I don't think that there is a single hospital that isn't understaffed. We have a major problem in America with retaining nurses, and it's led to a nationwide nursing shortage. It's gotten to the point where hospitals are now starting to utilize Licensed Practical Nurses (LPNs) at the bedside again, because they cannot hire enough Registered Nurses (RNs) in order to fill their needs. This isn't a new problem, it's been present for a few years now. But why?

One theory is burnout. Nurses can only handle so much before it becomes next to impossible to enjoy going to work, much less enjoy caring for patients. And when you're a critically or acutely ill patient, the last thing you want is to be cared for by a nurse who currently hates her job and is just trying to make it through her shift. Burnout robs nurses of their joy, and it robs patients of the compassionate care they desperately need. The nurses who used to think they were fulfilling their calling by working are now the nurses who see work as more of a burden, and a means to an end. But the question is, does burnout lead to lower nursing retention, or does lower nursing retention lead to burnout? It could honestly go either way.

If you have nurses who are burned out and don't want to stick around, eventually they won't. And that will leave units and floors short staffed (or more short staffed), with even higher patient to staff ratios. However, when your unit or floor is chronically understaffed, you have nurses who are constantly dealing with those higher patient to nurse ratios. Not only do they have more patients to care for, their patients are all fairly sick. Patient acuity has increased throughout the past few years, which can be a big problem when there is a lot of pressure to get patients out of the hospital to make room for others who may be sicker. The patients that should be staying for a few extra nights are sent home, and a lot of times they end up being readmitted. Frequent readmissions aren't good for the patients, they aren't good for the nurses, and they aren't good for the hospital.

From the patient's perspective, not only do they get more medical bills, they are also put at a greater risk for developing new infections each time they come into the hospital. And while it might seem convenient, in a sense, to develop a new infection while you're already in the hospital, the ability to be treated right away is overshadowed by the fact that the patient came in for one thing and a new problem has just been added. Hospital-inquired infections are a big deal, mainly because they can be prevented. And a lot of times, the bacteria causing these infections are resistant to a lot of different antibiotics (if you were a bacteria in a hospital setting, surrounded by tons of different drugs, you would be multi-drug resistant too!), which makes treating them much harder. It's harder for the patient, because we have to use super strong antibiotics to kill the bacteria, and those drugs can be costly. It's harder for the nurses caring for the patient, because the patient's acuity has just increased some, and giving antibiotics in a timely manner is a priority for that patient's care. In addition, if this is a patient who has been in and out of the hospital, especially on the same unit, that can be both a blessing and a curse.

It can be a blessing because the staff will be familiar with the patient...which can also be a curse if they're TOO familiar with the patient. The patient might be referred to as a "frequent flier" which takes away from the patient's humanity because he or she is now being viewed as a bit of a burden. If you have patients who are frequently readmitted, you might have heard this conversation during report, or one similar to it.

Day shift RN: "So Mrs. _____, she's back AGAIN with the same old stuff. We discharged her two weeks ago and she came back in three days ago for the same symptoms. But get this. Now she's under contact precautions for MRSA, AND potentially has a catheter acquired urinary tract infection."

Night shift RN: "Well she made it a week and a half, that has to be some kind of record for her. But ugh. I was hoping we would have a longer break from her. Every time she comes in she's more agitated than she was the last time."

Day shift RN: "I agree. And the doctor STILL didn't put in for Ativan or anything. And now she's getting three different antibiotics around the clock. You're going to be in and out of her room the whole shift. Anyways, have a good night!"

Hopefully this is more of an exaggeration than what shift report is actually like in most hospitals, but the point still stands that when you treat people as their disease process rather than a person, it dehumanizes them. We tend to forget that patients are people too, and view the work, not the person. And I'll admit, it is easy to get too focused on checking things off of your to-do list, especially when you have sick patients with lots of orders to be completed. But taking just a few minutes to spend the time talking to your patient, and showing that you aren't just checking stuff off, that you really care about them and want to know how they're doing..it's going to mean the world to them.

