S/o healthcare shortages

[TexasProud]

nm

Edited October 16, 2021 by TexasProud

[HomeAgain]

I propose we have health care workers we can count on to be proactive about health instead of people who believe all sorts of alternative facts or who won't educate themselves.

I.don't.want.my.health.in.their.hands.  They need to move to a different profession.  If it leaves us short, that's better than people who are not up to date on health practices or who would not take care of their patients correctly.

Eventually when they find their employment options curtailed, they may end up realizing they should have not have thrown away their careers.  We need to stop entertaining poor education.

[Katy]

There's been a shortage of all healthcare workers for decades, this is just the straw that showed it off to everyone else.  Because there aren't enough slots open for education. Force schools and the medical association to triple the slots in training programs to correspond with the growth in population and we'll be back to layoffs again.  So would lowering the price of schools by providing loan programs that ACTUALLY pay off the loans with public service or lowering the price of tuition.

It would also help if funding wasn't tied to customer service ratings so nurses are glorified waitresses when it isn't a pandemic.  And if doctors had enough time to actually meet with patients instead of rush them through conveyor style.

[73349]

Well, ironically, letting unvaccinated ones continue to practice will lead to more deaths in the field, so that doesn't help either. (Reportedly at least 3600 died of it last year, out of the US's 600,000 deaths.)

I think it's a great time to listen to nurses in particular about drawbacks of their work and fix them & create incentives for more people to pursue that career.

[TravelingChris]

I want all nurses to have BSN degrees or more.  I have met good nurses and I have met completely ignorant nurses.  It just doesn't seem to me that you can get enough education to be a nurse with just an AA degree. 

[TravelingChris]

I don't know what is going to happen.  Apparently half of Chicago police are not vaccinated and refuse.  I can't see firing half of the police force in a city where so many innocents are dying every week.  

[prairiewindmomma]

Open more training slots for nurses and other health care workers

pay workers appropriately (the disparity between “regular” and travelers right now is crazy!!)

staff at safe ratios, let people have actual breaks and mealtimes and vacation pay 

end abusive administration practices

provide more security so nurses don’t have to deal with abusive patients and family members

ETA: cut the cost of education for doctors

change the pay structure for procedures etc

Edited October 15, 2021 by prairiewindmomma

[MEmama]

A lot of the reporting is hyperbole, I’ve noticed. Insert panicked headline about how healthcare workers will quit in droves over a vaccine mandate, but when push comes to shove (ie they either want to work in their field or not), very few are actually refusing the vaccine. Same with airline employees. The headlines are all (political) bluster but they don’t match the reality.

I would venture a guess that we are losing far more healthcare workers from burnout, mental health, and abuse as a result of unvaccinated patients than vaccine mandates. So let’s start there—wanna fix the problem: get vaccinated and stay out of the hospital!

FFS.

[LinRTX]

6 minutes ago, TravelingChris said:

you can get enough education to be a nurse with just an AA degree.

Well actually the RN is just an AA degree. My daughter is an RN through the community college. She had more clinical hours through her school than the schools around us that have the BSN degree. She is working on her BSN right now, only 2 more classes. It really is just a lot of papers and reading research. I don't think it adds alot to the degree. And in the rural town she is at now most of the nurses are LVN's.

[TexasProud]

nm

 

Edited October 16, 2021 by TexasProud

[HomeAgain]

15 minutes ago, TravelingChris said:

I don't know what is going to happen.  Apparently half of Chicago police are not vaccinated and refuse.  I can't see firing half of the police force in a city where so many innocents are dying every week.  

I wonder what would happen if they started firing them.  I mean, honestly.  With mandates those willing to risk a hard line is something like 1%.  If the line feels soft, it's much higher.

I don't want cops who think they're above the law.  Fire them in one fell swoop and see how many reapply after getting vaccinated so they can work with the public.

[TexasProud]

On 10/15/2021 at 4:07 PM, MEmama said:

A nm

nm

Edited October 16, 2021 by TexasProud

[TexasProud]

On 10/15/2021 at 4:16 PM, HomeAgain said:

nm

 

Edited October 16, 2021 by TexasProud

[TexasProud]

20 minutes ago, TravelingChris said:

I want all nurses to have BSN degrees or more.  I have met good nurses and I have met completely ignorant nurses.  It just doesn't seem to me that you can get enough education to be a nurse with just an AA degree. 

Ok, that is fine, but we don't have them. So now what? And how do we fix the shortage while we figure out how to open up more of those training positions?

[bolt.]

In my (Canadian) opinion, the amount of healthcare that can be *safely* offered to a population *is* the amount of healthcare that can be offered to that population.

