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    I am curious what you all think could or should be done concerning the understaffing issue.

    When I was the Director of Nursing with a Home Health and Staffing Company I used to tell my nurses,"If you arive to do a shift if you feel it is an unsafe environment for the patients please call me immediately before you take report or take the assignment". On the few occasions when I did get those calls I was always able to negotiate sending in another nurse or CNA to fix the problem. This decreased the danger the patients would have been in.

    When I used to work charge in the hospital for med-surg I used to do the same thing. I would get permission to staff r/t acuity and census with adequate staff and we could use agency, and did. Those were lucky days I reckon.

    Do you guys think it is reasonable to refuse to work for an employer who doesn't staff safely either due to policy, or failure to recruit and maintain a sufficeint staff?

    Personally I believe it is our RESPONSIBILITY to our patients to provide them with care in a safe environment. I think we enable hospital administrators when we allow them to short staff a hospital and we accept assignments that put our patients in danger.

    If we all stuck to those principles enrollment in schools would be higher and patients would be safer.

    The real devil in this is insurance and medicare who somehow ended up calling all the shots. Instead of hospitals telling them what care costs and asking for payment insurance has determined what they will pay and hospitals have altered policy to remain fiscially solvent.

    I wish I could go to the car showroom and say I will take that car and I agree to pay you 10K for it - but sir the car cost 22k - oh, but I am paying you 10k so you had better reduce costs be whatever means neccessary or lose money, no matter to me.

    The spiral healthcare is caught up in seems downright futile at times.

    HotSpam
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    Originally posted by HotSpam:
    <STRONG>
    When I was the Director of Nursing with a Home Health and Staffing Company I used to tell my nurses,"If you arive to do a shift if you feel it is an unsafe environment for the patients please call me immediately before you take report or take the assignment". </STRONG>
    Would you please come be my DON??

    At the hospital where I used to work, staffing was HORRIBLE. One night, around 3am, after a crash c-section left NO ONE to staff triage (9 beds--all full) because we were yet again short staffed, our CHIEF RESIDENT called our NM at home and INSISTED she come in. He said, 'you need to come in right now and get some extra staff in here. These nurses are drowning.' This was a totally unsolicited gesture...he was genuinely ****** that pts. weren't getting proper care because of short-staffing. Know what the NM did? She basically said 'deal with it,' and refused to come in. I left 3 months later, but not without a fight. I wrote a letter to the COO, CEO, and DON. I had a personal 90 min. meeting with the CEO himself. He blew a lot of sunshine up my a**, and basically wasted both our time. I gave mgt. 2 months to enact change, then put in my resignation. Those last 4 weeks working in that unit were HELL.

    My wonderful little community hospital unit is now starting down that same path. The NM whom I thought was competent has her head so far up admin. a**es with 'cost containment' and paper pushing that she has all but killed morale. We used to be a great unit. Now we're crumbling, because our manager is totally unsupportive, unprofessional, and cares only about the bottom line. Even our DOCS hate her and talk about what a poor manager she is. Well, 2 weeks ago, she made a grave error. She blatantly violated my confidentiality, and when I confronted her about it, lied to my face (I took a leave of absence for deeply personal reasons, and she told another nurse why I'd taken leave...IN FRONT OF other staff). I am in the process of writing a letter now, where I will DEMAND a meeting with her, the DON, the director of women's services, my husband, and possibly legal counsel. She needs to be stopped, and it needs to happen NOW. I don't care about my job, but I DO care about my personal life remaining PERSONAL, and when I can't even trust my manager to keep confidential information confidential, it's time to take action.

    I don't know what the solution to the problem is. The root obviously lies in management and managed care's stranglehold in a lot of facilities and units, as with my personal experiences. However, the problem also lies with nurses who are NOT in mgmt. and continue to ALLOW themselves to be treated so horribly. When I wrote that letter at my old hospital, the entire unit was seemingly behind me, all wanting to contribute to the letter, cheering my effort on. When it came down to the wire, and walking into that CEO's office, only ONE of my so-called 'supporters' had the spine to go with me. It's like a battered woman who keeps ending up in the ED with her face bashed in, and says she's going to 'finally' press charges every time, but never does when it comes down to signing the paper. He comes to her and pleads forgiveness and SWEARS this time things will be 'different.' So she tucks her tail between her legs and crawls back to the creep only to have the whole scenario play out again and again until she finally leaves the ED in a BODY BAG. As adults, we know that abuse, mistreatment, and being treated with disrespect can only happen when you ALLOW it to happen. Lying down and taking it is a big part of the problem, I think.

