3 years ago I was working in a New Mexico hospital as a medical scribe. There was a lot of things that I learned while working there but one of the most important things I learned was that nurses deserve more than they get. I have seen nurses covered head to toe in blood and fecal matter. I have seen nurses have to fight and restrain patients. I have seen nurses have breakdowns after a particularly tragic accident. I have even seen a nurse get punched in the face by a patient that required him to get surgery. Nurses aren't in medicine for the adrenaline or the glory, they CARE for their patients. They do a job that no one else wants which is often times messy, emotionally and physically grueling, and disrespected.
According to the New Mexico Workforce Report for 2020, only 15,500 nurses are currently working in New Mexico and 6,000 more would be needed to meet the national benchmark recommendations. Last year alone we had a net change of -2,000 nurses. This will likely get worse as baby boomers age and prepare to retire, but many young nurses are also leaving just after two years of work at the bedside. As more and more nurses disappear, short staffing becomes a more prevalent problem. Limited staffing of nurses has led to higher infection rates, greater hospital readmission rates, less access to healthcare, and ultimately more people dying.
Why are they leaving?
My research (see last three sources in references section) suggests that nurses are leaving due to organizational issues such as low staffing, poor work environments, excessive authority, no upward mobility, and nurse burnout. This is true for both rural and urban nurses. The truly interesting thing about nurses is that they are not leaving because of money. For many other professions, increasing salary results in better recruitment and retention, but this will not be effective for nurses. According to Nurses.org, New Mexico is paying their nurses 9th highest in terms of cost of living. Additionally, salary very rarely comes up in the literature about nurse turnover. Throwing money at this shortage problem in the form of higher salaries would be to ignore the root of the problem.
So what can we do?
I recommend that medical organizations create nurse led staffing committees. These committees can be formed by each shift type (day, swing, and night shift) and by each unit. The committees would decide on staffing levels and ratios for themselves with the support and partnership from higher ups. This will lead to more open communication between the nurses and the leadership teams creating a more collaborative environment in the future. Inviting nurses to the table will also lend itself to more organizational fixes that nurses care about such as better workplace environments, stress relieving initiatives, precepting younger nurses, etc. This helps reduce turnover as the literature illustrates a need for better organizational structures. Each committee would report on their findings to the entity assigned to their oversight. Mandated minimum nurse to patient ratios is another way of achieving better staffing but I decided against it as it is inflexible and hard for the government to implement. This policy does the same thing but is more flexible and allows for organizations to make their own decisions regarding staffing levels. This policy will vary based on the committee decisions themselves. However, if 10% of nurses participate at the average hourly wage from the state for a minimum of 10 hours a year, it will cost approximately $500,000. This policy is expected to help retain 12% of nurses.
Then, if the committees decide to hire more nurses than is available in the current applicant pool, I recommend that New Mexico expands their nursing school programs. According to CNN in 2017, nursing schools rejected 57,000 qualified applicants from undergraduate nursing programs across the nation.In fact, the University of New Mexico only has a 65% acceptance rate to their nursing program. The reason was because they just lacked the capacity and staff. The University of Minnesota partnered with their VA and was able to provide 100 more degrees with the addition of new faculty, technology, and educational scholarships. . As 700 nurses pass the NCLEX (the nursing licensing exam) per year in New Mexico, increasing the applicants by100 over 5 years is very doable. Additionally, to ensure nursing students stay in New Mexico, the scholarships will be prioritized based on those willing to stay in New Mexico after graduation. If the students prove they are staying in the state, than the grant will not need to be repaid, if they leave, they must repay this loan. This policy option will provide support to the understaffed nurses as well as reducing turnover. This policy is estimated to cost the state $5.3 million over a period of 5 years.
Both of these policies together will help the problem of not enough nurses in the hiring pool as well as helping decrease nurse turnover. Additionally, the nurse committees may lead to more favorable work places for nurses and more internal collaboration.
New Mexico was hit hard by the COVID virus but nurses were hit especially hard. I believe that it is especially important now to repay that debt by giving them extra help that they so desperately need.
Thank you to all the nurses and medical professionals!
References
New Mexico Health Care Workforce Committee. 2020. New Mexico Health Care Workforce Committee 2020 Annual Report https://digitalrepository.unm.edu/cgi/viewcontent.cgi?article=1007&context=nmhc_workforce(accessed January 21, 2021)
American Association of Colleges of Nursing. 2020. Nursing Shortage. https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage. (accessed January 22, 2021)
Aiken, L., Cimiotti, J., Sloane, D., Smith, H., Flynn, L., Neff, D. (2011). “Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments”. Medical care, 49(12), 1047–1053.
Nurse.org. 2021. Highest Paying States for Nurses (Adjusted for Cost of Living). https://nurse.org/articles/50-state-salaries-ranked-with-cost-of-living/ (accessed January 26, 2021)
Ahlburg, D., Brown Mahoney, C. (1996). The Effect of Wages on the Retention of Nurses.The Canadian Journal of Economics / Revue Canadienne d’Economique,29, S126–S129. https://doi-org.libproxy.unm.edu/10.2307/135973
CNN. (2018). Nursing schools are rejecting thousands of applicants -- in the middle of a nursing shortage. Retrieved April 20, 2021, from https://money.cnn.com/2018/04/30/news/economy/nursing-school-rejections/index.html
Nurse.org. (2019, August 23). Top 3 reasons nursing schools are rejecting applicants in 2019. Retrieved April 20, 2021, from https://nurse.org/articles/reasons-nursing-schools-reject-applicants/
EasyNCLEX. (n.d.). NCLEX pass rates for New Mexico. Retrieved May 11, 2021, from https://easynclex.com/passrates/State_of_New_Mexico.html
Adams, S. 2016. “Influences of Turnover, Retention, and Job Embeddedness in Nursing Workforce Literature.” Online Journal of Rural Nursing & Health Care, 16(2), 168–195.
Chan, Z. C. Y., Tam, W. S., Lung, M. K. Y., Wong, W. Y., & Chau, C. W. 2013. “A systematic literature review of nurse shortage and the intention to leave.” Journal of Nursing Management (John Wiley & Sons, Inc.), 21(4), 605–613.
Johnson, N. 2018. “Why Good Nurses Leave the Profession.”, from https://minoritynurse.com/why-good-nurses-leave-the-profession/ (accessed January 26,2021)