The real reason nurses are leaving

From the Boston Globe comes this opinion piece on part-of-what-is-wrong with the hospital system:

“Ask any bedside nurse what the worst part of the job is, and chances are they won’t even mention bodily fluids or patients’ insults. The answer I hear most often is the same as mine: “charting.”

Accurate, timely charting of nearly every patient interaction, assessment, and intervention is mandatory. Arguably, it’s the requirement that matters most to the hospital administration. I’m not being critical here — I get it. Insurance companies pay the bills. They demand documentation. It’s part of the job, and we do it, grudgingly.

I’ve learned most hospitals ignore these essential limits on nurse-to-patient ratios. Legally (except in California), they get away with doing so. We can argue about the reasons such as budget shortfalls, staffing crises, “it’s a pandemic!” Concerns over unsafe staffing ratios have been voiced for decades. They are likely to remain until hospitals are forced, either by law or by finances. Until hospitals accept that nurses are not bottomless pits of cheerful productivity.

We’re expected to complete more tasks in less time. But a patient who just had a hip replaced can’t be made to walk faster to her commode. An IV antibiotic that needs to be administered over five minutes can’t be administered in two. Good, safe patient care is time-intensive. Reduce the time, and it’s neither good nor safe.

“The problem is, nurses just take the path of least resistance,” my manager said to me recently. We were discussing my safety concerns about the unit. Safety policies and procedures are often designed by nonclinical staff and ignore the realities of patient care. Some are so cumbersome they are impossible to execute. As a result, they get bypassed or curtailed. I had suggested a particular workflow be changed to accommodate practical constraints. It would increase safety, because staff would be able to implement it.

My manager disagreed. Hospital policy, she explained, is based on best practice. Nurses need to figure out a way to follow it. Then she smiled, like we had an understanding, and thanked me for my input. I smiled back. What more was there to say? She finalized my resignation a few minutes later, while my anger was still fresh. 

I hear a lot of people blaming the mass nurse exodus on “burnout,” but I think that misses the point. Even in the midst of a pandemic, I loved my job. What I couldn’t stand was the constant administrative pressure to accomplish the maximum number of tasks in the minimum amount of time and the fundamental lie that I should be able to do so without compromising my patients’ safety — and my own.”

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