If that amount of supply (qualified healthcare workers who do not pose a known risk) does not meet the level of demand (people in need of care)... then you have a healthcare crisis. That means people suffer and sometimes die. It does not mean that offering healthcare from risky and unsafe personnel should be approved as a reasonable stop-gap measure. (We wouldn't approve reinstatement of doctors who had lost licenses due to malpractice, nor would we bring in untrained volunteers, well-intentioned veterinarians, or nearly-qualified students -- as examples.) On the contrary, the usual responses to a healthcare crisis are to reallocate resources and qualified personnel from less urgent, less life-and-death, or other locations within the healthcare system to work in the crisis areas. It also usually involves over-reliance on existing personnel (ie working overtime).

In the long term, incentivizing people to become qualified for these careers is a good idea. We can see now that running a healthcare system "efficiently" in non-crisis years means that when a crisis hits (ie a pandemic) we find ourselves awfully close to the wire. That means if we fill all our beds and use every staff person maximally just to run everyday operations, there is no capacity to expand the system according to a sudden need. This should stop. We need to be comfortable with everyday operations involving unused equipment, empty beds and excess staff hours -- on an ongoing basis. We need *margin* for an event like this.

In my opinion an unvaccinated person working in healthcare, it's not that "they don't deserve to work in the healthcare profession" -- it's that it's simply not safe for them to work in that setting, providing those services. They are a hazard, and need to be kept away from people they could accidentally damage in the course of their duties.

[Bootsie]

I don't know enough about the industry to propose solutions.  But, trying to understand the problm better, I have a number of questions.  Is the healthcare worker shortage across the board, or is it primarily in certain types of care and in certain locations?  Is the shortage due to those who are trained choosing not to work in the profession (in other words if all of those who were trained  were working, would we not have a shortage?)  Or, is a lack of trained people the root cause of the shortage?  Knowing something about those issues would help inform what would be helpful in designing a solution.

[TravelingChris]

12 minutes ago, TexasProud said:

Good suggestions. Well, as I mentioned, they are paying all the nurses the traveling wage and it is bankrupting our hospital and they still cannot find enough.

So how do we as individuals open up more training slots? 

 

The B and B owner of the B and B we stayed at over the Labor Day weekend was saying that her daughter, who is a nurse in Atlanta, was working in the ER and the hospital was going to lower her wage.  This was while they were paying traveling nurses much higher wages.  She quit, became a traveling nurse and is back working in the same hospital. 

It is an insane hiring structure.

[Rosie_0801]

22 minutes ago, TravelingChris said:

I want all nurses to have BSN degrees or more.  I have met good nurses and I have met completely ignorant nurses.  It just doesn't seem to me that you can get enough education to be a nurse with just an AA degree. 

I have two aunts who are nurses. Both think the one trained by the apprenticeship method was better educated. Maybe the training programs need to begin this way, since it gets people going in the job quickly. Then, further training could be added in smaller modules, so people aren't being held back from performing new responsibilities because they haven't completed an entire degree yet. Or allow RPL, if you've learned on the job. I mean, if all the senior nurses on your ward have supervised you in some procedure and are confident in your ability and knowledge, why not skip right to the assessment and get the box ticked?

I don't actually know how nurse training works here, let alone in the US, so I'm really making things up here.

[MEmama]

10 minutes ago, TexasProud said:

Ok, I AM vaccinated. That was not helpful. And I am reporting people I actually know. My husband is a doctor. Please don't respond unless you have something I can do. Thank you.

I’m sorry—my reply wasn’t directed at you personally. I *know* you are concerned and doing the right, helpful  things. ❤️
 

In general though, it’s not reasonable or appropriate to expect random individuals to fix the system. As has been mentioned, the problems are decades deep; they just get exposed to the rest of us in dire times like this (similar to the Black Lives Matter movement— it took specific, tragic events to open up white eyes to the systemic racism that has existed for all time). 
 

Others in the know have explained system changes that can and need to be addressed.

[TravelingChris]

12 minutes ago, TexasProud said:

Ok, that is fine, but we don't have them. So now what? And how do we fix the shortage while we figure out how to open up more of those training positions?

Over here, the problem isn't nurses as much as we don't have enough doctors, hospital space or any type of health care workers.  As someone said, we need to have more medical schools, more educational benefits to add healthcare workers and help supplement the education of so many of the ones who are already in place, and in my state and apparently about 30 others, we need to get rid of the stupid rule that says we have to go through a Mother, may I process to expand or open new hospitals.  My city is growing by leaps and bounds- we need more hospital space.  

