Warning, this is long!
I work full time on a specialty med/surg unit that is grossly understaffed. There is a critical shortage of nurses where I work. A couple of months ago, they encouraged staff to work overtime shifts by allowing us to sign up for bonus shifts in which we would get overtime pay plus a bonus. It was not mandatory to sign up, but enough nurses wanted the OT and bonuses that they were able to fill the shifts. Now what I've heard is that they want to force everyone to work overtime shifts. We would still get OT pay but no bonuses as they don't want to pay bonuses anymore. I actually thought it would be illegal to be forced to work more shifts than the 40hr/week.
The thought of being forced to work overtime shifts on my days off when I already work like 50 hrs per week, really makes me want to throw in the towel. It seems like every shift I work, I get a call to come in early. The other day I came in 2 hours early and got out 3 hours late! I admit I'm a novice and still working on time management skills, however, very few nurses get out on time, experienced and new nurses alike. When I say late, I'm talking about 2-4 hrs late!
I understand there are safety issues and they need more nurses on some shifts. What I don't understand is how they think its safe to have overworked, fatigued nurses working this much overtime. When I work a stretch of 12's, I really don't get much sleep. I really don't feel that I can provide safe care working more hours. The patients are high acuity with unsafe nurse to pt ratios and most of them have very limited mobility and require complete care. We are also short CNA's alot, so we pretty much do everything. Not only is it mentally and emotionally exhausting, but its very physically exhausting as well.
I have asked other nurses on my unit why they just don't hire more staff. The answer I get is that they can't get nurses to come here for such low pay and high cost of living and that travel nurses don't want to come here either. Yes, this may be true, but the other med/surg unit at this hospital has 15 travel nurses and we have 3? Well its quite obvious that they don't want to pay the money to hire more staff. I have been told that this is the worst staffed unit in the hospital.
It is not for sure that we will be forced to work extra shifts, but I sure hope it does not happen. I enjoy nursing and I enjoy the patients, but at this rate, I feel like I'm going to burn out sooner rather than later and I just started. I'm so frustrated with all the short cuts that are taken to save $$ and its the patient that suffers.
Thanks for taking the time to read this
Dec 7, '12
<shaking head> When will organizations realize that mandatory overtime is not a legitimate staffing strategy?? Many states have actually passed laws prohibiting "mandates" (mandatory overtime) for nurses... and this is also included in many union contracts. You need to check with your state BON to make sure you understand their position on this issue.
<putting on consultant hat>
So, what is the root cause of this "shortage" of nurses?
Are there unfilled vacancies? Why are these not being filled? If so, why not? Crappy salaries? Crappy schedule (mandated OT is a Red Flag to experienced nurses) Have managers actually been given approval to fill vacancies or are they being pressured to force existing staff to fill shifts (because it is a cheaper alternative). In some cases, upper management wants to keep the FTE count low to project an artificially positive "productivity" level... this could be prompted by a number of things - from CEO looking for another job to facility being prepped for a new buyer.
Is there a logical escalation process for filling shifts? ex: start by filling with PRN staff, then offer OT for volunteers, then require managers/charge to work.... then schedule some PRN agency ..... and if all else fails, STOP ADMITTING PATIENTS. Some organizations do have a well thought-out plan like this. How does the facility's staffing plan address this (they have to have one for accreditation)?
Does the manager have sufficient moxie to deal effectively with this situation? From the information you have provided, this appears to be a shortcoming for your department. Ineffective managers (lack of skill, lack of experience, lack of backbone, etc) are incapable of being a staff advocate. . If upper management is pressuring them to issue mandates (for whatever reason) it is always easier just to do what they are told rather than make waves. Be aware that the vast number of management "bonuses" in hospitals are based primarily on financial performance.
No matter what is causing this situation - you need to protect yourself. Don't agree to take on an assignment/work excessive hours if you feel that you are impaired due to fatigue. Report this situation to your organization's "Integrity line". If your state BON does not have a 'safe harbor' process, make sure you communicate your concerns (just the facts) in writing to your manager and CNE prior to accepting any assignment that you think is 'risky'. Keep a copy of this communication.
