Nursing

The death of bedside nursing (and why it should matter to everyone…)

This picture looks old and grainy because it is. That’s 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 recognize 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.

 

 

 

 

357 Comments

  1. I had no idea nurses had a high turnover but it makes sense with how hard they work. I know it doesn’t help much but I appreciate all you do in the name of health care. ❤

  2. One of the other keys is management – good managers retain a lot more staff than bad ones so admin needs to pay attention to who they hire into those positions.

  3. Working in an ER for 30 years was profoundly rewarding. However, some managers made me feel guilty if I couldn’t take that extra shift. The most important advice I have to offer is to know your physical limitations. You do no good if you are dead on your feet. I can’t think of anything more devastating to a nursing career than working beyond your body’s ability to function

  4. This is absolute truth, and very sad.
    An administrator from the hospital I worked in for 10 years became my neighbor. I told him I love bedside nursing and would love to still be doing it. The hospitals need to start thinking outside the box. I have elementary school aged children. All shifts begin or end at 7am- it is not possible to find a sitter or daycare that will take kids at 6:00am and then get them to school. What’s wrong with staggered shifts like the ER, or hiring someone like me to handle all discharges or admissions ? My neighbor said he took my idea to the CEO&CNO and they had no interest, wouldn’t even consider looking into it.
    It is a tragic situation that will only get worse.

    1. I totally agree. They need to start hearing us. But we leave, and a newbie with a plan of grad school comes along and sucks it up for two years and it continues. It’s a sad case.

      1. The biggest issue I have noticed in this over the years is nurses themselves. Nurses rately work together. I have seen nurses stab each other in the back, and deliberately sabotage one another. All because they think one is getting an advantage of the other. There is a another saying in nursing. Nurses will eat their young. This I think is the biggest single reason we have to work in the conditions we do. Hospitals would shutdown without nursing. You don’t think a doctor or administration is going to do the job do you? Even if they were willing they wouldn’t have the knowledge. The point being that if nurses would stop fighting each other. If they spoke as one voice. We could have anything. Better pay, better hours, better ratios. We wouldn’t work in health care and have the worst health insurance for ourselves. Nurses have to work together to fix problems or else administration will continue to take advantage.

  5. Another issue is taking away support staff and or changing their roles into something completely different. I started off almost 27 years ago as a PCA-when I thought I wanted to be a nurse. That was where I realized it was not for me. I became a Unit Clerk a year later. Now after 26 years suddenly the majority of my job, which started out as transcribing orders onto kardexes and entering then into the new. mputer system, has been delegated to the Physician and the RN to enter. I can no longer enter these orders even during an emergency. I work in a Maternity unit so that means the Pediatric hospitalist or nurse have to stop caring for a sick baby to do the job I once did. Now my job is evolving into an MCA- Medical Clerk Assistant. I am in the process of retraining if you will to do patient care on top of my desk duties. Vital signs, rounding, etc. Oh and don’t forget the EKG’s because we got rid of our EKG techs as well. This makes no sense to me. I didn’t continue with patient care as a career because thatvis not what I wanted to do but am being forced because the people that WANT to be at the bedside-the Dr and nurse- are being forced to be away from the bedside doing my job. We have a high turn over of nurses and just as high a turn over of nurse managerst/directors. It is nothing the the healthcare field I entered into 27 years ago.

    1. Cut the support staff and save money. Make the nurses do it. It’s the name of the game. Someone I work with has fought for us not to learn to US to place IVs because it will just become another one of our million tasks that will end up on our plates. Physicians are spending hours on the computer as well. You are so right. Thanks for commenting and reading.

  6. I graduated from a 3 year hospital RN school 50 years ago and worked for 11 years until back surgery ended hospital nursing for me. I loved caring for people, a lot of hands-on care. When I view nursing care now in a hospital, I rarely see nurses touch a patient. They are mostly buried in the computer screen and asking the same questions over and over. If I were young again, I’d leave hospital nursing too!

    1. That’s what my colleague said the other day. It’s really sad. Bogged down with tasks and charting. Quick story. The other night I took care of a patient that was very, very sick but I only had him as a 1:1 because he was so high risk. Not a ton of tasks. I gave him the nursing care I always want to. I cleaned blood out of his hair. I set up beds for his family who stayed the night. Fast forward a few days and I had him paired and his wife saw me running around and not giving him the care I was the night before and she was sobbing at his bedside saying “why are you letting him stay here like this?” I cried in the bathroom by myself after. I tried explaining I had another patient who needed me but I cried because she was right. I should be able to care for him like that any shift but the reality is that most patients have dried blood in their hair for weeks, eeg glue, dirty nails and old ekg sticker remnants because we’re too busy to be able to care for them like they deserve.

      1. I agree with you Kristina. The end of real bedside nursing ended about 20 years ago when computers stared being used. I, also loved hands on nursing. We all worked together as a team, and nurses actually did empty bedpans, made beds, and gave bed baths. People studied nursing because they were generally compassionate people. After a decade or so of working with nurses who should have been accounts , I left the nursing field.

    2. I agree, the computer has gotten so complicated and taken the nurse away from the bedside. There is little time for bedside nursing because the computer being filled out correctly with multiple questions is more important than patient car. A computer is not patient care.

  7. Management is happy to see the older experienced nurses leave because the experienced nurses are saying ” Stop…Too few nurses is a dangerous situation ” The less experienced nurses just go along with anything that management does. And the managers are young and inexperienced too and are threatened by the experienced nurses and are happy to see them retire or just quit. Sad situation. I have over 30 years experience and I never saw this coming. Also with the younger generation, there is NO RESPECT for the experienced nurses.
    We are willing to teach BUT these young ones come out of college with little real clinical experience BUT think they no it all.
    They don’t know enough to see a bad situation.

    1. I 100% agree. Sadly. I had a conversation with an older nurse the other day who said if she started in this environment she’d have never been a nurse so long. The new ones don’t know what a good unit functions like and are used to these conditions. Which is unfortunate for everyone and they just go along with what they know. However, I work with nurses who’ve been practicing for two years who say they’ve seen a change. It’s snowballing. At some point it’s going to spell disaster (even more than now). Thanks for reading.

      1. I see your point but it goes both ways. I can tell you that “nurses eating their young” is alive and well. I worked on a unit with many seasoned nurses for my first job out of school–it was hell. They tortured me to the point that I was scared to ask them for help or guidance–which is not good or safe for a new nurse. So I left that job and found another. My preceptor was the devil incarnate and wouldn’t teach me; she would only criticize. I would have panic attacks thinking about going in. But I loved my patients so I endured it. After 5 years experience, I took a job as charge nurse at another hospital and worked there for 5 years. The older nurses that I supervised took every opportunity to make me feel like I just graduated compared to their 30 + years! I agree with much of what was said in the article but I left bedside nursing in part due to the behaviors of other nurses. So I worked for my MSN and now have a great job away from the bedside. I miss my patients but I’m still working to make healthcare safer for them. I’m also finally getting the respect from my co-workers that I worked so hard to earn while on the floor.

    2. So true. This young generation of nurses does not want taught from us older nurses. They come out of college thinking they already know it all. I just had to leave and retire early after 31 years of critical care nurse at the bedside due to medical problems. I never wanted management. It still hurts I had to leave and quit my job after 31 years because I loved it. But I think because of the new wave of nurses with their attitude and coming in and taking over all the time with no experience behind them made my decision to leave so much easier. It’s just very sad how nursing has evolved and is going down hill instead of up.

    3. Anonymous,
      I would be careful with how you use extremes when discussing a new generation of nurses. I have been working as a bedside nurse for 4 years now. I have the utmost respect for the experienced nurses who helped orient and train me. Never once did I approach nursing with an “I know it all” attitude. At only 6 months of experience, I found myself orienting new “baby” nurses. To this day, even after changing hospitals, I orient on average, 6 new nurses a year.
      Contrary to your post, only 1 out of the numerous nurses I’ve oriented or have seen other “experienced” nurses orient, has been disrespectful and unwilling to learn.

      The new graduate nurses I come across are humble, enthusiastic and very willing to learn from the older nurses around them.

      Your experience may have been different and I won’t discredit that. But it’s important that we provide an environment for new nurses that fosters open communication, thorough learning and the building of great critical thinking skills and well-founded confidence.

      1. I think we have good and bad seeds with experience and those who are brand new. We need to unite to fix things. Infighting keeps us at odds with each other rather than dealing with the issues at hand that are making us all crazy to begin with.

  8. My husband has a chronic health condition and we spent much of 2016 in and out of the hospital. We had some super nurses. We had some not so super nurses. One thing I am noticing is there seem to be a lot of people going into medical care who are not there to heal or care for people, but for the paycheck, or for the feeling of power over someone. When I became an Animal Control Officer I had to pass a psych exam to make sure I wasn’t doing it because I wanted to abuse someone. Nurses need to be given that exam, too. And we’ve GOT to STOP recruiting people into nursing “because it’s great pay”. As you pointed out, it’s a thankless task and someone who is only doing it for the money is going to burn out and be gone in a year or two. And yes, the nurses who stay, who have experience, who do their best, who CARE – they’ve got to get some support and care and appreciation and respect for all they do. We always make a fuss over thanking our best nurses, but I know most people probably don’t. Your point about spending hiring bonuses on the nurses they already have is excellent. Vacations, maternity or family leave, and decent shifts. It’s simply idiotic to expect someone to work two or three days, then turn around and work nights for two or three shifts. It is unhealthy for the nurse, and probably not very good for her patients either. There really has to be a better way. Thank you for all you do.

    1. Well said. Thank you for your gratitude. So many of us don’t hear it enough. I’m glad you’ve had some great nurses but as a family member I’m sure you’ve seen a lot at the bedside that was eye opening. It’s sad and unfortunate that so many family members have to stand vigil at their family member’s beside to ensure their good care. Which is burning out families (another post for another day). I think if you’re here for a paycheck you’re in the wrong profession but I also think some people start with good intentions and get compassion fatigue or just plain burned out and they can’t care like they should. Take care of the nurses and they’ll take care of you. Thanks for reading!

      1. I’m in Nursing for 44 years. The change from 3 year Diploma programs to 4 year BSN programs changed the face of Nursing. In a 3 year program you lost alot of students in the first 3 to 6 months, when they realized nursing wasn’t for them. In a 4 year program they do 2 years of prerequisite college classes first, before they get to clinical work. When they realize nursing isn’t for them they’ve already invested 2 years of their lives, so they can’t quit or change directions.
        We now have many nurses who really aren’t happy & don’t want to be where they are.

        1. This is an interesting viewpoint. I would love to hear from nurses who felt trapped this way just as a learning experience. I know my dissatisfaction is more related to the environment currently.

    2. Thats acutally untrue. Studies show that people who do view it as their “calling” actually have higher burn out rates then people who view it “just as a job.” I believe the study was through the University of Akron. And why does everyone think nursing pays so well? Jesus Bus drivers get around the same (RN is 25-40 bucks an hour typically and Milwaukee county bus drivers which is where I am from got paid 29 bucks an hour this is sometimes even lower in more rural areas). Trust me, if you were under the stress and demands you would stop caring as well, yes there are jobs more demanding the an animal control officer. Weird Huh?

    1. Pay? Nope. I never got paid more than 60k a year as a bedside nurse; and that was dealing with dangerous workloads, belligerent patients and family members, patients shooting up in their picc lines, and all other kinds of crazy mess. I left after 8 years and went to a different type of nursing. Now, I make a lot more and I don’t have to put up all the other stuff. I can stop and pee whenever I want, I get lunch, and I get all federal holidays off. Why would anyone want to continue to bust it everyday, dealing with rude ungrateful people, and not making a lot of money, when there are other types of nursing jobs in which you can save your knees, back, and sanity??

  9. Unfortunarely most hospitals pour money into recruitment and NOT retention. Why?? Because those new grads do not cost them as much as that experienced nurse does…period.. and most hospitals do not look at the whole picture to see what this does to patients, or they simply do not care.

    1. I think the problem is they look at it in a very black and white lens. On paper they cost less. CMS not reimbursing, longer stays, more waste by a new nurse does cost more. I wonder if anyone is digging down and exploring the ripple effect because as so many of you have said we are seeing this with our eyes. Are they looking?

    2. I dont see any problem with hiring a new grad as long as they are properly trained. I respect all of you with 13, 20,10, 5 years of experience. That’s great! Thank you for your service. But remember you all started as a newgrad as well! Somebody was willing to hire and train you to start! So, it would be better if you come up with a project or a plan and suggest it to your managers and explain them the long term consequences of having majority of new grads on a unit compared to a balance of experience nurses coupled with new grads.

      1. I was a new grad in the ICU directly out of school so I agree. My problem is not new grads at all. It’s new nurses teaching new grads and everyone doing a 2 year stint at the bedside as a rung on the bottom of a career ladder. Bedside nursing used to be a career in itself and it isn’t anymore. I think working with what we are given is key to surviving but addressing cause is the bigger (and potentially) more long term issue I’m trying to bring to light. Thanks so much for reading!

  10. I don’t know which state you work at but here in California we do have a nurse to patient ratio but we still experience the things you mentioned in your article.
    I think it’s up to us seasoned nurses to train the newbies the right way and stop eating our young and maybe we will have better retention rate. I have seen a hospital who pays less than most hospitals around but has good retention rate because they train nurses well and have included the nurses in all that the hospital decides to do.Mind you this is not even a Magnet hospital. So I think it is our responsibility to make our work environment better and it can be done.

    1. I wish I could work in California. I’ve heard great things. I think that a lot of it is in our hands. I agree with that. We need to stand up to the unsafe staffing, advocate for ourselves. However if you’re in a system that squashes the people who speak up it can be an uphill battle. If you’re a squeaky wheel and they can just find a way to make you leave or push you out to hire a cheaper nurse it’s impossible. Management does not have the needs of the nurse in mind a lot of the time but the needs of the patient. Which is putting the priority in the wrong place. A patient who makes a stink about being NPO (as it’s required for a procedure or safety’s sake because of aspiration risk for example) gets more energy from management than a nurse who is saying we can’t run this tight staffing wise safely. I think bullying does need to stop but as someone who was trained by 20+ year veterans (some less than warm and fuzzy) people need to accept constructive criticism and look at it as a learning experience not someone bullying them. Which is what I find when people complain of “bullying” personally.

  11. Great article! This hits the problem exactly! For me as a nurse I have 7 years experience, kind of in the middle. I left my first ever hospital system at 3 years because of this. At 3 years I was making $1 more than when I started when others with the same amount of experience were making $3 more than me. And the amount if new grads I had to work with while relief charge was scary! For me I don’t want to leave the bedside, so I just change jobs every so often. Now I’m traveling, but I worry about going back to the job I love and it not be worth it to stay longer than 2 years!

  12. This is well written.was a nurse for 38 years and did Bed Side Nursing. Was a pleasure to help patients and keep them comfortable and informed.Was good to be assigned to same floor and same patients foe a few days. Was able to keep them from falls and bed sores by knowing their case.Seems like infections are rampart in hospitals ,even with all the modern meds and treatments. JUSt SAYING! OH, I am a 86 year old retired Nurse.

    1. Primary nursing is a thing of the past most days and I think it makes a difference in outcomes anecdotally. A nurse who knows them personally makes a huge difference. Patients are so sick these days though that infections and pressure ulcers are rampant because people live their lives in hospitals. ESRD, ESRD DM patients with one limb sitting in a bed everyday for a year are nutritionally complex and at such high risk of pressure ulcers it’s hard to avoid them. Steriods and chronic invasive lines or chronic foleys spell infection when they live in an understaffed nursing facility or are plain uncompliant at home.

  13. I totally agree I am a retired RN retired now 10 years. I left because of the computer BS. I have been a patient several times since I retired and I can tell you that nursing care is not what it used to be or should still be. It is not the fault of nurses rather the invention of the computer. It take much longer to document pt care than ever before by having to do it in computer rather than assesing and documenting by hand. Therefore much less time is actually spent on hands on pt.care. computers may be helpful for some things but in my humble opinion they have absolutely no place at the bedside of a patient. I recall miss pt care even yet after 10 years but the thought of going back and having to deal with computers always brings me to my senses.

