The U.S. Is Running Out of Nurses

Ever since I went to nursing school - Good God- 30 years ago now, I have heard about the shortages. Interestingly this article only describes the basics about why they're aren't going to be enough nurses. Clearly capacity in schools and the aging population will have an impact. That's really a given. But what nobody talks about is the environment of care nurses have to work in as an impacting factor. Or, that fair compensation for the risks and burdens the job entails is still a bit lagging.
If you have ever looked at a hospital bill chances are you will not find a specific cost or line items for nursing care. These are rolled up into the "room rate". As such, this room rate covers not only the cost of nursing but other overhead costs as well, such as housekeeping as an example. As a result, the impact that nursing has on outcomes is not easily measured from this source.
Another major reason that it's hard to get and keep nurses is simply the difficulty of the job. When I started nursing it was at Walter Reed Army Medical Center (the original) in D.C. . Army nursing is vastly different that civilian nursing. Mostly because the patients will participate as much as possible and have a completely different perspective than the average civilian patient. But still, the job was tough. Systems were in place that helped you to maximize the impact you could make, even if all you could do were the "must do's" vs. "the nice to-do's". Nurse patient ratios were anywhere from 10:1 - 22:1, and even sometimes higher. We used acuity systems to document our workloads and to ensure we had the appropriate staffing or as close as we could get it.
On the civilian side, in my experience things have gone to hell in a handbasket. Many do not have systems in place to support nursing care. In fact, many systems make things not just cumbersome but obstructive to nursing care. Take the Press Gainey stuff for example. These are patient satisfaction scores. To me this is one of the most damaging things they could have done. Patient satisfaction scores are tied to reimbursement for hospitals. This means that in several areas patients can score their experience. If it's bad, or they just don't like something they give a bad mark. This has real impact operationally as data is aggregated and on reimbursement for care. Nurses are instructed to basically give whatever the patient wants in order to get good scores. This then also may impact patient care because sick people don't always want to do that which will help them get better, and nurses have been hamstrunged from pushing too hard. In the meantime, there are still bunches of other regulatory demands placed squarely on the shoulders of the bedside nurse "because she can do it" which takes time away from delivering direct patient care and providing the kind of care which many of us went to school for in the first place. It is exhausting, thankless work most of the time because of that. Patients complain about not seeing the nurse enough, nurses complain about not seeing the patients enough, and yet nursing hasn't even earned a line item on the bill. The new nurses today don't know what they are getting into, and once they do - it has often been my experience that they become so task focused/minded that they lose the essence of nursing. They are not asked to develop this and not asked to maintain it based on how they are expected to check all the boxes without fail. Doesn't matter that one of your patients coded, gotta get everything done, and done within a prescribed time. And also with 100% compliance to the standard of documentation. Or, your manager calls you in, or other comments are made.
It's no wonder to me why my profession is at risk!

Glad I worked there first though. Learned a lot.

I also started at Walter Reed on Georgia Ave. never had more than 5:1 ratio.