And for all the so-called in and out surgery clinics, there are a lot of people like me.  I am having a spinal surgery next month and I will have to spend the night at the hospital versus many of his other patients- it is because I am a much higher risk patient. 

[regentrude]

24 minutes ago, TexasProud said:

Ok, I AM vaccinated. That was not helpful. And I am reporting people I actually know. My husband is a doctor. Please don't respond unless you have something I can do. Thank you.

Huh? Are you in a position to do anything about the healthcare shortage?
Short of training to be a health care provider and applying for a job, I don't think there is anything any of us can do. I am very confused by your post.

Edited October 15, 2021 by regentrude

[Katy]

39 minutes ago, TravelingChris said:

I want all nurses to have BSN degrees or more.  I have met good nurses and I have met completely ignorant nurses.  It just doesn't seem to me that you can get enough education to be a nurse with just an AA degree. 

This is pretty misleading because to get that AA degree at a community college takes at least 3 years, if not 4, because of waiting lists. Going on to finish the BSN at a university may give you another year of classes but it’s not much about patient care or science. It’s mostly case management and nurse management. 

Also, plenty of MD’s are crazy conspiracy theorists. It probably has more to do with personality and media consumption than education. 

Alternatively, hospital affiliated schools provide very little liberal arts education. It’s largely very practical.  And I agree they tend to produce very good nurses.  Less theory, more reality. 

[TravelingChris]

3 minutes ago, Rosie_0801 said:

I have two aunts who are nurses. Both think the one trained by the apprenticeship method was better educated. Maybe the training programs need to begin this way, since it gets people going in the job quickly. Then, further training could be added in smaller modules, so people aren't being held back from performing new responsibilities because they haven't completed an entire degree yet. Or allow RPL, if you've learned on the job. I mean, if all the senior nurses on your ward have supervised you in some procedure and are confident in your ability and knowledge, why not skip right to the assessment and get the box ticked?

I don't actually know how nurse training works here, let alone in the US, so I'm really making things up here.

I would be all for this.  My point isn't to turn away nurses who have AA degrees but that should not be the end point.  And just to point out, I have met stupid doctors too- usually ones who didn't know enough and were arrogant to boot.  But that is what I am talking about with nurses too- ones who are ignorant and then also arrogant.  So I guess it isn't necessarily about education though I have met only good nurse practioners who are nurses who have Master's degrees or maybe even more education and who often know more than doctors.

Like the idiot doctor who I saw in the hospital about six or seven years ago who insisted that the only people who get vasculitis are (and here my memory fails me ) but it was either cancer patients or children- one of those.  When vasculitis is also a common enough feature in a number of autoimmune diseases too.  Or the moronic rheumatologist who actually recommended something that if I had listened to him, would have meant I could sue him for malpractice- he had looked at my large amount of medical information I brought, ordered tests from a completely unreliable lab, and then when my tests came back negative, told me to stop all my medications---which included a small dose of steroid and I am steroid dependent and stopping that suddenly can lead to deadly consequences.  

[Katy]

Oh, and I’ve noticed that people trained in hospital nursing schools I used to work with are mostly still in the same job a decade later. A few went on to grad school, but in general they have pretty good job satisfaction.  Those who trained elsewhere, including me, left.

[TexasProud]

14 minutes ago, regentrude said:

Huh? Are you in a position to do anything about the healthcare shortage?
Short of training to be a health care provider and applying for a job, I don't think there is anything any of us can do. I am very confused by your post.

Well then we should all just shut up then. I don't like to talk about things if I cannot fix them or at least make a difference.

[TexasProud]

23 minutes ago, Rosie_0801 said:

I have two aunts who are nurses. Both think the one trained by the apprenticeship method was better educated. Maybe the training programs need to begin this way, since it gets people going in the job quickly. Then, further training could be added in smaller modules, so people aren't being held back from performing new responsibilities because they haven't completed an entire degree yet. Or allow RPL, if you've learned on the job. I mean, if all the senior nurses on your ward have supervised you in some procedure and are confident in your ability and knowledge, why not skip right to the assessment and get the box ticked?

I don't actually know how nurse training works here, let alone in the US, so I'm really making things up here.

I think this would be a helpful idea.

[PaxEtLux]

29 minutes ago, regentrude said:

Short of training to be a health care provider and applying for a job, I don't think there is anything any of us can do. I am very confused by your post.

I would humbly suggest that a minor thing we can all do is to not contribute to the increased demand for hospital services.  Say, by getting vaccinated and encouraging others to do so.

[Carol in Cal.]

I favor vaccination but not the mandates.

