RNs overworked/underpaid/unsafe staffing

  1. Response to general topic are RNs being overworked and underpaid. For all the heath care adjustments that are abeing made and the added responsibilities RNs are assigned which used to be done by ancillary staff, darn tootin we are underpaid AND overworked. Yesterday I worked an ER where, due to short staffing, we tried to close down four beds because we had no nurse to care for the area. As the morning progressed and the ambulances kept rolling in and the patients kept coming in, it became impossible, We were starting IVs, drawing blood and placing patients on cardiac monitors in the halls all the while still being responsible for four other patients in the regular "bays". Our ER attending felt the situation was "dangerous" and requested to go on ambulance diversion but was overruled by administration - they said "no". I had one patient with numerous medications waiting for a tele bed on q 1 hour accuchecks (which maybe got done q 2 hours), an overdoes on a hall cart who I had to remember to stimulate to make sure she was still breathing, and in the "bays" I had an 80 year old female with the dizzies and frequent bedpan needs, a young woman with a pneumonthorax needing chest tubes, two others I can't recall their needs, an asthmatic in the hall in a wheelchair was getting nebulizers on a portable O2 tank and cared for the by the "charge nurse" who was trying to flow the rooms. What flow? We were log jammed and the people kept coming in. All this and the poor staff nurses get paid about $16 an hour. As a registery nurse, I get $26. This won't make anyone rich but maybe famous if we get involved in lawsuits because someone has a poor outcome because they didn't get "proper" care in the ER. Sometimes nursing sucks - yesterday did - and the patients who were there got cheated. This is in a hospital that couldn't get enough support to unionize a few months ago -- gee -- wonder why????
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  2. 15 Comments

  3. by   CHUBBY
    I hear ya. Even with agency, you can work some scary places with dangerous set ups. The ER I quit years ago (because I moved) was busy..you never got dinner, bathroom visits etc., I just went back there as agency...guess what..after a ton of us left
    they finally hired a ton of people. So now, I'm getting paid more to do less. You figure
  4. by   tracy maietta,RN
    I work in a MICU at a level 1 trauma center. During the "busy season" we often have no ICU, CCU, SCVICU, or trauma beds open. Last year we had 20 patients in overflow on 2 seperate units, with the exact same staffing as we would if only the regular units would be open. We begged to be placed on bypass, but the administration said no. The result--critical care nurses working 16 twelve hour nights in a row and caring for 4 or 5 patients a shift (policy states Nrs.-pt. ratio 1:3). But get this, we had overflow open two days before our JCAHO visit, which would have cost the hospital a hefty fine and the loss of their level 1 status. Not suprisingly, overflow was emptied out and we were placed on bypass the day before their visit. Administration was holding vented patients in ER overnight to avoid the overflow. Now you tell me who the administration cares about? Patients and staff? I don't think so.
  5. by   RN-1
    In many ways I agree that nurses are overworked and underpaid. However, I worked in the banking business for 15 years, and had a tremendous amount of responsibility for about 1/3 the money I now make. Everything is relative, right? What truly concerns me is that every cut in the hospital hits nursing first, probably because nursing comprises >50% of payroll costs. If your hospital has a high Medicare/Medicaid census, as mine does, the hospital is truly getting hit hard. As a supervisor, I feel like I spend most of my 12 hour shift going from unit to unit "plugging holes" in the dam, trying to keep the staff nurses from being totally overwhelmed with their workload. And what are their managers doing? Networking, which translates to one break after another. Nursing middle managers have been a huge disappointment to me. There is so much they could do to facilitate a smoother workday for their staff, but they just don't care! Anybody agree?
  6. by   debrn
    Strongly agree that nurses are under-paid and over-worked to the point of insanity and burnout and unsafe working conditions! I work in a small, 32-bed ,rural hospital that is trying to keep its financial head above water. But while trying to keep us all working, we are putting the patients at risk, as well as risking our liscenses. Or ER is not "staffed" 24/7, but one of the two RN's that work the "floor" is given the distinction of being the "ER" nurse per shift.(We are listed on the schedule as ER nurses, but do not have any pay differential.)If the ER isnt busy, then that nurse works the floor along with the charge RN, and everything is hunky-dory. But, let one bad patient, or, heaven forbid, a CODE come in and then all hell breaks loose and the poor floor patients are left in the hands of the ward clerk, or whomever we can spare from the ones needed to respond to the emergency. We don't have a doctor in-house; he or she must be called and awakened if it is in the middle of the night(and aren't all the bad cases then?), and we are on our own to stabilize that patient, or simply keep them breathing, while we wait for the doc to get dressed and drive in to the hospital. On a typical 12-hr night shift, we are lucky to have 2 CNA's, 2 RN's and an LPN working, along with one janitor and a ward clerk. That is the total hospital staff at night. I am one of the lucky few that are designated as the "ER nurse". Let me tell ya, I have been up to my elbows in some pretty tough situations that God only knows how we came through them with a viable patient. Especially the night that we had a cardiac arrest come in and all 4 of us there were doing CPR to beat hell, and the ward clerk called the doctor on call to tell him we had a code blue. This a##%&&e wouldn't come out until a "NURSE" could call him and give him "REPORT" on the patient's condition. TO make a long, ridiculous, story short, he did finally appear, and his apology was that he had "had so many false codes reported" that he didnt want to get "too excited" until the nurse could report to him(!!!!!!!!!!!). Patient safety????, it is a myth today. And, if anyone had wanted to investigate the situation, then this stupid ER nurse is the one who would have had to take the brunt of it. The patient had been down 20 min. before CPR was begun, but the MD didnt know that, and he still chose to handle the situation the way he did. Episodes similar to this happen more that anyone knows, we usually just dont talk about them, and the patients come in to us as trusting that we are there to help them and that all will be well. I would like to tell some of the arrogant doctors out there that WE ER nurses that have to handle most of their work before they even lay eyes on the patient deserve a lot more that 13.25 an hour.They drive a Lexus while I drive a 10 year old Ford. They vacation in Hawaii, or ski in Colorado, while we work the holidays. Hey, DOCS, if it weren't for your nurses, you would be up the proverbial creek. Just once, I would like to see the nurses given credit for what they have to do. CNA's too..good ones can make or break you..i've been both, and we shovel the poop and take the poop from the MDs and administration and grovel when we get our pitiful paychecks.
    Sounds like I am burnt-out, doesnt it? Maybe I am, or maybe I just needed a place to get this off my chest. Glad there is a site like this to let off some steam. I really like my job, it is the situations that we are all (as nurses) put in that gets my dander up.

