations.
    I am a home care nurse…for 1 more month (retiring). I hate to say it but it’s not any different out here. Focus is productivity, unrealistic expectations, increase in traffic with slower mobility from patient to patient, administration that cannot relate to us in the field despite some having done that very thing a few years back. Unwillingness to reassign non clinical tasks to office personnel. I really think that the problem is that nurses do not know how to set personal and professional boundaries. I hear things like “the patient needs me. Nobody else will/can do it.” The more nurses take up the slack, the more is expected. It has become a vicious cycle! Then the burnout and the leaving.
    Even in retirement, I will actively encourage nurses to stand strong and say “no” to practices that distract from their professionalism and yes to adequate time to genuinely care for patients. I support single payer system of health care!

  6. Don Fowler says:

    I have had these frustrating feelings u speak of for so long! A practicing RN for 30 + years. We must mobilize and save real nursing, time is running out!!

  7. Israt says:

    This is a very informative post. I really enjoyed reading your post. Thank’s for sharing your article.

  8. 6monthNurse says:

    I am a new nurse six months in at bedside who is disappointed in the way I feel currently. I love being at the bedside but I cannot see how anyone does bedside nursing for 30 years. I can’t even imagine staying more than five. At first I thought I just felt that way because I was new and I needed to suck it up, then I spoke to other new nurses and many of them feel the same and are already planning their exit from bedside. It also doesn’t help that I see seasoned nurses staying after their shifts OFTEN because they didn’t have time to complete charting or tasks in the 12 hours they were scheduled for. In a meeting many nurses voiced the frustration that it feels like we’re doing the jobs that other disciplines should be handling. They said what I was thinking, but I felt like, I’m new, I don’t know what I’m talking about.

    I’m a new nurse, but I have a young child who I don’t want to miss out on growing up and I want to have more and while I knew nursing would be a difficult career I thought I’d feel gratification and I don’t most days. Expectations and workloads are so high, staffing isn’t adequate, there’s lack of support staff, disrespect from patients and families ( I have not yet experienced this from co-workers). Also trying to request weekends off, forget about it. I fee

    I read someone say somewhere, nurses can do everyone else’s job but no one can do a nurses job and it’s true. I feel like if I’m focused on doing everyone else’s job I can’t focus on doing mine. I’m considering moving on to something that allows better work life balance and doesn’t include the ridiculous workload of bedside. I feel like I’m sacrificing time with loved ones, time for myself, my sanity, my sleep, and the sacrifice just doesn’t feel worth it.

  9. Gc says:

    I’m new nurse, after working 8 months bedside I left so I can go working in the school system. you made all great points, but there still the little dirty secrets that nurses dont speak of. it’s the nurses eat there young mentality. I felt like I couldn’t approach some of the more seasoned nurses to ask for help. Also there isnt that much support from administration when you voice your frustrations. I didn’t get in the profession to get yelled at by co workers or to be mistreated. I also felt I was changing. I was miserable most of the time
    Now as a school nurse. I really love and enjoy my job. Yes, I make less as a school nurse, however I have my happiness and sanity.

    1. CS says:

      I can relate to this article well and with the “nurse eat their young” mentality. I am close to 5 months as a new nurse and while I don’t 100% hate it I think of quitting pretty much every week. I was just brought into the office to be told that I don’t help the support staff enough because I asked the nurse tech who was working with me and playing on the internet at the time to please do one blood sugar for me (they don’t do finger sticks normally when there is only 2). I was swamped at the time and I normally don’t ask, and I ask if they need help with patients, turns,ect. It wasn’t even her that told on me it was one of the nurses that butted in to tell me that they don’t have to. I didn’t pay much attention to that nurse at the time because that nurse is one of the more experienced nurses on the unit that has grouped up with others, refused to help out someone who needs it, has yelled at me and other nursing staff in front of patients,ect. Honestly after one nurse lost it the other day, one nurse quit to work days because of the issue, and several staff have voiced quitting because they felt isolated, put down, and not benefitted from the favoritism I didn’t want this person to beat me. So I guess I shouldn’t have been too surprised to be pulled in the office by management and accused of not helping but still… Sorry for the long comment but that was just the newest example and fresh on my mind. On top of that is the patients who can be violent and we are getting a lot of them. One poor nurse got 4 patients that were known to constantly try to get out of bed and I mean every 10 minutes and 3 of which that could be violent. She couldn’t even get her charting or med passes done. We all teamed up to help her that night but her 2 years are almost up in a month and she and one other nurse are thinking of moving on. I don’t mind at all taking care of patients whether its meds, the bathroom, turning or whatever it’s the bad assignments and wondering if there will be someone on the shift I work on that I can ask for help and rely on. As a new nurse I know there is growing pains and everything but this is something else.

