Vital Views

Unknown Speaker 0:08
Hello, and welcome to vital views UNLV school nursing Podcast. I'm Joe Gaccione, communications director for the School of Nursing. today's topic: nursing shortages. nursing shortages have recently been identified here in Clark County and other parts of the country. And while it's fair to blame COVID-19 For exacerbating the conditions to make nurses leave, shortages are not just pandemic based shortages have existed for decades before for a multitude of reasons, and eventually resolved themselves depending on the scope, whether they are temporary or regional forces affecting supply and demand, or more national factors. For a series of episodes, we'll be exploring different aspects of nursing shortages, from current conditions to previous shortages, the causes the impacts, and what are the most optimal solutions to either avoid or minimize gaps in nursing labor. In part one of our nursing shortage talk, we'll be looking at the current frontline situation with two UNLV nursing alumni currently working in Las Vegas, Billy Luzong graduated from UNLV, back in 2007, and he's worked in both Nevada and California. He's currently a critical care nurse here in the valley, as well as a nursing preceptor. Billy, thanks for coming by. Appreciate it.

Billy 1:18
I'm glad to be here.

Joe Gaccione 1:19
Since graduating, you've alternated between working in Nevada and California. You came back to Las Vegas in January 2021. What's been your experience in general, since you've been a practicing nurse, when it comes to nursing shortages?

Billy 1:32
I mean, it really depends on like before pre COVID I mean, it really depended on the amount of nurses that were that were available in the unit that that that could work. And depending on whether or not a human resources at the time was hiring people you know, not to mention, like there, there are other other factors in in that via where the dynamics of the unit itself, where you have people either dissatisfied or found something better in terms of for their career, or rather, their their whole outlook in life, you know, something better for them. So I mean, it really depended on on on that case. Say, for instance, for me, you know, I had back in 2012. You know, I was I was a nurse, working here in Nevada, in the med surg unit, and then a good opportunity for me to travel and do and do travel nursing, came around that time. So I went ahead and did some traveling in California and ended up staying there for about eight years. You know, and what attracted me to California is because of the state mandated ratios that were that were there, because California is the the only state that I knew of at that point that had that state manatee radio shows where you had a certain amount of patients to a nurse, for instance, you have for med surg five to one ratio on on, on that you have for med tele a four to one ratio. And in Nevada, for as far as I know, they mixed med tally and med surg patients, medical surgical medical patients together, but in California, where they don't need cardiac monitoring, they split that up where you have noncardiac Monterde medical patients in in one section. And then you have another set of patients that have cardiac monitoring, have issues with their heart on an on another section of the hospital. And then of course, you got your step down units, which are three to one over there. And I your ICUs, depending on how sick of the patient could be either two to one, one to one, or one to two and one to two, meaning that you have one, one patient to two nurses. I mean, so that really enticed me at that at that prospect where, you know, like, you know, I don't have to deal with too much nurses. As far as too much. Too much patients at that point. It felt really safer because at the time I was a really young nurse so you know, it got my it got my bearings down, you know, and I learned a good deal while I was in California. Doing no Doing my rounds over there and, and working over there as a nurse. So that opportunity for me at that point was actually one of my, one of my reason, one of the reasons why I left over for California at that point. As far as when I came back here, I mean, I'm I was mature enough to figure out, you know, that I could handle what I can handle, you know, and I was seasoned enough to figure out well, you know, like this COVID season, pretty much going to be dealing with no patient to nurse ratio, at the same time, you know, or no mandated patient to nurse ratio. But at the same time I could handle for patients in a in a step down ICU, I mean, it's okay for me, because I've dealt with those, those types of patients. prior prior that maybe for a good three to four years. So I know what to expect, you know, it comes down to, you know, what you feel, what you feel is good for you, what you think you can handle and what, and overall, you know, the quality of what you what you what you think is life at that point.

