Where Have All the Good Nurses Gone?

Those familiar with the nursing landscape and the patient options universe have been noticing a talent vacuum for some time. Has the general quality of nursing fallen off? Where have all the good nurses gone? Hospital policy and budget cuts, public mental health policy and supervisory practices combine to eradicate the best and most talented nurses out the door.

Risk averse nursing workplaces are becoming harder and harder to find, thanks to Social Security’s failure to keep mentally ill populations locked appropriately in pace. Mentally ill patients now take up regular population beds, a violation of nursing care in ethics if not in deed. Because these are not actually critical care patients, i. e. no amount of direct nursing care can restore mental logic or activities. Many new nurses (and old ones) do not have concentrations and/or documentation and licensing for strictly psychiatric patients, even if patient organization loads and assignments offer them these patients!

Consider: if a nurse applied for a position of equivalent nursing station in a psychiatric ward they would not be accepted because they did not have the credentials or experience. These patients would formerly have been residents of hospital wards more suited to round the clock care specific to this kind of patient need. And ward backups could otherwise have absorbed the extra patient care load.

But burnout of regular nursing staff and nursing shortages are behind this new gap in patient care. Why, as one old pro asks, should they wear themselves out simply because the State wants to save a few bucks on medical costs? They don’t get paid more for severely heavier care demand patients. But according to the present model of overstuffed wards, they are expected to do the work!

This “Lost Generation” of nurses will pass on thankless extra work, thank you very much. Generally speaking, more experienced nurses in older conventional labor models could be counted on to fulfill more complex nursing tasks to more demanding and more complex critical care patients, such as dementia, Alzheimer’s, or even Huntington’s Disease cases. But many experienced nurses looking to retirement do not feel the same push to fulfill additional case work per patient for no additional compensation.

More experienced nurses are simply not to be depended upon anymore to “pick up the slack” because newer grads want the easier cases and managerial staff can’t be troubled to properly supervise them. The charge nurses assign them to heavier load patients. Nurses are likely to pass on extra shifts or extra duty and extended hours, because they will simply get dealt the harder tasking. Nurses are likely to call in sick and take the personal time owing than spend the day chasing a thankless care load.

Many new nurses are “new grads”, shining with brand new diplomas but heartily lacking on practical nursing experience. New grads, as they are being termed are simply not experienced enough to care for mentally ill patients. These patients can be a significant drain on ward care time, because they need nurturing and coaxing to eat, take medications, and need more intensive body nursing than an ambulatory patient. And ambulatory and non-mental patient populations are deleteriously affected. Patients who “behave see the “problem children” get all the attention.

How taxing is the average mentally ill patient on a regular care ward tasking? Take for example the fictional case of “Robert Fickle,” an aging dementia victim undergoing unilateral amputation of the right leg. His care requires negative ionization chamber care and round the clock nursing care of a (1:1) one to one ratio assigned directly to him. But there is no rest for those on the same ward as Robert Fickle.

Fickle has transformed a quiet and orderly ward into a chaotic and noisome irritant. Bawling incessantly, he wears down every nurse and supervisor. Encouraged by the attention he receives, Robert continues to yell and scream if he does not get the attention of every person who passes into his field of vision, and yells abuse at other patients or staff if they do not instantly hurry to his side. The social worker licensed to carry out medical activities for Robert Fickle is only employed onsite from nine a.m. to five p.m.

Robert has abandoned all attempts at coping and spends all night yelling at nurses and passersby in the ward. Robert refuse to wear his hearing aid and can be heard all the way down the hall on a nightly basis, haranguing nurses for hours about fictional missed appointments he must get to (at five o’clock in the morning). There is no way to shut the noise out and other patients suffer to no avail.

Robert’s constant verbalizations wear out the nurses, who must complete the charts and medicine dosages of other patients while this noise is going on. It is very distracting and nurses feel put upon to keep their performance error free in this environment. The new admissions to the ward are accompanied by family and visitors, who are struck with amazement at this spectacle while their loved ones are taken into “restful” hospital care.

Sickle’s “condition” rule the ward. He refuses to stay in bed and insists on sitting in the doorway of his room, heckling patients and hospital staff, employees and visitors alike as they walk by, with imperious screams and abusive catcalls. Hospital policy limits what nurses can do or say to limit this nuisance. Numerous complaints from other patients go on “deaf ears”.

So, where are all the good nurses? Looking for alternate employment, or counting their days until retirement. And considering that any of us might be the next “Robert Sickle”, that is food for thought indeed.

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