Blue collar treatment with white collar expectations

[wordstew]

All nurses in the United States have been socially engineered by the system to accept this type of treatment.

Most nurse policy is written nurses who have a disconeect from the average working nurse and don't usually practice real day to day nursing for which they are writing policy for.

Policy writing nurses are not the ones getting the forced overtime, working holidays and dealing with increased patient loads.

I think nurses as a whole we should advocate for nurses who actually work the job to be writing policy for it, not a nurse that had thier last patient care experience 20+ years ago.

How many of your upper management nurses are getting forced overtime and working weekends and holidays???????

[EmerNurse, BSN, RN]

New nurses on my unit are thrown maybe 3-8 weeks orientation, learning to drive in the fast lane on I95. Even if they have experience, or do pretty well, when they're on their own, the stuff hits the fan. New nurses have absolutely no interest in martyring themselves, let me tell you! We run, fly, and still get "bopped on the head" for what we didn't do, when it's all we can do to stay afloat and keep our patients cared for properly.

We work short nearly every single night these days. I LOVE my job and the people I work with, but the environment is getting worse and worse. I have no patience left for the "respect my authoritai!" interim charge nurses who have no question of dumping a few more patients on an already critical zone cause we're short, while standing in the middle of the nurses' station looking important. Biting my tongue is becoming an new sort of aerobic exercise and I'm quickly losing interest in it.

I don't know what the answer it, truly I don't. If you open up your mouth, the managers that agree with you will also admit that they can't do anything about it. The others simply use the "it's the same everywhere" with a little condescending smile. They swear they're hiring as fast as they can, but then beating the new hires to death with crap orientations (cause they NEED to be off orientaion) only flies them out the door faster.

Sadly, they're right - it IS pretty common for it to be this way, at least in my neck of the woods. Where ARE all those new grads going? The ones that land here don't stay - so where are they staying?? I'm tired.

[TrudyRN]

FYI -I am a mid-management nurse, working as director of an ICU. I put in an average of 50 hours a week, more than any of the staff I supervise. The upper-level management at my hospital also are working more than 50 hours a week. When we have a week-day holiday we have to use our vacation time PTO to get paid for it, it is not part of our salaried hours. I am on call 24/7 and it is not uncommon for me to work a 10 hour day shift going to meetings as well as helping in the unit, doing admits/transfers, general ICU patient care, etc. I get home for about an hour and have to go back in to work part or all of the night shift because of a sick call. I took call to cover night shift this past Thanksgiving and Christmas because some of the staff wanted off. We are in a rural area so there are very few agency staff we can utilize to fill these sort of needs or we would. We regularly seek to hire into vacancies. When I did the math on how many hours I work I figured out I am being paid less per hour than any of my staff.

I am also responsible for writing policies.

Your generalization regarding management is not accurate. I highly doubt I am the only manager in America working like this.

:angryfire

I think you are the exception, though, in that a lot of managers do not come in on holidays or work the floor to cover call-off's. And even though most managers I know are salaried and do put in more than 40 hours, the huge majority of these hours are spent at a desk or in meetings, not cleaning poo and being forced routinely to work over. They do get lunch and pee breaks, while their staff routinely do not. Plus, you can flex your hours. If I am 1 minute late, I get docked for 8 minutes! But if I stay over, I have to beg and plead to get paid. Besides, you are the boss. You don't HAVE to work the unit. You do it to keep in touch with the staff and keep your skills up, presumably. And I doubt you routinely do it for 8, 10, 12, 16 hours. You probably spend an hour or 2 at the bedside per day, at most.

All of which is commendable, don't get me wrong. I know, having been a Head Nurse, that there are lots of valid reasons that you aren't full time at the bedside. There is the schedule to make, interviews, personnel matters to handle, meetings and more meetings, etc. And, yes, it is not at all uncommon to work 50 to 60 hours per week, some of it at the boss's house on the weekend.

If I'm wrong, I apologize in advance.

Being the boss is its own brand of stress. Things often look rosier than they really are.

[TrudyRN]

I don't know what the answer it, truly I don't.

We all know the answer, EmerNurse. We are just afraid of it.

[TrudyRN]

OK Timothy, how do you make that happen? I work in an ICU. Our ratio is suppose to be 2 pts to 1 nurse maximum and pts on CRRT are 1:1. We also have open visitation, which has come to mean family members out the wazoo following you around. Then there is the unwritten, but official policy that we aren't allowed to refuse an admission just because we don't have enough nurses to care for the patient.

