Why does Nursing put up with short staffing? - page 10

I am wanting to get a little feedback as to why Nursing (in general) allows short staffing to be an issue? I am on our research committee at work and would like to get an idea of where to take my... Read More

  1. by   Ariesbsn
    I think the sad truth is we work short staffed because we are told we have to by management and our charge nurses. I work in an ICU and we were told by management that ICU can't refuse to take a patient just because we don't have the nurses to care for the patient. WOW, if that ain't a law suit waiting to happen, nothing is.

    Saturday, as a prelude to telling people what their assignments were the person doing charge said "OK, here are your assignments and they suck. Don't ***** about it because there is nothing I can do." We were 3 nurses short and still got 2 admits.

    Management frequently shoots us in the foot with their ideas. Twice in the 2 years I have been there, they have opened new sections or expanded existing sections and not had enough staff to cover the new additions when they started filling the beds.

    Then there is the "rapid response nurse" position that they created. This is a nurse that any floor can call if they have a patient that is going bad, is acting different, or needs IV access. This nurse can follow protocol and either resolve the problem or get the pt to ICU if needed. They didn't hire any new nurses, they just assign one nurse from our barely adequate pool of ICU nurses as RR for the shift. Well 99% of the time, the RR sits on their butt and surfs the web. Saturday there were 2 calls for IV starts in 12 hours.

    Management has also decided we will be responsible for stocking our own rooms and this includes refolding our linen to get it to fit in our closets, as well as emptying our own trash and dirty laundry.

    I work nights and the latest thing to come to pass from management is that every Weds and Sunday, night shift has to change all the tubing, luer hubs, and IV site dressings. It doesn't matter if they are less than 24 hours old.

    Oh yes, they are cutting our incentive pay for overtime as well as the shift differentials for working nights and weekends. So much for regular staff picking up when we are short.

    As far as what the ANA states regarding patient abandonment, that is all fine and dandy. However, the state board sent out their publication with the comment that refusing to take an assignment could constitute abandonment and that we, as nurses, shouldn't work in institutions that require us to take unsafe patient assignments.

    Nurse retention is another problem. The horizontal aggression in our facility is horrid so nurses frequently leave. When I started, I was one of 15 new ICU nurses. At the 6 month point, I was the only one of that group left. I have been chewed on enough by these nurses that I put in a request for a transfer to ED.

    From what I hear, it is worse at other hospitals.

    I talked with my husband about paying for a consultation with a nurse attorney so that when I have to refuse an extra patient or they float me to a unit with patients that I haven't been trained to take care of, I can say "On the advice of my attorney, I am going to decline that experience." I feel the need to do this because I had my manager, who was an ICU nurse 2 years ago, tell me that as long as my nursing actions were deemed "reasonable nursing actions" I wouldn't lose my license if something went wrong with one of my patients and they died due to my lack of experience. It may well cost me my job, but like another person said, I worked too hard to get my license to lose it.
  2. by   Gennaver
    Quote from RNsRWe
    Because there will always be harder shifts to get coverage for, and facilities are willing to pay more for those shifts than they are for easy to fill ones. At my facility, lots of nurses want day shift. They get a base rate of pay. Nights, however, require far more baiting, and therefore we get extra $$ per hour. Do I "put up with it"? No....I want and expect it!

    Why do I want hourly pay (not salary) plus differentials? Because I want to be paid for every single minute I work, as I do now, and because I AM willing to work hard-to-fill shifts, I will take the extra cash, thank you. Definitely not "nickels and dimes" where I am!
    Then give those working off shifts a higher salary to start with, not nickles and dimes or dollars for shift differential.

    I think we are selling ourselves short, (then again I am not yet a nurse, merely been a tech working alongside nurses for 15+ some odd years).

    edit: then again, I am very aware that my thoughts are not common and I respect yours...yet, I also want to see nurses as being seperate from the actual Hospitals as are the doctors. I would love to see hospitals trying to attract and reward nursing and nurses to have billing rights and so on...we are not vocational we are professional...
    Gen
    Last edit by Gennaver on Mar 5, '07
  3. by   RNsRWe
    Quote from Gennaver
    Then give those working off shifts a higher salary to start with, not nickles and dimes or dollars for shift differential.

    I think we are selling ourselves short, (then again I am not yet a nurse, merely been a tech working alongside nurses for 15+ some odd years).

    edit: then again, I am very aware that my thoughts are not common and I respect yours...yet, I also want to see nurses as being seperate from the actual Hospitals as are the doctors. I would love to see hospitals trying to attract and reward nursing and nurses to have billing rights and so on...we are not vocational we are professional...
    Gen
    I understand what you're saying, but maybe when you're in that situation (become a nurse and work as one) you might feel differently. Maybe not, I don't know.

    Another thread, in the Poll forum I believe, asked whether nurses preferred salary to hourly pay. It was overwhelmingly hourly-preferred.

    Thing is, I've had salaried positions that paid nicely. And in those positions, I ALWAYS worked far more hours than I was told I needed to upon hiring! And when one looked at the number of hours spent on the job versus the paycheck at the end of the week, one had to question if it was worth it. Ultimately, I decided it was not.

    Hourly pay means I get paid for every minute not only when I work my regular shifts, but am eligible for some pretty tasty incentives when scheduling goes bad and I am called to come in extra shifts or extra hours per shift. If I were salaried, there'd be no incentives, period.

    And don't imagine that everyone would simply be paid at the higher dollar amount off the bat, as you suggest: hospitals ARE a business, and basic business sense says you pay the going rate for the basic job and offer greater incentives (ie: CASH) when they need more from their employees than the employee is obligated to give. They would never in a million years start paying at the rate it would take to get hourly nurses to give up that incentive.

