RN shortages in long term care

Thanks for the links DeeAnna. Interesting read(s).

I worked in Long Term Care (which includes Skilled Rehab Nursing, Nursing Home, and Hospice in a Nursing Home) as a RN Charge Nurse, MDS Coordinator (Medicare/Medicaid Resident Assessment Coordinator), and as a Clinical Instructor for a LPN Nursing Program because I LOVE working with the elderly. I always have...ever since I was a Candy Striper in a nursing home when I was in Junior High School. 

One of the MAJOR causes of the nursing shortage is the fact that there are not enough qualified PhD educated Nursing Instructors for all of the College of Nursing/Nursing Schools in the US.  Ten years ago when I was a Clinical Instructor for a LPN Nursing Program, I could teach even though I "ONLY" had a BSN (Bachelor of Science in Nursing). NOW Nursing Instructors for LPN programs are required to have a "MSN (Masters of Science in Nursing) ALONG WITH a Post-Masters Nursing Education Certificate". To teach BSN nursing students, Nursing Instructors are required to have a "PhD in Nursing Education". If a nurse has a MSN, but does NOT have a Nursing Education Certificate or if a nurse had a PhD but NOT in Nursing Education, then they will most likely NOT BE ABLE TO TEACH at a School/College of Nursing. Also, there is a shortage of PhD College of Nursing programs that prepare PhD and MSN Nursing Education Nurses.

I suggest that you research the RN shortage by reading what the American Nurses Association (ANA) has to say.  Copy and Paste URL to your browser:
https://www.nursingworld.org/practice-policy/workforce/

Nursing Shortage Legislation and Strategies: "ANA advocates for nurses at the highest level, to ensure that the voice of 3.6 million registered nurses is heard by policymakers. ANA lobbies both houses of Congress, as well as the federal agencies, on policies and legislation to bolster the number of RNs and nurse faculty." 
Find out the latest on nurse staffing issues on Capitol Hill:
https://ana.aristotle.com/SitePages/safestaffing.aspx

The American Association of Colleges of Nursing (AACN)
https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage website

https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet-2017.pdf

I think that these websites will help you to better understand the nurse storage in the US.

In response to the comment that only RN who have charges against their license work in nursing home's. Not true. I recently went to a skilled nursing and rehabilitation facility. My choice nothing against my license ever. After 40 years in ICU ER PROGRESSIVE CARE I wanted less action and I love the elderly

Where my mother was they had Med techs that gave out meds. My daughter worked in nursing homes as an LPN and she gave out the meds. Now she is an RN and does not do Med passes. I find in NHs the RNs are in charge.

RN's do not want to work in skilled nursing facilities. We were warned in school that working in one would put our license at risk because the unrealistic demands. There is a big disconnect between the regulations that govern nursing homes and regulations for nurses. For example, only one 1 nurse is required for up to 99 patients, but how is that one nurse suppose to prepare and document meds, and then go and adminster meds, while staying to watch the patient swallow the meds for all those patients in the two hour window that is allowed? It is a medication error and our license is at risk if we dont. That is less than 2 mins per patient. Also we are not allowed to prepare and pass medications for more than 1 person at a time and have to do three checks. RNs don't want to work in SNF because we are afraid of losing our license. Why work in a SNF where you have 10x the number of patients and are paid $20-$40 less PER HOUR than a hospital. The RNs working in SNF are either new grads or other RNs who have had actions already against their license and hospitals wont hire them

No worries, I'm not in USA so rules are different. Frankly I thought our care plan meeting was a big farce anyway.

I'm not really worried about the quality of care from the mom's nursing staff, just concerned that the current system(s) aren't sustainable, and it seems nobody outside the workers themselves are talking about it or have even noticed.

Like Shane stated, "(an) assessment along with the Care Plan must be completed for all residents in Medicare- or Medicaid-certified nursing homes and non-critical access hospitals with Medicare swing bed agreements. This cycle (Comprehensive assessment – Quarterly assessment – Quarterly assessment – Quarterly assessment – Comprehensive assessment) needs to repeat itself annually for the resident" unless the resident has had a Significant Change in Health Status Assessment or was hospitalized and returned to the nursing home.

