“If they believe they can sweet-talk us with just a few bucks—they got it coming.”

Norma X. is a very qualified and smart Critical Care nurse that has been seriously considering retiring from the profession after more than twenty years off service due to the physical and mental exhaustion after two long years of pandemic. Management is desperate to keep her, not only to continue taking care of seriously ill patients, but also to guide the young nurses that seem to be entering the career with less knowledge and experience than before to meet the increasing demand. She scoffs at the array of perks they try to entice her with to sign another contract. She confessed to us that she is only dreaming of her retirement in easy Key West with her hubby and two dogs (their grandchildren can visit them but only once a year)

All health care providers know that nursing personnel is the main pillar of a modern Health Care Delivery system, usually more important than the medical corps itself. Most public and private delivery organizations have the strategic imperative of retaining them, and what is more important, to keep them happy in their careers. After the 2008 recession, rates of  unemployment rose in all the economy sectors and some experienced nurses delayed their retirement to account for an increased living cost. At that time retention of nursing personnel was not a problem and institutions were not hiring the new graduates. Now the tide has turned as the new clinical demands of a protracted COVID-19 pandemic has strained the human resources of many hospitals and clinics in the USA. Newly graduated nurses are in high demand but that brings new operational challenges to policymakers and administrators.

Training qualified nursing personnel is very expensive, approximately amounting to double their yearly salaries; institutions cannot afford to have a normal 2-3% staff turnover without suffering the consequences. Their four main reasons to quit are:

  1. Excessive patient workload, worsened during the pandemic,
  2. No scheduling flexibility to accommodate the family life obligations.
  3. Sub-par financial compensation that stresses their family budgets.
  4. Professional frustration due to the lack of continuing education possibilities to advance their careers inside their institutions.

As the exodus rises, the remining nurses inherit heavier workloads, which in turn entices them to follow their colleagues to the exit doors, and so on. A vicious circle. Moreover now large institutions, desperate to cover their many vacancies, are hiring increasingly younger graduates, who have the highest attrition rate in the first year. To meet the market increased demand for nurses, their licensing requirements have been streamlined and the novel nurses get their badges much earlier than before. The rookies are increasingly being deployed in highly critical areas where there is a lot of stress and require clinical knowledge and expertise that they do not yet possess.

Note. This World War II Navy recruiting poster was taken from Wikimedia Commons.

These novel nurses must be paired with an experienced nurse providing emotional support and clinical expertise to the newly entrants; checking on them in a regular basis and simply by “being there for them” will boost the morale of young recruits. Now these “support role” has been systematically developed into protocols by the American Associates of Colleges of Nursing that established the Vizient/AACN Nurse Residency Program to support the entry-level nurses as they transition into clinical practice. The evidence-based curriculum focuses on three critical areas:

a) Leadership Skills and Pathways.

b) Patients’ Good Outcomes.

c) Continuous Professional Development.

A not-so-well-kept-secret-of-the-caring-professions is the mendacious role played by some old-timers in the nursing profession that systematically harass and demean the rookies, perhaps trying to make them pay for “sins” committed by physicians, in a classical example of what Sigmund Freud described as a displacement mechanism that we fully discuss in our new book Emotional Frustration – the Hushed Plague. The horizontal abuse of colleagues must stop, and senior staff must be vigilant. Because most of these recent nursing graduates are young ladies a little bit too shy for their own good, who prefer to quit their jobs in silence rather than complain. The formal mechanisms to report labor abuse must be operational and easy to access.

Of course the salaries and perks of Nursing personnel must be raised to make them closer to what physicians actually earn in the public and private institutions. But more importantly the feminization of the Health Care workforce has given new impetus to the longstanding demand of nurses that management should consider the family life of their employees by offering more flexible scheduling and coverage. Promoting a healthy, inclusive, respectful environment will certainly impress nurses.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.


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