    1. I think in ways computers do help, that being said, the level of charting required to do simple tasks is astronomical. 200 clicks to give blood. That’s insane. Patient safety is paramount but if that patient needs blood quickly it’s not getting done. Also the programs are not made by nurses at the bedside. It’s obvious. If we had hands in it maybe it could make our lives easier not harder.

  14. From a patient/caregiving mom point of view..spot on.
    The general public has no idea. There is no education like experience. Knowing that a drug needs to be held because it isn’t indicated..that pharmacy schedule is wrong, it should say PRN.
    Not knowing how to properly use a Hoyer lift results in a patients broken nose. Unclogging a feeding tube..heck, properly applying a condon catheter. All taught by family because a the nurses had little training in such things.
    Experience.
    Everyone is pushing for a higher degree, and patients are paying the cost.

    1. Amen. Looking at a person and knowing they’re hypoglycemic or anemic. You can’t teach that. Also stuff that makes an experienced nurses life easier, organizing a room so that if a patient codes you have the things you need. Unfortunately you can’t anticipate issues if you’re just caught up in tasks and the patient does go south there’s no emergency equipment or lines labeled so you’re pushing meds through something incompatible.

  15. I’m going to be blunt and say that alot of the hospitals are so focused on cost cutting they forget they are there for the patients, I also feel that nurses are the escape goats of hospitals, we are drowning with these patients, then they decide to take off an assistant as we dont really need it. Are you kidding me?! I bet these decisions come from people who have never handled patients. Admins always say, “we are here for you” I always had to bite my tongue to keep a “shut-up” from escaping. If you are here for us, how bout staffing us better? How about stop making us your nurses your jack of all trades and be what we really are suppose to be as which is a NURSE! I’m not your engineer nor am I your maintenance! Fixing faulty outlets and beds are not my thing. We are burnt to a toast, are backs are aching and our morales is low. I also get really annoyed at green nurses who keep on talking about moving up to management, please, you can’t even start an IV, now you want to be an even bigger pest becoming an incompetent magement who has no idea on the whys and hows the world of nursing work, no doubt will pushing unrealistic, overly hopeful dumb ideas that looks good on paper but is a terrible plan in action.

    1. I agree and shared governance is a step in the right direction to put bedside nurses in front of the policy people but it’s not an answer. Staffing ratios, safe work environments and clear roles with adequate support staff would do wonders. Also support for nurses over patients or families when patient relations is called (by the family or patient) by management would help nursing feel supported. This is not hospitality. It’s nursing.

  16. Redistributing hiring bonuses to experienced staff and thus increasing compensation may not improve retention of experienced nurses if hospitals continue to increase nursing salaries in lieu of increasing staffing. I am a physician and have cut down on my workload and thus my income, making my job much more satisfying. Nurses may experience more job satisfaction at a lower salary if staffing could be improved.

    1. Yes totally agree! As a travel nurse, I look for positions with low patient to nurse ratios. These jobs pay considerably less than the “crisis rate” jobs; however, I am such a happier person.

  17. My husband was recently a patient in the hospital for a fairly long stay.. I have to say, as a nurse with 50+ years of experience, I was appalled at the lack of knowledge( and common sense) exhibited by so many of the nurses. Also their failure to recognize a sudden change in a patients condition. It seemed they were totally focused on the computer and task oriented. They seldom looked at the patient. I was afraid to leave my husband in their care and stayed with him 24/7. Twice, he was in severe respiratory distress and the staff just stood there, apparently not knowing what to do. I found myself in charge of his care, ordering them to take action. I remarked to my daughter ( also a nurse) that I had to get him out of there before they killed him.

    1. I would live at my husband’s bedside as well. It’s frightening. He’s lucky you were there, sad that he needed you to babysit his care, but good for him you were there. I feel so bad for those patients who have no one with any medical background to help watch out for their care. Thanks for reading and I hope he’s doing well.

  18. This does nothing but scare patients.. novice or not we learn new things.. yes an experienced nurse would save a lot of $ in the system.. they work faster. But we innovate as new nurses/employees/whatever your profession calls you when your new. As long as hospitals hire competent nurses who are cautious and are eager to be trained I don’t see a problem other than the pace things gets done. We were all fresh right? Agree/disagree?

  19. I have been a NICU nurse for 17 years. I could not agree more with the change in our work flow and how it is pulling us away from the bedside and in front of a computer. I spend 20 minutes with hands on care and 40 minutes charting it. We are told to work smarter with less resources and sicker babies. I go without lunch more than I care to admit. The focus on the budget and saving money at every turn has destroyed my love of the job I thought I would love forever.

    1. I could have written this. I told my mom when I started that this was all I wanted to do with my life, now I don’t know how much longer I can do it.

  20. I have 33 yrs bedside nursing experience and now find I can’t do the job anymore. I am tired of being treated as a second class citizen because I’m a nurse. We don’t get breaks sometimes no lunch and administrators don’t care. I am forced to stand in front of a computer for most of my shift,thanks to EMR,not at the bedside. Most nurses are afraid to complain or we lose our jobs and hospitals know there isn’t anything we can change because it’s difficult and costly to fight.

  21. As a practicing bedside nurse for 40 years now, this is such a great story for the decline in Nursing retention due to the massive focus on using evidence based data, and ability to obtain funding for the facility they over look the Loyal nurses in all areas for scheduling, raises,genuine respect for their experience. No longer is a single nurse held accountable for her actions but all changes made for problems and incidents are considered a team problem….Management no longer has the backbone to handle the individual causing problems anymore ….So nursing will continue to decline as long as Nurses are considered a team member, and not considered the heart and soul of a facility.

    1. I so agree with your “evidence based practice” comment! I have just started back for my BSN (80/ 20 by 2020) and my final paper this session is why a BSN is important. My instructor continues to say, “the evidence shows patients do better with BSN prepared nurses over experienced nurses.” I am so tired of hearing about “critical thinking skills”! Blech.
      I love my job but I would like to enjoy it again. I’d also like to see my co-workers happy again.
      We may now be offered lunch 30-60 minutes before our shift is complete and have to take it because it will come out of our pay anyway.
      The conditions fractions ate some of the reasons nurses unionize. I’m not a big fan, but I am not as opposed as I used to be. I just have a hard time imagining being represented by the grocery or hospitality workers union.
      So much to say and no one that can create change quickly that is listening.

  22. What a fabulous article! I have been a nurse for 40+ years. Now on SS disablity! I have vast knowledge, but on able to work. My body is shot. I put my heart and soul into my job! Now I have had 3 failed back surgery. Now have implanted TENS, and on pain management! Double knee replacements, shoulder replacement, carpal tunnel releases, GB surgery and a rectocele and cystocele! Also, Bariactric sugery! Stess wI’ll make a good nurse fat!

  23. Only ONE ‘product line’ or service justifies the complexity of building and operating an in-patient hospital. That service is QUALITY IN-PATIENT NURSING CARE. Every thing else a hospital does could be done cheaper and easier in a free-standing center. Ms. Kyer is absolutely correct. Quality bedside nursing is the reason hospitals exist. We forget that at peril to us all.

    1. Absolutely! Thank you for stating it so directly. Healthcare costs continue to rise as nursing continues to struggle. Costs of multi-level administrators and CEOs of hospitals, pharmaceuticals, and insurance companiea are at amazing levels while those who are the essence of hospital patient care, nurses, continue to be compensated at much lower levels.

  24. I’m a unit clerk from a very small facility and in the 15+ years I have been witness to nursing getting more computer generated and losing the patient care that was the reason for you going into the business in the first place. 3/4 of the time our nurses have gotten so they write their assessments in the er on scrap paper and afterward input it into the computer system because the computer program the company bought is entirely too slow. I see nurses everyday stand and cuss the cows (computer on wheels) they are forced to use because they don’t want to work at all, crash while inputting the patient information in, or are so slow that they could have done that assessment 3 times over. When asked to get better equipment we are told that its not the cows fault but the internet that is used, or the modum is the cause, or its operator error. So what it shows is everyone doing ten times the work they used to because the ones who work that emergency dept or the med/surg floors are dedicated to a job done well that they will skip their lunch or stay hours not minutes past time for them to leave because they by all rights took an oath to protect and care for patients and cant in all good faith leave when the next nurse comes on duty because she is going to be severly short staffed and cant get any help at all, and admin sees this as “oh they do more and more let’s see how much more we can put on them then we can cut staffing and save more money”. Also another problem is Nurse managers are required to staff according the accruals, so if let’s say your census is low by your hospital standards they send you home. Many many times I have heard nurses say, ” I can’t work like this. My check was short x amount of dollars and if they keep sending me home I am going to have no other choice than to find a new/part time job just to make ends meat”. Its a sad situation when it comes down to money or patient lives. I can guarantee you that 99% of the time the one who is making the decisions at the top has never been in healthcare as a nurse/physician or any other support staff before landing the job that nets them well into the upper 6 digits or been a patient in a hospital where staff was so short that your call light rang for hours before you saw a face. So this makes it easy for their concious when they cut staff to bare bones. That spread sheet they are using says even the bare bones is over staffed but because of guidelines they can’t cut any further. Its sad

    1. It’s a bigger problem than we can solve today for sure. I don’t envy those accountants but I wish they would talk to us more. We have ideas and solutions if they listen.

  25. I get what’s being addressed here, and for the most part I whole heartedly agree. However, I feel as though some of it was a ‘bashing’ of some degree on newly qualified nurses. I’ve been qualified 10 months so I am the less experienced nurse but I don’t feel that is a negative. I have fresh eyes and ideas and can see where ‘institutionalised’ or ‘the old way of doing things’ is not the best evidence-based way of doing some things. Personally, I believe that it’s the skill set of a ward/clinical area that is crucial in the gold standard care delivery. Yes, newly qualified nurses training trainee nurses isn’t ideal but in an industry where nurses come last and money comes first there will always be a deficit.

    1. I was a new grad in the ICU fresh out of school. I have no issue at all with new grads anywhere. We need nurses with fresh eyes and ideas. Heck, I’ve been speaking my mind at my job since year 3 to make the place a better environment. I don’t think new nurses are lazy or not caring or any of that. I think nurses today, versus when I started have it much harder and that’s only ’09 to now. The environment is more toxic, sicker patients, more turnover. My problem is not with fresh eyes (because honestly I feel that the only way to fix most things is to throw out the book and come up with another plan- rather than bandaid) is the turnover at the bedside and new nurses teaching new nurses. Evidenced based practice is needed, things fall out of style and need to be revamped. It’s just not ideal to run any unit with new nurses, regardless of their education or intelligence level- Benner’s stages of clinical competence is very true. It’s the same concept of physicians. Interns and residents may have great ideas but they need to run it by an attending to talk it out with someone with more experience and time in the position. Nurses need the same resources.

  26. Although I agree with the major points in your article I am going to have to interject about your thought on new nurses. I’m a newer nurse myself and in my opinion if the new nurse is willing to learn and open to asking questions they will do just fine by themselves, and thus teaching someone else. After all we do work in an area that is constantly changing and one will never know everything. I have asked questions about something my preceptor is doing because I learned something different than what they are teaching me and I ended up being correct. I believe older nurses shouldn’t forget we may be young and inexperienced, but we are fresh from school and are aware of the up to date information. After all more experience doesn’t directly equal a better nurse. In the end being a great nurse comes down to if you care about your patients, are willing to always learn, and never be afraid to ask a question! 🙂

    1. I agree on some points. I was a new grad too and I started in the ICU. You are 100% correct the key to a good nurse is the questioning attitude and experience does not necessarily make a good nurse. My problem is the turnover. No one wants to stay at the bedside. Again, I don’t blame people. The ICU especially is the means to an end for most people. I think good nurses are inquisitive and humble with the patient at the heart of care. Some of the best nurses I work with started as new grads, the problem is they don’t stay.

  27. I recently was forced into retirement after a 50 year nursing career. The person responsible was 40. Years my junior. Nursing used to be patient centered. We knew our patient’s histories, lab values, meds., etc. We knew what they needed and were able to look for complications. We were not tethered to a computer for 8-12 hours a day. Nurses today do not know their patients. There focus is elsewhere, looking at a screen,perhaps. I am not speaking for every nurse, please note.
    The bottom line in the hospital business is not patient care, but how to save a dollar!

    1. This is why I could not do floor nursing. I’m too OCD and want to know everything. Floor nursing is a beast all its own. The tasks are never ending.

  28. Great article. I’ve been a nurse for 23 years. I recently asked a new nurse on orientation how her day went. She told me she spent 12 hours nursing a computer. I never heard a more true statement. How sad. The big problem I see is nurse managers that love to hire nurses who are pursuing advanced degrees. These nurses have no interest in bedside nursing and are certainly not intending on staying long. Management are more generally concerned with maintaining Magnet status or obtaining it, then taking care of patients. Good bedside nurses have only one goal. That is having the tools and infrastructure to care for their patients. Management has other goals. Management wants to look good to administration. When goals are not congruent, success is unachievable. The only reason for a hospital to exist is to provide nursing care. Everyone but the bedside nurse had forgotten this.

    1. This is on point. I agree wholeheartedly. Magnet annoys me personally. I feel it’s a glossing over and falsehood to entice patients to this hospital vs that one. A cheap marketing ploy. I love how you said it. “Good bedside nurses have only one goal.” This has been my soapbox since day one and I’ve been told it’s bigger than you, just get used to it. I can’t. I won’t. Thank you for reading and your thoughtful comment.

  29. Worked 7a-7:30p yesterday . Ate a bowl of peas from an extra tray ( patient discharged before lunch. Got to pee twice . Didn’t sit down except to quickly chart each patient interaction. I work as specialty so although I am a staff RN , and they are completely slammed and overworked, I see almost EVERY PATIENT , which yesterday meant 25 patient visits on my unit and two more to specialty area down the hall. All had to be charted.
    I came home , took 4 ibuprofen , 1 melatonin when it became clear my mind was not going to let my exhausted brain shut down after I spent an hour watching tv with the hubs.
    Today ?? I haven’t the strength of a snail…..
    I am 59. Been in nursing for 36 years. Sure do miss ” the good old days ” but they are gone forever. Thanks for your article .

    1. I’m sorry. I also feel your pain. It’s terrible. I hope in my wildest dreams someone sees this and it opens their eyes. Maybe I’m in an echo chamber but this article has gone way further than I ever thought it would. Maybe someone important is listening.

  30. Well written article; however I must respectfully disagree with some aspects of your article. I am a second career nurse who has been at the bedside for 4 years, and it’s a career that I chose believing that I could do some good and help people in the process. I was motivated and dedicated, but that all changed within 3 months of being at my new job. It was an 8-week orientation after graduation, then left on my own to care for patients with high acuity levels, not to mention given the highest number of patients allowed – 6 in our hospital in SC. The experienced nurses, who are often in charge, are finding ways to hand down the busy, difficult, high acuity patients to the new nurses. I have walked in on new graduates crying because they are overwhelmed while the experienced nurses, with 4 patients a piece, sit in the break room or nurses station chatting away. I guess they feel it is time to pass the baton. I started working 3 day/36 hour shifts, but soon went part-time (24hours/2 days). I finally had enough and dropped to 1 day on an as needed basis and will soon be out the door quitting nursing for good. Maybe my problem is unique to my unit, but my first and only experience in nursing has left a sour taste in my mouth. The experienced nurses are calling into the unit before their shift to be assigned the easy patients, while the new or not so experienced nurses are given the total care, chest tubes, trachs, and everything in between, in addition to caring for the highly demanding patients who constantly call for anything and everything and the confused ones. In addition to the bedside care, we are left to navigate the multiple additional tasks on our own – the different disciplines, handling a death, spending hours on the phone finding information that an experienced nurse could have given to you in minutes, but they are too “busy” to take 5 minutes out of their yapping. And if I sound angry, it is because I am. It has been a disappointing experience and it is a career that I’ve tried to discourage my loved ones, or anyone that will listen, from going into. I would love to hear a different opinion from nurses who have had a different experience and who have a positive culture where they work.