    2. td1288 says:

      Agreed! I have been licensed for 19 years but have only practiced for 8 of those years. So sad what nursing really is……mistreatment, exhaustion and abuse!!!

  10. ED says:

    Well stated. So many things have changed over the years being a nurse; the policies, rules regulations, many made by individuals that have never done the job, so it just doesn’t work.
    I have many years of experience but when it came time for me to move on with my life and find another job, it was a bit of an eye opener. I had experience in almost all areas except the operating room. I had my CCRN, PALS, ACLS, BLS, NRP instructor on top of my experience but it was not enough. There was no BS after my name, I was too expensive to hire or too old (although that was never stated). I believe part of the issue is with today’s education of nurses and medical staff. It seems a lot of the basics and common sense are not being taught and there is very little hands on training. Examples: A graduate not knowing that there was a 50 unit syringe available to give 1-2 units of insulin so was using a 100 unit syringe, “I’ve never given a fleets or suppository”, trying to irrigate a catheter through the balloon port. These were responsible new nurses but lacking in the basic hands on knowledge. A sophomore class of students half way through their year “we haven’t had any pharmacology yet”. Education should prepare you for your new job, being able to walk into it feeling confident.

    I believe that the best situation for loved ones or family having to receive medical care is to have a strong advocate with them, to speak up and ask questions when the need arises. Everyone has the right to a choice as long as all of the information, pros/cons are on the table and understood.

    Today’s medical world is governed by the insurance companies, the drug companies, and hoops are jumped through to comply with this control. It is about numbers and money. Putting a bandaide on a hangnail requires a provider’s order, a report in the computer system, discussions at a management meeting, changing the care plan, and documentation in the nursing notes. Employee value is not reflected either. When an employee is a repeat offender, what is wrong with the idea of meeting with that person and constructively approach the issue, “What can we do to make this better?” Instead memos go out reprimanding all employees making poor moral.

    Nurses need to stand up and change today’s world and bullying. These are real people that we care for and we deserve the right to be able to give them the care that they deserve.

  11. Suzy Q says:

    I am a seasoned nurse with hx of critical care, house sup,case managment etc. After working at a 350 plus bed hospital 18 yrs I went to home health so l could be in control of my schedule and be at home when my kids are home from school.
    The transition was very painful. The work is great but the paperwork is horrible and takes long time. Which means l spent more time on charting at home and l do not get paid for my time. There is no union so owners do whatever they want whenever they want.
    I have tried to go back to hospital work but without BSN nobody is hiring in my area. Hospitals hires cheap meaning l would not make what l am used to get.
    So all my experiences do not count nor wellcomed anywhere else. Yet hhc is so rewarding. I serve geriatic population and l am loving it. I wish the charting would be less…
    Hospitals get what they pay for. I remember one rn who came to my moms room and told me she had to get CNA to place a pillow behind moms back while I was holding her so she could do it. She was too good to put her hands in use for such a job..l remember how the RN did not use her common sense and almost killed mom. She was post op fay 2 and not eating anything but this nurse gave her blood sugar meds snd when mom passed out her bs was like 35. When l told her under no circumstances mom should not get her bs meds until she is able to eat, her respond was she needed MD orders not mine. She did not even think to use her common sense!😠😡
    These are the new gen nurses with their alphabet soup titles next to their names and have no experience.
    Over 25 yrs of experience… l feel like they do not deserves the experienced RNs and they get what they pay for!

    1. Jen says:

      As a practicing nurse of 45 years, I have seen the goid, bad, and ugly in nursing and healthcare. I totally agree with the article and responses. I feel for the patients who get an inexperienced nurse. I have an advanced degree, but my basics were taught by the old timers, who had the experience and education to show me. I had to take a break from teaching after a student cried in front of the patient cause she didn’t want to wash the patient’s back who requested it. So sad. The blind leading the blind.

    2. Mackenzie Thompson says:

      Thank you for sharing your experience and thoughts with us!