It sounds like the nursing home is having a Care Plan Conference with the family only when the "Annual" or "Comprehensive" Assessment is completed. You need to talk to the Nursing Director and the Nursing Home Administrator and find out why Care Plan Conferences are not happening every 3 months. If they don't give you a satisfying answer, you can contact the State Long Term Care Ombudsman and tell them about the situation.

Cwillie, I get what your saying.. at one meeting we actually asked if the SW and DON had brought the correct patients chart.. Nope, no diabetes heart problems or high BP.. and why is that drug her DR ordered 6 months ago still not here?
Our recovery room is still staffed by mainly nurses from other countries,, one of our float pool staff got fired for finally asking a nurse to "speak English" Not PC I know but as my own department is getting filled with people with limited ability to speak English in an inner city area.. getting report is a nightmare, the Drs complain to us ( but never to management) that they have no idea why they went along with some crazy idea because "that guy was non stop about it".. they can't understand what the RT/RN was trying to say and they figured one of us "old timers" would be in for the next shift and "just fix it".

In the US care plan meetings  are required to be quarterly in nursing homes. If that is not happening that should be reported to management first, then up the chain of command. It is required in Medicare/Medicaid facilities to post the complaint procedure for all to see.
Yes DeeAnna, 1979 here too. Nursing is hard work!
I was a candy striper- I used to fill the water containers with fresh ice. That actually was very rewarding.
I always encourage people to go into nursing. It’s been great for me. But I’ll be ready to hang up my cap soon - need to work 6 more years for full SS - not sure I will make it. 
I know many who do begin the nursing curriculum then can’t pass anatomy and physiology, or the other prerequisites. You have to have smarts to do it.
I didn’t care for Pediatrics or OB/GYN either, lol.

Quarterly care plan conferences? LOL, we get them annually.

Hey, Shane, I graduated from a diploma hospital-based school of nursing in 1979 and then received my BSN 15 years later. There are a couple of other people who post on this website that are also "old time nurses". What a difference 40 years make!?!

I LOVED working at Long Term Care facilities or Nursing Homes. I was a "Candy Striper" when I was in Junior High. I wore the pink and white pinafore with a white blouse and later I worked a nurses aide at the same facility. I could have worked there as a RN if I had wanted to. There are so many specialties that nurses can work in now. And so much more medical and health information. It is mind boggling as times.

cwillie, Communication with the nursing staff is VERY IMPORTANT. The Quarterly Care Plan Conferences that are held to discuss your loved one's care is another important way for you to communicate with the nursing home staff. Ask questions, but do it with a desire to learn how your loved one is doing and not with a desire to find fault. Nurses have a tendency to "shut down" if they think that the family member is trying to get them in trouble and they won't be as cooperative with you if you are always "looking for trouble". Treat the nurses as you want to them to treat you--with respect and kindness.

I am a working RN, BSN trained for almost 40 years. When I was in training I worked at a nursing home one summer. I realized I could never do that full time. Why? For me, it was the sadness of seeing elderly people never having any visitors, not enough staff to feed those seniors, the long hours and feeling there was minimal if any satisfaction in the job I did and I was just a student nurse!

Nursing has changed. The newer grads seem to come out of training not ready to really work - there’s no sitting with the patient for an hour taking a history, no time to complete a complete physical assessment, and in my experience as a patient in a hospital, no desire noted by the floor nurses to complete the above. And these nurses are assigned 6-8 patients a shift with Tech support! On evening shift back in 1982 we had 2 - 3 RN’s for 60 patients. 2 if one called out. Everything got done correctly. 

When I was a new grad in 1979 nurses did it all. Now a lot is delegated to CNA’s who you can’t even be sure took a patient’s blood pressure correctly.
To me, the only accurate blood pressure is taken the old fashioned way - cuff & stethoscope. I cringe every time someone takes my BP with a machine because there are so many factors in taking an accurate blood pressure that are ignored using that damn machine. 

Long term care? I could never do it. During my summer working as an aide at a nursing home I was just horrified in what I saw - elderly folk left to sit all day in gerichairs in excrement, no proper skin care, no one to feed them or hold their hand, & patients that never had a single visitor. Lots of  helplessness and hopelessness.

