Paul M. Dohse, RN, CDP
Donald Trump may not have a bigger fan than this nurse. With that being said, his new initiative to improve staffing issues in LTC (Long-Term care) is dumb and will lead to a further decline in care. Since I like Donald Trump, I will blame this predictable fail on his advisors. Ronald Reagon once said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’” Here, we have yet another example.
First, the initiative has the wrong target. The initiative targets nurses and not nurse aides, who are the foundation of LTC. Again, we bypass an opportunity to supply a vision for the foundation of care. Again, the foundation is further eroded because of caste system blindness.
It seems that the theory follows according to what I have read about the initiative: Gee whiz, the whole problem with quality of care in LTC is staffing shortages, so, a solution is to pay for aspiring nurses to go to school IF they agree to work in LTC. And gee whiz, this will lead to more nurses, because you know, more nurses is the solution. This theory is woefully ignorant on every level.
In the same way that some religions can be misguided and hypocritical, conservative capitalism can be misguided and hypocritical. Conservatives often criticize liberals for “throwing more money at a problem as if that will solve the problem.” That is what this initiative does with little understanding of how LTC works in the trenches.
While Donald Trump is highly critical of Barak Obama, this initiative borrows from Obama’s playbook, except in Obama’s case, the results were unintended regarding healthcare. Trump’s initiative shows zero understanding of nursing. During the Obama administration, manufacturing jobs were sent overseas to appease corporate crony capitalists, and of course, to acquire political stock for the DNC. So, a vast majority of Americans making 30-plus per hour in manufacturing suddenly lost their American dream overnight. Remember, among assembly line workers at GM, the company was known as “Generous Motors.” Obama himself told workers to get over it and redirect their careers towards technology rather than labor.
So, a lot of people began to frantically look around for a solution to prevent riches to rags, which was nursing. One year of training could easily yield a replacement for what they made on manufacturing assembly lines. The means for bankrolling the education was federal student loans, which are uber easy to obtain.
The result? A new phenomenon in nursing; people who are in nursing mostly for the money and little else. Many note that today’s nursing is inundated with nurses who see the profession as just another job. The genesis of this trend is the Obama administration, but to his credit, it was an unintended consequence.
But here we are: Trump’s initiative will bring in a second wave of people into nursing motivated by money. Prior, few nurses became nurses for the money; nursing has always been a career of the heart. A minister who is in the ministry for money is known as a charlatan, and the same was true for nursing, but no longer, and we see signs of this. One example is the fact that cheating on exams in nursing school is prolific, and why wouldn’t it be? Nursing school is merely a means to an end. You can also add the new phenomenon of fake nurses. What you really are as a nurse doesn’t matter, it’s all about the money and your perceived entitlement to what you deserve rather than the needs of others.
My point? People with the heart of a nurse will find a way to get the necessary funding for school. People who are right for nursing and have the heart of a nurse are not waiting around for a way to get funding, they have found a way already come hell or high water. The initiative does not understand who nurses are or what makes them tic. Furthermore, If you buy your teenager a car, they will likely not take care of it. However, if it is their own hard-earned money, they will. The initiative will harken a new wave of people who are not called to be nurses and limit their skin in the game from the beginning.
For certain, due to a pandemic of weak leadership and crony Capitalism in healthcare, nurses are leaving the profession in droves, as one recent article in a major news outlet put it, but could part of the exodus be due to a number of nurses that were never meant to be nurses in the first place? In short, this initiative does not ask, “Why?” anything in healthcare is happening, and is hypocritically throwing money at the problem like hypocrites who live in glass houses throw stones.
The one good thing about this misguided initiative will lead to deeper staffing shortages in LTC and make the problem worse than it has ever been. Nurse aides, that is, the good ones, who have been working under weak leadership for years, will see this opportunity as a means for upward mobility because, unfortunately, they have never been shown upward mobility in their discipline, which is the foundation of healthcare to begin with. Please note: the very definition of “burnout” in any profession is the lack of self-actualization. Hence, burnout is pandemic in healthcare because the healthcare industrial complex does not supply the education and leadership necessary for self-actualization.
