I've been a member of my hospital's newly established nurse retention committee for the past few months. I represent 1/2 of our large med-surg floor. After much discussion and brainstorming about retention ideas, I decided to write a letter to my manager and unit director as well as 2 other senior managers and the CEO of the hospital. The letter basically stated that, after almost 10 years as a med-surg nurse, I'm convinced that the only way to retain nurses on our floor is to reduce the nurse to patient ratio. More money won't keep burned-out nurses at the bedside in the long run. Large recruitment bonuses will not KEEP a nurse in a chaotic, stressful environment for very long. Morale is bad, quality of patient care is down, while I think more errors are occuring. I also sited statistics from the 2002 Aiken study in my letter. http://www.dpeaflcio.org/policy/factsheets/fs_aiken.htm
We are averaging 6 to 7 patients for all shifts, 1 PCT (aide) for 12 to 18 patients some evenings I work. Acuity is not a consideration in patient assignments and staffing, and we're told that this is the "benchmark" or "norm" for med-surg units in most hospitals, and that is why we are staffed the way we are.
BUT-- If you're having trouble RETAINING your nurses and you can't RECRUIT new nurses, in spite of throwing money at them, wouldn't it be wise to consider reducing the ratios and investing that money in hiring additional help? From the Aiken study: "RNs working in hospitals with the highest patient-to-nurse ratio are twice as likely to be dissatisfied with their position and experience job-related burnout as those working in hospitals with the lowest patient-to-nurse ratio. By increasing RN staffing levels and thereby lowering the patient-to-nurse ratio, hospitals could reduce turnover rates by decreasing the job dissatisfaction and burnout that may lead to resignation." (I keep having this overwhelming desire to say DUH!) Also from the study: "Satisfactory nurse-to-patient ratios can save money as well as saving lives and decreasing RN turnover. Estimates indicate that the cost of replacing a hospital medical and surgical general unit nurse... as $42,000."
I know from reading many threads here at allnurses that 6-7 patients is generally the norm on med-surg. If my 6 patients are self- to partial-cares and none have a serious problem during my shift, I can certainly be busy, but not inordinately; I may even be able to leave the floor for a 30 minute dinner break. But USUALLY, I'm running almost my entire shift (I work 3-11) with post-ops, admissions, patients going for tests, calling doctors, hanging blood, covering LPN's patients, etc. etc. etc. I'm almost embarrassed to say we have an IV team, so we don't start our own IV's, and yet I hear that many of you have to draw your own blood for labs, start IV's, do respiratory treatments in addition to your patient load..... How do YOU do it all? Do you have more nurse's aides? I'm having trouble just managing 6-7 patients and I fortunately have IV nurses and phlebotmists to help. Nurses who work med-surg will also know that some nights, just THREE patients can be a lot of work, depending on their problems and acuity.
Anyway, a meeting is being scheduled with me and the 4 managers I wrote, and I guess they'll then report to the CEO. I'm not worried; I wrote a respectful but truthful letter about our med-surg working conditions, and I'm not afraid to talk about them. I want to work med-surg; I have no desire to work anywhere else, but I can't stand to see unhappy, stressed-to-the-max co-workers, to not be able to give the kind of care I'd like to give, to see new nurses and new hires bail after a few months, and to often dread going to work myself.
Does anyone have any words of wisdom I can take with me for the meeting?