All of the health care workers who faithfully took care of Covid patients with nothing but PPE are now told that they have to get a brand new drug or lose their jobs.  I think that is ridiculous.  There needs to be an alternative available for them, involving continued use of PPE and frequent testing.  

I did not want to get the vaccine, because it’s brand new, but I decided to so that I would be able to more safely attend a wedding that involved changing plans in a Covid hotspot city airport and then attending a semi-rural wedding where it seemed likely that masking would be uncommon.  

However, if I were still in my child bearing years I would not want to have the current vaccines until a few sets of troubling stats make themselves clear.  I don’t think we should penalize people to the extent that they have no real choice.

There has been a medical services shortage out here for a long time now.  People who live in rural areas, which is a very large portion of the state, frequently have no quality medical care available to them for over 100 miles.  And people who are elderly or already sick are often not accepted into practices that are ‘full’.  Doctors are retiring in disgust with the newer documentation requirements, poor insurance reimbursement rates, and ever skyrocketing overhead, and not being replaced.  The job losses, strikes, and quitting now are just speeding up something that had been going on for a long time but more gradually.  Maybe we will wake up and fix it, but I doubt it.

[TexasProud]

2 minutes ago, Carol in Cal. said:

I favor vaccination but not the mandates.

All of the health care workers who faithfully took care of Covid patients with nothing but PPE are now told that they have to get a brand new drug or lose their jobs.  I think that is ridiculous.  There needs to be an alternative available for them, involving continued use of PPE and frequent testing.  

I did not want to get the vaccine, because it’s brand new, but I decided to so that I would be able to more safely attend a wedding that involved changing plans in a Covid hotspot city airport and then attending a semi-rural wedding where it seemed likely that masking would be uncommon.  

However, if I were still in my child bearing years I would not want to have the current vaccines until a few sets of troubling stats make themselves clear.  I don’t think we should penalize people to the extent that they have no real choice.

There has been a medical services shortage out here for a long time now.  People who live in rural areas, which is a very large portion of the state, frequently have no quality medical care available to them for over 100 miles.  And people who are elderly or already sick are often not accepted into practices that are ‘full’.  Doctors are retiring in disgust with the newer documentation requirements, poor insurance reimbursement rates, and ever skyrocketing overhead, and not being replaced.  The job losses, strikes, and quitting now are just speeding up something that had been going on for a long time but more gradually.  Maybe we will wake up and fix it, but I doubt it.

You are probably right. It will get get worse and worse. No one feels the need to do anything but gripe. We are doomed as a society.

[Bootsie]

18 minutes ago, TexasProud said:

Well then we should all just shut up then. I don't like to talk about things if I cannot fix them or at least make a difference.

One of the ways that people can make a difference is understanding the root cause of a problem.  That usually comes from discussion and hearling lots of different perspectives, experiences, and inputs.  In the end, we may realize that something is a true dilemma without easy, straightforward solutions.  Or, we may realize that there is something that we need to support (or object to) as far as public policy.  I often find if a conversation moves too quickly to "what specifically is the solution" the realy underlying problem is not identified; when that happens the risk of having a solution that, while on the surface seems like it will help, really makes the problem worse.  

[TexasProud]

1 minute ago, Bootsie said:

One of the ways that people can make a difference is understanding the root cause of a problem.  That usually comes from discussion and hearling lots of different perspectives, experiences, and inputs.  In the end, we may realize that something is a true dilemma without easy, straightforward solutions.  Or, we may realize that there is something that we need to support (or object to) as far as public policy.  I often find if a conversation moves too quickly to "what specifically is the solution" the realy underlying problem is not identified; when that happens the risk of having a solution that, while on the surface seems like it will help, really makes the problem worse.  

May be true. But I do not have the time to get into in-depth discussions about what to do in every area of society.  I need the several things I can do to make the world better and that is it. I get overwhelmed. I need a to do list.

[TravelingChris]

6 minutes ago, regentrude said:

Huh? Are you in a position to do anything about the healthcare shortage?
Short of training to be a health care provider and applying for a job, I don't think there is anything any of us can do. I am very confused by your post.

The only thing I can do is write to my state rep, state senator and Gov and ask that our state stop following the dumb rule that makes hospitals ask Mother May I to the state regarding expansion or the building of new hospitals.  The states that have gotten rid of that idiotic rule are doing better than the states that still have that rule.  But otherwise, that is the only thing I could do and I am not the 

[TechWife]

1 hour ago, TexasProud said:

Good suggestions. Well, as I mentioned, they are paying all the nurses the traveling wage and it is bankrupting our hospital and they still cannot find enough.

So how do we as individuals open up more training slots? 