Though upward mobility is an important part self-actualization, it can also be a cheap shortcut for nurse aides. Present nurse aides, particularly the good ones, who are already dedicated to LTC, fit into this initiative perfectly and are the primary candidates. Oops. Not only will it lead to a deeper shortage of nurse aides, more than likely, the initiative will draw the best ones into becoming nurses.
But wait, what then? The initiative does not address the “Why?” regarding the nurse exodus to begin with. So, nurse aides will merely be jumping into the fire from the frying pan, while creating more nurse aide shortages in the meantime. Then, per the trend, will be part of the nurse exodus at the end of it all. The initiative is going to trigger an ugly downward spiral for LTC.
But, among the many bad things about this initiative, it will help the LTC policy of attrition for hiring nurses. How does that work? All the focus is on how many nurses you can get into HR for an interview. It is HR driven. Investing in nursing culture issues to retain nurses or nurse aides is not practiced. In other words, retaining staff from an understanding of what makes people tick is not on the radar screen, only a policy of attrition. “We lose this many nurses per year; hence, we must hire this many nurses per month.” This policy of attrition does not ask, “Why?,” but only, “What are the numbers?” The Trump initiative will actually aid that process by supplying more nurses to interview with the same cycle continuing.
Here is where we discuss the initiative’s utter stupidity. It assumes that healthcare administration will say, “Oh my! Look at all these new nurses we have because their school was paid for! This is wonderful because now we can reduce nurse-to-resident-ratio to have higher quality care! And of course, this will relieve stress on nurses leading to higher retention! Oh my! This is so exciting!” Really? How stupid can these people be? LTC has pushed the envelope and gets the work of three nurses out of one for one third of the price, and it is assumed that LTC is going to let go of that? That is not going to happen. All it is going to do is supercharge their HR-driven policy of attrition. More nurses to interview that will be hired if they can chew gum and walk at the same time.
So, let’s revisit the initiative’s theory: more nurses leading to less staffing shortages resulting in less stress on nurses leading to more retention. But, nurses actually thrive on stress. What they can’t tolerate is lack of self-actualization, which is the very definition of burnout. The main cause of burnout among nurses is the prevention from doing what they trained for: bedside assessment and care. The main cause of burnout for nurse aides is the prevention from doing what they trained for: supplying the foundation of LTC, while making nurses better at bedside care. Both are prevented from achieving their self-actualization by clock-punching, pencil-pushing, LTC administrators and CEOs. In addition, LTC doesn’t even understand the implications of a noun (nurse) receiving the action of a verb (aid) and the residents of LTC hardly need such ignorance and incompetence to be further funded by anyone including the government.
However, the initiative could do some good if the government mandated resident-to-nurse-ratios, right? But, oh my, that would be “regulation,” and as good conservatives, we can’t have that! In fact, the Trump administration rescinded a Biden administration mandate that required certain care hours per LTC residents. Obviously, without such mandates, more nurse are not going to solve any LTC problem. In fact, why would anyone think more nurses alone without any concern for nurse aides would solve anything? It’s fundamental ignorance on a spectacular level.
So, what is the answer? Here is where we have to give American liberalism some merit. The answer is regulation, specifically, mandated nurse-to-resident-ratio in LTC. This will force the LTC industrial complex to do their job. This will force LTC to invest in things that truly lead to clinician retention rather than mere number crunching. Unfortunately, the most profitable LTC management companies are setting the standard. In other words, supplying high quality care with a decent return is not acceptable because it’s probably half of what other companies are receiving. While healthcare needs money, obviously, it should not be the sole consideration.
The answer is not some complicated nurse-to-resident-ratio that requires certain hours per resident from different disciplines, but rather, a simple nurse and nurse aide ratio. A nurse can only care for a certain number of residents per shift and the same for nurse aides. That number could be increased if a facility uses qualified medication aides.
This would force LTC to cure staffing shortages, which is not rocket science, especially when they have shown the ability to get nurses to care for 30-plus residents during a shift. They have shown amazing ability to pull that off along with other exploits when it benefits their bottom line.
Leave a Reply