  12. ROWBOW says:

    Just call me Rowbow. I’ve been a nurse for 38 yrs & enjoying being a bedside nurse in a very high acuity stressful unit with multiple critical care cases…Trauma ICU, surgical ICU, liver, pancreas & kidney transplant ICU. I’m. 59 y/o & still enjoying the bedside & also involved in teaching & as a resource to the newbies. I have a broad nursing experience internationally & locally. Had my initial experience in Manila. I migrated to Toronto Canada where I studied my specialty nursing in ICU cardiology, nephrology, critical care nursing & gerontology. My 11 years experience in all of the above specialties molded me to advance into nursing management when I migrated to Saudi Arabia. I stayed in Riyadh & had an experience working at the most famous military hospital, The King Fahad Medical Center now called the King Abdulaziz Medical City. My stay at this huge high acuity, state of the art has molded me to be inclined w the various more sophisticated equipment where I can’t find in the western world. But my 10 years experience in bedside, education & management still made me feel to advance my studies further. I took the NCLEX & appiied in three hospitals in the the United States. I was immediately hired by the the most famous hospital in Los Angeles. Since I want to switch my specialty in Education or Nursing Management I went back to school as a part time Student & finished my Masters in Nursing Education. Since the completion in America is broad I concentrated w/ my full time job in the surgical ICU, Neuro, trauma & Transplant ICU. To gain more experience in Education at the same hospital I tried to apply to teach ACLS teaching as a specialty instructor in ACLS, EKG, hemodynamics etc. I was also doing CCRN (Critical Care Registerd Nursing) reviews & doing my NCLEX tutorial reviews. My vast knowledge & experience didn’t make me feel to get bored. I don’t want to leave my bedside nursing since my bedside experience is helps my teaching experience by putting my teaching experience into practice. It’s a lot more comfortable to teach the real stuff than just reading the text of nursing experience & putting it into practice. The nursing world now is populated w/ newbies who would set forward & do a lot of questioning. I would call myself an expert in the Critical Nursing field & never in my thoughts would I leave the bedside until I retire. I’m one of those who enjoy the compassion at the bedside & I enjoy to see my patients recover & receive all the great acknowlegements of what I have shared to everyone. It is of course emotionally draining when you see a sobbing family if the patients are suffering or dying. I get used to it though although sometimes I get too sympathetic & tend to cry with them. All is a part of my job & we have to deal with it. Caring & sharing is part of my Nursing practice & until now I’m very positive about it. Even how difficult bedside nursing is I’m enjoying it using my patience & compassion w/ care. Some tips would help when I’m stressed out coming home late & exhausted. I make sure I have enough rest, excercise, social life by not endulging into the bad vices like alcohol or drugs. As far as hobbies: I sing, cook, travel & play golf. My golfing helps me a lot in relieving my stress. Hitting the balls would take away some negative experiences. Learn not to use hate & frustration at work. All experience either good or bad is a “Challenge”.. what I always utter is “I LOVE MY JOB” even if I had to clean shit 10 times a day of transfuse 20 or more blood & blood products a shift or do surgical & ulcer dressings repeatedly. Once all of these difficult tasks are completed, well it should be a matter of a job well done & fullfillment. Hope you would learn something from my story.. Keep “SMILING”… Love your job!!! We’re lucky to have one & were blessed we’re not sick & get stuck in the hospital beds like our patients. Love all & have peace…

    1. Mackenzie Thompson says:

      Thanks for sharing your story Rowbow! We love to hear the passion and dedication behind our nurses!

      1. Rowbow says:

        You’re most welcome Mckenzie. Didn’t have much time to edit co’z I’m just having a quick break at work. Thanks for the appreciation. Though it’s true that experienced nurses are leaving the bedside. The Exodus of retiring baby boomers & the newbies going back to school for advanced nursing practice to become young managers, educators, other higher positions other than bedside nursing. I don’t blame them though since bedside nursing is getting more difficult. Thanks again & God Bless😘😘😘😘

  13. Dina says:

    Recently heard the story how the fresh nurse, 2 weeks out of orientation, almost killed the patient… Scary… I am a bedside nurse, and I love my job, and my manager, and my coworkers… Sounds strange? I can explain. We have union, we have one of the highest pay rate in LA, we have a “retention benefits” such as 403 K matching, annual salary increase (scheduled), retairement and pension, also we always have a resource nurse on the floor, aside from charge and shift manager. The resource nurse is helping when you behind with anything, and covers lunches. I honestly feel tired after 12 hours, however, compare to my friends working in the different places, I am not exhausted after the shift. Also, we have many nurses, who work here !!! 15 to 30 years… Great resource for new nurses, and safe care for the patients.

  14. Todd Cathey says:

    I hope you can find some purpose and aim in life, and maybe get out in the world a bit. Feeling like you don’t have a clue what you’re doing is partly the twenty-something speaking. Telling your readers, directly, that they probably are also aimlessly doing things isn’t the way to win people over. I’ve lived around the world, been in the Marines, worked as a nurse for 24 years, raised two daughters, toured the country as a musician, created and sold my artwork, volunteered on medical missions overseas as a triage nurse . . . . I know exactly what I’m doing, and why, and I’m good at all of it. I’m not sure who you think you’re speaking to, in your bio, but I’d suggest an edit.

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