Dec 7, '12
Thanks for your response and advice HueTx. This gave me a greater insight as to what is really going on.
"Are there unfilled vacancies? Why are these not being filled? If so, why not? Crappy salaries? Crappy schedule (mandated OT is a Red Flag to experienced nurses) Have managers actually been given approval to fill vacancies or are they being pressured to force existing staff to fill shifts (because it is a cheaper alternative). In some cases, upper management wants to keep the FTE count low to project an artificially positive "productivity" level... this could be prompted by a number of things - from CEO looking for another job to facility being prepped for a new buyer."
The salaries are very low with an extremely high cost of living. The population has increased exponentially in a short period of time. Due to the population increase, the hospital does not have the means to accommodate the influx of patients. They are planning on building a new hospital in the next few years, hence the cost-cutting strategies.
"Does the manager have sufficient moxie to deal effectively with this situation? From the information you have provided, this appears to be a shortcoming for your department. Ineffective managers (lack of skill, lack of experience, lack of backbone, etc) are incapable of being a staff advocate"
The nurse educator and Assistant Manager are advocates for more staff, however, the Unit Manager is not. I've heard all kinds of excuses for not hiring, but the fact that another unit has 15 travel nurses and my unit is reluctant to hire more makes me believe that this is just a cost cutting strategy rather than issues with recruiting staff.
When I had my interview, I was told that the ratios were high, but they are working on getting them down. I was also told that they were hiring more staff so the situation will improve. Five months later, the exact opposite is happening. A few days ago we were told that the ratios are increasing and that we all need to "stop complaining". I feel bad about wanting to find a new job or quit and go back to school, but this is not what I signed up for. I know its unethical to quit before 1 year, but I have safety concerns if we are mandated to work OT and the ratios go up. In my opinion this is unethical.
Dec 7, '12
I just researched mandated OT in the state I am currently in and there are NO laws for Mandatory OT. Its perfectly legal here and employers can and are getting away with it all over the state. I just read an article about a nurse who was working mandated OT and involved in an MVA due to fatigue..
Longtime Sanford nurse says mandatory overtime may be putting employees, patients at risk | INFORUM | Fargo, ND
Dec 8, '12
How would you be 'forced' to come in on a day off?
What will they do? Drive over and drag you in?
I work my scheduled time.
I never call in.
If they were to (last minute, after schedule is posted) schedule me on a day when I am not scheduled (without me agreeing to it), I would happily stay home (and nap of course)
Simple really. It's my day off.
Staffing the unit is not your responsibility, it's theirs.
Showing up for your pre agreed upon (by you and your scheduler) shifts is your basic requirement...Nothing more.
And if they call you to come in early: Just say no. It's easy to do, and there should be no guilt involved.
It's your time, period!
You cannot be charged for abandonment for 'forced' OT, or 'no call no show' or for leaving at your scheduled time.
Report off to charge, and leave, at your scheduled time, period.
Last edit by hogan4736 on Dec 8, '12
Dec 8, '12
See: I, sub section 'E'
I would be hard pressed to imagine any state's BON not having similar language.
And if some don't address the topic, there's nothing stopping one from quitting after said shift.
"Mandatory" OT exists b/c nurses continue to allow it.
Worst case scenario, they could only fire you for not coming in ON YOUR DAY OFF.
BONs do not get involved in HR issues (though they are consistently the #1 type of complaint that comes in)
Yours is an HR issue.
They are bullying you
Do not tolerate.
Staying over your shift, or coming in to help out (early, or on a day off) is YOUR choice only, not theirs
Shame on them for doing this
Shame on nurses for laying down and taking it
Last edit by hogan4736 on Dec 8, '12
Dec 8, '12
Staff will quit because of it and it will self resolve! Sounds like a crappy place to work, have you looked elsewhere?
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