File This One Under: Duh!

I read this news report this morning:

New RNs find job market tight
By Alison Young, USA TODAY
(click the title to get the full article)

Even as a national nursing shortage looms, many newly graduated registered nurses can't find jobs because the economic downturn has delayed retirement of experienced nurses, regulators and health care associations say.

Those who find work often can't get the better-paying hospital positions they had hoped for and instead are turning to nursing homes, home health care or other settings, says Carylin Holsey, president of the National Student Nurses' Association.

and the first thought that popped into my head was: "Duh! When has there NOT been a tight job market for nurses?"

When I graduated from my LPN program and got my first license way back in 1975, only 2 out of the 20 of us were hired right away in the hospital we trained at, both of them had parents connected not only to the school system but in local politics. The rest of us had to scurry around the state, taking not only nursing home and even state home (residences for the mentally and developmentally disabled) jobs but most of us also had to take the night shift or rotating shifts, meaning one week we'll work 3-11pm, the next work 11pm to 7am, sometimes finishing our night shift for Sunday at 7am Monday and going directly into the next week's schedule of 7am to 3pm that same morning, meaning we're now doing a 16 hour shift. Then Oops! You find out at 3pm that someone from the evening shift called out sick and since you're "the new guy" you have to cover for her, so now you're doing a 24 hour shift, then have 8 hours to go home for the first time in 2 days, sleep, and get back to work at 7am Tuesday.

It's not just medical residents who are forced to work dangerous shifts until they're so tired they're falling down on their feet!

Some of us assumed we were getting "picked on" because we were only LPNs so we went back to school to get our RN license, many of us also grabbing the newly formed BSN degrees, assuming the admission directors were right and that with our BSN degrees we would be on the fast track to not only steady day shift positions but supervisory ones. Little did we know after spending all that time and money that by the time we graduated diploma nursing programs would be obsolete and the basic entry level requirements for a registered nurse would change to demand BSN degrees just to get the same crap jobs we were trying to escape. Colleges were now offering "fast track" degrees to diploma nurses so they could get their BSN degrees in just 2 years instead of 4, and a MSN in just 3!

And at the time were never realized how lucky we were to have even those crap jobs. In the decades since then, insurance and hospital regulations have changed drastically, as well as the job duties of doctors and nurses. Things we were trained to do as LPN you now had Certified Nursing Assistants (CNAs) doing; jobs RN's were doing the LPNs are now handling; procedures that only a doctor or pharmacist could perform back in the 1970's are now being done by RNs; things only RN's with certification in advanced life support, etc., are now being done routinely by both RNs and LPNs right at the bedside on regular med-surg units and not ICU/CCUs.

Another casualty of all these changes are hospitals themselves. With insurance companies paying out less money for procedures that are becoming more complex and expensive, not only are hospitals cutting their staff to the bare bones, but many are closing entirely. Our city's hospital went bankrupt, was bought by some conglomerate who changed it to a for-profit institution, cut staff even more while adding more out-patient and specialty units, like cardio-vascular disease testing and bariatric surgery units. They used to have a sleep studies lab but that "fad" faltered so they did away with it, giving that space over to the out-patient chemotherapy and dialysis units. Less hospital beds mean less need for nurses, even highly trained ones. One RN can run a dialysis unit with a few trained technicians who earn about a quarter her salary instead of using all nurses.

A few years ago our local hospital, when it was still owned by the city, a not-for-profit community hospital, the powers that be decided to drop the private duty nurses' registry, the listing patients and their family used to go to when they wanted to hire a registered nurse to be by their side and care for only them while hospitalized. This registry had been in existence as long as the hospital had, and that went back to when our city was first founded, close to 200 years ago. The hospital didn't want the legal responsibility any more, they claimed. In actuality, one of the national chain nursing employment agencies opened up, the franchise owner being connected to someone on the hospital's board of directors, and now all private duty nurses, even all per diem nurses, were now going to be hired from the pool there. To become part of that nursing pool, they demanded a minimum of a BSN degree. Most of the registry nurses who were now out of work graduated during the diploma program days, back when nurses not only learned the nuts and bolts, the science of medicine and nursing, but the hands-on skills, both medical and empathetic, required in nursing. They learned by working with the patients and getting their hands dirty, not from sitting in a college classroom watching videos of procedures being done. They learned how to interact with the patients, how to bathe them top to bottom, how to make a bed with sheets so tight you could, pardon the cliché, bounce a quarter off of them. They learned how to sterile their own equipment, how to fix medical equipment in case something broke on their shift, they washed their patients' bedpans. And they knew everything about their patients - their medical status, sure, but they also knew about their family life, their social and job status, their standing in their religious group - anything that would help the nurse and the doctor make this patient's standard of living improve. Nurses today, all college trained, rarely see a patient until their third year of school, and then it's just for an hour or so a week. They graduate knowing the why but not the how or even the who of nursing care.