 

Realizing this is a longer term solution, I wonder if lobbying efforts for additional funding would help open up slots for residency programs? Or for increasing the number of federally funded residency slots? I think the funding cap hasn’t been increased in over 20 years. Some states add to those funds and some larger hospital systems fund slots within their own systems, if I understand the system correctly. Residency funding is very confusing to me & seems unnecessarily complicated. 

Shorter term, I am not at all sure what could be done on a local level. A lot is in the hands of the hospital or practice making the job offer for MD’s that  have completed their residency. Should programs increase their recruitment efforts in more rural areas to increase the likelihood that people who are already invested in a rural community will go through the system and return to a rural area to practice? Would that even work? 

Larger hospital systems  have bought out small, more rural hospitals at a quick clip over the past several years and have shut many of them down because they aren’t cost effective. If we could change the mindset on that somehow - focus on community health instead of money in those areas where we know care is needed and get these conglomerates to accept the fact that some hospitals simply aren’t going to be self supporting, but they can still provide great benefit to the community and even to the larger hospital system by keeping care close to home. 

I sure wish we could come up with some fixes that don’t seem so difficult or take so long to get results. 

[ktgrok]

54 minutes ago, Carol in Cal. said:

I favor vaccination but not the mandates.

All of the health care workers who faithfully took care of Covid patients with nothing but PPE are now told that they have to get a brand new drug or lose their jobs.  I think that is ridiculous.  There needs to be an alternative available for them, involving continued use of PPE and frequent testing.  

I did not want to get the vaccine, because it’s brand new, but I decided to so that I would be able to more safely attend a wedding that involved changing plans in a Covid hotspot city airport and then attending a semi-rural wedding where it seemed likely that masking would be uncommon.  

However, if I were still in my child bearing years I would not want to have the current vaccines until a few sets of troubling stats make themselves clear.  I don’t think we should penalize people to the extent that they have no real choice.

There has been a medical services shortage out here for a long time now.  People who live in rural areas, which is a very large portion of the state, frequently have no quality medical care available to them for over 100 miles.  And people who are elderly or already sick are often not accepted into practices that are ‘full’.  Doctors are retiring in disgust with the newer documentation requirements, poor insurance reimbursement rates, and ever skyrocketing overhead, and not being replaced.  The job losses, strikes, and quitting now are just speeding up something that had been going on for a long time but more gradually.  Maybe we will wake up and fix it, but I doubt it.

There is nothing that indicates the vaccine is dangerous regarding childbearing, and plenty that shows Covid is. 

[Carol in Cal.]

3 minutes ago, ktgrok said:

There is nothing that indicates the vaccine is dangerous regarding childbearing, and plenty that shows Covid is. 

There are some disturbing upticks in miscarriage rates after vaccination.  I think the jury is still out on that.

I’m fully aware of the dangers of Covid, and as I said before, am vaccinated and favor vaccination.  

But if a medical professional who got through the Covid crisis using just PPE wants to hold off on being vaccinated, I think they should be able to do so.

[Katy]

1 minute ago, Carol in Cal. said:

There are some disturbing upticks in miscarriage rates after vaccination.  I think the jury is still out on that.

I’m fully aware of the dangers of Covid, and as I said before, am vaccinated and favor vaccination.  

But if a medical professional who got through the Covid crisis using just PPE wants to hold off on being vaccinated, I think they should be able to do so.

That is not true. But there’s definitely a strong uptick in maternal death rates in pregnant women who don’t get vaccinated.

[Jean in Newcastle]

2 hours ago, TexasProud said:

Ok, I AM vaccinated. That was not helpful. And I am reporting people I actually know. My husband is a doctor. Please don't respond unless you have something I can do. Thank you.

Why in the world would you think that it's up to you to do something? 

[TexasProud]

Just now, Jean in Newcastle said:

Why in the world would you think that it's up to you to do something? 

Because I asked. If i ask about something, I want you to tell me how to fix it. 

My husband doesn't get that either. I hate all of that stupid marriage advice about let her vent, don't try to solve the problem. Well my husband is awesome at that, but I WANT IT FIXED.

[catz]

And because I hate misinformation stated as fact on a thread without linked info ...

"COVID-19 vaccines don't raise miscarriage risk, 3 studies show"

https://www.cidrap.umn.edu/news-perspective/2021/09/covid-19-vaccines-dont-raise-miscarriage-risk-3-studies-show

Agree the health care shortage has been out there a long time.  This has just highlighted the problem and burned out some health care professionals.  We have thousands and thousands of qualified students applying to nursing and med school every year that don't get in because there are just limited spots.  There are probably many more that don't apply due to odds and the finances involved in these very expensive programs.  We need to fund higher ed and subsidize expanding these programs.  Vote for politicians who acknowledge health care and higher ed as issues and prioritize those.  