I’ve worked direct patient care my entire career except for the past  3 years. I can just look at you and know if you are sick. Not so with many nurses these days. 
BSN vs AA or diploma? In my opinion BSN’s are better trained hands down.  

Fast forward to 2011; my mother needing to go to a nursing home herself.

Nothing has changed in the 35 yrs from my summer as a student nurse working at a LTC center.

I never give a nurse a rough time until I have tried all courteous avenues first as I know how a nurse needs time to process symptoms, not to be interrupted when giving meds, etc. Thankfully I haven’t had to set many straight. Give that nurse taking care of your loved one respect as she/he is doing what many cannot ( or will not ) do. 

My advice - Be There! Be your loved one’s advocate, stay involved, question care but with courtesy, attend those care conferences, let the staff know that if anything happens to that 
86 y/o  ex dynamo (using my mom as an example) they would have to deal with me. I may have lived 4 hours away, but my brother visited my mom every day & we were fortunate to be a team. 

It’s not going to get better.  

 

Where I live, nursing homes/care facilities are just a training ground for new RNs. most RNs want to work in hospitals but can’t get hired without having experience so they start out at nursing homes/long term care/rehab and get a year of experience & then get hired on at the hospitals. Also LVNs are being phased out, now everybody wants RNs with a bachelors degree! It’s also hard to get into the nursing programs around here, the waitlist is several years long, it’s not first come first serve—they give priority to single women with children and others but I forget the criteria. My friends sister will start the nursing program this fall after being on the waitlist for 6+ years! She was unmarried with no children when she applied for the program. Have a few friends with 2 kids who only had to wait a year or two. These are AA programs too by the way. So these new RNs still have to go back for their B.S degrees.

I remember that RN shortage in the 1980s and the hospital that I worked at had some Filipino nurses working there. The ones that I worked with were great--once they could understand our English lingo.

Part of the problem with the nursing shortage is that there is a storage of PhD-ready Nursing Instructors for the BSN nursing programs. I was a Clinical Instructor at a LPN School of Nursing, but since I didn't have my MSN in Nursing Education, I had to quit teaching. BSN nursing programs REQUIRE PhD nursing instructors and many states require that they have PhD in Nursing Education and not a PhD as a Nurse Practitioner (NP) in any nursing specialty (which is sad because there are some GREAT NPs that could teach a lot about their specialty to the BSN students.)

I am so glad I’m retired from nursing. The big picture about the nursing shortage will reach alarming levels and no one is mentioning it, apparently worldwide.

Stay healthy and stay out of the hospital! As to the geriatric facilities, I try to be understanding if small boo boos are made. And this reminds us to visit our loved ones often.

There was a severe registered nurse shortage in the 1980s and we had Filipino, Portuguese, Canadian who had gotten visas to work. On the flip side, I found a weekend only job in a hospital (work 36 hours, all weekend and got paid mucho dinero).

Hospitals ought to pay better. And geriatric facilities ought to pay $10/hr. All nursing care is grueling. It breaks the nurses’ bodies and health down prematurely.

I worked in Long Term Care for over 20 years. I am not even going to start to talk...because I won't stop. All of nursing is different than it was 5-10 years ago and not for the better c{:-(

CW I'm sure you won't be a bit surprised to hear that it's the same over here, too. Reasons why? I read your post and muttered "don't start me..."

It is a COMPLETE BLOODY MESS is what it is.

Asset-stripping poorer countries - the Philippines (we went there after Nelson Mandela had asked us nicely to stop poaching all the South African nurses), Portugal, Poland, Romania - is neither ethical nor sustainable. Even before you throw in migration policies, which are also getting "interesting" worldwide.

Training your own is expensive.

Failing to distinguish between aspects of nursing that require high calibre academic and intellectual abilities, and aspects of nursing that really don't need those but DO demand exceptional vocational strengths; and deciding that all nurses must be degree qualified, then realising than graduate-calibre trainees tend not to be chock-full of the milk of human kindness, then downgrading degree courses so that everyone can get one, then realising that you've just told the less intellectually gifted ones that their humanity isn't worth sh*t but it's okay because now they have a degree so they can still be a nurse but genuinely caring whether a patient is comforted or not is bordering on unprofessional...