3 weekends ago, we started the shift 3 nurses short. The nurses who had the patients on CRRT also had another patient. I started the shift with a pt on an insulin gtt, who had schizophrenia, was restrained and still climbing out of bed. My other pt, on the opposite side of the unit, was on the vent, unsedated, thrashing, and coherent enough to realize that if she scooted down, she could reach the tube. Her pressure was in the 190's. At 2000, I was given a pt on a dopamine gtt who looked horrible and who had a MAP of 48. I was told that I either had to take that patient or the admit.

Monday morning in our staff meeting, we were told that yes, we have worked short but our level of care hasn't suffered because our Press Ganey scores were good and we had no cases of VAP or infected lines. Our manager said that really, there was nothing he could do. There was just nobody to hire. He said he could contract someone from an agency, but if our census dropped, regular staff would be put on call because you have to pay the agency person, even if they don't work.

In addition to providing nursing care, we also have to empty our own garbage and laundry (day shift refuses, but night shift has to or we hear about it), and stock our own supplies. This includes the linen which we have to refold to get it to fit in our cabinets. We draw our own labs, which is fine if the patient has a central line, but when they are a stick, it is time consuming and difficult. We don't have a CNA so we do our own baths, I&O, and accuchecks. It isn't unusual to have patients that weigh 400-584 pounds. Our computer system is wireless and frequently loses the connection so you have to chart the same thing several times. We also just got a letter saying that while the hospital is making money, it wants to make more money so we need to be careful with staffing.

So how does a group of people barter with an institution where the CEO said it is cheaper to get new nurses than to fix the ventilation problem in the ICU that causes severe asthma exacerbations?

If you haven't been there long enough to be vested in the pension, which probably is non-existent anyway, get out.

If you want to stay, you must simply (not easily, I know, but simply just the same) start refusing to work with less than the required staff. As for the trash, let it overflow. Days apparently does, why should you worry about it? The laundry? Let it fall where it may. How ridiculous to worry about refolding it when Laundry should fold it to fit where it has to fit in the first place. You all need a lot of courage and you need to Just Say No. How do you know the CEO said that? Gossip or did you hear him say it?

Take the whole group with you and have a sit-down with the top dog there and make your views known.

Or go public. Do the other approach first.

You know what to do, you are fearful, though. I understand but no one can or will fix this for you. You guys must band together and help yourselves. Call up SEIU and get them to get a union started in your place.

Your manager probably really can't help you. He has to preserve his own neck and he is not going to stick it out for you - guaranteed. Do it yourselfves. No one else is going to.

[woody436]

Nurses should NOT have to leave a position they enjoy because "the company" won't change it's behavior. We can all blame previous generations of nurses for being passive and letting abuses and behaviors, especially by physicians and non-medical/non-nursing management, continue unchecked. A union might help, but in the end, all you have are unionized pincushions. Same stuff still happens.

If you haven't read it yet, I highly recommend reading Nursing Against the Odds by Suzanne Gordon. It woke me up. I will be much more prepared for actual "real life" nursing when I graduate simply knowing the behavior out there. There's one incident highlighted in which a nurse wasn't moving fast enough for a surgeon or was doing something to protect the patient (I can't remember exactly) and the surgeon grabbed her arm so hard that she had to wear a cast for some time. He only was suspened for awhile and was forced to apologize. Why didn't she go to the police??! I can say that that would probably not happen to me because as a 5'10" 250# male, not too many surgeons would risk their health doing that to me. :) But had that been my wife...or sister...or mother...I can tell you that without any hesitation, Dr. Surgeon would be paid a visit. Argghh...I'm off on a tangent..again...

My point is that collectively nurses have endured a lot of crap! It's time to stand up for ourselves, eachother, and the profession. Start by actually mentoring students, don't treat them with disdain just because that's what you went through. We can also legitimize nursing by getting rid of nursing diagnoses and treating patients diseases, illnesses, conditions, psyche!! Nurses diagnose and treat the "human response to disease/illness/medicine"?!?! What the heck does that mean? Why do we need to have a seperate language? The language of nursing??!? Why the distinction from the language of medicine? Aren't we all in the business of healthcare? Why not the language of health?

It all comes down to this: We get treated the way we want to get treated. All this non-sense I mentioned above not too mention all the ways one can become a nurse (LPN, ADN, BSN, etc, etc) opens our profession up to abuses. Only one way to become a doctor. Only one way to become an optomitrist. Only one way to become a certified public accountant. Time for a revolution in nursing, especially nursing education.

