Why Nurses Leave the Bedside; The Nursing Shortage. A Bedside RN's perspective
Homepage/Table of ContentsaaaaaTerms Used in These Pages [You are here, in a page from Intro And Overview ]

Terms Frequently Used in these Pages 

Nursing Shortage, Shortage, Current Crisis Nursing Shortage
The Industry
Overtime, Mandatory Overtime, Involuntary Overtime, Involuntary and Uncompensated Overtime
Resource/ Resource Requirements
Nursing Glut. A misunderstanding of the Resource Pool
Holidays  [believe it or not this demands an explanation!] 

In these web pages the term "Nurse" refers to the RN providing direct patient care . Unless stated otherwise, it does not differentiate between the RN who is BSN trained vs Associate or Diploma Trained. 
It also includes the organizations that represent the nurse as defined above. It does not include Nurse executives or Nurse administrators whose job function falls under management within the Industry
Implicit is the understanding there are others providing direct patient care who fall under the supervision of the Nursing Departments  in the Industry , and/or are mentioned in legislation regarding Nurses.  These include Nurse's Aides, LPNs/ LVNs, Clinical Specialists, Nurse Practitioners, Certified Nurse Midwives and Nurse anesthetists. [Understanding of these last 5 titles is provided in  Nursing Education   ] Within these pages those persons are not included in the use of Nurse as defined above unless comment is made otherwise. 
Nursing Shortage, the Shortage, Current Crisis Nursing Shortage:
In these webpages Nursing Shortage refers to the absence of sufficient Nurses to meet market demand.  The current Crisis nursing shortage has unique characteristics differing from previous periods of acute shortage.
As the shortage is seen by the writer as a long-term problem never adequately addressed, the term current Crisis nursing shortage is frequently used  . It is the understanding of the writer that the shortage has a long cyclical nature and that  the current Crisis  is only an intensification of a long-standing nursing shortage with roots in the post WW II era when first it began to exert its effect. 
Identification of the shortage historically,  and the unique current attributes marking the current Crisis shortage within it, occurs in detail in these pages.

The Industry
In these webpages the term "Industry" or "The Industry"   refers in aggregate to non-profit and public hospitals, nursing homes, health systems, nursing facilities, home care agencies, hospice and adult day care programs, and other related health care facilities and the persons who oversee them, among whom are sometimes included nurse executives. The Industry is often a consortium of those entities described above, although it can be the spokesperson for a particular entity among them. Nurse executives,  because of their role in management and apart from direct patient care,  do not fall within the meaning of the word Nurse as utilized in these pages. 
Although the Industry has been the nurse's primary employment venue since the 1929-1937 period in which private duty nursing collapsed in response to greater economic forces, the requirements of, and focus of Managers in the Industry have changed with time and in response to several exterior forces, with specific markers identifying them who is in command of the Industry in which nurses are positioned. See The Industry and history of Hospital Management.

In these webpages the term "Management" refers to those persons or groups of persons who manage the entities identified in "Industry" above. Because of the current trend of  conglomeration of facilities under large corporate umbrellas, the ability to separate Management from Industry  as defined above is at times  less easily accomplished.   There are many levels to Management from a Nurse's perspective impacting on her job, its requirements,  and environment. Management when  used  refers to an individual  facility,  or locale consortium of facilities'  managers and their agents, unless otherwise implied. Management  can, and often does,  include Nurse executives. 


Overtime, Involuntary Overtime, Mandatory Overtime:

Overtime is working beyond the contractual time frame as defined by fair labor practice in regards to a 24 hour period and/or within two work weeks. 

Nurses, as essential personnel, are subject to mandatory overtime from which other labor sectors of our economy are protected. If a nurse is told she must provide mandatory overtime , she is in abrogation of her professional code in not complying, as it is considered patient abandonment, and in doing so she is endangering her license. Management will whistle blow, or at least institute disciplinary measures.
Nurses complain mandatory overtime is routinely used by the Industry to address their routine staffing needs. Mandatory overtime is usually meant to reflect an extension of a shift to continue  the provision of patient care due to lack of personnel to meet the oncoming shift's care requirements. When lobbying against control of mandatory overtime, industry frequently calls it Unavoidable Overtime.

The use of extended work time, however, is  more insidious, as there is an infra structural reliance on the nurse for mandatory overtime not an extension of the shift.  This form of overtime is better referred toInvoluntary overtime;  It occurs in the form of routinely lost breaks, meal times, and the need to remain beyond the contractual shift in order to meet the demands of the shift just ended. During the shift, the involuntary overtime is usually devoted to pt care. At the end of the shift, the involuntary overtime is usually devoted to paperwork. 
To add to the weight of the problem, nurses complain that they are frequently not paid when involuntary overtime is required to meet the requirements of the shift, and that management denies its existence. When recognized by management, pay for the lost meals and breaks requires additional, and bulky, paperwork for the nurse. This tier of involuntary overtime is identified as Involuntary and Uncompensated overtime.

Involuntary overtime is said by nurses to be routine in their workdays, while mandatory overtime is used frequently to staff throughout the week. 


