[ARBY]

It was in our paper Sunday which was perfect with 60 Minute's spot about the nursing shortage. Thanks for looking at it. Rita
**the parts between the ** were not printed in the newspaper article due to space limits


**We hear frequently on the tv and read in the paper about the shortage of nurses. I have been an RN for 36 years and have some thoughts about the crisis.**
A decade ago hospitals downsized their nursing staff to cut costs. ** The insurance companies have mandated that only the sickest patients are admitted.** The RN's didn't just disappear, it is the market that pushed them out. Less staff with sicker patients makes for nightmarish working conditions.
The existing nursing population is frequently refered to as "aging" yet the work hours are increasing. MANY positions require nurses to work 12 hours a day. This day frequently becomes a 13-14 hour day as we have to work an hour longer to make up for eating breaks. Many times these are skipped or
eaten on the run. Eight hour shifts become 10 hours. ** Sometimes a nurse on the next shift calls in sick and we must stay until a replacement arrives. I occasionally worked 16 hours when the nurse on the next shift called in and there was no replacement. STUPID but I couldn't abandon the patients.**
**And then there are the reams of paperwork to be done, orders to be transcribed, labs to be reviewed, and nursing notes to be written. Sometimes there were so many CARE PLANS to be written I felt I couldn't CARE for the patient as I thought necessary. Bathroom breaks seemed like a luxury.** Many days when I left work I felt like I had either had to compromise my standards or the care my patients received.
Nurses are frequently assigned 10 patients on a Med-Surg floor. These patients may be fresh post op with frequent vital signs, dressing checks or changes, IV's to monitor, pain meds to give and frequent assessment. Add to this, perhaps, a patient with chest pain and and another with blood transfusions. And, of course, there is always the patient who is being dischared the next day but, because the doctor didn't explain anything to them, they have a million questions to ask the nurse. **Also, a patient who thinks you are their "private nurse" can take much of your time. You can't ignore their call because you never know if the call is for ice or because they have chest pain.** Sadly, today there are too many patients with deadly diseases, HIV for example. One stick of a needle or one splash on an open cut and the nurse is now a statistic. Her career/life may end because of one hurried action. The nurse is responsible for all care regardless if the load is too heavy. One mistake and someone could die, or the nurse could be fired/sued/or lose her license. Nurses are not willing to face these possibilities so the hospital (corporation) can fill the pockets of their CEO's and shareholders. **Bring these people in for surgery and see how they like the care (or lack thereof) that they receive.but then they are the ones who would hire private caregivers. If a co-worker calls in sick, the nurse has to care for those patients too until a replacement is found.and frequently a replacement is never found.** Management isn't going to come out of their office to help. In special care units the ratio is jut as bad. Five patients would be ideal but it is frequently 6-8. Doesn't sound like much of an increase but remember, these patients need almost constant monitoring.
**The last hospital-based job I had was at a drug and alcohol rehab hospital in another state. We could have as many as 40 patients with myself and 1 other person, either another RN or a LPN, to care for them. What fun to deal with a falling down, vomiting drunk who might be physically or verbally abusive or a drug addict withdrawing, with this number of staff. More and more we had patients who were despondent and on "suicide watch". After 6pm we were the only staff in the building. We had as many as 5 admissions during the shift , 8-10 admissions from the previous day that required special charting and the doctor making rounds. Plus we had to get their snacks before bedtime, answer the phone and answer questions about the program for those seeking admission. We also had to talk to previous patients who were calling to let us know how they were doing. And, of course we had visitors who wanted to know how their loved ones were doing. If someone vomited there was no housekeeping to call, we cleaned it up. If someone needed towels, we got them from the laundry, if a john clogged there was no maintenance to call.**
**Of course everything that goes wrong is the nurses fault. Everyone hears how , "The nurse who drew my blood left a bruise!" (actually it was a lab tech), "The nurse left me on that hard X-ray table without a pillow!" (actually it was an X-ray tech), "When the nurse brought my food it was cold!" (actually it was a dietary aid). When the doctor makes rounds he tells the patient that the nurse never called him to tell him the patien's
family had arrived (actually he was called but still had 3 holes to play on the golf course). In one office I worked I had to tell the patients waiting in the exam rooms that the doctor had an emergency at the hospital when he was actually downstairs test driving a car for his daughter's birthday that the dealership had brought to the office or perhaps he was off getting his hair "styled".**
When a patient complains because it took 30 minutes to get them the ice chips they requested, nurses cannot say, "Sorry, we're short handed tonight!" First we would be reprimanded by
administration if it got back to them and, basically, that would be like saying, "Sorry, you're kinda on your own tonight, hope nothing happens!" And we certainly can't say, "Sorry, there was an emergency and we had to attend to that." The patient then wonders what would have happened to them if they had an emergency at the same time. Nurses put their license on the
line due to poor staffing and other management demands to care for their patients. They are frustrated they cannot do more for them.
**At one hospital I worked, another RN , a doctor and I started a dialysis unit. We initially functioned in one big room so all patients could be seen by the staff. When our unit became extremely busy (and a great profit generator) we were move to a hospital floor that no longer had patients. As Head Nurse, I requested that the wall between 2 rooms be removed (or at least a door cut between) so a nurse could see 4 patients at once. Management
thought leaving one room and going thru the hall to the next was "good enough". Years later when I went back to visit, the walls were opened up. I wonder how many people died before they figured that out? It would have been easier to do it during the initial renovation, but I forget that nurses know nothing.**
Many nurses have continued to work under these conditions because they feel that if they don't care for the patient, who will? Many nursing schools have closed, mine included. Young people are not entering this profession because of the pay and working conditions. Nursing instructors can earn much more teaching at other schools. In some areas, the people who check
you out at the grocery store have better benefits and pay than nurses.**Many nursing programs do not educate the new nurse to the reality of nursing. The new nurse may be able to tell you academic things but has no idea how to suction a patient or start an IV. They have only limited "hands on" experience during their schooling and therefore receive this part of their education "on the job". Management looks at how many nurses are assigned but don't always look at their experience.**
**In case you haven't looked, for the most part, the small-town hospital doesn't exist anymore. Hospitals have become a business and the bottom line is PROFITS!!! If they can get by with one less nurse per unit, GREAT, 2 less even better. Yes, larger hospitals offer more services to the patient but at what cost to the patient?**
**Many ads I see here in California require a nurse to be bilingual. I went to school to learn nursing skills, not to be a linguist. Right now the requirements are usually Spanish but, the other day I was in a government office and directions were printed in 10 different languages. How long before we are required to learn those too? If I were going to work in Mexico or Spain I could see the need to learn the language but, working
here, I feel I should be able to concentrate on my nursing skills. Perhaps these foreign speaking patients should have an English speaking person stay with them to bridge the language barrier. Here's another thought, maybe THEY could learn the language of the country providing their health care.**
Perhaps if someone took the time to look, they would see that we are not in a nursing shortage, we are just short of nurses willing to continue to work under these conditions, jeopardizing their license along with their pateients lives and possibly their own. I feel if working conditions and wages were improved, many of our "aging nursing population" would return to work and many young persons would re-think their calling to be a nurse.