Thanks for letting me get that off my chest, it's been stewing awhile! :)

[jjjoy, LPN]

I also have a great nursing job and I get weary of people thinking that I am "lucky" to have it. Yes, a little luck was involved -- but mostly, I made my luck. I worked very hard and made lots of sacrifices to get the career I have. It didn't just fall in my lap, either.

It's not that it's just by luck that you have a good position. As you said, you made a point to look for it and to work for it and to get it. The point is that it seems that in some areas there just aren't that many good positions to be had. And by "good," I just mean decent - decent pay, decent workload - where you're not regularly understaffed and overworked. Of course, one shouldn't expect to automatically walk into their dream nursing job. But we should be able to expect that any nursing job will have a REASONABLE workload and not be unsafe, even if it's not the area that we want, the hours that we want, etc.

Nurses ARE walking away from many bad jobs and the response from many facilities HASN'T been to improve working conditions. It just seems to be leading to more and more understaffing. Meaning fewer and fewer decent nursing positions to be had. How many RNs could easily find jobs with comparable wages outside of clinical nursing? Sure, a few can, but most? And if you think it unlikely that you'll find comparable employment in your area then you might end up putting up with bad working conditions.

[lindarn]

Nurses should NOT have to leave a position they enjoy because "the company" won't change it's behavior. We can all blame previous generations of nurses for being passive and letting abuses and behaviors, especially by physicians and non-medical/non-nursing management, continue unchecked. A union might help, but in the end, all you have are unionized pincushions. Same stuff still happens.

If you haven't read it yet, I highly recommend reading Nursing Against the Odds by Suzanne Gordon. It woke me up. I will be much more prepared for actual "real life" nursing when I graduate simply knowing the behavior out there. There's one incident highlighted in which a nurse wasn't moving fast enough for a surgeon or was doing something to protect the patient (I can't remember exactly) and the surgeon grabbed her arm so hard that she had to wear a cast for some time. He only was suspened for awhile and was forced to apologize. Why didn't she go to the police??! I can say that that would probably not happen to me because as a 5'10" 250# male, not too many surgeons would risk their health doing that to me. :) But had that been my wife...or sister...or mother...I can tell you that without any hesitation, Dr. Surgeon would be paid a visit. Argghh...I'm off on a tangent..again...

My point is that collectively nurses have endured a lot of crap! It's time to stand up for ourselves, eachother, and the profession. Start by actually mentoring students, don't treat them with disdain just because that's what you went through. We can also legitimize nursing by getting rid of nursing diagnoses and treating patients diseases, illnesses, conditions, psyche!! Nurses diagnose and treat the "human response to disease/illness/medicine"?!?! What the heck does that mean? Why do we need to have a seperate language? The language of nursing??!? Why the distinction from the language of medicine? Aren't we all in the business of healthcare? Why not the language of health?

It all comes down to this: We get treated the way we want to get treated. All this non-sense I mentioned above not too mention all the ways one can become a nurse (LPN, ADN, BSN, etc, etc) opens our profession up to abuses. Only one way to become a doctor. Only one way to become an optomitrist. Only one way to become a certified public accountant. Time for a revolution in nursing, especially nursing education.

Thanks for letting me get that off my chest, it's been stewing awhile! :)

AMEN!!! I have said the same thing concerning nursing education, and I have take lots of heat over it. Now here this! There is not a place in the 21st Century for three levels of nursing education. Period. There is no need for less than a BSN as entry into practice. Our low levels of education have led to nothing more than a lack of respect by the general public and other Health Care Profesionals, who now have GRADUATE LEVELS OF EDUCATION AS ENTRY INTO PRACTICE.

Physical Therapy ASSISTANTS have an ASSOCIATES DEGREE AS ENTRY INTO PRACTICE. Our own LPN/LVNs have only a one year post HS education. And they are responsible for patients' lives, not the Physical Therapy Assistants. Is it any wonder that the public thinks that nursing is only an ON THE JOB TRAINING CAREER? That we can be replaced by HS dropout "patient care technicians"?

When hospitals started the assault on the nursing profession, and in health care in general, a decade ago, it was an easy sell to the public when RNs disappeared from the bedside and "minimally educated unlicensed personnel" replaced us. The public was told, "its no big deal. The nurses don't have college degrees either, like PTs and OTS. So this HS dropout nurses aide that we hired and laid off the RNs for, won't make any difference in your hospital care. We "trained" the "help", to do everything the nurses do. It will reduce your health care costs because those nurses were asking for too much money. This is a win-win situation because your hospitlazation will cost you less, and the quality of your care will not change". And the public bought it hook, line and sinker.

