Staffing, acuities, general BS: I gotta vent!!

[mamabear]

I'm so mad I could throw up! Our manager counts ward clerks and security personnel as part of staffing when figuring the acuity for each shift. Is it just my employer or do other units/hospitals have this assinine practice? They seldom, if ever, get low census days because of the alleged unique nature of their jobs, but I got LCD'd tonight AGAIN because they needed the security guy more than they needed an RN. How helpful will he be when meds need to be passed? Can he take orders from a doc over the phone? What about admission assessments or morning vitals? Will he clean and diaper the LOL paranoid schizo?

What about the worthless suck*** RN who never gets LCD'd for yet-to-be-determined reasons? As a nurse, this idiot would make a great ditch digger.

I realize that favortism, stupid practices, et al, are all too common in our profession: on one hand, if you don't offer to pick up extra shifts or come in early, you're the scum of the earth. But if you're designated 0.6 FTE and the useless a****le is 0.8 FTE, guess who gets LCD'd? To add insult to injury, who ever at any hospital looks at the damn acuities?:imbar

I know there's no answer for this, but I needed to vent badly.

[cactus wren]

Small hospital=no,zilch,nada security gurds, but...........m/s acutiy does count the cnas and the unit clerk. the cna are frequently put on call, so frequently that many of them are having troubles pay their bills. The UV on the other hand is never put oncall...you wouldn`t want the charge to have to answer the phones, now would you? There is a big hospital in another part of AZ that advertises its 4to 1 staffing, but when you check it out, they include the Us and the cnas in determing it....so.........not a true 4/1..... Acuity sucks any way its figured because its not about having a safe staffing level, it`s about the money...gotts save those dollars.....even if the nurses are overworked, and have too many patients to give quality care...

[prn nurse]

I was reading a Nursing Educator's Journal last month.

It was a real eye-opener.

Not so much that it said anything I wasn't aware of --on a

sub-concious level.

But, the brazen, concentrated , unapologetic manner in which

"the facts" were presented, certainly caught be off guard.

Basically, it said that nursing is in transition.

Anyone who graduated > five years ago doesn't have a clue and

is still following the "nursing orientation" they received in nursing school.

And that "patient care" is not the priority it was.

There's a whole new paradigm. It is "bottom line."

Tech's can perform nearly all patient care.

And that care is minimal care.

Nurses, for now, give meds and do documentation.

If you are on a big med-surg unit and doing more than that,

you need to learn to delegate.

Patient teaching is nearly history. You aren't being paid to stand & teach.

You'll see the difference in your own position....just start looking and listening ....Listen to your manager at meetings...what is their priorities?

PAPERWORK & MEDS

RISK MANAGEMENT ....no old folks falling out of bed

[purplemania, BSN, RN]

As for risk management, perhaps they can address the risk of a lawsuit when unlicensed staff outnumber the nurses. Prevention of a lawsuit is cheaper than paying. We need to come up with a way to quantify our skills rather than using a matrix or grid. One patient can make a HUGE difference in the nurse's time. Any ideas on how to do that?

[MollyMo]

We count RN's and LPN's based on acuity. CNA's/PCT's are counted based on census. Secretaries are mandatory because they also double as monitor techs. And somebody has to be in front of the monitors at all times. Security???

[Youda]

{{{{{{{{{{{{mamabear}}}}}}}}}}}

Sorry you had such a bad time. Kudos to you for caring!

Yes, I've worked in places where they counted laundry, dietary, and management as part of the "staffing" ratio. As far as the new paradigm (and I've read about this in several places), the fallacy in it is that the licensed nurses are still held legally responsible if something goes wrong. If management wants this new "paradigm," then I think they should assume ALL legal and moral responsibility for the consequences. But, of course, they won't do that. So, the nurses continue to be the victims just as much as their patients.

[Agnus]

Originally posted by mamabear

I'm so mad I could throw up! Our manager counts ward clerks and security personnel as part of staffing when figuring the acuity for each shift. Is it just my employer or do other units/hospitals have this assinine practice?

This is a practice that occures in many places. Even more prevelent than counting non nursing staff as part of the matrix to satisfy staffing for a particular acuity level is the practice of counting Nurses who are on duty but do not do patient care. They work in non patient care jobs.

Fortunately when we do our staffing at my facility we look at the number or nurses at the bedside. We do not include non nursing personell and we do not include the Case Manager, Nurse Manager, Nurse Liesion, or any other nurse who is not scheduled to be at the bedside.

The good thing about this is I can call on these non bedside RN's for advise and assistance in a pinch provided they are available.

Our CNA's, UC's, RT's, Security etc all have thier own staffing matrix that has nothing to do with the nursing matrix.

A security guard does not equal a nurse nor does a UC or what ever at my facility.

When asking about staff to patient ratio, I always specify RN at the bedside, LPN at the bedside, CNA etc. If you don't a potential employeer may just lump everyone together. Even with CNA you have to be specific because in some places not all CNA's are at the bedside. And I emphasize the At the Bedside part.

I learned this back when I was a CNA in LTC. After one or 2 times of inquiring and then discovering their answer referred to the entire staff or referred to one group in general (all CNA's) I learned.

[zudy]

Are you ready for this? I used to work in an ED that counted an elderly nun as staffing! (She was a retired schoolteacher) The order that owned the hospital didn't know what to do w/ her, so they sent her to us. She did things like get snacks for pts that were NPO, fuss at the drs for taking breaks (like for meals) telling pts they could have pain meds,etc. She took the place of a FTE.

[oramar]

I used to complain when the counted the nurse manager as staff. In the old days maybe when the were out on the floors it was OK to include them. Now days they are so tied up meetings and paper work that it has been years since most of them have touched a patient.

[mamabear]

Agnus:

Where do you work? In heaven? Let me know, and I'll be there in a heartbeat!

One of our security guys is pretty good at dealing with actively psychotic patients, which is a Godsend when there's just me and a female psych tech/CNA working:kiss , but the other one spends most of his time hanging out.

Our ward clerks are a total joke. The one on days spends her time sucking up to the boss, the docs, even the clinical instructors from some local of the local colleges, and stirring up crap: she wrote me up for "disrespecting" her because, in a moment of frustration I told her I didn't need her to tell me how to do my job. The evening ward clerk, when he gets up off his fat butt, likes to tell the RNs what they're doing wrong, play Solitaire, leave the building to fetch take-out food, and use the unit computer for non-hospital use: he accessed a former employee's psych evaluation, printed it up, and passed it around for the evening shift to get their jollies (I reported him and, of course, nothing happened. He also sucks up to/spies for the boss)