    1. I’m so sorry this was your experience. I’m sure there are some people that feel this way that I work with, but I would guess that number is very low. It should not happen. I think our environment is less supported because of less staff not because of unsupportive staff. I’m sorry this is your experience. It’s not like that everywhere I promise.

    2. So typical. If you float or work part time, you get this treatment. They won’t even give you a decent report on yur patients, before you start the shift. Disgusting and sad.

  31. Excellent article. Your last 2 paragraphs say it all! Administration needs to see the light!! 42 years of mostly bedside nursing, left 12 hr shifts and total body fatigue and stress related cardiac problems to be a visiting hospice nurse, but also, at times, it’s managers heads were in the clouds, clueless to the stress. Not the stress of the nursing patients, but the stress of managing large caseloads, expecting us to quickly answer their emails while driving!! We didn’t have secretaries sitting next to us or a chauffeur!! And expecting us to do so much work related repirts on our own time so as to keep OT to a minimum. So glad I am now retired, but I don’t look forward to being a patient as I age!!

  32. very well written and how so very true. Many hospitals see the mighty buck now days and would rather pay the new nurses than pay to keep the experience nurses around. More cost effective have been told. They no longer see older experienced nurses as a safe guard. They want new blood . but new blood doesn’t nmean great experience either. I have been a nurse for 34 years and now they are pushing the more experience nurses out. Many hospital want all RN”S and dont see the need for LPN’s and aides which is very problematic in my view. They can be a key when things are going south as they say. We all need to get back to the basics and work as a team, because people are now coming in sicker and insurances want them out sooner creating more problems.

  33. The problems run far deeper than mere dollars and cents, though that drives most of it. It really isn’t all about hours, scheduling or rations either – they’ve always been there. There aren’t any more hours in a day now than there used to be, and if you were to ask an old nurse, she’d likely tell you that the ratios today are a fraction of what they once were.
    No, the greatest challenges nurses face today are more institutional, more administrative. We have complex computerized documentation systems to master, and they consume a great deal of our time. We have mandatory documentation regimens based on compliance with law and regulation, areas where nurses are both untrained, and frankly, uninterested. We are beset from all sides by demanding and entitled patients, contemptuous families, allied health disciplines that condescend to tell us how to do our jobs, and disconnected administrators who care far less about their staffs than about how happy our patients may be – and we generally find ourselves chucked under the bus because of it. In response, new nurses, already prepared with minimum-requirement bachelor’s degrees, will complete a grad degree as an ARNP or CRNA, and leave the bedside, never to return. That’s if they don’t leave healthcare entirely.
    These are problems Nursing didn’t cause, isn’t equipped to remedy, but have to deal with every day. Given such realities, there really isn’t any question why new nurses leave, older nurses burn out, and prospective nurses reconsider their career goals.

  34. I spent 7+years as the Dept Secretary in Care Management and was shocked at the happenings. Length of stay was the only thing that mattered. The condition of the patient was secondary to reimbursement. Patients became known to the administration as “customers”. Older staff who still focused on the patient were constantly under the microscope; literally blackmailed into making sure the outcomes were what was best for the hospital. It just made me so sad because my own daughter was in nursing school at the time. I knew She would be a passionate new nurse who wanted to save the world. She is now on her way to NFP because she feels she will be able to be more patient focused. I pray she won’t be disappointed.

  35. Bravo! I’ve been raging for years about the death of the bedside nurse. It seems that nursing as a profession is a driving force behind these trends; with the persuit of identifying as a profession, which meets the defined standards of specialized knowledge and skill, research driven, higher education, and community and professional recognition. This fosters a thought that the bedside nurse is not good enough, driving younger nurses to pursue advanced education. But I say long live the bedside nurse, we are the ones in the trenches! Celebrate the bedside nurse!

  36. I preface my job interviews with: I’m an expert in bedside nursing. Educated nurses do not care. They think nurses who live bedside nursing are stupid. But we’re smart. We live our job but need good support staff to do it. We are administering blood while passing juice and ice. Our tasks list is huge. I have retired after 36 years. Status post hip replacement and kidney transplant. Tired but I loved it❤️

  37. I am 42 yrs in and 40 at the bedside, before I ventured to another branch. There have been a lot of changes. I started as a new grad out of a 4 yr college degreed school, to a med surge unit. Went to the new beginnings of a step down unit where we did do primary care, no aids. Ended with 20 yrs ICU/CCU. I appreciate your article and I have read every comment. This is what I see. 1. Somewhere along the way, the patient and/or family feel we (staff) are to be at their bedside at the drop of the hat. You mentioned reimbursement. CMS in their infinite wisdom has contribute to this feeling when they send out a survey, and based on the patient satisfaction depends on how much the hosp. gets reimbursed. I have had young 50 yr old who had a brain bleed that has little recollection of being in the unit, of me or anything that took place. Now the person getting the survey in Social Security age, ICU psychosis, maybe on the vent and you expect them to have an accurate account of the care they did or did not have. 2. Magnet I have no use for. The money spent on that could go for capital expenditure, patient equipment or other supplies to take care of the patient. 3. New grads. I was a new grad once upon a time. I had older more experienced nurses teach and lead me along the way and new grads not give a different perspective. I always welcomed new grads. There is a difference. I knew exactly what I was getting into when I graduated. I had already had a full team of patients, made the assignments to the aids, passed the meds and did the charting up to what the state would allow a student nurse to do. But there were very few surprises. Today, with fast track, on line classes, I have had student nurses, going to graduate in a few weeks, who had essentially no clinical experience. So, when they come into the real world, the strip on the hat (telling my age) they have no idea where to start. There a lot of factors that contribute to the nurse no longer being at the bedside. These observations are just the tip of the ice burg, I could be here all night. There is one thing I do want to point out about most new nurses. Becareful with the long hours and the extended days in a row. Experience helps when you are half a sleep. I know the difference between normal vital signs being a good thing and a sign of trouble a head. I can respond to a CODE in my sleep. Somethings you can’t get by asking question or books, It comes with a long time at the bedside.

  38. Not to argue, nor be disrespectful to the profession but certified nurse assistants, aka (CNA’s) play a huge role in the infection, pup, and bathing events. RN’s pass the evaluation and most meds as well sit to chart. Unless they are primary nursing doesn’t really seem like the back breaking work they complain about. Here’s a tip, don’t treat your Cna like trash and you might stick around a little longer. Just in case there a ponder, I’m a nurse and see more than most.

  39. This is an excellent article. I have a daughter and granddaughter that are both registered nurses and another granddaughter starting nursing school in the fall who wants to be a PA. So I well know the strain that nursing has on them. I am also 63 and been in the hospital when nurses had no time for me, and the doctors made me feel like I was a mental patient, and I left the hospital three days later with a UTI from a catheter.

  40. Thank you from a 25+ year RN who is still at bedside and I like it there. I have an MSN in education, I am 60 and I do not want to be an NP.

  41. I am one of the statistics. I had to retire on disability after only 21 years in nursing. I had planed on having a long, satisfying, caring, and helpful career. This dream was shattered when I hurt my back, had surgery with major complications. I believe that this was due to years of moving patients by myself, not having enough help. Administration and Nurse Managers didn’t care because they just needed another body to take my place. I miss my profession and believe that if I could have afforded rehab for a longer period of time that I would be working today at almost 64 years of age. I was a great nurse, a hard worker, and I saved lives!!! 🙁

  42. I haven’t worked for 10 years but have been an RN for 30 years, what the nurses are complaining about these days are what we were complaining about then. It’s sad!

  43. Good article, unfortunately I’ve seen SO many ones just like it and they’ve been coming out for years. Nothing happens, nothing changes except to get worse. I am an old ICU nurse with years of experience with great teams of nurses yet the core 40% that stays trains all of the new nurses who almost all go on to advanced degrees or easier nursing jobs in a year or two. This would be ok. But only if our help has not slowly dwindled away to nothing. We used to have a PCT and a secretary for every unit, now one person does that job and floats between all the units. We work all weekends and all holidays and for Christmas we get a $20 gift card to a grocery store. I don’t think inexperience is the issue. I’d take an inexperienced nurse with lots of help any day over an experienced nurse with NO help. Oh, and I’ve since left the bedside myself for graduate school. I couldn’t be more glad, but I do miss the people.

  44. I’ve worked 16 years as an RN in the float pool in a teaching hospital. I agree 100% with everything in this article and the comments!! As a float nurse, I see a lot of the good and bad on every floor. But one thing that’s consistent is the extra tasks that take away from patient care. After 16years you’d think I would feel confident in my work and experience each shift, but I don’t. I spend way too much time and energy worrying about the ‘task list’ (which seems to get longer every week) that must be checked off in a shift instead of the real reasons I want to be a nurse. I leave late every shift still feeling like I wish I could have done more and been the nurse I wanted to be to my patients. I miss the time when I could sit on the side of a patients bed and really hear their story. Or help the family figure out all the new medications and information after having a loved one experience a heart attack. There’s too much tasking, and not enough caring. It makes me sad because I’m one of the nurses who wants to leave. It makes me sad because the career I wanted and envisioned seems unattainable. It makes me sad because our patients DO deserve more, and we WANT to give more. But without the support staff, meaningful administrative support, and better staffing solutions, it looks bleak. I really think the only people who truly understand this is the nurses and PCA’s who work the floor. And yet when we have concerns or want changes, it’s viewed as complaining or not working hard enough. But, I’m tired of working hard enough and then always feeling like it’s not enough. When I can go home feeling like I’ve given good care, it gives me hope. But that feeling is rare. I hope we can be heard and things can be changed. Because when I or a loved one becomes the patient, I always hope the nurse has time to give good care. Every patient, and every nurse, deserves that.

  45. When I graduated in 1975, Nursing was at the peak. Our floor had a secretary, a transcriber,about 4 nursing assistants, and 2 attendants . We also had an IV team and an admission RN. We had a low nurse/ patient ratio, and had plenty of time to take care and interact with our patients, their families and the doctors. We spent most of our patients and not hours charting on slow or half working computers We had time to eat lunch,pee and got to go home when our shift ENDED ! Then things started changing in the mid 80’s and it has been a downward spiral since then. We could no longer use soft restraints to keep a patient in the bed or wheel chair, and spent most of our time trying to care for about 10-12 patients while trying to keep our confused patients from wandering off, pulling foleys or IV’s out or falling and injuring themselves. It was impossible to have help in the hospital to help watch them, and many family members refused to stay with them. We were stressed to the max. The charge nurse was tied up with patients and problem s with them, and since there was no secretary on our night shift, had to work all the desk duties into her patient care. We had NO time to chart on the computer until the end of the shift, so most of the nurses clocked out, then spent an hour of unpaid time doing her charting. I refused to clock out before charting, so management didn’t like that and wanted to know why I was the only one not finishing my work and working overtime. When I explained why the others were clocking out before finishing, They said they had no idea that was happening. That little item was changed for the good of the overworked nurses, but floor nursing was and is still a nightmare. I was much happier when I changed to out-patient Surgery.

  46. I think a significant problem for nurses who remain loyal to their health system is the failure of that organization to compensate them appropriately. Many times, a nurse must leave their job to get the wage that correlates to their level of experience. Annual increases do not keep up and hospitals often do not give increases to retain their experienced workforce. The only option to earn a salary that is equivalent to years of experience is to jump ship until you max out. Nursing is the only profession where you are required to take personal leave time when called off your shift for low census and are required to work mandatory call shifts or OT when census is high. Bonuses are rare and are often less than what an unskilled workforce receives (i.e. My child works retail part time and received a larger Christmas bonus than me).
    Nurses stay at the bedside because they care. Hospitals are making it harder because they don’t seem to care about their nurses. It’s a conudrum that has only one result–the patient suffers. And eventually we all will suffer, because one day we will be someone’s patient.

  47. My Mother was a RN and I admired both her competency and compassion. I also saw her battles. Nurses are the voice and hope of most patients. There is no substitute for a skilled nurse. I pray someone can find a way for us all to support systems that both entice and reward nurses to apply and remain in service at their initial hospitals of employment. God bless you all for the wonderful work you do and your willingness to go above and beyond for the patient.

  48. I was a bedside nurse for 43 years. I finally had to leave. Nursing has changed so much to the detriment of the profession, that I could no longer go to work everyday and not be able to do the cares required of us. Short staffed, poor pay, long hours, lack of respect, they all weigh heavy on nurses. We are expected to do the work of two and not complain and yet when there are mistakes made by anyone, the fingers always point at the nurses first. I just couldn’t watch what is happening to this profession. I tell all who are admitted to a hospital, they must have a patient advocate with them at all times, or they risk a higher chance of mistakes, etc. So very sad what the nursing profession has evolved to.

  49. So very true. 34 years on the job this month. I can’t tell you how many fresh faces I’ve seen come and go. It doesn’t take many extra shifts and nights with too many patients for even the best young nurses to get disillusioned. Oh, and yes, at this point everything hurts.

  50. They need to bring the LPN/LVN back into hospital settings. They are good hard working nurses too. Hospitals don’t want them. They only want RN BSN. Bring back the LPN and create the teams the way they were supposed to work. 2 or 3 LPN’s for every RN and you could have an amazing team. The pt gets well taken care of and the RN is freed up to do the higher acuity tasks for their Pts. I saw the writing on the wall 10 years ago when they started replacing LPN’s with MA’s. Now most floors don’t even have those. I’ve had several surgeries and my nurses had no clue what they were supposed to be doing. Turned off my fluids. Didn’t give me the antibiotics ordered. No SCD’s. Didn’t give me the break through pain meds ordered. Didn’t help me stand the first time or walk me to the bathroom just after standing. The first night nurse introduced herself and then I didn’t see her again. A different one came in 2 hours later and apologized. My nurse had walked off her shift saying she was overwhelmed. The second one was horrified by all the stuff my day nurse messed up on. Turns out I wasn’t t on a post op floor at all. I was on some overflow floor and they weren’t used to taking care of Pts post surgeries. We need more experienced nurses at the bedside. Both RN and LPN.

  51. Administration gets top dollar and cut off their noses to spite their faces. I’ve seen this for 15 years and now I don’t do bed side nursing for the reasons that you stated which are true and heartbreaking. GOD BLESS you all for your hard work and dedication.

  52. Your article is spot on!! I just read an article the other day where there is going to be nursing shortage again because the baby boomers stuck around and worked little longer and are retiring. Tired of staffing issues, poor management, expected to do more with less. It’s crazy the changes over the last 20yrs. If I had known back then it would be like it is, might have chosen a different profession. I live being a nurse am all about my patients but continues to get harder and harder to do! Thank you for publushing.

  53. Was a bedside nurse for 46 years. I retired 6 months ago. I have seen so many changes…some for the better but many not. Patients are much sicker and the workload of a nurse has increased. The paperwork and inservices expected of a nurse is outrageous! ( time I could have spent with my patients). Family requests are sometimes unreal….I am sorry but you and your 4 children can not spend the night with their mother who just had surgery ( who will watch a 3 year old in the middle of the night when the rest of the family is asleep?). I really like patient care for the most part, it is the other crap that ruins it.

  54. Great read – I’m an inpatient pharmacist and son of an RN, and I can’t even begin to say how much respect I have for the profession. I can duck out and hide in my office when patients get combative, nurses have to keep grinding on!

    Your article reminds of shift change. Our day shift is stacked with 10-20+ year experienced nurses. When I work nights, I walk through the units and everyone is fresh faced under 30, even with generous differentials. I’ve seen mishandled clinical situations escalate because of this collective brain drain that happens after hours. Sometimes, I just cross my fingers and hope a patient makes it to day shift.

  55. Great and informative article. You nailed it on the head when it comes to the business of nursing. I do know the National Council of State Boards of Nursing has been looking at this very subject and has been doing not only research but has established pilot programs called Transition to Practice all over the country. Look on the NCSBN.org. They call it a public Safety goal. Also the VA has a program called Nurse Residency Program. They look at how they. Am help train new nurses and retains experienceed nurses. Thank you for bringing this subject forth. I am a nurse but the best gift to me is that your article was shared with me today by my daughter who has recently become a nurse.