We are forever apoligizing for our education (or lack thereof), and feel guilty when we ask for more money, benefits, better working conditions. The hospital big whigs are always throwing it in our faces- "what do you girls expect? You only went to school for two years?" And they are right. It doesn't matter how hard our job is, how much responsibility we have, how important our job is to patient safety and quality. At the end of the day and pay period, we don't have the college degree after our name and title, like other health care professionals do. It does matter. Period. Other health care professionals did not have to validate their self worth and self importance by believing the lies told to us by hospital administration. "You don't need a college degree! Your better than that with the "training" that you have"! And while other health care professionals validate their worth because they bill for their services, a nurse's professional contribution to patient care and positive outcomes, is rolled in with the room rate, housekeeping, and the complimentary roll of toilet paper and box of kleenex.

As usual, we fell for it because we did not want to burden ourselves into going back to school. We use every excuse in the book why it wouldn't work if we went to a BSN as entry into practice, ands we have a plethora of excuses why we can't attend a BSN program to start with, and/or, why we can't find the time to go back and earn the BSN after the fact. Why we can't make it work to go back to school. We have too many other things in our life to go back to school. What would happen if it did come to pass, that the BSN was the only way you could become an RN? Like in the other health care professions. There is no choice. And potential students don't complain, they just do it. The choice that nurse are always raving about does nothing but cause deciviness and that, of course, is "just what the doctor ordered".

Rather than attempting to make it work, pushing for a BSN as entry into practice, and pushing for rewards for the nurses who do accomplish this, we fight any attempt to reward BSNs. Indeed, we feel slighted that anyone would have the audacity to even suggest that BSNs should earn more money. We fight to remain the least educated individuals at the bedside, even though we are the ones with the most responsibility. It is reflected in our pay, benefits, (or lack therof), and the general lack of respect we receive from EVERYONE.

A BSN entry would reduce the number of individuals coming out of school, and force the hospitals and nursing homes to put effort into that four- letter word- RETENTION, NOT REPLACEMENT. More nurse coming our with a BSN, and less nurses vying for jobs, puts nurses in the postion to DEMAND, NOT ASK, FOR MORE MONEY FOR A BSN. Just like PTs, OTs, Pharmacist. We would DEMAND ON- SITE ADN TO BSN, AND LPN/LVN TO BSN PROGRAMS ON SITE IN THE HOSPITALS. AND DEMAND THAT THE HOSPITALS PAY FOR IT, LIKE THEY ARE DOING IN CALIFORNIA. AND BSN TO MSN PROGRAMS. And like they are doing for pharmacists who need to go back for their Doctorate.

It would cut the number of nurses coming our of school. By the law of supply and demand, like in PT, and OT, our salaries would rise. You can tell that there really is no nursing shortage, just a shortage of nurses who are willing to work at bedside nursing. Our salaries have been flat for a decade, and indeed, with the increase in the cost of living, we are actually making less than we did. The hospitals push the schools to produce more nurses, rather than use higher pay and benefits, and better staffing, to entice nurses to stay. That would cut into their control of nurses, and that, boys and girls, is the name of the game. CONTROL.

Increasing our education will polish our image and give us the confidence that we lack now. Nurses just need to believe and give it a chance. I also agree with the above poster, concerning the book by Suzanne Gorden. It should be a MUST READ FOR ALL NURSES AND STUDENTS. JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[jjjoy, LPN]

New nurses on my unit are thrown maybe 3-8 weeks orientation, learning to drive in the fast lane on I95.

Good analogy!

Lindarn, on the one hand, I see your point that people in general think nurses must not need to know that much or must not have that much responsibility if at least a 4-yr degree isn't required.

On the other hand, if BSN became the entry level for RNs, I'd imagine that facilities would be doing all they could to minimize the number of RNs that they needed to hire. Creating all sorts of new roles and positions. I imagine a sudden lobby for an extension of scope of practice for LPNs. More certified medication administration techs, etc. I imagine this is likely to happen anyway as the "nursing shortage" continues.

I think hospitals, and society as a whole, need to need acknowledge that with the push to discharge patients as soon as they are stable, professional nursing care isn't just one small piece of the hospital package. And that professional nursing care isn't just "following orders" and "giving bedbaths." It's continual monitoring of unstable patients, the ongoing treatment of active disease processes, and the ability to recognize and deal with emergent situations. Professional nursing care IS the major product that hospitals are providing so OF COURSE staffing SHOULD be one of the biggest (if not the biggest) cost. Scrimping on staffing isn't the way to manage a budget. Inpatient care SHOULD cost hundreds of dollars/day if it's being done right.