[regentrude]

9 minutes ago, TexasProud said:

Because I asked. If i ask about something, I want you to tell me how to fix it. 

My husband doesn't get that either. I hate all of that stupid marriage advice about let her vent, don't try to solve the problem. Well my husband is awesome at that, but I WANT IT FIXED.

Most people ask about a lot of things they have absolutely no chance of influencing because they want to learn more about them.
We can control very, very few things.

As for the marriage advice (which I have never heard and consider utterly stupid): of course the woman has to TELL her husband what she wants of him: listen to a vent, or suggest a solution. Men are not mind readers. But they can be trained to ASK.

 

[catz]

18 minutes ago, TexasProud said:

 

My husband doesn't get that either. I hate all of that stupid marriage advice about let her vent, don't try to solve the problem. Well my husband is awesome at that, but I WANT IT FIXED.

Well, I do think sometimes people do just need to vent to someone.  If you want suggestions on a problem you can directly ask for them. 

If you want to do something local and hands on, our hospitals locally are allowing volunteers back in.  Do you have active health care workers in your life working through the crises?  You could offer them meals and errand running.  Otherwise, I don't know how even as a concerned group we can meaningfully tackle this as an overarching problem.  Even if the whole US took it seriously, it would take many years to resolve.  

[TechWife]

35 minutes ago, Carol in Cal. said:

 

But if a medical professional who got through the Covid crisis using just PPE wants to hold off on being vaccinated, I think they should be able to do so.

Previously, PPE was the evidence-based best practice for protecting HCW from getting Covid or from  unknowingly giving it to someone else.That determination was made based on the information and resources available at that time. Now, the best practice is vaccination + PPE. That determination is based upon current information and current resources. HCW should follow best practices. If they are unwilling to do so, then health care is no longer be the best field for them to work in.  

How would a hospital administrator, a physician, nurse or any other clinical professional justify knowingly increasing the risk of a staff member giving Covid to a patient by scheduling unvaccinated staff to work? How do you justify knowing that you are scheduling someone who is unvaccinated to work when at any time they could work with a patient who cannot be vaccinated? How do you justify having them work near a co-worker that is undergoing cancer treatment and would get deathly ill if they contracted covid? How do you schedule someone who is unvaccinated to work when you know they are more likely to get Covid when they treat a Covid patient than the vaccinated staff member is? How do you do that? 

[Frances]

2 hours ago, TexasProud said:

Ok, that is fine, but we don't have them. So now what? And how do we fix the shortage while we figure out how to open up more of those training positions?

Sadly, I think you actually need the consequences of shortages to actually get more training slots, at least public ones. My state is terrible when it comes to training spots for almost every healthcare profession. In the almost 25 years we’ve lived here things have only gotten slightly better. We still don’t have a full blown public physical therapy program which shocks me even more today then it did when we moved here. We’ve basically been screwing over young people in our country for a very long time by limiting training slots and bringing in people from other countries when the shortages are serious enough.
 

And certainly if they do increase training slots, I hope they don’t admit any people not willing to get any and all necessary immunizations. Just like the military and all of their required shots, a healthcare worker shouldn’t be able to wait several years for a vaccine in the midst of a pandemic. They need to choose a different profession before they take a training slot.

You could try talking to your state legislators about increasing funding for public healthcare training slots.

Edited October 16, 2021 by Frances

[Danae]

1 hour ago, Carol in Cal. said:

But if a medical professional who got through the Covid crisis using just PPE wants to hold off on being vaccinated, I think they should be able to do so.

A firefighter who runs into a burning building to save a person when no protective gear is available is a hero.  A firefighter who refuses to don protective gear when it is available gets fired.  This is not a contradiction.

[SeaConquest]

I posted this back in August:

"I tell this to everyone I know: It was more difficult for me to get into nursing school than it was for me to get into Stanford Law School (if you go based on # of applicants vs # accepted, it is worse than any medical school in the nation). I was rejected by Western Governors twice before I was admitted and my TEAS score was well over the 99% -- I scored 94.6 https://www.ppcc.edu/application/files/4215/6678/1303/ATI_ADN_Scores_as_of_late_Jan_2019.pdf.