  56. I am an RN. I found myself post-op on a Neuro-surgical unit. The charge nurse had 5 yrs experience and my nurses had months-2yrs. You want to talk about being scared! I stopped them from making 2 med errors on me!

  57. When my wife was in ICU, she had an experienced Nurse who for some reason was giving my Wife expired medication. One of my Wife’s visitors happened to be a Nurse from a reputable hospital in Southern California, she brought to my attention that the meds were 4 days old, and that they are only 50% effective after the third day, increasing the possibility of an infection. When asked about the medication she said, “all hospitals are different.” The visiting Nurse said not so, explaining that standard care procedures are the same for all hospitals and nurses. Relatives and even visitors can be the best patient advocates for a patient, even with an experienced Nurse.

  58. There is a high turn over…These nurses come on the unit thinking they know it all. They get there orientation and a year and a half on the floor… now experienced they go to a different hospital that pays them at a higher rate, go back to school, or simply go per diem for a $10 increase, no weekends/holidays. There is absolutly no work ethic. It is infuriating.

  59. This is very true. I have said if something don’t change they will not be anyone doing bedside care in 30 years because people are not going to commit to the stress in the job. CNAs are overworked and underpaid. They can’t find them because you can get jobs paying the same or even more behind a computer. RNs are living there life heartbroken and miserable because what they worked so hard for (Nursing School by far is not easy) is not the good life they went to school for. Patients have changed throughout the years, they are more needy and less appreicative, (Not all but way more than previous years). Some are just flat out mean. People are not going to continue to be treated this way. They will choose a less paying job to have peace rather than the pay of an RN and the stress that comes with it, that shouldn’t. The stress of being overloaded; RNs and CNAs have to go through is mentally challenging along with unhealthy for the body so many people calling your name at once. Yourself needing to pee but don’t have a chance, being so hungry you feel like you are gonna hit the floor, having to skip breaks. I have been in the medical field for years and watched: every word of this entry is true. I know friends that went to school for nursing that stay at home now ( because their peace was not worth the money). I put a hold on my school even tried to chance careers but I have took all classes pertaining to nursing it would take me forever to start over. I have come to the conclusion if I do RN program bedside care (hospital setting) will be my last choice of employment. There is a huge problem in the medical field.

  60. I couldn’t even finish reading this. I am an LPN and your article makes it sound like the only nurses are RNs. Pretty typical.

  61. Being one of the “dinosaur” nurses that has stayed bedside for over 40 years, and my career is coming to a close fairly soon, I have lived everything you have said. I went into nursing for a career, not a job, it was a calling for me. That really no longer exists. Many nursing students are looking for a job and are using the “RN”, as a stepping stone for something else, and others just didn’t realize how extremely demanding nursing at the bedside can be. Many new nurses, are task oriented, some can evolve and become connected to patients and families, some cannot. The “greenies are training the greenies”, no fault of their own, it is now the system. Medicine has truly turned into a business. I understand it, to some degree, but it does sadden me. It saddens me, but always remember, life is cyclic, maybe if luck prevails, the cycle will swing back bedside. Let’s all hope for that!!!!!

  62. I was shocked to find that most new rns , and bsns had no clue how to do a soap suds enema or insert a Foley catheter. When I asked them why most said it never came up when they were in clinicals. Being a lpn for over 20yrs, I was amazed. I was happy to show them the procedure, but I am ever so greatful that my instructors made sure that I had every opportunity to have many experiences. I don’t understand why schools think basic nursing skills aren’t important.

  63. I was shocked to find that most new rns , and bsns had no clue how to do a soap suds enema or insert a Foley catheter. When I asked them why most said it never came up when they were in clinicals. Being a lpn for over 20yrs, I was amazed. I was happy to show them the procedure, but I am ever so greatful that my instructors made sure that I had every opportunity to have many experiences. I don’t understand why schools think basic nursing skills aren’t important.

  64. I have been thinking about returning to hospital nursing after not working since my daughter was born 5 years ago. This article really brought back the reality of what it was like. I still go over in my head why I wasn’t more efficient at my job. I always felt incompetent because I could barely get it all done. I felt that I spent too much time charting not that it was not needed but that I must have been too detailed. I went in to home health after working in an ER for 6 years. And that was a good California hospital. I think they really understood what was important but yet the same job stresses existed. Home health was a nice change but again the charting is insane and I experienced a lot of the more experienced home health nurses as they say “eating their young”. I myself had to train new grads in the ER and remember feeling like how could I possibly fit in training someone on top of everything else? Perhaps this is why older nurses aren’t sometimes the most helpful to new nurses? I’d love nothing more than showing someone the ropes but when you are already super stressed that becomes obsolete. Anyway, good article and this turnover trend is super scary.

  65. It isn’t only the nurses, doctor ratios are horrible too. I see hospitalists with 20+ patient, one of them ordered a MRI on my patient and the only reason they aren’t dead is because I got the order cancelled as the patient has a pacemaker. Even if management is on your side, they have no power. Management can’t tell the CEO give me more staff, they would be laughed at. In fact I would say the CEO has no power either. Imagine if a CEO announced profits would be cut in half to hire more nurses, the board would be firing that CEO in 3 seconds flat. The only way this gets fixed is through state legislation mandating ratios such as what happened in California or we continue to unionize and have the union put mandatory ratios in the nursing contract.

  66. I agree and am very sad at the state of nursing. One point though I would like to make is that home care nursing- which I believe is true nursing – is no relief to an overworked hospital nurse. I have been working in home care for over 20 years in a busy urban setting . We visit 6-8 patients a day and have high patient turnover which means we do new patient assessments and discharge assessments daily. Overtime is expected on a daily basis and there are always more patients that need to be seen. Nursing positions have been steadily eliminated while more and more administrators are hired. When new nurses are hired they are given very little support and leave quickly.
    The only answer to better patient care and nursing retention is hiring and supporting nurses.

  67. I’m a bedside nurse in a ICU “step down” unit which isn’t always step down. But my biggest complaint about nursing today including the staffing ratios is the amount of box clicking and redundant charting that has to be done instead of actually performing nursing care. The unit where I work has no support staff, so just changing pts and taking them to the bathroom and passing meds is about all we have time for. In addition to charting vitals on computer, we hand write hourly vitals on sheets of paper. We also hand write labs, which are readily available on the computer. Why? Because JCAHO likes them. I like actually assessing pts more. I am usually there 14 hours doing all of this. It’s very frustrating to leave feeling that I wish I had more time to give baths or face to face care to pts. I don’t know what the answer is. It seems that charting significant changes should be more important than hourly, redundant, repetitive charting seems to be.

  68. A seasoned nurse doing bedside nursing, operating room, management in long term care facilities and rehabilitation, surgical nurse for mission trips to 3rd world countries. Administrators, Doctors and Managers need to don a uniform and work along side of nurses before they go back to their board room to make decisions on how to provide quality care for all patients and ensure retention of seasoned nurses and provide quality receptors for new grads. I was taught by the best nurses and CNA’s way back when and continue to learn more everyday. Being a nurse is a gift from God. If you don’t have the gift, you don’t belong there. YOU are the advocate for your patients and yourselves. Nurses are not taught the way they were in the old days. So many clinical hours at the bedside, monitored by experienced instructors. It’s all about documentation for Magnet status and inspections so the institution looks good while the nurses are exhausted from trying to take care of their patients and document in several areas the same information taking time away from what they were chosen to do. I’ve seen it all. So many levels of beauracracy making decisions and decisions not approved until it goes through another level of beauracracy. Nurses meeting to change the status quo but held up until it is reviewed by people who don’t have a clue about what the nurses are trying to do to improve their units, staffing and patient care. No one sees anything but the numbers and the stats. Stats are more important than people. I have had excellent care as a patient but assure you that if one of my loved ones were in a hospital, I would be there as their advocate watching every move, every decision, every drug prescribed, asking questions, watching everything. Why? Because I have seen too much. Good and bad. Was misdiagnosed after the removal of a brain tumor. 12 hours of med students, residents, PCP and Neurosurgeon saying I was suffering from acute depression when in fact I was having a partial complex seizure and they had me convinced I needed Psychiatric in patient care. Fortunately, I had an advocate friend who never left my side and saw to it after 12 grueling hours of giving detailed accounts of my symptoms over and over again that finally a senior Psychiatric resident came in and within 5 minutes with my friends documentation diagnosed me with a partial complex seizure. I wasn’t crazy. I was on the wrong seizure medication. This helped me when I returned to work to identify the symptoms in a patient and inform and nudge the doctor to change the medication and the symptoms disappeared. That’s my story and I’m sticking to it. Love what you do and continue to advocate for your patients, family and yourselves. Don’t throw away the gift that God has given you. You are needed. Continue to fight for all of us for someday we will all be there.If a Seasoned, compassionate Nurse made the rules, what a difference it would make.
    Seasoned nurses, don’t eat your young nurses. Teach them well. Pass on your gift and make a difference. Never stop advocating for your patients, your family, staff and yourselves. I am so grateful for all my experiences and fortunate not to be in the thralls of such high expectations from an institution and I can go to 3rd World countries and work with less and give my undivided attention to my patients and my staff and and only have to document on two pieces of paper and am thrilled that we have positive outcomes for all patients. We take the high American standards with us and take care of the whole patient from start to finish. My rant is over. God bless all of you and please don’t give up. We need you to care for us and change the pattern of where Nursing is going.

  69. Very well written and so very true!!! As an RN of 20 years, I am totally burned out. I have pursued advanced nursing education and will finish my Master’s in Nursing as a Family Nurse Practitioner in a few months. The expectations and demands of bedside, or patient care nurses are unrealistic and downright dangerous. Until the public becomes more aware of this reality, we will continue to spin our wheels trying to keep up. Thank you for sharing!!

  70. I am a 20year plus nurse and I walked away from nursing a little over a year ago. For some of the very same reason written above. I did not want to be a part of a system that did not allow me to care for people the way they deserved to be cared for. When I started nursing you could and now… I truly felt like it was constant care on the run. Not how it should be. Maybe I am unrealistic but when I went home each day knowing there is more that could have been done with more time, more experience and more hands It is just sad and in the long run does not help the health care companies, the people receiving the care, or the people giving the care.

  71. I love your article. I have been searching for something I feel passionate about to write a paper required for my BSN. I would love to reference your article and your data. Are you able to cite where you received your data from?

  72. Hey great read! I am starting a blog and follow this both because the content but also to learn how you do it 🙂 I completely agree. Unfortunately, this epidemic doesn’t end with just nurses. Cutting CNA, Caregivers, and support staff hours is huge. So is keeping there pay so low it’s not worth it for them to stay. I had a CNA turn in notice to me and when I asked why, they handed me an ad to flip burgers at more than what they were currently making. It also doesn’t stop at the hospital. Assisted living, medical offices, etc have the issues affecting their care.

  73. I graduated in 1966 as an LPN. My first job paid $3.50 an hour. My Orientation consisted of being escorted to the second floor, introduced to other staff, shown the Utility Room and told which side was “clean” and which side was “dirty”. Shown the kitchen, the linen closet and the treatment room and told to, “Have a nice day.” If I asked a question, I was treated as though I was some kind of an idiot. Seven years later I went back to school and graduated in 1976 with my AAS in Nursing. I worked 48 years in bedside nursing. Some days I loved it and others I hated it! Staffing has always been an issue. Nurses were frequently told they needed to assist the Nursing Assistants. I spent so much time doing the work of Nursing Assistants, Respiratory Therapists, PT, and sprinting down the hall to answer the phone because the Unit Secretary was not at the desk (probably doing some Aide work) that it was difficult for me to get my own job done. If everyone concentrated on the job they were hired to do instead of spending so much time doing the jobs of others Nursing would have gone so much smoother. Not only do we need more Nurses, but a few extra Nursing Assistance etc. wouldn’t be a bad idea. It would end up being safer and more cost effective. If there was a complaint the Nurse was always the one to blame instead of looking at the lack of staffing. On occasion I would write up a paper noting the number of patients and the staff on and noted it as being unsafe and sent it to Administration prior to starting my shift so they could not say they were not aware (if you do this, be sure to keep a copy). As a seasoned Nurse I often asked new Graduates for a fresh perspective and I made it a point to be available to answer questions and told them that no question was too stupid. If someone called in Supervisors frequently told staff someone had to stay. It was not uncommon to find myself pulling a double shift and getting home in time to get a couple hours of sleep and head back for more of the same. Finally, NYS put a law in place that, by saying four key words, would keep Nurses from working 16 to 18 hours. They are, “I’m no longer safe!” Once you say that they have to get you relief and it is amazing how fast they find someone. If you don’t say it and stay for the next shift and make a major error you will go down. Supervisors would tell the seasoned Nurses not to tell the newer staff this and I said, “Well, if I see anyone being told they have to stay I’ll pull them aside and give them a copy of the Albany paperwork.” By the time I retired from the hospital where I worked it was the older Nurses that were running up and down the halls (one with bilateral knee replacements) while the new Nurses sat at the desk chatting it up with the doctors and talking on their cell phones (technology is great, but those belong in the locker). I was almost 70 when I officially retired and sometimes I miss it like crazy and at other times I wonder if I was just plain crazy to have done it for so many years!

  74. Absolutely agree! I left bedside nursing after 15 years. The nurse to patient ratio and the acuity became too dangerous and it was not going to get any better. I could not jeopardize my license. I am now working at a surgery center and love it! I have been there about 4 1/2 years and will never go back to bedside.

  75. Medicine is becoming a corporations assembly line. Skilled labor is replaced by unskilled task fulfillers .
    Doctors have already been isolated and replaced by ‘nurse practitioners. Hospitals used to provide equipment and diagnostic suppirt. That now falls on individual doctors.
    Nursing tasks are farmed out to a series of semi skilled nurses aides, who perform routine, repetitive tasks.
    Hospital administration geared towards money, not patient care.
    Cogs in the assembly line.

  76. Thanks so much for this! I completely agree! I got asked to start orienting new nurses at 8 months in my current facility. I was experienced at another facility but still was learning the policies/protocols of the new facility. Thankfully, it actually pushed me to learn alongside of the new RNs and I do belive that it made me a better asset to my unit. Fast forward a bit and now I am part of the Nurse Retention and Recruitment comittee and we are trying to do what we can as nurses to fix some of this (the stuff that we would need HR to change). It seems like it will be a long road but as more and more of this comes out thorough comittees and blogs like yours, I think that this can be addressed and possibly fixed!

  77. So glad I came up in the days when I did. I was able to still be a good bedside nurse,and computers were not too big a thing. I was shocked in recent years of the la k of care that I received as a patient. Good thing I was a nurse,or I hate to think of what would have happened. We need to get back to the basics of the days before computers.

  78. So I can see this from multiple angles. I’m a seasoned nurse, worked med/surg/renal/pulmonary/ transplant and PCU and ICU. Nurses cannot keep up with the demands put on them. Not just from the hospital, but CMS, and the patients and families. So often, they think we are here to wait on them hand and foot and that they are at the Ritz Carlton. That drives me nuts. What happened to the days where the patients were sick, and they wanted us to help them get better. Now we get the belligerent, the demanding, the self-entitled, and from all ages and walks of life. It makes an already demanding job, even more taxing.
    I am now a Nursing director over a cardiac floor. This has given me further insight in to the staffing issues. Staffing is based on some standard set by corporate. People who sit behind a desk and punch numbers to determine profits, etc. It is determined by reimbursement for each type of stay. We (the managers and directors) get zero say over what this number is. Zero. What we do get to decide is how we get to use our numbers. Do we want more nurses, more aids, or no aids and more nurses. It’s exhausting. And then just when you think you have staffing right, other departments lose staff and we get to flex ours to help them out and then short our own unit, thus creating an endless cycle of unsatisfied employees. They are unsatisfied because they float to another floor, thus leaving their home units understaffed. They are unhappy with the ratios, they are unhappy with the float, they are unhappy. It has to be a combined effort for all of us to be successful. What we need is to legislate for ourselves. We need to take it to the federal level, make a nation wide law that protects the nurse to patient ratio, otherwise the cycle will never end.

