Staffing Shortages in HealthCare

by madwife2002 9,665 Views | 25 Comments Senior Moderator

I'm overwhelmed. Can you imagine how new grads and inexperienced nurses feel like? Sometimes I feel like I am swimming for my life and the sharks are biting at my ankles and if I stop or slow down ... I will be pulled down into the depths of the ocean - where it will be impossible to come to the surface.

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    Staffing Shortages in HealthCare

    I have been a nurse for 22 years and have worked in a variety of hospitals. Now, I manage a dialysis center. I can honestly say that I have never worked anywhere where we had perfect staffing!

    With new grads searching for jobs you would think that organizations would take them under their wings and provide training and experience. Its' just mind-boggling how we just sit by and not support new grads.

    I remember the day when hospitals stopped training student nurses ... saying they were being used and abused as members of staff.

    I was one of those student nurses who complained about working 40 hours a week while having to study, pass assignments, and finals each year.

    I was thrilled when students would no longer be used as a pair of hands on the wards, working 10 days in a row.

    The rationale was if we send them to become University trained nurses, they will have more academic training and the hands on experience will come. It will also mean that nurses will be classed as professionals.

    On the whole, it was a good thing. However, now student nurses struggle to get the hands on training that we got.

    Also accelerated training courses mean that less and less practical experience is obtained by students. In the past 3 years, hospital based training was the minimal amount of time to become an RN, and 4 years if you were doing a BSN.

    We owe it to our new grads to fight for them to have post grad experience and training in a hospital. So that we have good quality back up for our future and their future.

    I do not believe we should have to work under the conditions we work under day in and day out. The stress on staff is horrendous and eventually we all burn out.

    New staff members are thrown into the deep end on a daily basis and expected to swim amongst the sharks.

    Yes that's how I feel. Overwhelmed. Can you imagine how new grads and inexperienced nurses feel like? Sometimes I feel like I am swimming for my life and the sharks are biting at my ankles and if I stop or slow down ... I will be pulled down into the depths of the ocean - where it will be impossible to come to the surface.

    Yet all nurses are held to the same accountability, and it is not an excuse to say you are a new nurse, we are trained to point out that certain circumstances and situations are not safe.

    How many nurses actually go the distance and stand up for themselves and others?

    How many are brave enough to go to your manager and tell them what is going on?

    Is your manager supportive? Does she roll up her sleeves and go work with you side by side? How many nurses feel brave enough to do this?

    Not many because nurses are afraid of the consequences of their actions.

    It is bred into us that we must never abandon our patients. The charge nurses themselves are over worked and stressed. So, it's no wonder your call for help goes nowhere.

    We are all afraid of failure so we struggle on and hope things get easier. Sometimes the experienced nurses appear to be relaxed and less overworked. Yes this is because things do become easier with experience so we don't struggle in the same way and we can prioritize our work, we learn what to panic about and what to not.

    I think most nurses are so tired that when we have down time we avoid helping each other because we are just worn out!

    I dont think all nurses are able to get to this comfortable stage because their personalities insist that they must always be running and doing something. They stress about their patients because they haven't learnt to read their patient accurately.

    They will always run around causing chaos, not taking breaks, charting at the last min and feel very used and abused by their work colleagues.

    So how do you get through this chronic staffing crisis ??

    Laughter and Fun help enormously, I honestly think the reason I have been able to survive nursing is because I have a good sense of humor and I can laugh at most situations!!

    Nurses really do have to be comedians to survive the stress and the negativity.

    It might seem sometimes that my blog is full of negativity but I really didnt set out to be negative what my intention is to let nurses know what they are going through is normal!

    That all over the country in fact all over the World nurses struggle with day to day issues of short staffing.

    I know in my place of work we employ to what our "budget" says we can employ and we are happy but in one week it can turn around and bite you on the nose.

    For example last week this is what happened to my staff
    1/ Full term pregnancy so off work to enjoy her happy event
    2/ Leg injury so off work for min of 4 weeks
    3/ Grandparent passed away so on bereavement leave
    4/ Stomach Flu so a call off
    5/ Grandparent also passed away
    I am left with 2 RN's and I need 3.25
    4 Techs and I need 8
    No float pool and no agency!
    What happened? Well, the staff who could work worked - but picked up very little. One tech worked 80 hours straight! The supervisor worked 67 hours straight and as for me the unit manager well I was there for 70 hours.

