Have you heard of travel nurses getting blacklisted from hospitals? But, what about the hospitals or units that nurses should avoid?

The term blacklisted refers to a list of people or organizations that are regarded as unacceptable, untrustworthy, or unethical and should be avoided and excluded 

Definition

I first learned of being blacklisted within healthcare when certain travel nurses during the pandemic were banned from working at a particular hospital or hospital system if that hospital blacklisted them.  As a result, travel nurses were threatened with the label “blacklisted” and fearfully suffered through unsafe or unethical contracts/assignments to avoid being banned from the hospital and losing employment. 

The consequences of being blacklisted or banned by a hospital meant that the hospital would not renew your contract or hire you in the future. I saw the effects of being blacklisted by hospitals, but I didn’t see the reverse for hospitals. As I searched for nurse blacklists, where nurses deemed certain hospitals that should be avoided for work, I came up empty partly because nurses may not speak up and don’t have a strong united platform for nurse advocacy. While I believe this is an area for growth within the profession, the closest attempt I’ve seen toward nurse advocacy has been through nurse strikes. 

Although I’m not here to point out specific hospitals that nurses should avoid, this article will help to identify potential factors that nurses should cautiously consider before working at a facility. These hospital or job ‘red flags” are based on key factors of nurse dissatisfaction and could indicate the type of work environment to expect.

Nurse Satisfaction and Burnout:

As of 2020, almost 62% of nurses experience burnout and dissatisfaction with their jobs. In addition, nurses have extremely stressful jobs working in highly intense environments with the threat of liability lingering in the background. So, nurses must navigate the working environment cautiously and intentionally to improve satisfaction and prevent burnout. 

What are the factors that lead to nurse dissatisfaction and burnout?

These statistics are real and alarming! Many nurses are burnt out and nursing school may not have prepared you for this. While it’s important to have proper coping mechanisms and work-life balance, it is equally important that you understand the factors that lead to nurse dissatisfaction. Factors including:

• Unsafe nurse-to-patient ratios
• Lack of support from coworkers / Shortage of nurses 
• Lack of support from management/poor management
• Lateral violence from coworkers
  • (ex: nurse bullying, “clicks” on the unit, or the unit “mean girls”)
• Rotating Shifts
  • (Required to flip between day and night shifts) 
• Inadequate training

With this in mind, as you navigate the nursing job market consider the factors of nursing burnout and how the potential employer addresses them. (Pro-tip: These are great interview questions to ask the hiring manager about.)

Signs of Jobs That Nurses Should Avoid in 2024

There are some predictors of a bad unit and they can be seen in the offer phase, interviewing phase, or with the type of hospital model. This section will highlight “red flags” from potential health employers before and even after accepting a job. If you notice these potential “red flags” early, then you can navigate the nursing job market and adjust or avoid working in an environment that fosters poor nurse satisfaction. 

1. The Offer

Before Interviewing, what does the job posting say?

• Sign-On Bonus:
  • A sign-on bonus is a lump sum of money offered for accepting a job. For example, a hospital may have a $10,000, $15,000, or even $30,000 sign-on bonus for “X” amount of time commitment. This is enticing, but this points to the desperation of the employer and their retention issue. Oftentimes the sign-on bonus isn’t given upfront in full, but instead broken out over a set period or the duration of the contract.
  • Pro tip: The larger the sign-on bonus, the longer the commitment and the greater the sacrifice of your potential job satisfaction. Also, sign-on bonuses are TAXED!
• Contacts:
  • Contracts are offered over varying time frames (ex: one, two, or three-year commitments) and state that you will commit to work for the company for that full amount of time. These contracts may not even come with a sign-on bonus. The downside is if you decide to leave early and break the contract you may have to pay hundreds or thousands of dollars. 
  • Although this might be your dream job on your dream unit, remember that people who enjoy their jobs usually aren’t required or forced to stay and penalized for leaving. Happy workers stay because they want to! The beauty of nursing is the flexibility to switch units, specialties, jobs, or even states to work.
  • Pro-tip: Avoid contracts altogether if possible and enjoy the freedom of nursing. 
•  Rotating Shifts
  • If the job requires you to rotate between day and night shifts…run! This is a quick way to burn out as a nurse and it’s not beneficial for your health. It’s hard to balance your sleep cycle, establish a routine, or have the energy to experience life outside of work when you flip between day and night shifts. 
  • Pro-tip: Be set and choose a job where you either work the day shift or night shift. 