  79. Where I work, the rumor is that it is actually encouraged to have the newer (less than 5 yrs experience), younger nurses train new staff. The reasoning is that the new hires are able to learn better because they can relate to their preceptor better than to an older, more seasoned nurse who can come across as intimidating. I see the reasoning, but don’t agree with it in all instances. You need to look at the experience, critical thinking, personalities, learning styles, etc.

  80. This is a great article. Like you rightly said upper management staff care more about the money than the staff. Some nurses work so hard, but family members don’t understand what nurses go through. As nurses you can never win, you are always wrong and under appreciated in gratitude and money. I saw a new nurse with less than one year experience training new nurses. This is scary!

    Another reasons why some new nurses are leaving bedside nursing is also bullying. Old nurses tend to bully new nurses and take advantage of them. This is a wrong way to introduce a new nurse to the practice.

    I pray someone will do something before it gets out of hand.

  81. I have been a registered nurse for over 46 years. When I first started working, Team Nursing was in vogue and RN’S as leaders of the team. were responsible for total patient care. This meant that the RN provided team leadership (organized and monitored staffing, did in-service training. provided moral support and counseling of team members), dispensed and delivered medications, mixed, prepared, started and monitored IV therapy, provided wound care, and emotional support of patients and their families. It was rare that you had time for a break for a meal. By comparison today, the RN has a lot of support. There is a unit dose medication system managed by
    the Pharmacy. The Pharmacy prepares IV
    medications and the delivery is monit
    ored by an electronic pump. There are many support personnel, like chaplsibs.

  82. It is interesting, being what would apparently be classified as a “green nurse,” how much I have watched in my short four years in Nursing. I have done joint and spine, Acute dialysis, and community care. Oddly enough, I had a mixed bag of experience in learning.

    I had veteran nurses that were incredibly knowledgeable and willing to teach, veteran nurses who were incredibly knowledgeable but unwilling to train as they felt I was just a nuisance and slowed things down. I had veteran nurses that were poorly trained, slow, and knew less than I did as a “new, inexperienced nurse.” Others who couldn’t figure out the new computer systems, new meds, or new technology.

    I also witnessed the premadonna new grads that were book smart in class but had no actual clinical knowledge that was applicable to the job, new nurses who didn’t ask for help of education in areas they didn’t know much about. I met New nurses who get they knew better ways, regardless, of what older nurses said. I also met new nurses who wanted nothing more than education, guidance, and someone willing to do the training that these older nurses once received before they could touch patients.

    Now, we, the new nurses, get less training time due to census issues or turn around. Lower wages that haven’t been raised but declined related to the flood of pop up nursing schools leading you to believe you will be so well paid and respected as a nurse. We have most places that want “experienced nurses,” yet, no most hospital floors are unwilling to adapt to train their own under proper, educated, staff that enjoys passing on knowledge; as opposed to saying something snarky when you don’t know how to set up TPN after being shown one time 3 weeks ago.
    The issue in nursing which I feel, from my point of view, falls with staff management, funding, and reimbursement. Many many more hospitals are becoming for profit, caring greatly on their star rating and reimbursements from Medicare. We know have more documenting time and forms than ever. We have to worry about surveys on how long someone waited for a call bell, not knowing that each nurse now has 7-8 patients. We have to distribute the meds both scheduled and pen, scan meds, document the med, document the PCA pump, do the admission, do the discharge, write the care plan; meanwhile that tech that is running themselves ragged is supposed to cover 20 patient rooms… leaving the nurse to also get Jello, bathroom help, turn patients, empty the foley, readjust pillows, do the 4hr vitals… it’s just not safe, possible, and leaves little to no time for training.
    Older, experienced nurses are fed up because hey remember times when things were focused on patient care and the “green nurse,” is overly focused on getting all the charting done.
    It’s sad, to be honest, I’m lucky in the fact that I have a patient sister who is a veteran nurse, I’m lucky that my preceptor in my first job was patient and exposed me to as much as possible. I’m lucky that I’m a quick study and knew that my documenting was secondary to my care measures even if it lead to a 14-15hr day.
    I have seen many things in dialysis since I went to 11 different hospitals in their ICUs, MICUs, SICUs, and Med surge floors. I watched the same thing plague each floor… time and again, agrevated patients who feel they are at the Hilton and demand more as they can due to the knowledge of a survey rating, a yelp review, knowing it can affect the hospital. The veteran nurses eat the newbies because they are bitter because they are tired of the turn over, the newbies reject the veterans because the newbies fee the veterans are no longer “up to date.” Most of this is related to having no time to truly interact because we are underpaid, overworked, and often understaffed.

    Perhaps, if nurses stopped the internal cannibalism, stopped feeling it’s due to the slow old nurse or the young dumb new nurse and focused on how the its make up of the new way expected of nursing. The part of nursing that slowly fading, the part that made nursing such a rewarding career, helping people heal emotionally and physically through time, care, and education.
    That’s my two cents.

  83. Nice article. I have been a nurse for 32 years and stay because I love what I do. Not that I haven’t gotten to the point of looking at other career options over the years. I stay only because I like what I do, certainly not for pay or recognition. Most experienced nurses sit at the “top of the scale” for years without any raise or bonus. I feel bad for new graduates. They lack clinical experience from school and the hospital’s do not put the funds into educating and training like the use to. It is sink or swim and hopefully you can latch on to a nice, patient experienced nurse to show you the ropes!

  84. Both my Daughter and her Husband are nurses. They know and have shared with me the stories about the administration of services in their respective hospitals. It’s pretty scary.

  85. I’ve been a nurse for 40 years and recently retired. I have seen all the changes you describe and then some. Many of the new nurses are in it for the money, I guess no one told them they have to bust their butts to earn it. Patient care should not be about the bottom line and that means healthcare should not be a business model and all about profits. Even the “not for profit” entities are all about their excess revenue and nursing is viewed as an expenditure that needs to be replaced by those with lesser training and thusly less money. Nurses need to learn to stand up for themselves and demand nurse-patient ratios, organize, form a union. It helps but isn’t the complete answer. We still need to get big business out of healthcare – Medicare for All. My motto has been if it’s good for patients, then it’s good for nurses.

  86. One of the things I have noticed the most is how many nurses no longer want to work the “floors”. Many Med/Surg and Tele floors are just revolving doors and places where new grads go to get their first job and then move on other specialties. This is just as bad as losing a nurse to another facility, training a nurse to ICU can take months and once again lack of experience can lead to poor outcomes. Not that I blame them in the least, I still take a float to the floors and shake my head. An assignment can be 5-7 patients with an aide having an assignment of over 15 patients! None of this is safe or a good working environment and hospitals no longer working hard to keep nurses for 10 plus years they figure they can replace a veteran with a cheaper nurse. It’s very sad, I learned so much from those veteran nurses and it has made me the nurse I am today.

  87. Totally agree with the overworking, understaffing and high turnover that you mention. But as a nurse of 10 years I need to say something in defense of those new grads that some commenters are showing frustration with. I can tell you that “nurses eating their young” is alive and well. I worked on a unit with many “seasoned” nurses for my first job after getting my BSN–it was hell. They tortured me to the point that I was scared to ask them for help or guidance–which is not good or safe for a new nurse. So I left that job and found another. My preceptor was the devil incarnate and wouldn’t teach me; she would only criticize. I would have panic attacks thinking about going in even after my orientation because it continued. Nurse bullying is REAL. But I loved my patients so I endured it. After 5 years experience, I took a job as charge nurse at another hospital and worked there for 5 years. Although I worked my tail off for my patients to provide great care, the older nurses that I supervised took every opportunity to make me feel like I just graduated compared to their 30 + years! They always knew more, their way was better, any new process or initiative that I tried to enforce was met with push back. They were gossipy and disrespectful to supervisors because they knew better then everyone.

    New grads may not have the clinical skills that the diploma era nurses have but they are taught critical thinking and to look at the big picture. They are taught to embrace new ideas and change. Much of the older generation doesn’t like it.

    I agree with much of what was said in the article but I left bedside nursing in part due to the behaviors of other “old school” nurses. So I got my MSN and now have a great career away from the bedside. I miss my patients but I’m still working to make healthcare safer for them on a higher level. I’m also finally getting the respect from my co-workers that I worked so hard to earn while on the floor.

    1. I’m so sorry that you had that experience. I said in other comments I have no problem with new grads at all. I was one. I have issue with people who act like they know everything, seasoned or not. I’m glad you found your place. Thanks for reading!

  88. AMEN. When you have emergency oral surgery and call out sick because you are taking vicodin and the supervisor says “that’s ok, you can still work.” When every shift you are afraid you could lose your license because of patient acuity and poor staffing and you are afraid you will make a mistake and harm a patient. When you waste time trying to deal with the demands of unreasonable patients or family members who act like they are your only patient when you have patients with critical clinical indicators that need to be addressed now but heaven forbid we get a bad Press Ganey from a patient with unreasonable demands. Or the practice of the ER sending up admissions at change of shift when you are trying to get report on your assignment – so unsafe! Despite the horrible working conditions I love taking care of my patients, but I am burned out! I will probably leave bedside nursing within the next year.

  89. I should have been more surprised by the turnaround numbers. But in all honestly nurses, nurses aids, LPNs all feel burned out while the Hospital administrations are demanding more from less people.

    Stuff rolls downhill but then it causes a reaction wave. Ex. Charge nurses say they unit is shorthanded and over taxed with XX% of patients to only xx% of nursing staff. The administration gives someone a new title to ensure thing go more smoothly, no hiring occurs and the staff who feel they are at the bottom of the totem pole feel the weight of being crushed and you know something sooner or later is going to snap.

    I empathize and I pray for a solution where patients can get the best possible care from the best trained staff at an affordable cost from preventative medicine rewards to trauma teams.

    God bless all our nurses no matter what rank they have and may they be lucky enough to be in a training mode under a good leader all through their career and pass it down.

  90. Very good article. I am a Nurse with 36 years of experience. I am retired now and the only thing I miss are the precious moments at the bedside of a patient. I loved my job, most of the time. I agree we need to get back basics and put patient care first. My best days of nursing were done with a team, all of us working together to help the patient and each other. All the hours listening to “new” demands in meetings, all the useless inservices so we meet all institutional regulations are a waste of time money and mental wellbeing.
    I have oriented many new nurses, I always knew the ones who would leave, and the ones who would stay.
    I worked hard long hours and missed a lot of my children’s milestones. I have had my hips replaced. I have known some really dedicated nurses and have known some really bad ones. I believe the attitude of the units depends greatly on management. It all trickles down.
    Nurses ARE the heart and soul of any facility, how long before coperations wise up. Take care of us because we will definitely be taking care of you.

    1. I wish I could pin this to the top. I love this comment. Thank you for your service to the profession. I’m sure you’ve made a difference more than you know.

  91. I was recently was in the hospital and had 2 nurses: one had 5 years on that floor , the other was a new nurse. There were so many problems: once awake and hurting, I asked for pain medicine. I was given 50 mgs of Tramadol! Fresh post-op. When I asked for more an hour later, I was told I’d have to wait 3 hours, then I could have a Percocet!! Meanwhile, I’m really sore. When I asked if there was anything else they could do they told me I had an order for a PCA with Dilaudid!!! Talk about backwards.
    Then there was my catheter. I called and said I was extremely uncomfortable and very distended (I’m a retired RN!). They looked at the drainage bag and said there was urine in the bag…never palpated my abdomen!!
    Thankfully my son was with me and he helped me move the drainage bag from the foot of the bed to the side of the bed. And my knees were hatched.…urine cannot drain up hill!!
    You have to call your meals in. I’m post op and quite uncomfortable and the phone was across the room. Again, thank goodness my son was there.
    Hourly checks?? Nada!! Check my dressing? Nope!! Listen to my lungs (I’d had lung biopsies and had a chest tube): yes!
    Quite an eye opener! All I could think of was getting out of there as soon as possible, which I did!!
    My chest tube site took 3 months to close and i got pneumonia!!!

    1. Jesus I’m sorry that was your experience. Sad to say I’m not surprised. Thank goodness your son was there and that you had your wits about you. It’s a sad state of things.

  92. I left direct patient care to attend graduate school after 2 years of working and that was more than 10 years ago. And for many of the reasons you listed as well as the move to the 12 hour shift. I never worked them and you couldn’t make me now. I wish we knew how to tackle this issue. I think the long hours not only influence your physical and mental ability to deliver nursing care but also takes away from the time you could give back to your profession through nursing associations. Since we’ve chosen to limit our voice in numbers then our power is lessened to make changes. It’s a self-fulfilling prophecy?.

  93. I think nurses are leaving that floor to go on to more specialized areas or to further their education as a nurse practitioner. I highly doubt that statistic you threw out there is the amount of people who waste a four year education. Also, the older nurses aren’t able to keep up with the change of pace in health care so they are constantly rushing around, behind. None of them even know how to operate EPIC and stay after work for hours to chart. I would not want that nurse taking care of me.

    1. Thanks for reading. The statistic for people leaving the bedside doesn’t differentiate between reasons for leaving. Most of the senior nurses I know aren’t senior in the sense of being a senior citizen but a 32 year old nurse with 10 years seniority so they are plenty capable of charting in epic. Not sure who you’re talking about but thanks for taking the time to make a silly nonsense comment on my post and call it stupid. Good luck with your attitude.

      1. I can’t really say that I am old. I am 42 years old and have been a bedside nurse for 21years. I am pretty able to learn new things such as epic (I am on the epic build team for my hospital) and have been an Icu/Pcu/ ER nurse for most of my nursing career. I see it everyday from various organizations. The “older” nurses cost to much money, they are “disposable”. I see lots of nurse’s leave for greener pastures. It may be advancing their degrees to something less stressful. That is a generational thing. Millennials tend to change jobs often. The 20-30 year employee of the past is no longer.

      2. I’ve been watching these changes happen for the past 30 years and you are spot on with your observations. I think nurses these days don’t want to do bedside nursing for a variety of reasons and continue very quickly to other degrees. Nurses should be required to work thru levels. Experience is where its at and the powers that be are taking that necessary factor out of nursing. I cringe at the thought of ever having to go to the hospital. I’ve watch my 84 yo mother receive some of the worst care I’ve ever seen at a John Hopkins Hospital in Baltimore. I think that nurses have in essence ” shot themselves in the foot” with higher degrees and more and more requirements all the time. Some of the best nurses I’ve ever worked with were LPNs and Associate degree nurses, who were invested in their profession. Yes, I know the statistics on BSN entry levels but their are poor performers in every level. Keep up the good work on being ” in tune” with what really matters.

        1. I think there are good and bad nurses at every level. I think it’s more a result of investment and the soul of a nurse. I know associate degree nurses and hospital trained nurses and BSNs who are are amazing and have the care of the patient in mind. If people don’t care about patients they’re in the wrong profession.

      3. Thanks for the read – I agree with your stance. As a novice nurse, I became a preceptor within 8 months on the floor. I was very nervous to be training someone when I felt like I still needed the training and guidance of the more experienced nurses.

        Sorry about the bad attitude commenter above – your stats seem pretty accurate to me according to the text within my BSN program.

      4. Jen thanks for the informative article. This has been happening at the hospital that I work at for some years now. It’s a running joke to ” learn one do one teach one”.

      5. Wow!!
        Jen, obviously that person that replied doesn’t have a clue. I’m sure there is a percentage of nurses that are bettering their career but it isn’t that high. I am not a nurse but I know several. They are very hard working passionate people that LOVE what they do but are being burnt out by the politics , being understaffed & not being able to spend the time needed for each patient.
        Nurses are wonderful!!!!

      6. To stupid article! You are the prime example of the type of nurse I hope none of my family ever has in a hospital! After36 years of nursing I find your comments disrespectful and immature! Go work on a cruise ship!