Joe Gaccione 6:30
and there are obviously a number of reasons why anyone would leave any job, let alone nursing. I mean, there's, for nursing, burnout especially has been given the spotlight for lack of a better phrase, and for good reason. I mean, it's, it's, it can be a challenging profession in general, than when you add on a pandemic, but there have been situations before, where periods of time nurses will just get stressed out, or they leave at a particular at the same time, basically, right? When you have those situations, as a nurse, how do you manage? How do you say to yourself, Okay, we don't have as much help right now, as we normally do. How do you get in that mindset of, of just

Joe G 7:12
just moving away?

Billy 7:14
I mean, for me, the best situation for me is like, just thinking that it's 12 hours of your day, you're doing this three to four times a week, you know, and you can get it over with in one go, you know, and in that sense, it makes me feel better to realize that part, where you're not necessarily taking your work home with you. All right? Sure, sure, you might have a bad bad days or nights, and that's going to happen at any job. But at the same time, it's temporary, it's a very temporary thing. And it's going to be it's going to be a pass later down the line where you're like, it may have been a rough situation, at least I'm stronger for it, you know, I'm learning from the experience, I know what not to do. And what I could do in a similar situation afterwards, you know, that's how I got I got along with it now. My, one of my best friends, okay, he and I, he and I grew into, like the profession together, you know, he didn't go to the same school I did here and UNLV but, you know, he was he was a nurse nonetheless here. But I remembered him being so stressed out, very stressed out with, with everything, you know, like, like, how, how there was so much lack of support, you know, what he feels so stressed out after work, you know, that he nearly at one point quit at nearly nearly at one point consider quitting. So, I mean, it's, it's just something whether it was support from, like, his fellow nurses, you know, pushing him hard or or telling him like, No, this is what you need to do. Or, or, or, or possibly some bullying. You know, I wasn't necessarily there. But he was he was basically burned out. Yes, solution was basically basically finding a niche in his in his nursing career. A couple of years afterwards, and he's still a nurse now, he's still he's still definitely a nurse. He's, he enjoyed his job for at least the good. At least a good eight years after, after his first experience in nursing. Now he's a case manager.

Joe G 9:51
and that's another point. And we touched on this before. Just because there are these holes in nursing doesn't mean that they're getting out of nursing. It just means either there are taking a break, they're getting promoted, they're going on to finding a new role within nursing. There are a lot of times where bedside nurses will either go back to school, they're getting their advanced degrees. And then they'll take on a specialty or maybe more administrative roles. So it's not like they're all just leaving nursing. It's just they might be finding different roles, but the holes are still there. Yes,

Billy 10:21
vary from purposes. I mean, the other things too, like what I noticed, you know, is that, you know, I'm a 14 year nurse. All right. It's hard. It's sometimes hard to swallow that you're a 14 year old nurse, you started out as a 22 year old, young in, and now you're a 37 year old person. Turning going on 37 year old nurse here. The nurses that I grew up are our aging, right. Some of these, some of the nurses that I knew were well, in their 50s and their 60s. You know, I mean, the mean, I think the mean age for nurses, let me, let me put this up here. I mean, the mean, or age of a nurse, in between 2000-2018 is somewhere around 42 to about 48 years of age. I mean, so we're an aging population. So, I mean, retirement, we can't do this forever. So I mean, that a good chunk of us. I sad to say that the wealth of knowledge that they have will probably end up going with them because they're retiring. You know. So, again, another whole another whole is our, our aging nursing population, is the fact that we're aging. We're getting tired, obviously, you know, and we want to and in that sense, we're burned out, you know, because we're, we're getting older, you know, have I felt that burnout to an extent, to an extent, but not not as much as I want to retire, want to quit nursing or what? Or find or find a better option for me,

Joe G 12:17
you've had supervisory roles before, can you talk about some of those, and how, when you were in charge, you would try and help the nurses under you to be able to say, okay, when times are tough, this is how we keep going. Because we can't just, we can't fold, because not just our livelihoods, but especially our patients livelihoods. Right, right. Right.