2. The Interview

• If you’re hired right on the spot
  • If the interview was just a formality and you’re hired right on the spot this could also point to the desperation of the unit and how heavily they need to fill spots. Of course, every situation is different and you might have been referred for the job or impressive in the interview so take this with discretion.
• Offered position without even interviewing
  • Even more of a caution than being hired right on the spot is being hired without an interview. They didn’t screen you (although you are probably great and qualified), but this also didn’t allow you to screen them. Interviews work for both parties and lacking an interview speaks to the desperation of the unit.

3. On the Unit

If you’re allowed to shadow the unit or you’ve just started working on the unit, here are some red flags to consider.  

• Everyone’s New:
  • Lots of new graduate nurses (meaning less than 1-2 years of experience)
  • New grads training other new grads 
  • No senior nurses (everyone has less than 2 years of experience and barely any nurses over at least 5 years of experience) 
  • Charge nurse has less than 2 years of experience

This is cautionary because new grad nurses are still training and growing professionally. A good unit has a good balance of new grads (< 2 years), mid-levels (2-5 years), and experienced nurses (at least 5+ years). Remember that one of the factors of nurse dissatisfaction is the lack of training and support. Without experienced nurses present, is hard to support new grad nurses.

• Lots of travelers/temporary PRN staff

As a means to bridge the gaps or lack of nurses on a unit, hospitals will utilize travel nurses. This is understandable because there is a shortage of nurses, but if the unit is made up of primarily travel or temporary staff then this is telling of the retention health of the unit. Especially if these travel/temporary nurses are the charge nurses or preceptors on the unit. Caution! 

• High/bad nurse-to-patient-ratios

What are the nurse-to-patient ratios? As a standard, we can look to unionized states for enforced safe ratio requirements. These unionized states usually establish safe ratios with nurse satisfaction and patient safety considered. 

Based on California’s safe staffing law, here are the nurse-to-patient ratios depending on the specialty. 

So, note the nurse-to-patient ratio for that unit and compare it against California’s safe staffing law. If the manager says, “Occasionally we go over ratio or occasionally we’re within ratio” then this tells you that you may have unsafe shifts where you are responsible for too many patients. This isn’t safe for the patients and jeopardizes your nursing license!  

4. The Type of Hospital: For Profit Hospitals

• For Profit Hospitals

While I won’t identify specific hospitals, I will mention that the type of hospital and their model should be considered. For-profit hospitals compared to non-profit hospitals are just as they sound. For-profit organizations are focused on maximizing their profits and as a result, nurse satisfaction is often not prioritized.

A known for-profit hospital system is Hospital Corporation America (HCA) with hospital locations around the nation. (List of HCA hospitals). As a for-profit organization, maximizing their profits often means creating nursing staff shortages leading to dissatisfied nurses. In response to this nurses recently protested in North Carolina when HCA purchased a hospital and created unsafe working conditions.

• MEDITECH Charting system

In addition, HCA also uses Meditech as a charting system and nurses have rated this charting system as one of the lowest. Meditech is the charting system owned by HCA, once again highlighting their priority for profit. Although some nurses would describe Meditech as simple, it is also archaic and doesn’t quite adapt to the workflow of today’s healthcare workers in a technological world.

Pro-tip: Look at the reviews of a hospital first and do your research.

Disclaimer:

This article considers common anecdotal experiences and nurse forums that support existing research on contributors to nurse burnout and the nursing experience. 

As a disclaimer, this list should be taken with discretion and for informational purposes only. Every case and situation is different, but these are just factors to identify and consider when navigating the nursing job market. 

Conclusion:

This article shows the common signs of jobs that should be avoided for nurses in the hopes that you can navigate the job market intentionally with an informed decision. Navigating nursing can be difficult, but with the right caution, you can select the best job for your career while also not sacrificing your potential job satisfaction. Even though it may appear to be your “dream” job, you can’t neglect the dynamic of the unit.

Looking at the bigger picture, if nurses avoid unsafe, unacceptable, unethical, or “blacklisted” hospitals then this, in theory, forces change within healthcare to improve nurse satisfaction. Improvements such as more unions, safer care, and pay increases can happen when nurses reject bad jobs within healthcare. Nurses are in demand and can evoke change by what they choose not to accept. Put simply, 

Avoid the job + nursing shortage = change in healthcare

However, if you’ve noticed these signs and you’ve already accepted the job then look for ways to leave or transition to other units and opportunities. If that’s not possible and you’re under contract, then increase protective factors such as your self-care routine to help you recharge for each shift. 

Great Resource: Link to The Nurse Recharge Guide

Overall, my goal is to help nurses navigate their careers. Not all experiences are the same, so take this article with discretion and use it for informational purposes.

Happy job searching!