It's About Time For One About Nursing

You want a chocolate cake, fine, I know a dozen recipes just off the top of my head because when I was about 10 years old my mother got sick of me asking for cake and told me to bake my own, We pulled the old Betty Crocker batter-stained cookbook down and from then on I was the family cake wholesaler.

But I'm no pastry chef, and we wanted to make apple turnovers so we went to the local gourmet market to get pre-made pastry and a snack.

Nice scene at lunchtime. A musician outside. An outside sandwich grill going, too. As well as the usual mid-Phoenix scenesters and characters: the tall newsguy dude we feel sorry for, the guy with the Bouvier de Flandres dog, and other regulars.

I think I recognize a woman at a table with others as we settle into an outdoor table ourselves. I sat at the opera next to her last year, and she cried out loud when Magda stuck her head in an oven.

I listened in as they talked about job turnover wherever it is that they slave away their weekdays, and I noted that she had a baked apple smell about her. Perhaps it was the perfume she wore to the opera also? Maybe not. Who wears apple perfume?

In the twelve years I have been a registered nurse I've held seven different positions, most of which have sooner or later involved bending over and grabbing my ankles with my hands while keeping my knees locked straight.

Old joke. But what isn't really funny is this:

"America’s nursing shortage has worsened and is eroding the quality of patient care. A recent study found that 60% of registered nurses are now over 40 years of age and projects that if present trends continue, the nationwide shortage of nurses will exceed 400,000 by 2020. According to the Acute Care Hospital Survey of RN Vacancies and Turnover Rates report by American Organization of Nurse Executives, the average RN turnover rate in acute care hospitals is 21.3% with an average nurse vacancy rate of 10.2%."

When I first came back to the city of Sonoran Tile-Roofed Endless Sprawl, I had been recruited by a large metropolitan medical center. Even though they gave me an appreciable relocation bonus of well into 4 figures, I quit before my orientation ended and I returned the bonus.

Is there a statistic for that? Is it called "nurse turnover" if you quit while still an orientee?

On one of my training shifts I witnessed a perfectly decent nurse, my preceptor in fact, drop a pill on the floor only to pick it up and administer it to a willing patient. So what? you may ask. Five-second-rule and all that.

Not me. Not my style. Okay, so sometimes I bark at the moon and scratch my ear with my foot. But, I don't eat off the floor.

Later that same shift one of the other nurses was talking about shooting cans with his new gun. He went on to say "You know, Mexicans, Africans, Puerto Ricans... Creeped me out totally. And besides that, he kept looking at me funny.

So I quit. That was a Thursday. By Friday afternoon I had completed a couple few interviews, caught up on my sleep, and landed a job that matched the sign-on bonus and even paid a little more in salary.

Of course you may think that the magic invisible hand of the free market, guided by the infallible laws of supply and demand, is responding to these issues of nursing turnover and shortages. Then again, maybe not.

"According to the National Council of State Boards of Nursing, the number of first-time, US educated nursing school graduates who sat for the NCLEX-RN®, the national licensure examination for registered nurses, decreased by 10% from 1995-2004. A total of 9,353 fewer students in this category of test takers sat for the exam in 2004 as compared with 1995."

On my next job, the entire staff of my little 28-bed telemetry unit turned over during my first year there. There were days when I was the only worker on the unit who was not an agency nurse who had just come in for a shift. We went through travellers like Mike Tyson went through ears.
The second year, during a meeting the director of nursing informed me that the turnover rate was only 87%. Much better.

Then she got canned, and my unit supervisor left. He was the guy that had hired me, and I always liked him. His replacement lasted a few months, then the "new" director of nursing was also let go. Sometime during all this we purchased Shrimplate Manor in the central corridor, and I wanted to work at a place closer to home.

I called the guy-who-had-hired-me ex-supervisor, and he insisted I join a specific organization. Before I could even finish my online application, they were calling me, and soon I was working at The Great Muffin Factory.

The turnover rate here is probably about normal, which is to say a lot less than 87%, but I see people come and go.

Things are much worse in nursing homes and long-term-care facilities:

"In May 2005, the National Commission on Nursing Workforce for Long-Term Care released Act Now for Your Tomorrow report which found that there are nearly 100,000 vacant nursing positions in long-term care facilities on any given day, and the nurse turnover rate exceeds 50%. The shortage is costing long-term care facilities an estimated $4 billion a year in recruitment and training expenses."

There was a time when I did about a nine-month part-time stint in a nursing home back in The Dismal Wilderness. I went to work never knowing if it would be an 8 or a 16-hour shift, because if your replacement didn't show up, you had to stay all night. I didn't know much what I was doing anyways, having just come out of school and off an intensive care aide job where I had become familiar with cardiac medications but knew relatively little about stool softeners.

As trends continue, there will be more patients and fewer nurses, which will only increase nursing turnover rates and shortages, as well as good old-fashioned burnout.

It might be different if the magic invisible hand of the free market would respond to increased demand for nurses and retention of nursing staff by actually, you know, paying them more. But where oh where would we ever, as a society, find the money to do this?

Oh, I dunno, maybe here:

"Iraq was awash in cash - in dollar bills. Piles and piles of money," says Frank Willis, a former senior official with the governing Coalition Provisional Authority. "We played football with some of the bricks of $100 bills before delivery. It was a wild-west crazy atmosphere, the likes of which none of us had ever experienced."

We could abandon our notions of pre-emptive wars for oil fought against third-world countries, and in so doing usher in a new period of responsibility and commitment to the healthcare of our fellow Americans, or, as Theodoric of York, Medieval Barber would say, "Naaaah."