I was basically told by the San Diego State admissions rep not to even bother applying because I didn't have a 4.0 in my science pre-reqs. He said that the average admitted student had a 4.0 in science and a 3.92 overall. I graduated magna cum laude/Phi Beta Kappa from a top 10 liberal arts college, am a SLS grad, had a three page resume of international experience at top law, consulting, and finance firms, volunteer healthcare experience in the ED and ICU of a magnet hospital and women's/community health experience at Planned Parenthood, and other volunteer/pro bono legal work for a disability rights organization representing the homeless and setting up domestic violence/crisis houses for women in Moscow, several competitive scholarships (e.g., the Rotary, which sent me to Moscow State University to study constitutional legal development after the fall of the Soviet Union), military service, plus stellar letters of recommendation, including one from a nurse practitioner I took three masters level nursing courses prior to even going to nursing school (I took advanced pathophysiology and advanced pharmacology -- NP level courses before I went to nursing school), None of that was enough to get me into nursing school right away at WGU or SDSU.

I was admitted to one local community college, but couldn't make the schedule work with homeschooling. Two other local community colleges went by a "points" system and I wouldn't have scored enough points to have been competitive there. For two other community colleges near me, it would have been about 50-50 if I would have been competitive with their points system, so I didn't bother applying.

Now that I have my BSN, in my area, I am competing with close to 1000 applicants for every position because there are so few new grad residencies available to train new nurses at our hospitals."

Let me update:

Since August, I have been working per diem at the job that I had while I was in nursing school, working for an agency that staffs our county psych hospital, a 100+ bed locked facility that serves a mostly homeless/indigent very acute population of psych patients. During nursing school, I was a mental health associate (aka a tech) at the facility, but once I was licensed, they changed my status with the agency to an RN and I have been working full time+ at the hospital because they are severely understaffed and rely on the agency to staff about half of their positions.

I had all of *10 days orientation* (most new grad residencies provide 3-6 months of preceptorships) before I was on my own, *floating* between our emergency psych unit (where I triage often acutely psychotic patients, usually brought in by the cops, and whose Covid status is unknown) and our inpatient psych units, which have completely different charting systems and workflows, taking up to 6 patients at a time. I handle the aforementioned ED triages, discharges, transfers, all medication administrations (including intra-muscular administration of meds when patients are too psychotic to take meds orally, which they often fight), seclusion and restraints, frequent assessment of both psychiatric status, but also any medical issues that may arise (which are frequent and quite heartbreaking among the homeless and mentally ill/drug-addicted), collaborating with our interdisciplinary team of physicians, social workers, dieticians, recreational therapists, etc., and all the charting of all of that. Plus, trying to find any time to actually help my patients with therapeutic communication skills, so that I can impart a tiny bit of compassion and some lived experience of coping with bipolar (which I have to keep on the downlow because of the mental health stigma that I live with -- yes, even among other psych nurses).

Suffice to say, it's not the safest situation, especially for a new grad, and has been incredibly stressful. Every shift, I have at least one patient who can be a "hot spot" (aka is frequently being violent with staff or other patients), so I have to do all of this while somehow managing not to pass out from low blood sugar (I am supposed to eat small, frequent meals with my gastric bypass, which does NOT happen), get a UTI from not peeing (if you don't drink water, you don't pee!), and not making any mistakes, which new grads are prone to do (because nurses DO eat their young -- ask me how I know!) 

Meanwhile, I have been interviewing for new grad residencies in the ICU at the major hospital systems in SD because I was advised that, even though I think that I may want to be a psych NP down the road, I also love the ICU (so am torn on which direction I want to go long-term), and getting my start in intensive care would be a better place for me to begin my career. To that end, I have had serious help from several attending physicians, lobbying/making calls to hiring managers on my behalf, and thus far, I have managed to land a grand total of 3 interviews -- 2 ICU spots and 1 in the ED -- none of which have resulted in offers because the positions all went to the techs that already worked in their units. So really, although 1000 people applied and a handful of us were chosen for interviews, the jobs were really already someone else's to begin with. So, really a complete waste of time. 

Now that I understand how this system works, I had a nurse friend hook me up with the nurse manager in another ICU. I was able to get my resume in front of this ICU manager and talk with her on the phone for 15 minutes. It went well. The nurse manager already went to the ICU that didn't hire me and talked with them about me. Since I was one of their top candidates, she told them, "Well, if you're not going to hire her, I will." That seemed positive. So, she plans to open up a new grad position in the near future in her unit. 1000 more people will apply. Hopefully, I will get an interview and hopefully she will choose me, but this is the system that currently exists for hiring here. It is all about seniority and who you know.

