January 1, 2018

O Nurses, Where Art Thou?

Is all you want for Christmas a team of badass ER nurses to work with for the next twenty years? Yeah – well me too. Unfortunately, an experienced ER nurse is quickly becoming a relic of a bygone era. An era that can be traced back only about five years ago, at most. Amid ever increasing challenges in the clinical environment, nearly all emergency docs have noticed that life in the ED is a little less sweet and at times downright frightening.

Anyone who has been working in the belly of a hot, steamy hospital ER for longer than a handful of years knows the difference between a life saved or lost relies heavily on a strong team. In Emergency Medicine, unlike our surgical or primary care colleagues, we work under highly uncontrolled conditions and rarely have influence over the global staffing needs of the department. We don’t have the luxury of hand picking our team. As a result, most of us have learned to adapt daily to different coworkers, and do so quickly.

Who amongst us in the ED has not dreamed of synchronizing our shifts with the “A team”? How sweet would it be if shift scheduling software allowed us to move throughout our monthly shifts with a “preferred group” representing team players from across the allied health professions (RN, ER tech, rad tech, respiratory tech, pharmacist, doctor). My guess is some of us would even give up some major lifestyle perks to have this ability. Unfortunately, we aren’t afforded freedom with scheduling.

Through my experience as a ER doctor, it appears peak team performance and high levels of experience are a thing of the past. Now we’re fortunate to work with a nurse these days who has a minimum of two year of experience. In fact, working with a fresh out of nursing school grad is quickly becoming the new normal. No offense to newly minted nurses, but we want our experienced ones back. Instead, rookie nurses, with maybe two years of experience, are training the newly inducted RNs. What’s that about? We need a balance of fresh out of school nurses plus seasoned veterans.

What is the major force working against us all? The high nursing attrition rate. Nearly 30% to 50% of all new nurses either change positions or leave the profession altogether within three years. A culture of indifference, lack of support and moral distress are commonly cited reasons for nursing attrition. These conditions propagate low levels of job satisfaction, burnout and ultimately attrition. How can we ever build sustainable teams and a deep bench roster in medicine against that sort of headwind?

Everyone in the ED has felt the palpable loss of some our most gifted colleagues to nursing attrition. The skill set of our most talented “Emergistan” compatriots goes beyond technical abilities. They spend an estimated 25% of their time keeping lines of communications open between physicians and family members; a task that can save us doctor types a lot of time and pain. Another badass and little known fact is that nurses at their peak master a workflow that is estimated to include 125 activities per hour and task switch every 29 seconds. Nurses are the backbone of the ED and without them us physicians are left in an even more chaotic work environment.

So, YES! We are feeling the pain and their absence. What can we do to try and bring back the experience level of nurses we so painfully miss?

The first highly recommended action step is to demonstrate great appreciation and support for the outstanding nurses who remain at the bedside. A show a gratitude could go a long way in increasing nurse happiness on the job. Then we should advocate on behalf of our nursing colleagues. Here are three facts that will position you to being a greater advocate for our nursing colleagues.
The true cost of nurse turnover ranges from $22,000 to $64,000 per nurse.
Lower turnover rates, ranging from 4% to 12%, are associated with shorter lengths of stay and lower risk-adjusted mortality.
Increased nursing to patient ratios (i.e. better nursing coverage) could save millions (even billions) of dollars and hundreds of lives. Nationally, short-term savings related to better nursing ratios could be as high as $242 million. Adding more nurses overall to the US Hospital Workforce would reduce patient care costs by as much as $6 billion.

Use these staggering facts to take action and talk to your hospital on ways to reduce nursing attrition at your workplace. The longer nurses stay around the more experience they build and the more trust you build working in the Emergency Department.

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