Anyway, the diploma graduated former private duty nurses were all out of a job. Many of them just retired from nursing or went into other fields; some continued to do private duty in private homes, finding clients by word of mouth; but those who wanted to stay in nursing in an institutional setting had a tough time of it, and still are. With no college degree or even advanced nursing certifications they couldn't get hired in any hospital setting, nor would nursing employment agencies take them on. Some found work in doctors' offices when their current nurses would retire, but that accounted for less than a handful, even 10 years later. Some kept looking, living off their savings, dipping into their retirement accounts. Many of them are now within retirement age but because they had used up their savings while searching for jobs, have to remain in the workforce.

One of my neighbors was one of these private duty nurses. It took her almost 5 years to get another nursing job after the apocalypse, and it's working part time in a nursing home, revolving shift work, earning about the same as a new graduate would. She had to give up her car years ago because she couldn't afford the upkeep or insurance, and may have to seriously consider moving in with a friend of hers because she can't really afford the rent in her apartment. This is a woman who, even back in the 1980's, was earning top dollar, had the finest of things, and frequently went out with friends to cultural spots in NYC while dressed in furs and jewels.

My sister-in-law is one of those college trained nurses who never got her hands dirty by doing actual patient care. This woman has multiple college degrees, including Masters, in various fields of study. Nursing was her latest "passion" around 20 years ago. Remember how in high school the schools had different tracks - the academic track was taken by those who planned to go to college and those students took more history, math and English courses, while those taking the technical track took courses that taught them a trade, like auto mechanics? The college my s-i-l went to offered similar tracks - those who planned on taking actual nursing jobs took one set of courses, and those who planned on going into administration took others. She opted for this, because as a former teacher who really disliked doing anything like manual labor, she naturally assumed any institution would be proud to have her as part of their management/supervisory team. She didn't realize that nursing managers and administrators started out as floor nurses and worked their way up the ranks. She graduated almost 15 years ago now and still hasn't found a nursing job, even though she's now willing to work any shift in any kind of setting practically anywhere in the state. Nobody will hire her because she has no experience, even though she's in her late 50's.

Even I've looked a few times over the years. I last worked full time as an RN back in 1983. My gynecologist strongly urged me to quit my job back then because AIDS was a fairly new and deadly disease, transferred to others by unsafe homosexual practices and IV drug users. Very little was known about its transmission other than this, and most patients who got it died from it. The unit I was head nurse in at the time had the only private rooms in the small inner city community hospital I was working in at the time (now long closed, thanks to budget problems) and because of that I would get all the AIDS patients, all of them IV drug abusers, many with long histories of violence. More than once I was threatened with dirty syringes until I gave them a dose of narcotics. This would happen so frequently to us on this unit that the hospital worked with the doctors and nurses to write up a procedure to follow when it happened. My GYN knew about all this, even though he didn't come to that hospital (No OB/GYN department since the 1940's) and was concerned for my safety, hence the recommendation to quit. I did. When I was ready to go back to work when my son was starting elementary school (but before his asthma diagnosis, which is another long story) I first went back to this hospital, now under new ownership, but they could only give me a few hours a week per diem, and in those few hours I was there I was responsible for all 8 hours of medications for an entire 60 patient unit, PLUS writing charts for 2 of the nurses aides' patients, PLUS doing the treatments for those patients PLUS covering other nurses' and aides' patients when they went on their coffee and lunch breaks, PLUS run up and down to the pharmacy to get medications that weren't on the med cart or doctors just ordered and wanted given right away, or for the out patient surgery patients that the OR called for three times already, even though they just walked in the door and hadn't even taken their shoes off or been admitted yet. I get tired and psychotic just thinking about those days! I lasted a few months before I quit. I quit not because the job sucked - any nursing job sucked at that time - but because I had so many responsibilities tossed at me, including 2 and 3pm meds, even though I was supposed to leave at 2pm, that every day I worked I wound up leaving at least an hour late and would always be late picking my son up at school. When I knew ahead of time I would be too late to get him I would call my husband, who worked just a few blocks away form the school, and he would get him and bring him to my m-i-l to watch until I got there, but too many times something came up at the last minute, or my husband couldn't get him, and the school let my son wait in the secretary's office until I got there. Finally they got fed up and said if I was late one more time they would report me to child welfare services. I called the hospital back that day, that HOUR, and quit, never to return to nursing ever again.

But now and then I look, especially in the past 10 years since the military base my husband worked in closed and he's been working one crappy low paying job after another (And he has a Master's degree!). I look in all the free nursing magazines different organizations mail out to all licensed nurses in the state. If you don't have a BSN they won't even let you apply for the majority of the jobs; ditto special certifications. If you had a Master's in Nursing you might get hired for a day job in administration or teaching. When an institution does have a job open that doesn't require advanced degrees, it's usually nights, either a 2, 4 or 13 hour shift, and somewhere out in the boondocks where you would need to drive 3 hours to get to from where I live. And if you've been out of nursing for a while, like for me it's been over 20 years, they insist you go for refresher courses at your own expense, and while you're at it, grab a few of those certification courses, too.

I guess we'll just keep on living on beans and rice meals and I'll continue to stay at home.

Quick Request

Will somebody PLEASE turn off the heat already??

3 days of 102º heat is a wee bit too much for these poor asthmatic lungs to handle, don'cha know.