Billy 12:37
Well, I mean, the way I help when I was a charge nurse, I wouldn't just sit around and do paperwork, you know, I would actually help out on admissions, you know, I would try to get patients to their CT scans or MRIs, well, the nurses take care of the patient. There are other patients there, you know, you know, I do IVs if I need to, you know, I mean little things, I mean, it's not going to curb the stresses that, well, it might help a little with their stresses at work, you know, and it may or may not persuade them to stay per se because of their, because of the stress. But, you know, at least I'm trying to help with them in terms of like, you know, I'm in there. I'm trying to show them that, look, I'm in there in the trenches with you guys. I'm not necessarily twiddling my thumbs, and, and looking at a computer screen and, and looking at this, you know, I'm, I'm trying to help you out. I'm giving you an assignment, but at least I'm here to help you settled the patient and, you know, do execute some of the orders that were supposed to be executed, from the doctors that were ordered, you know, like a heparin drip or cardizem drip or, or, or anything, you know, as a supervisor, you know, I, I often if I get called up to a situation where there is a potential code or anything of the sort, you know, I usually go to I usually listen and I go to the, to the source, you know, I go to the room, I assess the I assess the patient, like, Well, yeah, this patient looks like he's not breathing. Well. He might need to be intubated, or whatnot, depending on the clinical presentation. You know, overall, I'm trying to convey a thought to my to the nurses Well, yeah, you're not alone in this. I'm here to support you. What do you need from me? You know, I can, I can try to help you as much as possible to get the ball rolling on. On the on the issues here, so that we can give the most positive outcome and to the patient, you know, and minimizing any sort of adverse adverse effect of inaction.

Joe 15:13
It's almost like an all hands on deck situation, if you need, if there needs to be an extra hand, you're there to make sure there are no missteps; we keep going. Yeah, the train keeps moving. Yeah. My last question for you, arguably, the biggest pipeline to fill these holes is to graduate, high performing nursing students into nurses, for prospective nursing students and current nursing students, what would be your biggest piece of advice to them, especially when it comes to having to potentially deal with shortages in their future for whatever reason, whether it's pandemic related or not,

Billy 15:52
when you get out of it, get out for the first time you passed your NCLEX. And you get a job. If you have a good preceptor, listen to that preceptor, learn as much, but also think for yourself, think what it is, what you're trying to do, and, and why and why you're doing it. I think one of the bigger issues when it can't, when it comes to, like a new nurse, is that either they're, they're too bookish, and they, they're looking at the at what you need to do in terms of a task, but not necessarily looking at the patient. So, again, observe your your preceptor, see what see what that how they would react and what what they would do in this situation. And not, and not. And not be as by the book, because what you learn and in nursing school, may not may not necessarily translate to what you you do at practice, you know, it's all theory, when it comes to nursing school. And, and don't get me wrong, the, the information that that nursing school teaches gives you the foundation for it, okay, but you got to build on that foundation and, and observe and learn from the people that, that have the experience, all right. There is an old adage, in our, in our profession, where where nurses eat are young. And which means that you know, you could, you could have like a preceptor or you have, you can have a colleague, just because you're new, that means they'll take advantage of you bully you and whatnot. Again, don't let that happen, you know, either you, they you can talk to you, you can talk to them professionally. And that's one of the reasons that's, that could be some of one of the reasons why some, some new nurses leave, they may feel like they're not cut out for it. Because, you know, so and so is saying, you're an idiot, like or you don't know what you're doing, or, or what have you. Of course, you don't know what you're doing. You're new nurse, you're trying to learn the profession, you know, and in that case, you know, you're you're trying to, you're you're trying to learn but also you're dealing with, with a with a toxic working environment. So try to try it try to handle that as professionally as possible. If it hasn't resolved, you could also you could always go to your manager or your director about it. You know, don't let don't let experienced nurses so called experienced nurses bring you down because you're yours, you're new, per se, I wasn't. And I had that experience as well. You're, you aren't alone in that type of. And that type of sense. I'm a big proponent of like, learning on the job and and learning under fire. But at the same time if if learning under fire is not beneficial, then, you know, what's the point?

