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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Jen Kyer

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!

10
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.

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