Resource / Resource Requirements: A business term for Stuff you Need, basically. There are technical resource requirements, physical plan resource requirements,  Medical Supply Resource requirements and there are human resource requirements, among others. In these pages, unless informing otherwise,  "Resource Requirements" refers to the nurses who constitute a significant percentage of the Industry's Human Resource Requirement and the largest segment of our health care industry's professionals.  Misidentification of resource availability yielding layoffs, salary stagnation and erosion of benefits in the 1990s seriously affected the Industry's ability to assure the continued resource requirement of their entities was met safely, fluidly, and in absence of detriment to the resource pool itself. 
Glut , what WAS that speeding ,  deadly  object?
Its Identification
The glut refers to the  temporary , brief and misperceived period of nurse overabundance emerging in the late 1980s and exerting greatest influence in the mid 1990s and until 1998.  Identification of the nursing glut was  based in part on the well publicized increase in nursing school enrollment of the  early 1990s, an increase resultant of the hard won benefit and salary adjustments occurring to nursing's benefit in the mid-late 1980s and the mistaken belief among nurses and nursing students that market competition to keep nursing attractive in the general market economy would continue. Among the gains in union negotiated contracts in the late 1980s was recognition for years of practice; This marked the first time in the history of nursing when each year of service was rewarded with an increase of some sort in many nursing contracts, and it extended outward from the unionized entities to the non union arena as non unionized entities sought to maintain their access to the resource pool.  Soon after the modest salary adjustments, wages again stagnated. The perception of a nursing glut was readjusted in 1998, when word of a reemergence of the longstanding nursing shortage threatening  to reach proportions beyond any previous experience of the nursing shortage in all its history began to appear in allied literature, and lay news media. 
Its Impact: 
Industry, now almost entirely profit oriented, and widely reporting enormous strain in the managed care era,  took the opportunity of an identified glut  to lay off senior nurses [more expensive -and more experienced], cut back on ancillary support staff [increasing the remaining nurse's workload and non nursing tasks], scaled down its ratios of nurse to patients [while the acuity of those patients was on the rise] and rewarded the nurses remaining with salary and benefit erosion and a greatly diminished , when already weak, voice in the hospital hegemony. Through these efforts they gained  further alienation from the nursing pool upon whom the industry depended, and severed the thin strand of trust holding the industry and nurses together. 
Evidence of the Glut Perception, and Its Reality as a fragile Graduate Nurse Glut: 
Perception of the glut was  substantiated by the 1996 Nursing Survey  with its preliminary results released soon after collection,  in which a >14% increase in the nation's RNs was identified as the graduates from nursing schools entered the workforce. The industry, bolstered by these results, continued to woefully misidentify  a nursing glut for what was in reality a nurse graduate glut, the results of which are evident in the statistics on future plans of current under 30 year old RNs to  seek non nursing jobs while the number of RNs  not working in nursing at all is increased remarkably .  The  2000 Nurse Survey results  show 1996-2000 having  the highest number of nurses leaving nursing a over any period since the 1980 first q 4 yearly nurse  survey reflecting the period of 1976-1980. 
1995 marks the first year in an [also cyclic]  increase in successful unionizing efforts nationwide, and nursing strikes yearly increasing until the present. The economic benefits currently being gained are often announced exuberantly ['28% increase over three years for  hospital  gained in recent labor contract!']  back treading and ignoring the devastation  of this heavy handed and irresponsible response to a perceived nursing glut , a period of time in which nursing and nurses suffered miserably.  Nursing salaries actually ERODED from 1992 to 2000,  when  spending power and inflation are taken into account. The 40 somethings  who obviously love their work but who just as obviously often hate their jobs, and who as a group represent the greatest benefit and current resource  to nursing in terms of their numbers, knowledge base, expertise and efficiency, not to mention staying power, have been rewarded for 10 years with , actually ,  increased work loads, less pay, and a general sentiment of job dissatisfaction, while the persons whose numbers substantiated the misidentification of an overabundance of the nursing labor resource pool, melted away. 
And that, in general , is the nursing glut. 

To Top of Page  [Terms Used Table of Contents]
See Chapter Nursing and Nurses
Back to Website Table of Contents

Differential :  Differential is the additional per hour money received by a nurse to encourage scheduling of difficult time frames, or tasks requiring additional work load, while pay for "on call" need to the hospital can also be utilized. It is commonly referred to as "diff ".   Examples of differentials existing in the industry include Charge nurse diff, Preceptor diff, Evening and Night shift diff,  holiday diff, and weekend diff. Not all nurses experience one or any of the above , and their use varies from region to region and facility to facility. In addition to these moneys above base salary, some institutions utilize "call Pay" where they pay a nominal fee of several dollars for the nurse to remain available and able to present to work if need arises. Any study of nurses salaries does not discuss these differentials, and the data is sorely missing, as its  study would enlighten regarding enducements to continue the work and the regional effect they have when utilized. 
Holiday Time : Because the Industry varies in its recognition of what constitutes a recognized holiday, and because how holidays are scheduled and paid for is at the wide whim of the institutions, Holiday time and its pay, or lack of it, requires its own definition. 
A nurse's holidays are established by her institution. All full time nurses are subject to mandatory holidays, and these vary from one of the two major [Christmas/ New Years] to half of the holidays recognized, and all institutions maintain the right, and many exercise it routinely, to flex a nurse to a holiday she was not obligated to work, and this based on "Need".   Many nurses report that they are not free from the possibility she may have to work a holiday, even though her mandatory annual allotment has been met, as a result of use of both mandatory overtime, and management whim in pre scheduling. 
Many institutions recognize as few as 4 holidays, not even compensating nurses time and a half for the  holidays other sectors enjoy. 
While some do not recognize more than two -four holidays, other institutions recognize 8. Some institutions include a holiday diff of double time and a half for the holidays they DO recognize , others provide time and a half plus an additional day off in the month's schedule to encourage staffing of holidays. In institutions providing time and a half plus one day off for holiday work, or double time and a half for a holiday worked, nurses report their units have little trouble meeting the holiday resource requirement, while nurse satisfaction and sense of control over her free time is reported achieved. 
Those institutions offering increased economic incentive for holiday work generally also have a lower annual mandatory holiday requirement , corresponding with the institutions ability to utilize their full time staff's willingness to take economic advantage of holidays throughout the year. Nurse's  report little difficulty for management or the nurse in staffing holidays in those institutions. 
back to top