Billy 19:23
that was a big cookie to swallow. Yeah,

Billy 19:25
I mean, it's really hard to really wrap your head around that because you're talking to four to your, your, your former alma mater, and you're telling them what, what you would do if you knew all your knowledge back in your head, but you're starting to graduate again, essentially. So I mean, that or you would tell your your own self, your own press of what you would do differently. Right, you know, so

Joe G 19:57
well, that is all I have for you, Billy, thank you very much for joining us.

We also have Gabriel Wan, who received her bachelor's in nursing from UNLV back in 2020. She is a critical care cardiac nurse here in town. Gabriel, thanks for coming in. You graduated, during the height of COVID-19, you started working fall 2020. What has that experience been like fresh out of nursing school and right into a pandemic,

Gabriel 20:19
it was a very crazy experience, and you definitely learn fast coming into an ICU setting. There was a lot of shortages during this time, since we're talking about this. In an ICU, you're normally two to one, that's the ratio that we're supposed to be having. And during that time, a lot of the times we were tripled is what we call it three to one, patient and nurse ratio. So it was really hard because you had to learn how to be a nurse as well as care for the sick, sick patients. And they were even sicker during the COVID 19 pandemic.

Joe G 20:55
I mean, you're learning on the job, whether or not it's COVID-19, you're picking up things as you go along coming out of college. But now, it's almost like you have to grow up faster. Exactly. And for those at home who don't understand, can you explain like the patient to nurse ratio is exactly how it sounds one nurse to two patients or three patients.

Gabriel 21:15
That's exactly how it sounds. So in the ICU setting, you're supposed to have two patients or one patient if the patient is critically critically ill, and other settings like stepdown units IMCs, it could be anywhere from four to five patients. And then med surg is five to six patients. Those are this is recommended ratios. Of course, it's not like that during the hospitals here. But that's how it's supposed to be.

Joe 21:39
And during this time as you're learning how to do your job as a nurse, but also seeing that your workload is going to be increasing because of labor holes. How do you move forward? How do you tell yourself, okay, it's gonna get tougher, before it gets better, but I have to move forward.

Gabriel 21:57
During that time, I thought to myself, well kind of has to be done, these people need someone to take care of them. And safety is my number one priority as a nurse. So even though it was very hectic, and very busy time, I still tried to keep that forefront, still tight, tried to do things slow and steady as I was a new nurse and just take it day by day.

Joe 22:18
And for those listening to when it comes to shortages, whether it's pandemic or not, there are a lot of reasons why people would leave nursing just like any job. burnouts, obviously a big factor. But students go back to school, they get advanced degrees, they get promoted. Travel nursing has been a big factor since the pandemic started. But the end result is still the same. How do you build that morale around you? Like once you get yourself situated? How do you try and help fellow nurses that might be feeling the same thing.

Gabriel 22:49
I think it comes down to the unit culture, on where you work and who you work with is very, very important. And if people feel like they're not supported, or they can't talk to anybody about the struggles that they're going through as a nurse, that becomes a big problem. You see people lead to that. Thankfully, I do have a good unit culture where I work. And we really support each other. And it's a great teamwork. So we've been able to retain a lot of the people that are there and go through hard times together.

Joe 23:18
And that's such a huge factor. And I think it's an underrated one is the workplace culture, because it could so easily be disrupted. And it could so easily be ignored because especially in a fast paced job like nursing, you have to keep going. Little things like improving workplace culture, whether it's it's morale building, confidence building that might fall on the wayside. Do you feel like now that we're, it feels like we're kind of getting out of the pandemic, but cases have been going up? Do you feel like the shortage situation is getting better? Do you feel like it's about the same?