I don't know how or if costs and reimbursement could be restructured to make it financially possible for all hospitals to afford to staff liberally. I hope so, but it looks like a rough ride ahead.

[lindarn]

Good analogy!

Lindarn, on the one hand, I see your point that people in general think nurses must not need to know that much or must not have that much responsibility if at least a 4-yr degree isn't required.

On the other hand, if BSN became the entry level for RNs, I'd imagine that facilities would be doing all they could to minimize the number of RNs that they needed to hire. Creating all sorts of new roles and positions. I imagine a sudden lobby for an extension of scope of practice for LPNs. More certified medication administration techs, etc. I imagine this is likely to happen anyway as the "nursing shortage" continues.

I think hospitals, and society as a whole, need to need acknowledge that with the push to discharge patients as soon as they are stable, professional nursing care isn't just one small piece of the hospital package. And that professional nursing care isn't just "following orders" and "giving bedbaths." It's continual monitoring of unstable patients, the ongoing treatment of active disease processes, and the ability to recognize and deal with emergent situations. Professional nursing care IS the major product that hospitals are providing so OF COURSE staffing SHOULD be one of the biggest (if not the biggest) cost. Scrimping on staffing isn't the way to manage a budget. Inpatient care SHOULD cost hundreds of dollars/day if it's being done right.

I don't know how or if costs and reimbursement could be restructured to make it financially possible for all hospitals to afford to staff liberally. I hope so, but it looks like a rough ride ahead.

That is where staffing ratios come into play. California took care of the problem by instituting RN nurse patient ratios. You are right- it will not work if the hospitals use the legislation to reduce the number of RN staff. I believe that California also forbids the hospitals to cut ancillary staff, which would make the staffing ratios a moot point, if you have no help.

Kaiser nurses also just ratified a new contract, that, from what it sounds like, is the best in the nation. Hospitals can afford to staff liberally. The just choose not to, and for years, nurses have had no say in how the money was spent.

Here in Spokane, nurses have received contracts, with pennies on the dollar for raises, and steep increases in the cost of medical benefits. All the while the hospital has built an expensive Womens' Health Center, a Pediatric Hospital. Is there any wonder where the money has gone? The nurses salaries and benefits that didn't get paid, are paying for all of these Capitol improvements. And this is a union hospital. But of course, we are talking about the Washington State Nurses Association, not California Nurses Association, or the NY State Nurses Association. Unlike California, there in Washington, WSNA was asleep at the wheel while the Washington Legislatures added the Medication aides to nursing homes and ALF, and of allowing ther de-skilling of our professional practice. Nurses need a strong state nursing association, and be committed to staying involved and up to date in what is being proposed in our state governments.

Nurses need to involve and educate the public, so that they understand that the double talk by the hospital and nursing home industry is not in their best interests. This is what the public school teachers do, and they do it well. If they didn't there would be unlicensed Teaching Assistants teaching in our public schools, with class sizes of 50 - 60 kids per classroom. We can learn alot from them.

Nurses need to write Letters to the Editor, and inform the public what is going on. Nurses need to stay involved in their State Nursing Associations, and keep in them to fight back laws that reduce RN staffing, and de- skill the Nursing profession.

And it starts with basic nursing education, be it BSN, ADN, or Diploma. Students need to be taught that, although they feel that they are called to Nursing, they are first, and foremost, LICENSED MEDICAL PROFESSIONALS. They are entitled to respect, consideration, and A SALARY THAT IS COMMENSURATE WITH THE SCOPE OF THEIR EDUCATION, RESPONSIBILITY, AND ACCOUNTABILITY FOR THEIR LICENSE. THEY ARE ENTITLED TO A SALARY THAT COMPENSATES NURSES FOR THE HARD, BACKBREAKING WORK THAT IT IS, THE RISK/DANGER TO OURSELVES, AND THE INCONVENIENCE TO US, AND OUR FAMILIES FOR THE HOURS THAT WE WORK.

That, by the way, is why doctors charge so much. Don't believe for a minute that doctors work on call, and long hours out of the goodness and kindness of their hearts. Yes, they do it because they have to, but isn't that why nurses work nights, weekends, holidays, etc? It wasn't that long ago, that nurses were not compensted for working weekends, holidays, etc, while the garbage collectors were making triple time to collect the trash on a holiday, or work weekends.

As you stated above, NURSING CARE IS THE PRODUCT THAT HOSPITALS ARE SELLING. NURSING CARE, AND INPATIENT CARE, SHOULD BE AT THE TOP OF THE BUDGET, AND NURSES NEED TO MAKE IT THAT WAY!! JMHO, AND MY NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington