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Your Nurse Manager may not be the Problem.

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No, your nurse manager can’t just hire more people. It can be hard to give your manager credit when working short-staffed, but unfortunately, adding people isn’t the easy solution we would like.

Your manager is responsible for the budget. That budget details a certain number of people your unit can have. It is most often based on the number of people in bed at midnight in inpatient units, the number of money-generating visits, and the length of stay in outpatient departments. For the manager to have the authorization to hire more people, there either had to be more visits, better turnaround, or documented safety issues or patient satisfaction concerns.

This was a reasonable argument for not hiring more staff before Covid, but it isn’t always the main factor today. Many units are vastly understaffed, relying on travel nurses or tired staff members to continue picking up shifts for overtime hours.

It’s reasonable to think that if the hospital can pay a travel nurse over a hundred dollars an hour, they should be able to hire a few more people. Except, there aren’t any people. Even with large sign-on bonuses sweetening the deal, CareerBuilder noted that over 48% of their nursing ads were unfilled after 90 days. There was already a shortage of nurses expected to increase by 2030, but Covid conditions have hastened the threat.

Many nurses are turning to travel contracts to make bank before the options run out. Still, in many states, the possibilities are already declining. In some areas, travel nurses can make more than 95 dollars an hour, far greater than the national average pay for staff nurses in any position. Unfortunately, that’s only the tip of the iceberg. The agencies sponsoring those nurses can charge 20-60% above the nurse’s salary, meaning that temporary help can run hospital budgets into the ground.

Large for-profit hospitals may pay the bill for longer, but smaller hospitals with less capital are already struggling. Many were working before the pandemic. Essentially, your CEO has to choose to lose more nurses due to short staffing or pay baffling rates for one or two nurses when the floor needs many more. There isn’t a good answer when 50,000 dollar sign-on bonuses don’t attract people to the door.

It’s likely that your manager doesn’t have much say in that decision and that they are impacted by the pandemic’s toll, feeling responsible for their staff members, constant changes in regulations, and trying to keep the budget green as overtime stacks up.

So how can you help?

First, recruit. Post listings on your social media and talk to your nursing friends. Be a willing mentor for student nurses and new nurses alike. It costs a lot of time and money to hire and train someone. The more people who stay, the more likely money can go to more new nurses.

Report safety or patient satisfaction concerns. Right now, it may not help you get more nurses, but it can help you get more ancillary staff. Maybe a CNA can’t pass your meds, but they can help you keep patients from falling. The dietary aid won’t feed your patient, but at least you won’t need to deliver the tray.

Most of all, keep your head up. As Covid cases continue to decrease, many of the nurses who left for contract positions will find their way home. You can only hope they will choose your facility since the market is in the employee’s hands. Keep it positive and do your best to retain the help you get. Your nurse manager may be a problem for other reasons, but staffing typically isn’t one of them. Don’t like how they do the job? Nurse manager turnover is at an all-time high as well, now is your chance to try the hat on for size!

Amanda Ernst, DNP, RN, CEN

Amanda Ernst, DNP, RN, CEN


Amanda is an ER nurse with 10 years of healthcare experience. She currently works as a nurse educator and as an adjunct professor for several schools. She also works as a freelance healthcare writer in her spare time. Amanda thinks the greatest thing about nursing is the endless possibilities and opportunities to learn. What have you learned today?


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