    2. That is BS!!! First of all, nurses are becoming nurse practitioners because they dont want to do floor nursing anymore or at all. And excuse me, older nurses are struggling to keep up because they were taught to care for patients completely while the younger nurses have learned ways to cut corners and not finish all the tasks expected and even lie about the results! Older nurses are taking care of patients all shift and chart later while younger nurses spend time charting and cutting corners so as not to spend valuable time with the patient. YOU know it’s true! I would not like having you take care of me

      1. I dont disagree with you completely. I also think that many people go into higher degrees because they dont like patient care. I know not only from my own training but from listening to my mother and seeing the care she got in hospital that “often” nurses these days dont do basic cares like offering someone a bath. Keeping dressings and people clean is a big deal in my world.

    3. I retired early. I have my MSN and I can chart on the computer. I totally agree with the stats that article ” threw out” I wouldn’t want YOU taking care of me or my family as you have the TONE of a know it all

    4. I have to admit that as an older experienced RN I would not want to have to take care of you as a patient. I fear you would be a non compliant irrational patient. Your expectations would be based on your feeling s of entitlement and selfishness, me number one. You would blame the medical staff for your illness and not accept any responsibility for your weight induced hypertension and joint pain. You will be a whiz at internet look ups and know it all. But at the same time you will not be able to apply any of this information to improving your health. Too much physical work.
      If you were my coworker I am sure you would be spending the majority of your time on your phone. Click click click. PCTs would groan when assigned with you because you are not a team member. You are a delagater only. You pass your meds on time and as ordered, no deviation based on patients needs. Little to no interaction with your patients. You know it all from the chart. You expect any information to come to you from your subordinates. You sit at your monitor and plan your day. Everyone is expected to play their part as you have planned. Heaven help the patient who needs to go to the bathroom while you are passing meds… you call out to the PCT as you exit to go to your next patient.
      I must admit I am stimied as to why you became a nurse. It’s not empathy for patients. It’s not even the feeling of accomplishment in being a part of a stroke patient learning to care for them self or providing emotional support for a family of a dying child. Providing health education in a manner and at a level that allows for your patient to understand. Sharing all the information you learned in college. Why did you become a nurse?
      You did not know it could be so physically demanding as well as emotionally. You did not count on having to pick up extra shifts when your coworkers become ill. Holidays, weekends, birthdays work work work. Time to go back to school and get even further away from the patients.

      Just some thoughts that you brought up as a result of your comment!

    5. I personally think you’re smoking something you shouldn’t be. You sound like one of “them”, you know an administrator. Experienced nurse are leaving bedside (not old, crotchety nurse rachet… I mean 35-50 year old seasoned nurses you WANT at your bedside protecting you from those “knowledgeable ” new doctors) in droves because the administrators have lost touch. They’ve lost touch with the realities of patient care and the complexities of patient care. All they’re concerned about is JC and keeping cost down all while turning a blind eye to overworked, under-appreciated staff. We recently combined 2 ICUs into one unit…2 different sets of staff into one…do you know how many bedside staff nurses were asked about the best way to possibly make the transition a smooth one?? None, absolutely 0. It was a disaster…and do you know who kept patients from not dying during the mass chaos that ensued?? The seasoned staff nurses. The ones who promptly left for the GI clinic and PACU as soon as they could. I still to this day ask myself how there weren’t any sentinel events. But anyhow, this article is truth. I see more and more new nurses helping brand new nurses get oriented to our facility. I work in a military facility so I also see many of the middle ranking RNs get fed up with the “leadership ” and get out of the military. Those that don’t get out, are often whisked away to do some bogus admin project for the crusty, out of touch Colonels. And I see the problem getting worse and worse. Thank you for drawing attention to the issue.

      1. Thank you. This sounds like something that happened at my facility. It’s a lot of doing and figuring out at the peril of patients. Thanks for reading.

    6. Wow! I am guessing you are a baby nurse so you took offense. The knowledge I obtained from all the experienced nursing staff I worked with is irreplaceable. I went from a Unit that had all experienced nursing staff to a Unit with all new graduates. There was a huge difference. The new grads were not incompetent by any means but their nursing career was definitely impacted by my knowledge and expertise. Especially because I love to teach. They noticed the difference in how my patients were taken care of, that my call lights never went off, and I chart everything! This is a real problem. You have not worked in the profession long enough to notice the difference! I would absolutely love to have an experienced nurse that can say the hardest part of her job is the charting because she is going to know the signs and symptoms when something is going wrong from experience. You can’t learn that from a book. Come read this article again in 5 years and see if you have changed your mind.

    7. Those who are older are actually assessing their patients for change and listening to their lungs or god forbid took time to give them a bath and assess their skin and wound at the same time. Pull you head out of the computer get rid of your attitude and put your patient first . Graduated in 1985 from nursing and if you put some faith in to us old timers you might learn s thing or two rather than in the darn textbook. The art of nursing is LOST if you prevail with the idea 4 years of school is a “waste” at the bedside or beneath you! I begrudge no one in moving on for whatever they desire. But you do not know abnormal until you see something normal. Honestly if you gauge the success of a nurse by her computer savvy skills you are not In touch what it means to be a nurse ….it is their compassion, instinct, knowledge and ability to work with their team and accurate concise charting that Makes the best nurse possible. And maybe that is where bedside is lost to . How can you chart if you never touch a patient? How can you assess if you never do it for more than a few weeks … Sad …let’s start screening our nursing students better. Not just anyone can be a nurse, and that is the attitude that prevails. And yes, unfortunately those who can not do become administrators some times ! Bring in new ideas and positive patient interactions for feelings of success . But overall , be kind ! utilize all levels of experience . And if you see your fellow nurse having a hard time help them. It seems to have gotten to survival If you can

    8. Are you a nurse? I highly doubt it! It takes more than a college education to be a true nurse. I can’t answer to the statistics but the rest is exact.

    9. Seriously? I’ve been nurse for 14 years and can fly through Epic. I can manage my time and patient load smoothly and am done waiting to give report every shift. I don’t leave anything for the next shift except their duties required by time. I can dance circles around new grad, they don’t have enough experience to keep up – so watch your words and generalized statements. Once you’ve hit a point that you are asked repeatedly to do more at the expense of patient care you start to burnout. It’s stressful and anyone with a conscience finds the work exhausting year after year with more demands both from government requirements, administrative demands and patient demands. Let me guess, you’re one of these new grads who think they know everything. I hope it isn’t someone’s death that humbles your pride. Good luck to you and your patients.

    10. I take offense to your comments. I have been at the bedside for 39 years and can navigate a variety of EMR’s. I can also run circles around unmotivated younger nurses who don’t feel it’s their job to answer a call light .
      On another note I completed a BSN completion program while working and raising 3 children, and just completed an FNP program .

    11. Sorry you feel that way about us “older nurses”….after 25 years, I can chart faster in Epic than most teenagers can post in Facebook. I can also run circles around most nurses these days. ED/CVICU/Flight nurse here. Generalizations are never a good thing. My motto has always been “change is our friend.”

    12. Many older nurses weren’t “brought up” with computer charting, their nursing skills are, however, most excellent. The “new nurses”, some not all, nurse the computer. Give me the bedside nurse that takes care of her patients and not her computer, any day.

    13. Really …..do you work at the bedside? I have worked at two hospitals over the duration of my 10 year career. All in ICU’s. I have seen almost a 80% -90% turnover in nurses at bedside in one hospital total. And the other is just starting to see that trend. A loss of 30 yr experienced nurses all the way down. Those 30 year nurses in critical care would run circles around the younger less experienced. Yet they were forced out. The value of loosing the experience at any level to replace that with brand new nurses being trained by novice nurses is a shame at any level of nursing.
      To say that a nurse takes longer to learn EPIC on the computer is someone that you wouldn’t want taking care of you? I bet some of them run circles around ya at the bedside. Get a grip EPic is a computer documatation tool. It does not reflect a good vs bad nurse bud

      If we do t work on retention, and keep the experience at bedside pt outcomes will suffer greatly

    14. Wow I’m speechless. Yes you are probably one of the millennial nurses who check your pts only when their call light comes on. Therefore getting all of your boxes checked in epic on time so you can spend your “downtime” online either on your smartphone or brazenly on a facility computer shopping, planning your wedding or next summer’s vacation. Those who are staying after to chart are doing so because they actually worked for their paycheck and maybe are making sure that their documentation is accurate and completed.

  94. Who are you? How dare you generalize that older nurse can’t keep up! Many who enter the field of nursing today don’t have a clue about compassion, dedication and know very little about team work. Anyone can learn computers and documentation ..nursing is an art that few learn and even less master. I wouldn’t trade any of my ” older nurses” for some of the technology-dependent nurse “wanna-bes” of today. This article holds a lot of truth.

  95. Stupid Article is very misleading. Older nurses aren’t slow. They are trying to take care of patients the way they were trained to do. Younger nurses like Stupid Article are cutting corners, lying about results on charting to get done and get out on time. They become nurse practitioners in order to not have to do floor nursing! Very condescending you nurse

  96. Jen, Thank YOU! I’ve posted this on every social media account I have with the note: This article says it ALL! Read all the way through to the end. If anyone in hospital administration reads and takes to heart, maybe bedside nursing won’t die an ugly, quick, un-recoverable death. Amen. Hear! hear! May God have mercy on us and The Force be with us! And with our Spirits!

    You are right. I fear for the future of bedside nursing. But most days my back and sleep deprivation beg me to look for another job. Thank you.

    1. Thank you for sharing and helping me bring this to the attention of people. I hope non nurses are reading and I hope it can maybe, just maybe make a difference. Thank you again.

  97. Having been a bedside nurse for 10 years at a teaching medical center, I so identify with with many of the scenarios mentioned in this article.
    The expierenced bedside nurses are a special lot and are so needed in all hospitals
    In my 20 year career. I saw many new grads come aboard and luckily where. I worked we had people who had been at it a while and knew what they were doing . I saw many of them go up the ladder to run a unit,or to educate, and yes some left.
    Nothing is perfect but with the right mix it can be done for excellent patient care which is what u and. I would hope to get if we were a patient
    My hats off to all nurses ,they are special people

  98. Having been a bedside nurse for 10 years at a teaching medical center, I so identify with with many of the scenarios mentioned in this article.
    The expierenced bedside nurses are a special lot and are so needed in all hospitals
    In my 20 year career. I saw many new grads come aboard and luckily where. I worked we had people who had been at it a while and knew what they were doing . I saw many of them go up the ladder to run a unit,or to educate, and yes some left.
    Nothing is perfect but with the right mix it can be done for excellent patient care which is what u and. I would hope to get if we were a patient
    My hats off to all nurses ,they are special people

  99. You aren’t going to get anymore help so don’t work for less money!

    And stop sending nursing students to walk around with directors! Teach them patient care and how to manage a load of patients and think for themselves, not how to make another power point!

  100. I suppose I am the dreaded newer nurse with about 2 years under my belt, and I am also looking to leave bedside nursing for two main reasons. First, I do not like how nurses are the catch-all for anything going wrong with the unit, ex: missing equipment; why didn’t the nurse report it, if the CNAs are short handed; why didn’t the nurse do their tasks also, the EMS drivers taking a patient from the hospital to rehab lost the patient’s hearing aid; why didn’t the nurse make sure they saw them? We do not the necessary supportive staff, and all of the extra responsibility is being put on our shoulders.
    Second, Healthcare has turned into customer service in regards to insurance reimbursements. So we not only have to tackle our nursing responsibilities of med passes, cleaning/turning, charting, care coordination, and constant assessments. But we have to make sure their Pepsi is fresh and their ice cream didn’t melt to ensure a good score on their Press Gainey survey. And yes, I actually had a patient complain to my manager that they went for testing as dinner was being served and “the nurse let my ice cream melt.”
    I enjoyed reading the article, there are a lot of reasons why nurses are leaving bedside nursing, and unfortunately I do not see any of them being fixed any time soon.

    1. I don’t blame you at all. Those reasons and others are why everyone leaves. It needs to be fixed. That’s the point. You are at that critical point in your career where things are clicking and your becoming even more skilled but the environment is pushing you out. It’s really maddening because you obviously have your priorities straight and we could use someone like you at the bedside longer.

  101. I’m not sure why “furthering ones career means becoming an NP”.

    I didn’t settle to be a nurse. Just like flight attendants don’t settle to be flight attendants when they really want to be pilots. Ah no- it’s 2 totally different professions.

    1. Thank you. The same thought process that gives those lovely “why didn’t you become a doctor?” comments. I didn’t become a doctor because I didn’t want to be a doctor I wanted to be a nurse.

  102. My daughter sent me your article to read. She said, read this and you’ll understand what I’ve been telling you all these years. Well you hit the nail on the head. She was a floor nurse for 5+ years and needed to make a change if she was going to stay in a career she loved. She now is a charge nurse in a specialty clinic. Thanks so much for an excellent read!

  103. Hey Jen, Great reply to the mental midget that said your article was stupid. Some people don’t even suspect just how stupid they actually are. I’ve been in the medical field for 35 yrs myself and understand your plight. GREAT Article and keep plugging away!

  104. Well written! FYI nurses never stop educating and inservice is part of keeping our licence! We deal with life seriously !

  105. Healthcare Corporations are unable to plug decubiti or CAUTI’s prevented into a spreadsheet on a profit/loss statement so they don’t see it as savings. That’s why they hate paying for security guards. You’re thinking like a nurse instead of an administrator. Advanced degree = bigger paycheck??? Not by much. Most Nurse Practitioners I have discussed wages with make $4 to $5 an hour more than I do as a staff nurse. While paying off student loans for said Grad School tuition for the next 15-20 years after graduation, you will be making a lot less than said staff nurse. I don’t know how many NP’s I’ve ran into that are back working as staff nurses due to low satisfaction with their NP role or because they make better money as a staff nurse. Frankly, if I had to do it all over again I’d go the P.A. route.

  106. I was a manager of an ICU for 10 years. Experienced nurses were always golden to me. They made our unit the best unit. It was a privilege to be their manager.

  107. Thank you for a great article, Jen. So very glad I found this! I’ve been a nurse for almost 30 years and have seen a lot of changes. The saddest thing for me is seeing the job become so technological. Not that technology is a bad thing, because of course it’s not. But because the more we’ve become technicians, the less time we’ve had to truly nurse our patients. To remember that they are real people, with emotional and psychological needs in addition to their physical needs. I would like to say one thing about the comments on this article. I see lots of young nurses saying that older nurses are mean-spirited and non-nuturing. And I see lots of older nurses complaining about young grads who think they know it all. Having seen instances of both for myself, I know both can be true. And yet, who doesn’t remember being a brand new nurse and how some days you were so terrified of what you might have to confront during your shift that you were practically hyperventilating in the elevator on the way to your floor? Perhaps we can forgive them for any perceived cockiness and ask ourselves if maybe they’re just trying to hold it all together. As for older nurses eating their young? Perhaps new nurses could try to understand that we are physically tired and emotionally exhausted, and that many of us function every day with some degree of back pain. Or more importantly, that we are saddened by the changes we’ve seen over the years with decreased staffing and increased acuity levels. The stuff that leaves us crying in the bathroom because no matter how hard we push ourselves, there’s just not time to give our patients the care we feel they deserve? It’s a tough profession, and as someone pointed out, not one that anyone should ever go into “for the money.” Bless you, Jen, for staying at the bedside and doing what you do best. You’re a hero who makes lives better every day.

    1. Thank you so much for your kind words and for this comment. I wholeheartedly agree. We need to start to look at each other with kinder eyes and try to understand where the other is coming from. Thank you for reading.

  108. I would have to tell stupid article that I would much rather my nurse take care of me instead of the computer. Those nurses you are referring to take care of their patient needs first and when they are relieved by the next shift then they have time to document via paper or electronically. I am a 62 y/o experienced nurse and have no problem keeping up with my young coworkers or with my patients care. The older nurses come from the days where we cared for 10 to 15 patients a shift and when they said Med/surgery you could be dealing with anything. You are right documenting is at the end of my shift because I have been busy at the bedside taking care of my patients as well as those patients for that nurse over there making sure her documentation is in pristine order. For the younger ones I have seen leave for higher education it is because they don’t want to do this for the rest of their lives. It’s hard mentally and physically but well worth every battle scar.

    1. This is me too and I’m 30. I don’t give a flying shit about charting I need to take care of my patient. My patient with rapid A. Fib isn’t going to wait for me to chart my damn assessment. That person is a chump.