    [This message has been edited by debrn (edited January 09, 2000).]
  7. by   CHUBBY
    I dont think you're burnt, otherwise you'd have left the job along time ago. I think you're expressing the frustration that everyone else has-do more with less for sicker and more pts. I can't tell you how many people I readmitted to the hospital this week because their pneumonia hadn't cleared, they were septic..all because their capitated stay had expired. It is only going to get worse. Look at the ER--it's the last bastion of where you can pack in a million people...you can't divert them if they come in by private vehicle..into a small area, do everything from concious sedation and disch. D&E's, TPA, etc. and if they need to stay..oh well, you'll have to hold them because there are no beds.

    [This message has been edited by chubby (edited January 10, 2000).]
  8. by   nikki norton
    This is to Debrn. I hear you. I work at a 36 bed hospital in Texas. Thanks to many episodes of the stories you described, we finally got a nurse in the er on 11-7. Sometimes it is not any better. I had a mi on tpa when my second chest pain came in-- i have no pbx (that is me) no aid or anything. I could not leave my tpa to even triage my next chest pain, and due to the flu we had 38 pts( we are a 36 bed hospital) we had them in the halls, including one on a vent so I had no help not to mention I was in the middle of a transfer. Sometimes the dr's help sometimes not. We have ER docs from costal and to get dr's to work at our low paying facility they tell the dr's it is "sleeping for dollars" ha ha. We are also trauma designated. Depending on the dr. that is very scary.

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  9. by   eyeball
    Quote from RN-1
    In many ways I agree that nurses are overworked and underpaid. However, I worked in the banking business for 15 years, and had a tremendous amount of responsibility for about 1/3 the money I now make. Everything is relative, right? What truly concerns me is that every cut in the hospital hits nursing first, probably because nursing comprises >50% of payroll costs. If your hospital has a high Medicare/Medicaid census, as mine does, the hospital is truly getting hit hard. As a supervisor, I feel like I spend most of my 12 hour shift going from unit to unit "plugging holes" in the dam, trying to keep the staff nurses from being totally overwhelmed with their workload. And what are their managers doing? Networking, which translates to one break after another. Nursing middle managers have been a huge disappointment to me. There is so much they could do to facilitate a smoother workday for their staff, but they just don't care! Anybody agree?
    Oh yes I agree. I just came back from a meeting which left me with a combined headache/stomachache. We were informed that our already ridiculously busy floor/heavy workload would be increasing in several ways and that we were expected to suck it up and it would all be ok. When protests were made there were weak and feeeble assurances that they would be of help. They are not of help with the current workload which is terribly heavy. Why do they think I believe that they will be of help now? They sit around and do nothing but talk and laugh with each other and ignore the chaos feathering their "wanna be manager" nests. Our actual manager didn't have the b**** to show up at the meeting to deliver the bad news and deal with the protests. Hospital nursing blows.
  10. by   Anna Flaxis
    Wow. I will never complain about my job again.