Nobody wants to be stuck in a hospital bed. It's a foreign environment, a lot of freedoms are taken away, and privacy is impeded by the multitudes of medical personnel coming in constantly. Being constantly poked, prodded, stared at, having doctors talk to each other about your disease process and prognosis in front of you...that's dehumanizing enough. Imagine if you had to deal with that multiple times a year due to frequent readmissions. You're constantly in the hospital, nothing's ever completely fixed, you develop hospital acquired infections, and every time you come into the hospital you wonder if you're going to leave in your car or in a body bag. Wouldn't you be a little agitated too?

In addition, not only will the hospital get dinged for a frequent readmission, they'll also get dinged for a hospital acquired infection. It all comes back on the system, and some insurance companies will refuse to pay the hospital..resulting in the hospital absorbing the cost of care for the patient. And when it's multiple patients that are frequently readmitted and develop hospital acquired infections, it spells financial trouble for the hospital. If the hospital's finances are going downhill, that means pay for nurses might as well. Either they reduce pay (which NO ONE WANTS), reduce bonuses, or reduce staff so they don't have to pay as many people. Reducing staff doesn't necessarily mean firing people, but it can mean that staffing ratios will have to change. Units will have to call in fewer nurses for more patients, in order to save the budget. Which results in higher patient to nurse ratios, with higher acuity patients. It's a vicious cycle of suckiness, to be honest. Is it really any wonder so many RN's are going for their Masters in Nursing degrees as soon as possible? They want to get away from the bedside. It doesn't matter if you've been at the bedside for two years or twenty, bedside nursing is a lot of work. It's exhausting, and when nurses are exhausted, patient satisfaction and safety are going to become big problems.

Nurse managers don't want to hire nurses who have the mindset that they'll work somewhere for a year, and if they hate it, they'll leave. They want to hire nurses who will stick around for a while, because high turnover rates are truly problematic. As a new grad RN, I think that mindset of "if I hate it I can leave" has become more popular among the newer nurses. It's the mindset of, "I'm just going to finish orientation/nurse residency and get the heck out of here," or "I'll put in my two years and then I'll travel and make more money." But the thing is, did you think about what that was going to do to your unit? To the hospital that just sank thousands of dollars into your orientation? There's a big difference between the mindset of nurses who have been in the same place for 20+ years and the nurses who are just starting. I don't know if the problem is that my generation doesn't truly know what we want, if we get bored too easily, or if it's wanderlust...but we seem flighty and that's not a good thing.

“You can only become truly accomplished at something you love. Don’t make money your goal. Instead pursue the things you love doing and then do them so well that people can’t take their eyes off of you.”

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

"The desire to reach for the stars is ambitious. The desire to reach hearts is wise."

I hope you read these three quotes from Maya Angelou and really thought about their meanings, and applications. I know I did. And the thing is, if I truly believe that nursing is a calling, then I should be thinking about these things often. Do I truly love being a nurse? Do I show up to work because caring for my patients provides some sort of fulfillment, or do I show up for the paycheck? How am I affecting the lives of my patients? Do I consider how my actions and attitude will stick with them beyond their stay in the hospital?

For me, being a nurse is more of an honor than it is a burden. As a nurse, I have the privilege to walk alongside patients during some of their worst days, and some of their best. I've been present as people have come into the world, and as people have left it. I love my job, but I'm not going to deny that it's hard, and can be exhausting. And a lot of it is due to higher patient acuity. In the ICU where I work, higher patient to staff ratios aren't as much of a concern as they are on med-surg floors (6-10 patients per nurse on some, whereas we have 1-3 per nurse), but when you have higher patient acuity, and a lot of patients for not a lot of nurses, it can cause some serious problems. Whether it's burnout or boredom that is driving nurses away from the bedside, something needs to change, and fast.