  109. @stupidarticle. You are everything that’s wrong with nursing today. You’re bad attitude and ageism must make you a peach to work with. I’ve been a nurse for 30 years and guess who’s the go to for Epic issues and when the shit hits the fan? Before you sneer at the statistics you might want to do a little research yourself. Your sweeping generalization of older nurses being incompetent only makes you look like a putz. And here’s a clue… Just because you “think” it doesn’t make it true.

  110. That attitude right there is exactly why I left.
    Home health offered me an opportunity to set my own schedule & deal with patients one on one. I deal with 3 different charting programs, for each company I work for. I do everything from teaching, wound care , to a large variety of IV services. I have to be adaptable. Just because I’m not 20 anymore does not mean I’m incapable of being a good nurse. The article was wonderful, you however have a lot of growing up to do.

  111. Unfortunately I think you are right on point,which is a scarey thought as I get older and will probably at some point spend time on a hospital unit. I worked an extremely busy med surg floor for years and trained countless numbers of new nurses and while no one would deny the value of education, expierance gives you life saving knowledge. I can’t even count the number of times I stopped a new nurse or resident from making serious errors. I recently left and am now working in peri op and the differrance is mind blowing. I left my previous unit for every single reason you mentioned….just could physically do 14 hours on my feet with no breaks being yellled at and degraded by both patients for lack of better care and manGement for better press gantry scores.
    While I still work hard I am now treated with respect, the pateints are lovely and I am appreciated….and I can honestly say I love going to work. I actually have nightmares where I am told I have to go back and work on my old unit
    As for the kid who thinks older nurses don’t know epic…let me just say in a 30 year career I came across lots of challenges and changes and going to a computer was certainly not the worst. What it did do was take away a lot of personal contact with patients.

  112. “THE RISE OF THE CLIPBOARD NURSE”

    Our policies are driving this behavior, instead of increasing pay for backbreaking clinical work , government has placed more emphasis on how the hospitals and outcomes look ok paper So you see bunch of good nurses flocking from bedside to jobs like quality measurement, hospital computer support , length of stay monitors etc etc and you can see them walking around the hospital with a clipboard
    We need to reward the purple in the trenches

    1. You are so right. Auditing is out of control. I’ve been told we need to turn patients to check their skin when they are frankly too unstable to turn period. Umm no I don’t care if they have a pressure ulcer if they will code with the turn thank you very much.

  113. I am an experienced nurse with 39 years of bedside nursing experience. I am also 62 years old now. Yes, I don’t move quite as fast as I did in 1978, but I am deeply troubled by the nurse practitioner’s view of older nurses. I can use computer programs as well as any of the younger nurses even though it took me longer to learn. We want to remember mutual respect for the strengths that each generation brings to the profession. I’m extremely glad I don’t work with this nurse practitioner.

    1. I’d gladly take you at my bedside or my family member’s. My mentor was three years from retirement in her 70s and she could run circles around newer nurses. She also charted on the computers just as well but in case anyone is wondering id take a nurse who can care for me over one that can chart any day of the week.

  114. I am a BSN nurse with over 20 years experience that lost her job due to “restructuring” to save money. The position I held was later filled with a RN who has an associate degree and only 1 year of experience.

  115. It is sad not only in nursing but in teaching also!! Almost for the same reasons😟. Teachers are just piled on with criticism for NOT saying the right words, posting the right things in the room, keeping up with grading, putting everything on their website for parents, getting students to score well on tests as if you are training a dog to do a trick because some students don’t want to or can’t do it. Children are humans with feelings and they have talents that don’t always show up on academic tests. Sorry for the rant🙃. I am sad nursing is in trouble too. No one wants to be a teacher with the overloads of the job.

    1. I just talked to a physician about this. His wife is a teacher and facing the same issues. It’s bad. These careers are our future. We need to right them both and soon.

      1. Nurse educators are being killed off too for many of the same reasons. Low pay with unrealistic expectations, students that don’t really want to put out the effort needed, administrators that forget the challenges we face in the clinical settings with balancing skills with trying to teach them how to think critically. I never allowed students to sit in a report room and work on paperwork…patient comes first. After 15 years, I finally burned out…really just when I felt I was becoming more effective with my students but trying to meet all the paperwork outcomes…ugh…and paper grading took time that could have been better spent with the students teaching. I’ve been a nurse for 23 years and worked in multiple settings…hospital bedside/ school/education/ and am a psych NP. The struggle is real in all theses settings. The value of excellent patient care is invaluable. You just can’t put a price tag on wisdom and experience of veteran nurses. Excellent article! So so true!

        1. Thanks for reading and for all your work for the profession. Something needs to change. This isn’t a business machine or a hospitality business. It’s more than that. The important people in charge need to realize this before it’s too late.

  116. I live in a very rural are 3+ hours from a ‘big city’. I have been married twice, and both husbands died from cancer. Saying that— I’ve had a LOT of experience with small town hospitals. Our nurses have been very caring, but the hospitals have changed hands many times. Each change has been a buy-out by another “for profit” chain and it has not translated into good medical protocols. I am grateful both husbands had great insurance which afforded us the opportunity to go out of the area for their critical care, but many of my neighbors are not as fortunate.

    1. I’m sorry you’ve had such an intimate view of hospitals but you’re right. Corporations are eating small hospitals and things are changing. It’s not necessarily good.

  117. I’m an LPN who went to nursing school later in life as a second career. I worked as a CNAII while doing my prerequisites (I already had my Assoc. in Science) and while in nursing school. I spent 2 years iin hematology oncology and one in an ED. I would give anything to be able to work bedside in a hospital. But, we are not wanted, we don’t have the BSN that is somehow to make a person a better nurse. It doesn’t. I am a well trained LPN and let me say nursing school was the hardest thing I have ever done and the institution and educators that taught me were top notch with a 99% state board pass rate. I can do most anything an RN can do at bedside. The one thing they can do and I can’t is be a Charge Nurse. We LPN’s don’t want to be charge nurses, we want to be out there on the floor doing what we do best, patient care. Let us back in the hospitals!!!

    1. I myself have never worked with LPNs and I truthfully don’t know the scope differences are. I do know that RN vs RN BSN differences aren’t huge in my experience. I think higher education is a good thing, that being said I don’t think that it dictates the quality or skill of the nurse.

      1. I have been privileged to work with some talented, old-school LPN’s. I believe they have a role in healthcare, and much to offer, indeed. And while I don’t disagree that education is always good, I disagree vehemently that a BSN should and must be an entry level minimum for bedside nursing. Those who rigidly insist on this are generally administrative types who couldn’t tell the difference between a bedpan and a frying pan.

    2. I was an LPN and frankly I thought the boards were harder for LPNs. There was more rote memory on boards. With the RN boards the tests were laid out in a common sense manner with scenarios. I used to work in a hospital as an LPN and there is very little difference compared to RN. I worked telemetry, Psych and floated even into ICU a few times. In school LPNs have to learn how to write care plans. In the hospital that was the one thing I couldn’t do other than hang IVPB and IVP drugs. IVPB LPNs could get certified for. So the only difference was IVP and care plans which we were trained in even more than RN school. We had care plans drilled into us in LPN school.
      There was so much redundancy in school and cross over with what was taught. A real waste of resources once again.

  118. It is true, the turnover is very high. New grads are hired, trained for 12 wks, Then work 8 or 9 months to have 1 yr. experience , go to another hospital, and get more money Instantly!

  119. What you also should have mentioned is that even older, experienced nurses are not being asked to precept or train for various reasons. Although I am one of the senior nurses on my floor (became a nurse at 48 and have been floor nursing for 8 years), I do not get asked to train new nurses. Most of the nurses on my floor have been nursing for half that time, but because they do not get overtime, they are the ones who train. I truly believe because I was an aide for so many years and am older, I do tend to be more thorough and careful, resulting in some overtime at times. I have taken the preceptor classes and have expressed interest in mentoring new nurses, but am never given an assignment. Who do the new nurses come to, though, when they have questions? Me. I have given up being upset about it, but gotta say it shows when they get out of orientation and aren’t doing basic things they should be like some of the charting that gets missed (did they learn about how important reimbursement is to a facility?) or how to work with your aide to get the most accomplished for the patient’s benefit (getting them up and moving). It’s too bad, that this is happening, and that facilities/hospitals are not taking a closer look at their finances and coming up with better solutions than hiring bonuses. You are so right—-many $s being wasted on training that is lost when the new nurse goes elsewhere for greener pastures.

    1. I haven’t found that personally in my hospital. Our senior nurses are exhausted from constant precepting so they’ve moved on to newer staff who aren’t so burned out by it. Plus there are a lot more middle-low experience nurses than there are with a lot of experience.

  120. Your job is what you make it. I’ve been a nurse for two years. I’ve never caused a pressure ulcer and a patient has never fell on me. It doesn’t matter if you have been a nurse for two or 20 years. If you are lazy and do not turn your patient, they will get a pressure ulcer. If you are inattentive, your patient will fall. Lets see a study on travel nurses who get a heavy patient assignment verses the staff nurses who get easy patient assignments and sit on their bums and online shop all day or night. Compare the patient care of them to a well staffed hospital with 2:1 patient to nurse ratios for ICU, 4:1 for telemetry, and 6:1 for floor nurses. Retention is key? Yeah, make a fresh nurse straight out of college sign a contract with a bonus only for them to find out a year later that if they leave they owe the hospital a percentage of the sign on bonus back. Get real. New nurse beware and be smart. 🙂 There are plenty of hospitals without retention plan strategies.

    1. I don’t follow your comment really. If you’re one person and you have a patient with C. Diff that needs q 30 min turns you can’t really turn them yourself if the unit isn’t staffed with people to help you. The travel nurses I know didn’t get dumped on. In fact if anything they didn’t get the sick patients they wanted. More like turn, water, feed chronics. Retention is key. Hospitals without retention strategies are clueless. I don’t really understand if you’re agreeing with the article or not. Sorry.

      1. The two year nurse does not have enough experience yet to even comment. I’m glad your doing a stellar job but because people get decubs doesnt mean everyone else is lazy. You keep up the good work than call me when you start getting dumbed on and are burned out. I give you 5 years.

  121. This is so true. I retired after 30 years in the field. I was only 50 but after so many years and all the physical demands my body was no longer able to do the job. I loved every day I went to work and wish I could still do it and I loved sharing all I learned with all the rookies we need the sharing of experience and knowledge.

  122. Jen-I am your article. I graduated over a year ago and am just completing my first year on a med-surg floor. I went to a really well respected nursing school and was hired right away on the floor where I had precepted. It was clear they really wanted me. I was thrilled to be hired, I am also one of those second career middle aged people. Well the honeymoon is definitely over. After a year of 12 hour night shifts, I have started to recently make some errors, mostly late meds, with no pt harm. I had previously been in the managers office to state that night shift had been taking a toll, I wasnt sleeping well and didnt feel right cognitively with focus and STM issues. I also requested a regular schedule which i’d never had thinking some regularity might help the sleep issue. Nothing has changed. We have recently been through a period of all time record setting admits and discharges due to flu/pneumonia winter related issues and the least healthy get admitted which means high ratios and skyrocketing acuity causing some patients that used to be ICU or IMCU pts to be on standard med-surg floors with standard pt to nurse ratios. Interestingly there is a confluence between my errors and this period. After being taken into HR a few things were clear, they dont care to hear about the acuity and pt ratio issues from the floor nurses, they know it and have no answer to it, but it is clear there will be blame assigned without taking into consideration all of the context. I did get them to admit that the onboarding/orientation was wholly inadequate, a joke really. The result is I am on a self imposed LOA because my mother did not raise a dummy, I dont want to be fired for issues that the employer is partially responsible for but wont admit, and most importantly I would never ever want to cause harm to a patient. I completely accepted resonsibility for my part in all of the issues involved, and at the same time I know I am a good nurse and becoming a great nurse with the experience and training. I absolutely love my profession and want to continue but I am very worried about the future. I so appreciate your well written and researched article, because it needs to become a frontline issue. I believe many nurses, new and veteran, suffer silently due to the state of bedside nursing. My heart breaks. Thank You

    1. I’m so sorry this happened to you but I totally commend your choice to put the patients’ needs above your own (as so many of us do) and step away when you know you need to. I’m sorry that the management doesn’t understand. It’s easier to put a bandaid on the leak in the dam than rebuild the shoddy dam itself. I hope you get a break and come back refreshed. Our patients need you.

    2. Do take care of yourself and do what you need to do to have a balanced life. Hospital administrators care about the bottom line and the humanity that should not only be directed at patients but staff also is happening less and less these days unfortunately. The pressure to keep doing more and more is unrealistic and thats part of the reason people leave the field. Its unfortunate because it is a great profession to be in but at a point you have to put your own needs first.

  123. Thank you for writing this, I agree 100% After 30 years of Neonatal ICU as a RN, I’m out in 4 months…….I will not miss what nursing has become…….

  124. Good, true article. I miss working at the bedside in the CVICU. I literally loved my job…I really didn’t want to leave. Unfortunately after being at the same facility for eighteen years, two years away from possible retirement, I had to leave because I couldn’t deal with my manager any longer. She would praise how hard myself and my crew had worked during the shift and then degrade me in front of everyone for not doing something “her way” in the same breath. You can only beat a dog so long before they won’t come back, I was her dog. New nurses are cheaper and easier to push around than seasoned nurses that will stand up to doctors and be that patients advocate. If your family or close friends end up in ANY unit…you should probably check on them often. I still miss my job.

  125. I am a teacher (retired) and there are many parallels in my profession as in nursing. We no longer put the student first, even though there is much lip service given to that. The bottom line is money and how to get more of it. Usually it’s for the people at the top. Most of how we are supposed to do teaching comes from people who have never spent five minutes in the classroom. But they are the experts! When we continually ask children to perform at levels that are two or three years beyond their mental and emotional capability then we are not for the children. When we never ask the teacher, the one who spends the most time with the children and best knows what they are capable of, how to teach them, but only hold her responsible when they don’t meet impossible levels, and we are not for the children. The experts are not interested in patient care nor real student achievement but where the next dollar is coming from. Why do administrators always make such huge salaries and those on the frontline little in comparison? It’s become all about $$$.

    1. It’s crazy how these two professions that really shape the future and health of our society are being run by people who don’t have a clue. Thanks for reading. Hope it gets better for all of us.

  126. After 30 years of pediatric bedside busting, albeit mostly part time , 20 years in general peds and 10 years in pediatric ICU, I advanced to a PNP in child neurology. I was experiencing uncontrolled hypertension mainly due to shift work and 12-16 hour shifts .
    Child neurology is a very underserved area particularly in more rural areas and poorly reimbursed. Primary care providers are not necessarily well prepared in this area as well as practicing defensively by referring. I managed my own slate of stable patients with multiple different diagnoses.
    I did my turn at the bedside and did not believe that I abandoned the bedside.
    After 30 years at the bedside at teaching institutions it was clear that there is a turnover, for the past 45 years. In these institutions it is the ” nature of the beast.” When dealing with mostly younger nurses there are the multiple factors besides not wanting to be at the bedside: career advancement, job not a good fit, spousal job change, starting a family, caring for elderly parents, etc.
    I am now retired almost 7 years and still miss nursing, in all its forms.
    As a profession we need to remember to nurture ourselves and each other.!

  127. Add the fact that a lot of facilities have decided that more experienced nurses with mere Associates degrees aren’t good enough for them and now require more advanced degrees. So a nurse with 20+ years experience without an advanced degree must resort to finding a job in a nursing home, while young, inexperienced nurses with their valued Bachelors degrees are being hired instead.

      1. BSN degree nurses have proven to show better patient outcomes and better nursing stamdards of care. Our hospital offers tuition assistance and scholarships for going back to school.

        1. I’m BSN prepared and would suggest anyone who is thinking of nursing to get their BSN however for a 50-60 year old nurse to go back for their BSN or else be forced to leave the bedside is ridiculous.