    Results - Exhausted. Fed Up. Resentful Staff.

    But how we laughed and joked with each other and our patients. I guess you could call it a sort of Black Humor!

    I looked at the clock at one point and wanted to cry I ached and hurt so much and was so tired. I honestly prayed for the night to be over!

    Then I looked at my co-workers and we laughed at each other because we were all aching and hurting. We prayed for the night to be over.

    One of the patients - a blind lady - sang to us and a couple of the other patients joined in!

    I am a manager, I do work side by side with my staff because I know it improves moral, especially when the chips are down.

    I do not have. It's not in my job description. I do it because I cannot see my staff struggle without help and support.

    I have been that RN who has struggled with trying to manage a heavy caseload and have seen management look the other way.

    My upper management look the other way. I know this because I get senseless emails asking me if I have explored every avenue in my search for staff. I really wanna say, "No I thought I would wait and see if they flew in from Heaven to save me." Why would you even ask this question!

    The down side is they do expect it now and sometimes I cannot work the floor.

    Every place of work has the core staff who will work extra hours, who will not let their colleagues suffer short. They always come in and will always work what ever shift required of them. But one day they say NO! because enough is enough

    So look around...

    Do you have co-workers who need the support and help?

    Has somebody covered for you in the past and may need support today?

    Help each other, support your co-worker and don't abuse the willing ones, because one day they may bite back!
    Last edit by Joe V on Nov 22, '11 : Reason: formatting for easier reading
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    madwife2002 joined Jan '05 - from 'Ohio'. madwife2002 has '24' year(s) of experience and specializes in 'RN, RM, BSN'. Posts: 9,476 Likes: 5,211; Learn more about madwife2002 by visiting their allnursesPage


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    25 Comments so far...

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    The problem is the corporate way healthcare is run today and that administration doesn't want to staff adequately to keep the budget down and save money. Nursing is stressful enough without having to work short or being mandated or being pressured to work overtime! Its true as you become experienced hopefully some of the stress and anxiety will disappear and you will be calmer and able to function, but anyone can be overwhelmed. My trigger point is dealing with confused, agitated patients that get on my last nerve. You don't know what you are walking into and you have no real control over your work environment and patients and you are supposed to put on a fake smile and be a cheerleader. It is just too much so I work only what I'm required to. My refusing to work overtime is not out of selfishness, but about self preservation, my sanity at least. I cope by not working extra. If others have the stamina to work extra and can handle the emotional overload good for them, but given the current state of working conditions I'm not going to work extra unless for a friend on a rare basis. Problem is management expects everyone to be a "team player" always ready to work extra, yet the staffing shortages are not rare, rather they are the order of the day! Pool, agency, travelers are available but of course pressuring and mandating your staff is much cheaper so that is the choice of many hospitals. I feel sorry for the new nurses because working conditions are only getting worse at least I'm getting closer to retirement. I'm sorry but I don't think a person should have to work in pain and be consoled that all your coworkers are also suffering in pain and exhaustion. That's not the answer!
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    Excellent post. I especially enjoyed this:
    My upper management look the other way. I know this because I get senseless emails asking me if I have explored every avenue in my search for staff. I really wanna say, "No I thought I would wait and see if they flew in from Heaven to save me." Why would you even ask this question!
    While your institution may have to look around just a bit for experienced RN's, I'd be willing to bet there's a large pool of new grads who would jump at the chance to increase your staffing level. And I'd also be willing to bet that in the current economic climate you could hire not only new grad RN's but even experienced nurses at a steep discount to the existing prevailing wage. In fact, a cynic might say that this is actually the ultimate actual goal of corporate health care in the US, with RN staffing shortages deliberated cultivated for just this purpose.
    Last edit by chuckster on Nov 22, '11
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    The only job that I could find was at a dialysis clinic- at the time they were willing to hire new grads. I have over a year of experience now but it is still hard to transition to a hospital. Most of them want a BSN so that is something that I have to look into. I TOTALLY agree about laughter- it is what gets us through at work. One of the patients said that the only time that he laughs is when he is at our clinic- it was so nice to hear because we really enjoy our job. It is really nice to read your post because it is from a manager's perspective.
    whereslilly, lindarn, shaughsee, and 4 others like this.
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    There is a glut of new grads, and a shortage of hospitals/clinics/various places that do not want to hire and train them, because it costs money to do so, and they can't really be thrown in at the deep end and expected to swim, like someone with prior experience. What is the answer?