I exaggerate, I admit. But for me, at the very bottom of this, is a lack of recognition and true *respect* for people whose IQs may struggle into triple figures but whose compassion and industry are limitless. Instead, we've changed their jobs into work they don't like any more so that we can pretend they're basically doctors without the long words and the arrogance.

I bloody hate hate hate it. I want to write a book about it. No I don't - I want to go and kill somebody about it.

So, it sounds as though any young woman (or man) who is worried about not finding employment after university should consider a career in nursing.

(I'm in Canada BTW, the problem isn't just an American one)

Cwillie
Hoca has been short staffed all year -
caregivers are being asked to work doubles and 6 days a week, and although the DON is an RN, she doesn't work the floor. LVNs are stretched thin too - New ones are hired and quit within days

Makes having extra eyes on mom even more necessary 

It’s a matter of aging, $ & immigration. Yeah you read that right, immigration.
And it’s going to get worse. Here’s my take and my health policy rant fir the day....

Aging - many RNs -as RN traditionally “women’s work”- have or are nearing retirement & there’s not RNs to replace them as lots more options for women’s education since 1970s. I went to what is viewed as top 100 school in the 70’s & early 80s, & if you hinted you were thinking of being an RN it was looked upon as a lesser form of life; you instead did your MCAT, LSAT, GRE and went onto a professional program. Nursing was a vocation not a profession with status. Nursing program was over there with the Home EC dept. I imagine this viewpoint was common. And it’s been catchup with RN #s since..... and the catch up has been to go into Masters Degree RN programs or  be a nurse practitioner, like what GuestShoppe wrote about. 

$ - an experienced floor RN can make 50k-75k. RN administrator 100k. A DON (director of nursing) at a bigger hospital 150k+. Smaller NH groups and independent NH cannot pay a competitive salary & benefits to match what a health science center or big hospital group can. Between my mom & MIL, we dealt with 6 different facilities and I think all had as DONs older nearing retirement age women who moved from hospital RNs to go to the NH as it was better scheduling although way less pay.

Immigration - the H-1C program has expired. Fat chance this administration will ever allow it to be reauthorized. Backstory: 1980’s when AiDS first hit, lots of RNs refused to care for anyone though to have AIDS. It was a crisis & thousands of foreign nurses got emergency visas to come to the US to work. In New Orleans where I am, huge # of Filipino RNs to big Charity & Children’s Hospital. One effect was it freed up RNs to go to work in AL & NH that were ramping up construction in the 1980s & 1990s. Emergency visas morphed into H-1C visa program under Clinton (his mom was a RN btw and a nurse anesthetist at that!) and reauthorized under Bush. Obama placed it for reauthorization but Congress refused to reauthorize it like in 2010 and the last of the 3 yr system + 3 yr appeal waiver has ended. Now nurses are lumped into the H-B1 with everyone else.  The H-1CN allowed for their spouse and kids under 21 to come too and all could become US citizens eventually if they did the paperwork. I think 15% of all working RN are foreign born (25% in some cities) and due to this. 

You think it’s bad now, give it another decade or less... it will be another crisis. 
At all the places mom & mil were in, all had immigrant workforce. I don’t recollect ever seeing a E-verify sticker at a 1. So it’s self verification. Not a lot of folks besides recent immigrants want to work in a NH for $7.25 hr with no benefits and not full time.

In the US, the other problem is that it used to be ok to staff with LVN (licensed vocational nurses) instead of RN (registered nurses). When Medicare shifted what levels of care and licensure would be required for care, a lot of folks were not qualified to do the "nursing" things any more. My niece-in-law is an RN, now studying to be a nurse practitioner (which will pull her out of the RN pool). Her comments from the RN world? it's a dirty job to be an RN in nursing home or geriatric care that frequently pays less than working in a trauma center or with kids. You get spit on, cursed, hit, etc. Families file complaints about the level of care. Nursing homes won't hire double coverage so that you can take vacation or sick days. Some nursing homes or rehabs have financial issues and your check is "messed up", overtime is calculated wrong or defrauded, or you don't get paid when they go under. There are no financial perks to being a nurse like there are for being an administrator. If you want to make really decent money, you move into being a nurse practitioner. Many hospitals were staffing using visas to bring in "RN"s from other countries, and that pipeline has stalled. It's only going to get worse.