The gatekeepers are what are stopping us from helping with the shortage. They exist at every level -- from getting into nursing school, to finding clinical placements, to securing a job afterwards. I know that it's not like this everywhere, but I can only share with you what I know. Nurses in So Cal and SF are literally flying to NV, AZ, and TX to work their 3 x 12s back to back and then flying home. They get their one year of experience and then they are set here. Why don't they just move to those states, you might ask? Because being a nurse outside of CA is really pretty sh*tty, in a lot of places. I saw the difference when I worked in east Texas. The pay can be low, they can be treated like crap, they don't have mandatory meal and rest breaks, they don't have our ratios, and they don't have our strong nursing unions. They literally had ICU nurses taking out the trash at the hospital in Texas. So, there are tons of people who want to work in California especially, coastal California. A six-figure job, working 3 days per week is not a bad gig. Why would I move to Florida and make $30 per hour doing the same thing, while taking 8 patients. Eesh. No thanks.

So, yeah. It's a big ole charlie foxtrot, as we used to say in the Army. Throw in a pandemic, travel nursing pay that is 4x what you can make as a staff nurse, and the burnout and emotional distress that so many nurses are feeling after 20 months of this, and you get this:

Trigger warning: language (please click through and read the comments from other nurses as well -- people really need to understand how these HCWs are doing mentally and why)

  

 

 

 

Edited October 16, 2021 by SeaConquest

[TexasProud]

So Sea Conqest, what do we do? I see no solutions in your post. I know it is bad. Are we just doomed?

[TravelingChris]

2 minutes ago, TexasProud said:

So Sea Conqest, what do we do? I see no solutions in your post. I know it is bad. Are we just doomed?

There is nothing to do about a lot of situations.  Be responsible for whatever you are responsible.  Resolve to not be the problem patient or problem relative of a patient.

A lot of us are just perplexed why you think you can do anything?  I think it is making you unhappy but be happy about whatever you can do to help anyone.

[SeaConquest]

6 minutes ago, TexasProud said:

So Sea Conqest, what do we do? I see no solutions in your post. I know it is bad. Are we just doomed?

I don't know. In Judaism, we have the concept of Tikkun Olam -- our obligation to repair the world and make it a better place. So, I cannot speak for anyone else's worldview, but for me, it starts with each of us doing our part. I knew that I was healthy enough to work again, so despite my disability, I went back to school to try to do my part. If there are things that you know that you can do to help -- volunteer at a hospital, give blood, get vaccinated, vote for legislators that support mental health parity (healthcare workers are going to need it!), student loan repayment, and programs that work to close health disparities -- just do what you feel is right for you. 

But no, I don't think we are doomed. We just need to look honestly at our situation and take stock of where we are as a society, You cannot treat a sick patient without first doing an accurate assessment. The United States has a lot of very preventable issues, but we all know that getting any patient to change his/her lifestyle is hard.

[Jean in Newcastle]

I am a Christian.  God is sovereign.  But we also know that this world will not last forever.  We also know that this is the Devil's world though God is still ultimately in control.  Then everything else is in God's hands.  

I do my best to live under the filling of the Holy Spirit (no unnamed sin, using the principles of Scripture to guide and teach me) each day.  Anything that is outside of the fruit of the Spirit is not of God.  This includes anything that is not peace (which is a fruit of the Holy Spirit).  

 

[KungFuPanda]

6 hours ago, TexasProud said:

So yeah, I get it. Doctors and nurses should be vaccinated. Some of you think, perhaps rightly so, that they don't deserve to work in the healthcare profession.

I know probably 5-10 doctors, nurses and PA's who are not getting them, from around the country. Most just want to wait until the vaccine has been around for many years. They are not anti-vax. Most of them work in rural hospitals that are already shorthanded. One of them is the only surgeon at his hospital. If he leaves, they will have to go 2 hours away to have a surgeon.  Our hospitals here have raised what they are paying and right now are running in the red. Even though they have raised the salary WAY up, they cannot find enough nurses.  Primary care docs are short. 

So yeah, they should be vaccinated. Most are choosing to just retire early rather than do that. So how do you propose we have enough healthcare workers to treat people?

Doesn't putting their lives and their patient's lives at increased risk for contracting Covid violate the Hippocratic oath? This isn't week one of vaccine administration.  The ICU gap between vaccinated and unvaccinated isn't even close to 50-50. 

It feels especially raw this week because a friend's anti-vaxxer, firefighter father spent the last week on a vent and didn't make it.  He fought hard to convince everyone he knew NOT to get the vaccine.  It's just sad because his whole career was about helping people and his family is in so much pain.  

I know a lot of doctors, nurses, and scientists, but not any of the anti-vaxxer variety.  I don't know ANYONE who has left their job rather than get the vaccine.