    I can count on one hand the times I have had more than 4 patients. I get my meal break every shift. If you're in the "Trauma Zone", you'll have 2-3 patients the entire shift. If you get a Resus/Cath Alert/Stroke Alert/Trauma, you're 1:1 until that patient is out of the ED. The other nurses take up the slack. The Charge Nurse decides when to to on divert. We rarely board, and *never* ICU patients, only stable med/surg/obs types, and even then we get a float nurse to come and care for the boarded patients. I make a living wage. I'm lucky enough to make working part time what most people in my community make working full time. I have health insurance and PTO.

    Even so, I know with every fiber of my being that I am earning every single penny. Even so, it's easy to get demoralized at times.

    I simply cannot imagine working under the conditions you guys describe. I probably wouldn't even last a day. It is criminal.
  11. by   emtb2rn
    nice to see that nothing has changed in over 10 years

    Stargazer, you say that "We rarely board, and *never* ICU patients, only stable med/surg/obs types, and even then we get a float nurse to come and care for the boarded patients." You can ALWAYS get a unit bed? Wow. We board vents, multi-drip, whatever you can think of patients. If there ain't no bed, there ain't no bed. Sometimes we get a unit nurse to come down & cover our holds but that's pretty rare.

    6 patients is not unknown and during the winter/da flu season, it happens more frequently. Depending on which section you're in, you can have 4 rooms & 2 hallways or 3 rooms & 3 hallways. Almost always get a dinner break. We're staffed based on projected census. If we get slammed, they'll try to get folks to come in early or just pick up a few hours to lighten the load, but that doesn't always pan out.
  12. by   Pixie.RN
    Quote from emtb2rn
    nice to see that nothing has changed in over 10 years
    LOL ... thanks for pointing that out, because I was going to do that too.
  13. by   Anna Flaxis
    Quote from emtb2rn
    nice to see that nothing has changed in over 10 years

    Stargazer, you say that "We rarely board, and *never* ICU patients, only stable med/surg/obs types, and even then we get a float nurse to come and care for the boarded patients." You can ALWAYS get a unit bed?
    Sometimes we have to wait until they can transfer a patient out or call in another nurse, but it's not usually a very long wait.
  14. by   VICEDRN
    Quote from ~*Stargazer*~
    Wow. I will never complain about my job again.

    I can count on one hand the times I have had more than 4 patients. I get my meal break every shift. If you're in the "Trauma Zone", you'll have 2-3 patients the entire shift. If you get a Resus/Cath Alert/Stroke Alert/Trauma, you're 1:1 until that patient is out of the ED. The other nurses take up the slack. The Charge Nurse decides when to to on divert. We rarely board, and *never* ICU patients, only stable med/surg/obs types, and even then we get a float nurse to come and care for the boarded patients. I make a living wage. I'm lucky enough to make working part time what most people in my community make working full time. I have health insurance and PTO.

    Even so, I know with every fiber of my being that I am earning every single penny. Even so, it's easy to get demoralized at times.

    I simply cannot imagine working under the conditions you guys describe. I probably wouldn't even last a day. It is criminal.

    This is it. We can't be friends. EVER. lol

    My last job, we had a "team nursing approach" which left me and another RN splitting up 14-16 patients. If there were three ICU holds, one of us took those and the other took all of the other patients. My record is 11 ER patients and at another time, 18 urgent care patients. Needless to say, I voted with my feet and left for the regional trauma center.

    Ironically, feel like i can handle a lot after starting in the little country hospital with a ridiculous patient load and oh! of course, they were forever adding increasing "magnet like" garbage like more supervisors and more forms to fill out and documentation. UGH!

    Am thinking of departing for ICU so that I can have 2. Period. End of story.

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