Monday, October 24, 2011

more complexity = more money

Nurses should be making more money. Period. End of conversation. Our jobs have become increasingly complex. The amount of information we are expected to retain has become impossible.

The patients coming to the emergency room these days are no longer as simple as a sprained ankle or UTI. We get those, but they are a increasingly small percentage of who we see. Our typical patient has become someone with some kind of chronic underlying illness, sometimes a couple of them, who is in for an exacerbation of the illness or another problem complicated by their underlying illness. For example, we might get an ambulance call for someone with abdominal pain. They forget to mention that they are also a quadriplegic with decubitus ulcers that are MRSA positive. A woman with a UTI comes in, however she had a heart transplant last year and is having signs of rejection. Honestly, these kinds of patients are becoming more commonplace.

Everyday,policies and procedures change. Documentation requirements change. New drugs are being used. New programs are started. We have an MI program involving getting people to the cath lab in 15-30 minutes within arrival. Before they go,they have to have IVs, meds given, drips started. Documentation done. We have a stroke program. TPA started within an hour. A post cardiac arrest hypothermia program which involves placing the cool down device, staring about 5 drips, foley, OG etc. These are just a few of the complex procedures that are becoming commonplace in ERs along with
handling ventilators, bipap, rapid infusers, central lines, CVP lines, rapid sequence intubation, etc.

Then there is the documentation. We do electronic charting. Charting around conscious sedation, blood transfusion, restraints, critical patients has become a nightmare. With increasing HIPAA, medicare, CMS requirements, documentation is nearly impossible to keep up with.

I make a decent wage after all these years, but I should be getting a lot more. My job is complex, the responsibility is enormous, the stress is at times overwhelming. What other job involves this kind of complexity and makes this little money?

If hospitals don't pay more money, they will face a severe shortage of nurses, worse than the one that is predicted in the next 20 years. Nurses coming into the profession are not going to stay in this kind of
environment if they are not paid equal to the requirements. Why would they? They have so many other opportunities. I see them talking advantage of those opportunities. Many of them are becoming nurse practicioners, CRNAs, heading straight out the hospital door.


Anonymous said...

As a newly minted nurse about to start my career in critical care... I couldn't agree more with you. However, I would like to hear what you would suggest would be a fair wage in light of our changing profession?

rnraquel said...

Absolutely. I cannot tell you the number of new grads I have met who are just putting in time until they can get their CRNA or save money to go get their MSN or Doctorate to be a Nurse Practitioner. The stress and insanely excessive documentation requirements can be too much. There are days when I just want to go work at Starbucks :) but of course I always come back for more.

Anonymous said...

Try being a Respiratory Therapist.

We need to do nearly all the charting that you do and be proficient in the different charting requirements of: ICU, ER, Special Care Nursery, PICU, NICU, PACU, and the floors (add other departments your institution uses). AND this is just patient assessment, never mind ventilator and other therapeutic charting.

Someone tell me when JACHO/Joint Commission went from an accrediting agency making sure you (the hospital) was doing what it said it was doing ala ISO 9000, and became an all knowing God? I'd like to see JACHO personnel function under the rules they create.

It is just another bloated bureaucracy there to serve itself while damaging those it purports to protect (sounds kinda like Government).

Dan said...

And Anonymous shows the underlying issue: everyone is dealing with greater complexity and higher stress levels. So everyone deserves a raise? Probably. Is it remotely possible? Not at all.

Anonymous said...

Thats the point Dan. There is X amount of money in the system. Look at what the government is doing now. The gang of 12 is going to hit medicare providers as much as possible to save money (all the same pointedly avoiding the conversation of should we do everything for everybody all the time). The latest medicare MD cuts in december as per the SGR is pushing 30%. Yes congress forstalls the cuts but the reality is there has not been a significant increase in medicare provider rates since Bill Clinton was president. It is going to get harder not easier as we try to cut down the debt, or we ignore the issue and become Greece in the future. Which one do you want girlvet? In reality, lets look at the USA at large. Almost double digit unemployment, even larger underemployment .Then there is the lack of insurance coverage. Honestly, these are issues hospital/medical employees have by and large been able to avoid. Things could be much, much worse....and they likely will be. That is reality.