[pickledpepperRN]

You wrote a great article.
I wonder about why sentences were deleted. Could it be they were too graphic? Frightening?
People need to be so very afraid they insist on knowing the staffing levels just as they should know the abilities of their doctors.
Thank you!

[ARBY]

Spacenurse, thank you for your reply. Part of it was edited due to space. I notice that every article in this section (public opinion) of our paper only gets 1 column and that's how long mine was. I wanted to give them too much rather than not enough.

Someone suggested that I send the article to AARP for possible publication. I'm going to do it. That would sure get the info to a LOT of people.

Thanks again for reading it.

[Sally_ICURN]

Thank you for that well thought-out and thorough article. You did an awesome job communicating nursing's plight.

I have a ton of respect for what you have written, but I hope you don't mind a little honest critique. I think that the part about people learning "the language of the country that's providing their healthcare" is a bit of a harsh statement.

Where I live in California, I am a "minority" (Eastern European white, born in Michigan). The "majority" of people who populate the neighborhoods in my city are Asian. A lot of the elderly Asian people do not speak English. California has one of the most diverse populations in the United States along with New York and Texas.

More than 34 million Californians responded to the US census in the year 2000. Here is the "race" breakdown for California:

White persons (a) = 59.5%
Black or African American persons (a) = 6.7%
American Indian and Alaska Native persons (a) = 1.0%
Asian persons (a) = 10.9%
Native Hawaiian and Other Pacific Islander (a) = 0.3%
Persons reporting some other race, percent (a) = 16.8%
Persons reporting two or more races = 4.7%
Persons of Hispanic or Latino origin (b) = 32.4%
White persons, not of Hispanic/Latino origin = 46.7%

(a) Includes persons reporting only one race.
(b) Hispanics may be of any race, so also are included in applicable race categories.

Of the above percentages:

Foreign born persons = 26.2%
Language other than English spoken at home = 39.5%

source: http://quickfacts.census.gov/qfd/states/06000.html

So the question is, what constitutes the "language" of our country (or state)? And who decides what that languague is? 40% of Americans who speak a language other than English is a very substantial number of Americans.

The United States is made up of different people AND different languages and the diversity is projected to grow even more. One of the hospitals I worked at had a translator pool of close to 100 (yes! 100) different languages. Isn't that just beautiful and astounding?

I'm not saying that we, as nurses, should have to learn all these different languages, but instead embrace the differences and not suggest that "THEY" (like they are a burden) change to conform to what is, in my opinion, an ethnocentric belief...that there is only one language in this great country. How sad that would be.

I completely understand the frustration of not being able to communicate with patients due to language barriers, but I think that if people who use a language other than English were to read that part of the article, they may become offended. And with such a large portion of the population in the State of California (and American's in other states as well) speaking something other than English, that's a lot of folks turned-off. That's not the message that I would want to send as a professional nurse.

I wish I knew Spanish--it's a beautiful and romantic language.

With much respect,
~Sally

[pickledpepperRN]

Yes! Send it to AARP. (I am a member).

I speak broken Spanish, understand much if the patient is alert, calm, and able to taylor their vocabulary to a childs level. Many sick patients cannot do that.
I have had to care for Farsi, Russian, Polish, Korean, and other elderly patients, often with a child interperting. It amazes me that these kids seem so mature when their loved one is sick.

Mainly people need to know the dangers caused by short staffing and managed care so they can bring an advocate to the hospital with them.
Educating the voters is essential. We voters in Los Angeles County voted for a small increase in our taxes to keep the county hospitals and clinics open. There was an ambitious campaign about the importance of the ERs.
Again, good article.