    I'll end my tirade now. You really lit a fire under my butt today, HotSpam. Preach on, brother.
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    I read your post and it made me do some thinking. Over the last month I have been seriously considering resiging from my job but I remember now what it was like to have a good supervisor or manager and more often what it was like to have a spinless one with its head up someone elses a**.
    7 months ago I took my first management position as clinical coordinator in a fairly large geriatrics/rehab facility. I thought this would be a good way to add some supervisory experience to my resume along with long term care. I have 8 years of critical care experience so getting another position at bedside shouldn't be a problem.
    I try to be the supervisor I would like to have had when I was a staff nurse. I stick up for the staff, I point out issues to the rest of the management team that need to be addressed. I also work beside staff when I am unable to fix understaffing, ie. pass 9pm meds on half of the unit, help the poor remaining aid with 2nd bed check because her co-worker went home injured or ill at 3am.
    Over work and lots of stress have staff calling off sick and injured at an alarming rate. One person gets a virus and soon the whole place is ill, seems our immune systems have gone on vacation.
    One of the supervisors has resigned and gone back to bedside critical care nursing and many staff members have asked me when I am quitting.
    After reading this post I think I will remain as a supervisor and work with the staff to try to create a tolerable environment to work in. Their DON started about the same time I did and the Administrator has been there a few months so a lot of changes and the unknown have the staff very restless.
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    When I became a nurse manager myself, I too, tried to be the manager that I had always wanted as a staff nurse. I was determined never to do the type of things that my managers had done. I tried to be as supportive as possible to the staff, while at the same time trying to deal with what the upper management (old boys club) was expecting of me. I felt caught in the middle. I was getting blasted and critized by the staff if I wasn't there for them 100% and getting little support from the top administrators. Being a nursing supervisor/manager/director is extremely difficult!! I have been thinking of going back to being a staff nurse. Being a good manager takes experience (learning from your mistakes), incredible interpersonal skills, and added education in management techniques. Being a great nurse, does not necessarily make you a great manager!!
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    HotSpam, you are right on. We owe it to those we care for to practice safe nursing. I let those over me know when I am in over my head. If it continues or I am ignored, I walk. It's my RN and I will not let it be taken from me. No one stands up for you but you. I support my fellow nurses when they have problems and I don't eat my young. I have sometimes been the only one standing up but that's ok too. I have to live with myself and I can't do it any other way.
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    Hi. I agree that we should stand up for ourselves and our patients and not work in unsafe situations. I did not feel this way years ago. But now, I have no qualms discussing questionable situations with administration, while smiling, of course.

    At this point, I don't know what to do about understaffing, since it was never successfully addressed shortages ago.

    Not to defend the managed cost system, er uh, care system, I must write factually that when I did a short stint with an insurance company years ago, essentially all claims were paid according to what was on the bill. The problem is that greed is now so pervasive within the government and private industry, it has totally undermined patients, families, patient care and those that directly deliver it.

    The moral of the story. Sickness and injury pays for those who are farthest away from the bedside.
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    ITA with everyone. I am now the weekend supervisor of a small Home Health Agency. Iamme and fiestynurse, you remind me of myself, our backgrounds are similar, and like you, I also want to be the supervisor I would want. It IS hard! I can't please my boss if I turn down referrals based on low staffing, and if I take referrals, I can't please the staff. I try like hell to meet everyone's demands, arrange assignements so they each have an equal amt of visits in bad areas, so they can get there and out in the am, so that they are one general geographical area rather than traveling all over, but no matter what I do, I am always on someone's $hit list!

    Last weekend I was ready to just quit. I had had it with the lack of staff and the amount of referrals accepted during the week which fell to me on the weekend. BUT, then I decided to do some extra critical care shifts with the agency I work for per diem, in a local hospital. After the 2 3-11 shifts I did this week, I wanted to kiss the ground I walked on when I reported to work this weekend! I was all smiles as I kept thinking I could be working in the hospital again FT by necessity, YIKES! I think I'm getting too old for that anymore (38!)

    So, like the rest of you, I am going to hang in, albeit for my own selfish reasons, but I will just continue to do the best I can with what I have to work with.

    I think the most disappointing part about being a supervisor is that there are really no opportunities for mentoring, and leadership. It seems that 99.9% of my job is staffing and scheduling, with very little chances to even interact with patient's anymore. Occassionally, the staffing is so tight that I go out and open cases myself, but it is really hard to spend 90 min in a home while 3 different beepers are going off! Makes the visit extend to 2 hours, 'cause if pt's call, I need to go outside to maintain confidentiality. I felt I had a lot to offer in the way of mentoring and guiding staff, but it seems that you are soooo right fiesty...being a great nurse doesn't necessarily mean you will be a great manager!!


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