    1. This is me. I’ve been an ADN for nearly 25 years, and have extensive experience in Med-Surg, Cardiology, and ICU. But a policywonk in HR would be looking for a new grad who knows virtually nothing before they’d look at me, given my supposedly inadequate credentials.

  128. I actually was a bedside nurse for the past 32 years. I just left my position and went to home care because of the almost dangerous assignments I was given Yourarticleis Sopt on and it istruly a sad time in all of medicine I stay with any family member hospitalized now I believe it is the only way they will het safe accurate care

  129. Thank you for your very candid and honest description of the nursing issues we are facing in today’s world. I don’t know the solution either, other than hospital administrators getting their focus back on what is best for the patient and not the $$$ the hospital makes. Education like this increases awareness. Not only an I an RN (also ICU), but I am a nursing instructor. Seeing the excitement in the students’ eyes is wonderful, but I also try to make sure they have some concept of what they are going to face in the “real world.” Not an easy task.

  130. Great article Jen! We all have our own strengths and weaknesses… but to the person who chose to label this a “stupid article”.. and cited nurses “who can’t even handle EPIC”… well.. to that person, you COMPLETELY missed the whole point of this article. It’s YOU who I wouldn’t want taking care of anyone I knew! Because last time I checked, how efficient one is or isn’t has ZERO bearing on the thought processes going on between your ears. So to whomever made that comment, you go on and leave on time and let those of us who “struggle with EPIC” to clean up all the things that you missed. But I bet your charting is SUPERB!!!
    Sorry for being negative and I do understand why charting is legally important, however we all dropped the ball in allowing charting to become more important then the physical cares of the patient and in my humble opinion, that is exactly where we are today. I’ve seen it with my own eyes over and over again… Nurse A doesn’t take very good care of the patient, misses labs.. can’t think outside of a protocol to save his/her life but charts like a rockstar!! Nurse B took the extra time to talk to family or the patient about just what’s going on or maybe what to expect in the hours or days or weeks to come and fell behind on his/her charting. Nurse A will not hear a word about it…. Nurse B will be talked about for staying extra to make sure he/she “applied SCD’s for the 3rd time that shift” or that he/she “turned the patient every 2 hours”… or my favorite.. made sure to chart “how the patient slept last night in the ICU”. How do you think they slept while getting Q1H accuchecks and the NIBP cuff going off every 15 minutes??? I’ll take the competent nurse who actually truly cares and has empathy over the nurse who charts perfectly!! Again.. sorry for being negative, but that reply struck a nerve and I had to reply to the reply… ha! Again… great article Jen… we need to see more and more of these and maybe, just maybe somebody with some leverage will start to get the message and change can begin!!

  131. I have done so much research on this issue and no one has any real solutions. We have tried bonuses, no weekends, offered onsite daycare, more ancillary staff, tried numerous moral activities etc. I could go on and on. Everyone talks about money but that incentive only last so long they still leave because the stress is too much. If anyone has some truly honest things that has worked I would love to hear them not just management needs to do more. Real solutions. Go!

      1. Ok on my floor our ratio for 24 patients 10 nurses and 3 care partners. That is a ratio of 3:1 for RN and LPN to help task, a charge nurse and 1:8 ratio for care partner. Those are the best ratios I have ever seen on a intermediate stepdown unit and yet we still can’t keep staff. We run short most days because we can’t keep staff. I came to this unit because it is the best unit in the whole system. Before I transferred I was in the float pool and traveled all the units in four different hospitals. So even the best unit in the whole sustem can’t keep staff and it has the best patient to nurse ratio. This is my frustration we have implemented what
        everyone says they want but we still can’t keep staff.

        1. How’s your acuity though? My unit is great for keeping with ratios but the acuity of these pairs and triples in ICU is outrageous. Are nurses doing fifteen peoples jobs? We empty trash on nights. Are there staff without an assignment to round for help? Do nurses get breaks? Does the charting system and pharmacy suck? My thing is, if the acuity is out of control and the nurses are functioning as multiple roles without support than ratios are just that. I don’t know your unit. I’m impressed with all you’ve offered in the comments and I know you’d have people staying where I’m at if we had child care options and LPNs to help. There’s something more to it it seems.

  132. Thanks for your insightful article. I worked as a nurse for almost 40 years, after which I qualified for disability ! By the age of 45 I needed lumbar spine surgery. At 57 and 59 respectively, I had total hip replacements. Talk about a career that literally wears a body out !?
    I loved my work, when politics could stay out of it. And I loved my patients, from the newly born, to the frail and elderly. I miss them. Ultimately I am comforted with the assurity, that I did indeed make a difference.

  133. I Work as a P.S.W. In a long term care facility that is attached to a Hospital. I personally know many of the RN’s and RPN’s past and present. Majority are amazing and go above and beyond what ever gets noticed or recognized. That being said my coworkers and I have discussed many times that the student RN’s (mostly) because they work as PSW’s after a year of schooling are full of additude and lazy beyond belief and a lot are lacking common sense and bedside manner! I am an intelligent woman and look up to and respect many of the nurses I know and work with. Exampl…. I was training a second year R.N. Student. I was helping an elderly lady(that could not be left alone) get cleaned up because she was incontinent. The student came in and told me another lady was coming down the hall naked. I asked her what she did and she said “I’m telling you”. So I asked her to go bring the lady to her room and get her dressed. Her exact words were “I didn’t go to school to have to do this shit” and refused to do what I asked. All I could think is what a horrible R.N. This girl was going to be. I have had many experiences like this with the younger students and it makes me sad!

  134. Nurses who think they know everything when they have barely any experience, are dangerous and lacking in compassion, empathy and most importantly knowledge. You have no clue as to what us “older” nurses are capable of doing. Epic, sunrise, Cerna, and meditech are simple enough. The challenge is in keeping patients alive and knowing how to do CVVH, Titrate drips, auscultate lungs sounds and have beside manners. I’ve worked in the military, ICU, ED and Acute dialysis. I can run circles over new nurses and have trained those new ones to become great nurses. New nurses who THINK that they are better than us “older” nurses, gives our profession a bad taste. You could learn a lot from simply listening and not feeling so overconfident in your abilities to use a computer system.

    1. Jen,

      I was wondering if you could site the articles you were referring to. I am on the research committee on my unit and would love to share these articles with my fellow ICU nurses and management.

  135. I am now a retired BSN, RN and began my nursing career in ’84. I was a very dedicated nurse, often volunteering for double shifts, often sacrificing many holidays, birthdays and get togethers because of work. Ok I was quite often asked to mentor new new nurses just starting and was quite often sought out months or years later to tell me how much they had learned from me. I was always a “teacher” to fellow employees and students alike. I loved learning new things. As the years progressed, and everything became more automated,,,from documentation to medical records to medication passing. Everything soon became all involved with sitting or standing at the computer and spending less and less time at the bedside. By the time I retired, I was spending only moments a day at the bedside and the nursing care tech and LPNs were left with doing most of the work. After I retired, I did some work for an agency and was frequently called to a long term care facility to sit with ONE patient just to give him his meds. One change of shift, I was talking to an off-going person who was giving meds. I just asked her why she couldn’t give out the narcotics that I was giving the patient? Now folks this is the way it is in most nursing homes in FL: in most NH, she told me there is no licensed staff after 4pm. So, there is no one to give our controlled drugs. I asked her well How do you treat high BP or blood sugar and she said we don’t. I wonder if the fmily members are aware of this?

  136. As I was reading your article, I immediately began thinking how so much of what you were saying also applied to the field of education! While reviewing the comments and thinking about how I wanted to reply, I was pleasantly surprised to see that other educators had read your article and drawn the same correlations. I am in my 20th year of teaching and have taught all grade levels. Spent 11 years in public education, grades K-12, and now teaching on the community college level. With the continuous budget cuts, lack of qualified candidates, entitlement issues that get worse every day, and an overall lack of appreciation for the little things we do each every day, it saddens me to say I see the situation getting far worse before anything positive starts to effect change. I couldn’t agree more with the comments regarding how the administrators who are receiving the ridiculously high salaries, have absolutely NO CLUE what is actually happening in the classroom or in the patient’s room. It angers me even more that lawmakers, who have never stepped foot in either of these environments and can’t even handle balancing a budget, are making the majority of the decisions that directly affect us, which in turn affects the student/patient. I love what I do and have always planned to teach for 40 years. But, having been where I am now for 9 years, I’m learning that won’t be an option for me. At some point, either my position will be eliminated and/or I will be forced to accept an early retirement buyout. The real people who lose in this type of situation are the students and patients. Enough already!!!!

    1. I hate that it’s so relatable. It’s so sad for our families and our kids. Thank you for your service to the profession. I’m at my wits end as well. I hope something can change.

  137. Are you proposing you have to have “years of experience” to be competent? I would disagree.

    -Three years of nursing experience

    1. Not at all. I know third year nurses who are far more capable than some 10 year nurses. That being said it’s more related to their personal accountability and willingness to learn. Some are just smarter. Hate to say it that way. However usually these nurses were taught by really good preceptors who have been nurses for a long time. There are standouts and mediocre nurses at every level. Years don’t make the nurse. I used to get so angry when I was 3 or 4 years into the ICU and I knew more than some people twenty years my senior and people assumed I was young and new. I’m asserting that those (young) good nurses are leaving as well. The bedside is killing all of us. If you’re a good nurse at year three think of the rockstar you’d be at year seven. Sadly everyone is leaving and seven to twenty years at the bedside is a thing of the past.

  138. What an exemplary article! Having just lost my father after 3 weeks in a famously accredited hospital where I had to literally beg them to shave him after 4 days and being told the razor wasn’t good I had to contact the nurse manager to get basic nursing care done! Where are the preceptors? I moved on to home visiting after27 years of backbreaking work but my goal is to volunteer in a hospital if I remain healthy enough to do so! The caring difference no longer exists! Don’t get me wrong there are a handful of caring nurses left but something is getting lost in translation!

  139. I’ll try to keep this comment brief – 2009 my husband had a mild heart attack, transferred to Johns Hopkins University. As a nurse, I knew what to watch for, generally. The scheduled surgery went great, the SICU was marvelous. However, when he was moved to the regular medical floor, he received NO attention. One day an RN came in once at 9a, once at about 5p, both for medications. (I can’t report night activity.)Additionally, his room and bathroom floors were filthy. I bathed him, shaved him, fed him, watched his IV site, maintained his I/O, changed the linen on the bed, and literally, literally washed the floor which was black with dirt. Looking out the Johns Hopkins window to enjoy the view, I looked down and there were about 20 housekeepers sitting on a concrete planter, smoking cigarettes. The number #1 Hospital in the nation? I hope it’s improved.

  140. Unfortunately, this is not a new problem:

    – During my father’s hospitalizations in 1999 (CABG), he would never have been ambulated, bathed, or had his bed changed if my retired-RN mother hadn’t been there.

    – When he had an abdominal aneurysm repair 5-6 years ago, the surgeon wrote orders to d/c his IV, catheter, and NG tube. When he returned 2 hours later, none of it had been done. How many patients did his ICU nurse have? One, my dad. And don’t even get me started on the “bath” he had to give himself 24 hours after surgery with an 18″ incision. They didn’t even give him a call light, and of course, he couldn’t call for help because he’d just been extubated.

    – When my husband developed CHF a few years ago, he was admitted to be dried out. They drained >6 liters of fluid off him. I finally went home the night before he was discharged, thinking he was safe. Wrong. I came the next morning to find a half-full bag of IVF hanging. It was the 2nd bag. When I turned the air blue expressing my displeasure, my husband said he had questioned the order, but the nurse said… are you ready for this? “Because the doctor said so.” She didn’t even question the order! He spent an extra 1.5 days in the hospital because of it. And you can bet I didn’t go home.

    These are only 3 of the many experiences we’ve had in the last 20 years as my family has experienced strokes in a 28 y/o, multiple heart attacks, breast cancer, miscarriages, and more. The frustrating part is that when I tried to get a clinical job again (about 10 years ago) after raising my children, no one would even interview me. When I dropped into one hospital to see if I could find out why, they actually admitted that they would hire a new grad in ICU before they’d hire an experienced nurse and update her on the new drugs/protocols. I wasn’t trying to get into a new specialty. I was trying to go back to the area I’d worked in previously. Blows my mind.

    1. It’s frightening. I don’t know what is worse, to be aware of the problems or totally clueless. I swear they hire the newbies because they don’t understand how bad the situation is. We have something to compare it to. They don’t.

  141. EVERYONE SHOULD READ THIS Including the stupid hospital administrators. When people start dying and the lawsuits start rolling in perhaps they will take notice

  142. Those today in colleges do not get the training at the bedside to be a good nurse. The excuse is they are training for management and that the nurse will get their training by the hospital that hires them. Then what are they going to college for? We have lost with this attitude on the so called better education. They need to go back to the basic 3 year hospital training we had before. Learning to write research papers and statistics is not basic nursing. . The patient suffers the most. Loved being a patient with a foley in and it hadn’t been emptied all night When calling for help, they told me it was removed yesterday and that just walk into the bathroom and go. They think the trick is to just write it in the chart and it is so because it is in black and white on computer. There isn’t any real discharge instructions either. They tell you the homecare nurse will do that. By then it is too late for that family of the patient or for that matter the patient. BRING BACK THE REAL NURSING 3 YEAR HOSPITAL TRAINED NURSE. THEY ARE DYING OFF .

    1. As a college trained nurse I’m really proud of the science background I received. That being said the majority of my bedside training came from the bedside. I think with quality bedside training they can complement each other but the two year track to grad school nurses are not helping the situation I agree.

    1. I’ll check it out. I don’t think moving from the bedside should be the case. It seems to be the trend to the patients detriment unfortunately. Looking forward to reading your article.

  143. I am approaching 40 years of being a bedside nurse and will retire next year. Many of us forget that nursing is or should be a calling that we love and respect. I can honestly say that I have never been burned out, and I have seen almost every difficult situation there is to see and I still love it. Every profession has difficult challenges but at least with nursing we see lives saved and lives changed. Keeping a positive attitude and an attitude of continuous learning is key. We are blessed in our hospital as we recruit well, train well and even encourage moving on if that is someone’s dream. Our patients get safe and excellent care because we mentor until a new nurse is confident and ready and we support seasoned nurses if they find floor nursing challenging. I have been at my current hospital for 31 years and I would not change a thing. Nursing is a blessing, don’t forget that and don’t forget those experiences we have with patients, at the beside, that we will not get anywhere else.

    1. I’m glad you feel this way. I want to come work where you work! We do make a difference, I unfortunately feel my experiences have been less frequently positive than I would like. Thanks for reading and your positive perspective.

    1. I’d like them to stay. I’d like retention for nurses at the bedside. So that “green” nurses get experience and experienced nurses stay.

  144. Nursing needs to go back to team nursing. Having been an RN for over 40 years and an LPN for 14 years before that. Having to be an in patient frequently because of MS . I have experienced the declined of bedside care first hand. It is cost in loss of life and increase in healthcare cost due to lack good,safe prudent nursing care! 3yr nursing program was the best . LPN at the bedside also followed by an aide. Not by a 6 week CNA that comes in takes your vital signs and leaves! No one should ever be left alone in hospital today alone . Question everything!

    1. I wonder why hospitals haven’t looked to employ LPNs more. It seems like a wasted opportunity to help deliver more consistent care.

      1. As many look to strive for “magnet” status, sadly they leave the LPN option completely out. Hospitals want more BSN and MSN prepared nurses to make them “look better”. Not always the answer!

        I am a military nurse and 9/10 times you have a nurse with less than 2 years experience training a new grad. We have high turnover, but we know that if we train a nurse good, they move on to another military facility to grow and develop further on the skills we’ve shown them.

        Being a nurse 11 years, I see it as a generational problem. Most young people look for the instant gratification (bonus) and jump facility to facility looking for the best deal. Not thinking about their retirement or long term plans.

        TOTALLY love my profession and now being a CNS, but always looking for ways to help empower, intrigue and ignite that education, pursuit of personal development in my nurses to help retain.

  145. When did nurses get forced to turn into data entry clerks…and WHY do they put up with it! Where is your professional dignity ?!?

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