Gabriel 23:54
It's definitely gotten better from COVID times, that's for sure. But it's still not where it should be? You know, some days I go in, and I'm like, Oh, I'm triple today, or our charge nurses every evening. They have to have like a hospital wide. Kind of how do we look tonight? Like how was nightshift gonna look? Then I was asked my charges. Well, are we staffed tonight? And then you see them like Nah, not really, I don't know what we're gonna do. So it's still there? Definitely. But it doesn't feel as intense as it did during COVID.

Joe 24:25
That workplace culture we were talking about one of the biggest aspects is having a positive attitude. And that's anyone who has been in a tough situation at work will tell you that's easier said than done is to go in with a positive attitude, a smile. But what do you do to decompress to be able to get yourself in that positive mindset? How do you is there a way to separate nursing from personal are there too, and are they too intertwined?

Gabriel 24:49
I think there's definitely a way to separate them. Some people have a problem keeping them together, you know, especially working in the critical care setting. People die all the time. How can you separate that? At home, you know, so to me, it's very important to keep them separate. And I just, you know, treat work is work, and home is home, I don't mix them, like, you know, in nursing school, nursing was life, you know, I don't view it like that anymore. Of course, my job is very, very important to me. But my health in all aspects is more important as well. And so I do a lot of different things. I go to church, I go hiking, I work out, I do a lot of things to decompress, and just make sure that work stays work. And then my personal is my personal life,

Joe 25:32
talking about that route. In nursing school where students are learning the ins and outs before they get into the field full time. What would be your biggest advice to them? In the event that they may work at a place where there's a nursing shortage?

Gabriel 25:48
I would really look at the bigger picture and see is, is your boss working to fix the problem? How are they going to fix the problem? Are they supporting you? And then go from there? You know, don't be afraid to say no, a lot of times they'll ask, Can you stay late? Can you work another day, and they will work you to death if you let them. So it's very important to say no when you need to, and when you need rest, because we all need rest.

Joe 26:14
And it's gonna be hard to be able to say no, especially in a job like that. Because you know that what you're doing is for the greater good. And it is a rewarding career. But like you said, if you're not personally at 100%, or close to it, then you can't be that way for other people like patients Exactly. Along a similar vein, for nurses out there that are dealing with labor shortages, and they seem to be struggling, would your advice be similar to them? As far as big picture goes? Or would it be different since they're already in the field?

Gabriel 26:45
I think it'd be definitely similar. You need to take a step back and think about why you're feeling burnt out the way that you are. Is it really, because of how they're working with the job? Are you working overtime, because I have a ton of friends that they started working overtime during COVID, because of the you know, the bonuses that were being offered. And now they're all burnt out. So you just have to take a break. You know, thankfully, we work three days a week, try to get your days to where you can maybe work them in a row and then you have a longer stretch off. And so you can recuperate. Take your PTO. Take your PTO that's so important. A lot of people don't do that. And rest up because your health matters. You don't want to be a patient in the hospital.

Joe 27:25
My last question, in spite of having to work harder because of the pandemic because of labor holes. Do you feel like in spite of all that, or because of that you are a stronger nurse now that in spite of how hard it was maybe harder than you expected, that you are stronger as a healthcare professional now,

Gabriel 27:47
I definitely do and at the hospital that I work at for sure. They always say if you can work at this hospital, you can work anywhere. So it was a blessing in that aspect, but at the same time, not at the expense of patient safety. So I look forward in the future to having the ratios better and being able to take care of the right amount of patients and not it tripled as we say.

Joe 28:10
We want to thank both Billy and Gabrielle for joining us. Stay tuned for more episodes with different perspectives on nursing shortages and how we can overcome them. Have a great day everybody.

Transcribed by https://otter.ai