High Acuity, Low Staffing - page 2

I had another bad night at work last night, and the worst thing about it is that nights like this are beginning to be the norm. Our community hospital became part of a major health system about two... Read More

  1. by   mattsmom81
    Gotta agree, Fedupnurse...and agency work is most attractive now for ALL your reasons!

    If I was uncomfortable in my agency shift assignment, I just said 'NO', and if I got flack I called my agency to back me up......and didn't mind shrugging and leaving if I didn't get cooperation...

    When nurses work agency, the mentality is different and hospitals can't manipulate us......we don't get all caught up in loving our coworkers too much to make waves....

    Guess we might consider all 'going agency'...maybe we can effect some positive change this in the system in this way, eh?
  2. by   fab4fan
    RNinICU: From what you describe, I am convinced we work at the same hospital.

    And if we don't, isn't it scary to see that conditions are so bad in so many places that we all think we work for the same employer.
  3. by   fedupnurse
    Fab4fan, I have thought that a few times about RNinICU! In fact, she described alot of what my facility does.
    JeannieM I DO wish you all the luck in the world with the project! I hope it does work and spreads to other hospitals. I know the suits where I work simply do not have any intention on changing anything. We have even pointed out how they can save money and they have still ignored us. I can only guess because someone they knew was missing out on having thier pockets lined.
    Mattsmom!! You must have been reading my mind. The staff nurses where I work can get fired if they refuse to float and the Agency people can come in and dictate where they will go. That is how it should be for all of us. And when my colleagues would turn around and bad mouth the Agency people for having this "Power", I said what the hell are you mad at the nurse for. Be mad at the suits who allow this to happen. Be mad at those responsible for keeping us under their thumb! More power to the Agency nurses for getting what we all should get. I hope to be signed up with an agency here within a couple of weeks. Again, if it pans out, I am goingto bail!!
  4. by   RyanRN
    Boy, did I ever get sick and tired of being stopped during working hours to give acuity ratings. I once told my manager "12". She asked what I meant by that, "well there are 12 patients here and that's all the staffing by acuity rating you need". She wasn't happy, but knew darned well I was right! The ratings went by the wayside after that. We ,too, are staffed by numbers. A bit worse than you, though RNinICU, just today our 13 bed unit had FOUR nurses and 2 nurses asst. Scary, scary thought but happens over and over - letters of protest or not.

    I do agree with you that we at least have to keep signing those protest letters each and every time staffing stinks. Our RN's get tired and say it doesn't do any good and they are right. But I feel documenting the ongoing problem is essential and we need to keep a record of our poor situation. Hard to convince overworked, exhausted,downtrodden people who have taken the abuse and given up. Most stay because they are on their way to retirement and would no more consider moving to another hospital EVER. One is as bad as the next in their opinions.

    Couple of comments:

    I feel for the more experienced staff having a difficult time getting their much deserved time off. There should be another way and I don't have an answer.

    I think the "floating" issue is just as important as the "mandated overtime" and "pt./staff" issues and should be yelled about from the rooftops. The "nurse is a nurse' mantra from adm. is baloney and they need to be made to 'think out of the box' for a change. No one feels comfortable floating, we weren't hired to be pawns for miserly CEO's. We are educated, have specialties, should have a say in where we are willing to work - this isn't 19th century England and we are not serfs. JeanneM your idea is certainly a start, we need a major upset in that area. You don't want me, a Critical Care nurse, to be birthin no babies, that's for sure.

    I like Agency Nurses, I am nice to Agency nurses, I totally agree that when they sign on to work, say, in CCU, that is where they will work or they get to leave. BUT, there has got to be a happy medium for loyal hospital/company employees. Where in the heck does this leave us? Something about all this I can't lay my hands on, like we are forced to deal with the best of both evils and noone really is a winner. What is wrong with working for the 'company' for your entire professional career then retiring with some level of comfort. If we ALL go the way of agency (which I think just may be the wave of the future) then we ALL become 'self employed'-as most do not pay vacation, pension, health-and we have effectively wiped out one major type of nursing (which by the way, I think the hospitals will love as they save bundles of money ,can cancel you on a daily basis. Noone has any allegiance and I fear things will deterioate)

    Just some food for thought.
    Last edit by RyanRN on Aug 2, '02
  5. by   mattsmom81
    You make some valid points, Ryan. But the sad truth is most hospitals really don't respect their nurses. We have to accept this in order to progress...

    Personally, I think like Fedupnurse....if RN'sall went agency/self employed, the market would work itself out. If a hospital books me, hangs on to me and late cancels once...I give 'em one more shot...if they do it again, I won't schedule there again.