    Perhaps hiring new grads for a preceptorship period, in which they repay the hospital with a commitment to work there for 2 years, or more?

    I don't know, but I do know that it is hard to give quality care like we learned in school when we are short staffed. I only see things getting worse if health care businesses don't invest in new grads....and decent staffing!

    Jane
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    Hospitals should not have to pay for what schools neglect (and get PAID) to do.
    lindarn, BelleMorteRN, and DogWmn like this.
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    Quote from xtxrn
    Hospitals should not have to pay for what schools neglect (and get PAID) to do.
    You could look at it that way but you could also look at it as an investment.
    Lets get these new grads up to par and then we could have a wealth of nurses we could actually use.

    There is a huge need for out there for nurses no matter the hospitals would rather work all nurses short.

    I know when I cover shifts in my unit I am essentially free labor now thats all well and good but I still have my own job to do afterwards. I still have to stay on call for 24 hours a day 7 days a week-I frequently get called at 4 am or 10pm. although sorry I am off topic

    We should have a 'bank' of nurses who can be sent to cover shifts to ensure there is no shortage and our nurses do not burn out.
    Not_A_Hat_Person, lindarn, gonzo1, and 4 others like this.
  10. 7
    I see several issues here:

    First,
    I remember the day when hospitals stopped training student nurses ... saying they were being used and abused as members of staff.

    I was one of those student nurses who complained about working 40 hours a week while having to study, pass assignments, and finals each year.

    I was thrilled when students would no longer be used as a pair of hands on the wards, working 10 days in a row
    The loss of clinical hours has been a disaster for nursing, as xtrn put it, it is not the hospitals job to train new nurses who've not had good clinicals, it is costly. I went to school where we did 4 days a week of 8+ hours on the floor and then we did class and then went home to study and on the 5th day we were in class all day - I was prepaired as a new grad with a few weeks of orientation to do the job I was hired for, now hospitals and any other facility are faced with costly xternships and unless those become an unpaid xternship there will continue to be problems. One of my pet peeves is the 12's and how it has created more problems for students, they don't do a whole shift and can't see from begining to end unless they are working as a CNA...I'm for MORE clinical hours and less fluff or an unpaid xternship at the end of school to get those needed clinical hours to learn skills and time management.

    Second,
    Your staffing shortages are a symptom of our healthcare system, it's all about the money and bottom line, healthcare is run as a business now and it shows and until that changes staffing shortages will remain a problem.
  11. 8
    I've got one for you...

    A few years back, over the course of the year, we had several nurses out for FMLA leaves for various reasons. We all pulled together and kicked butt, managing to maintain our results and PG scores, all the while knowing that it was a temporary thing and would pass. Unfortunately, we did so well with the lower staffing that they cut our floor's staffing budget and changed our grid to make that our new norm. Way to reward everyone for not having a nervous breakdown...let's just do it all the time!

    Thankfully when they wanted to do the same thing last year, our managers pitched a fit. Otherwise it'd be even worse now. This year it won't be an issue since we haven't met productivity consistently...which of course we're getting talked to about.

    Sometimes all you can do is grit your teeth and smile like a maniac.
    Not_A_Hat_Person, RNnbakes, lindarn, and 5 others like this.
  12. 10
    http://www.medscape.com/viewarticle/...src=mp&spon=24
    This article describes what hospitals are doing in response to the recession. The recession drove many older retired nurses back into the workforce (often due to their spouses losing employment). Hospitals have taken the short-sighted, money-grabbing approach by demanding experienced nurses and shutting out new grads. But this will severely hurt hospitals in the long run. As soon as the economy turns around and older nurse's spouses re-gain employment, a glut of these older nurses will re-retire (along with the huge group of nurses about to retire for the first time). The RN vacancies will be vast, and then the hospitals will be forced to hire tons of new grads ALL AT ONCE. Hospitals can either gradually pay a little at a time to orient new grads at a slower pace (and thereby drop the average age of their nurses to a more sustainable level), or they can do the money-grab now and be forced to pay a LOT later on when they have to orient tons of new grads all at the same time with a shortage of experienced nurses who are able to train them. This will also lead to obvious safety liabilities. Forward-thinking hospitals and managers are taking note of the average age of their nurses and the probability of impending retirements and are gradually incorporating new grads and supporting them with adequate training.
    Last edit by AJPV on Nov 23, '11


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