    I've seen this happen in my metro area, and after awhile the hospital can't get anymore agency nurses to help them....which is a good lesson for them
  6. by   nimbex
    AAAAHHHHG!

    It's shameful that unsafe staffing is occurring. I have been on both sides of the fence as management and staff nurse.

    As management, I stopped looking at acuity numbers with in the first week and made room to room rounds at least once each day. Patient acuity and nursing experience need to be the sole determining factors in staffing... period.

    We have been through shifts with minimally experienced staff and high acuity. I made the very unpopular decision to pull an experienced nurse from another unit and place the inexperienced one in her place (where there were 4 other experienced nurses to help her). I caught so much flack and would have been upset If I had been floated, but the priority was PATIENT SAFETY !

    This should always be an option, however unpopular when you have more than one ICU unit.

    Also, one night, had 4 RN's for 10 extremely sick ICU patients, no safe tripple assignment.... The night staff all refused to clock in, until management provided one more nurse.... they got it!

    I'm not saying we should regularly refuse assignments, but when patient safety is in jeapordy, it should be done.

    If your manager lacks the authority to provide a nurse based on her assessment of the situation, who does then? This person should be contacted to do a bedside assessment of patient load... assuming they have the skills to do so.

    Good luck with your struggle
  7. by   Debi190RN
    Originally posted by RNinICU
    I had another bad night at work last night, and the worst thing about it is that nights like this are beginning to be the norm. Our community hospital became part of a major health system about two years ago, and things have been getting worse ever since. Seems the bottom line is the major motivator for these people. Last night we had seven patients in our ICU, staffed with two RNs with less than six months critical care experience, an LPN, and myself, along with a new orientee who has been with me for only a week. There was another seasoned RN scheduled, but she was given the day off for "low census." My patient was a septic shock with renal failure, CVVH, hourly accuchecks with an insulin drip, PA line, ordered q4h hemodynamics, and multiple other drips. His MAP was never above 55 all night. All of the other patients were high acuity also. There was a cardiogenic shock on an IABP, an active GI bleed, a post arrest and a massive CVA who was seizing. My patient was 1:1 so I was expected to cover the LPN, giving her IV ativan and dilantin for her CVA, calling her docs, and signing off her orders. The other two RNs were so overwhelmed with their own assignments, that they were little help. As a matter of fact, they both came to me several times through the night for help and advise. When I protested about the RN being given off, I was told "Your numbers only call for four people, and you have an orientee who can be an extra pair of hands." So I asked why one of the newer people or the LPN had not been given off instead, I was told that it was Nurse A's turn to be given off. Now the new girls and the LPN think I was complaining about them, and I wasn't. I just thought someone should have used a little common sense and looked at the staffing mix and acuity. I documented my objection to the staffing and assignments and gave a copy to my unit manager and our DON, but I don't think it will do any good. When I talked to my unit manager about the situation, she confided that she was thinking of resigning her position because of problems like these. I have always loved my work, and this hospital, but with the big corporation mentality that has taken over, I don't know how much longer I can continue to work here. The only problem is that the other hospital in our area is part of another corporation, and has similar problems. All I want is to give safe and competent care to my patients, but I feel that I can no longer do this. There are safe staffing laws before the legislature in my state. They can't be passed soon enough, IMO.
  8. by   Debi190RN
    Originally posted by nimbex
    AAAAHHHHG!
    I understand about BAD NIGHTS!!! i woirk on a med-surg unit that has a variety of patients including cardiac drips, CVA pts, and the general med-surg pt. Our facility has been using agency nurses, which some are great and some are not so hot> so, we have had a staffing shortage as well as most of the country.
    We have potential for 42 patients on our unit and we average 20-22 patients each night. Our staffing for 20 patients is held to 3 licensed nurses and a unit secretary until 11pm. Recently a male nurse was hired, (i have many friends that are male nurses). This particular guy is pathetic, he has been a nurse for 2 1/2 yrs, and has had 6 jobs. He has no initiative at all, spends all his time visiting with patients families, and stalking the other employees. The administration however, will not believe these things about him. He was caught sleeping at the desk his first night on night shift and nothing was done. His statement is that the female nurses are discriminating against him. There are 2 other male nurses on our unit that has never felt this way. This male nurse, makes many med errors, spends time in the parking lot during his shift, gets aggravated really easy and slams doors and throws things in the med room.......Our supervisor just says "everyone needs to give him a chance"

    Are we that desperate for nurses that we have resorted to poor quality.......Give me an Agency Nurse anyday over this JOKER
    It's shameful that unsafe staffing is occurring. I have been on both sides of the fence as management and staff nurse.

    As management, I stopped looking at acuity numbers with in the first week and made room to room rounds at least once each day. Patient acuity and nursing experience need to be the sole determining factors in staffing... period.

    We have been through shifts with minimally experienced staff and high acuity. I made the very unpopular decision to pull an experienced nurse from another unit and place the inexperienced one in her place (where there were 4 other experienced nurses to help her). I caught so much flack and would have been upset If I had been floated, but the priority was PATIENT SAFETY !

    This should always be an option, however unpopular when you have more than one ICU unit.

    Also, one night, had 4 RN's for 10 extremely sick ICU patients, no safe tripple assignment.... The night staff all refused to clock in, until management provided one more nurse.... they got it!

    I'm not saying we should regularly refuse assignments, but when patient safety is in jeapordy, it should be done.

    If your manager lacks the authority to provide a nurse based on her assessment of the situation, who does then? This person should be contacted to do a bedside assessment of patient load... assuming they have the skills to do so.

    Good luck with your struggle
  9. by   Debi190RN
    Nursing is stressful enough without being frightened of a co worker. Why is patient safety/care comprimised to hold the staffing to a minimum?

    Our facility is staffed at minimum which i'm sure is the case many many places and to have a nursing supervisor that is rude and hot tempered makes the struggle even harder.
  10. by   nimbex
    Debi, Document, Document, document... and keep a copy for yourself. Being from management, there are laws about employee protection from "a hostile work environment". When you document this jerk's behavior, state how you felt threatened and state that you know your rights by law, do not have to tolerate this behavior and expect management to take any course of action they see fit.

    When the next outburst occurs, start official letter number two, reiterating the issues, acknowleging that you know management has been made aware of this behavior by your previous letter and wish to add this new outburst to your FORMAL complaint.

    By letter number three... management should have consulted with human resources to know that they are LEGALLY responsible to intervene. Just don't put yourself in a slander position, by speaking negatively about this person to anyone, but management.

    carol
  11. by   mattsmom81
    Also had a very dangerous male nurse in my ICU who claimed he was being 'discriminated' against...I was actually trying to help him fit into our unit, but he was not helping himself...two of my coworkers flat out started documentation against him...he asked me to back him up and be on his side, but I finally had to say no there. He then reported ALL of us, began stalking and threatening ALL of us. I tried to be nice to the guy...then when I wouldn't 'take his side' I found myself on his 'hit list' ...amazing!!

    Be careful...not every nurse out there is rational and sane. We got followed home, got our tires slashed, he'd call us at work and tell us he was 'waiting for us' and knew where we lived.....scary stuff.
  12. by   Debi190RN
    That is so scary, it sounds just like this jerk.....but let me tell ya he can charm the supervisors like he's MR CASANOVA himself. What really sucks is they fall for it. He has been a nurse for like 2 1/2 yrs and you would never know it, he does not have a clue regarding skills. That is everyone's impression of him. He belittles other nurses to families of patients. The nurses that work with him catch him, report him, and NOTHING is done. I've tried (and it's been tough) to help him, and to make him feel a part of us, cause i know how it is to be new. BUT........he is not receptive to niceness from any of the staff. We had a dying patient and he charmed the family, stayed in the room with them, ate in there with them, he was even caught by another nurse downgrading the patient's doctor........once again NOTHING was done. He is really strange..........and YES!!! I am documenting, but i have not turned anything in to management no one has, we are in fear of losing our jobs........someone out there HELP!!!!!
  13. by   mattsmom81
    You are smart to document times, dates, events...and just put it aside for now....in a safe place. Try not to submit anything by yourself...or talk to anyone high above unless you REALLY trust them...hate to sound so paranoid...be careful if he has friends there.

    We finally had to get together as a unit...the threats and bizarre behavior got really bad.....so we all met with my manager and DON as a group to discuss group concerns. That usually gets the attention. After management heard about the threats, and deposed us individually, the lawyer and risk management got involved.

    Hope it doesn't get to that, but it might.

    I really think my crazy coworker had it in his mind he could get a payoff from the hospital so he wouldn't prosecute us all for 'male nurse discrimination.'

    It was really all in his sick mind...he was just a bad nurse with a screw loose plain and simple...had nothing to do with his male-ness. And he never got anywhere with his allegations cuz they weren't true.

    It took a long time for all of us to sleep safe...and a few of us even got to carrying guns for awhile, we were so scared. Last I heard, he dropped his license and was driving truck in Arkansas...

    Do you have an EAP service? Counseling for employees? You may want to talk to them first....they are supposed to be confidential, yet can still counsel you....good luck and let us know how things go!

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