    Salary is appropriate for some situations, but in an industry where demand far outweighs need, it doesn't make sense to even think about cutting off that financial advantage. Unless, of course, you're a hospital and think you can pay a LOW salary -- and competition would eliminate them very quickly from the running.

    By the way, curious about something: upon graduation, you will newly be joining the army? Isn't that unusual at age 40? I thought they didn't even take that age...? Maybe I'm dating myself, LOL!
    Last edit by RNsRWe on Mar 6, '07
  4. by   synesthete
    Quote from Baptized_By_Fire
    http://thomas.loc.gov/cgi-bin/query/z?c110:S.73.IS:
    Here is the overview of S.73


    http://www.aacn.nche.edu/Government/pdf/Billlist.pdf
    And here is the list of nursing- related proposals currently before the 110th Congress.
    Thank you soooo much!!!
  5. by   twotrees2
    Quote from wjf00
    I for one NEVER allow short staffing. I refuse the assignment, if in my opinion it is unsafe. This is a relatively rare occurance, but I have done it. Patient advocacy sometimes requires ruffling managements feathers a little.

    i have checked into this - and in wisconsin if you refuse an assignment you can be held for abandonment- if you do not call in in the proper amt of time ( most places it is 4 hours or 2 hours) the facility can claim abandonment on th nurse. we cant just walk in see our assignmnt and say nope wont take it its not safe. unfortunate for sure.
  6. by   twotrees2
    Quote from elfinM
    I agree with your statement! I am wanting to find out the root problem as to why this exist at all. I want to make a positive change for nursing, but until I can uncover the reasons that create the problem it can't be fixed.
    I have co-workers who blame it on just being women. I find that personally offending. Whether man or woman, as Nurses we face this together. I am just trying to understand why this problem exist at all. Where did it go from being about the patient and doing what is right for them, to the bottom dollar? When did the essence of Nursing get lost in healthcare?
    Just wondering.
    Thank you for giving me insight into what I am trying to understand.
    in my view when for profit corporations took over - in our area very few private run or non profit organizations are as bad as for profit organization run pplaces. governemnet run in our area are not lacking in staff very much at all either.
  7. by   twotrees2
    Quote from tencat
    So why don't we do that? It seems that everyone in the realm of direct medical care IS an independent contractor except nurses and CNAs. How come we can't all become independent and bill for our services the way others do? Just wondering. I guess that's a topic for another thread.
    some states do have it - you can get paid but its not to work in hospital or anywheer but in the homes- wisconsin is one
    - http://www.professionalhomecareproviders.com/
    dont know other states- there are like 4 or 5 of them- you get a provider number and get paid by medicare etc- just athought for some- i know i am considering it
  8. by   BBFRN
    Quote from twotrees2
    i have checked into this - and in wisconsin if you refuse an assignment you can be held for abandonment- if you do not call in in the proper amt of time ( most places it is 4 hours or 2 hours) the facility can claim abandonment on th nurse. we cant just walk in see our assignmnt and say nope wont take it its not safe. unfortunate for sure.
    http://www.mbon.org/main.php?v=norm&...andonment.html

    It does look like your state leaves the term "abandonment" very open to interpretation. Y'all need a better state nurses association to back you up and make sure the board makes that issue a little clearer LOL.
  9. by   twotrees2
    Quote from interleukin
    If there was one thing, and only one thing, I could get nurses to do, collectively and without reserve, it would be to make them stay home when they're sick.

    Nothing bothers me more than hearing these stories of going in sick because of this or that or some other guilt-ridden justification.

    For god sakes, stay home when you're sick! If there is no staff to take your place, it's not your fault, nor is it your problem.

    STOP PERPETUATING THE NURSE-AS-MARTYR SYNDROME!!!!!!!!!

    and maybe, just maybe, they'll get the message and staff properly.

    But please stop this throw-myself-on-a-sharp-stick behavior!
    i did not catch anyone protraying themselves as martyrs for going to work sick - just pointing out there is a difference in personalities - thise who are willing to work at all costs short of death( ive done my share as has many - wearing a mask and gloves and excessive plus handwashing lol) vs those who call in to gho shopping or just cause they are "sick of the job" - which truly wish i had the guts to do just that ( in esssencce i guess i have - after quitting my old job and before starting my new i took 2 weeks off - yeah is me clap clap lol. there is NO job out there that would put up with as many call ins as some of the staff do for this job- they are not going to staff any better with or without the call ins -
  10. by   twotrees2
    Quote from interleukin
    That's always a great situation...

    They'll pay someone from an agency who has no allegiance or dedication or history to the facility rather than pay someone who has been there years the bonus to work extra. Really gives me that fluffy warm feeling.

    Sooner or later, you'll understand that...until you start writing letters and standing up politically for what you know is right, you are warm widget on a spread sheet.
    and as soon as you start wrting em up and getting politically involved - which i love to do ( they call me a ummmmm - "bridge burner" i guess cause i dont cover my ass and kiss thiers) you will soon find yourself wiped off that spread sheet and maybe even blackballed. i refuse to give up even when forced out - i just pray god knows what he is doing with my life cause as much s i open my mouth nothing gets done excpet loosing my job or getting pushed out one way or another.......
  11. by   k3immigrant
    where i am working right now, there's a big issue on short staffing.we are the only hospital in the valley that have a staffing-ratio policy as stated in our union contract BUT the management is trying to tweak it by trying to use acuity though our union contract says management needs to sit down w/ union & bargain first. we are even told by management that if we don't take the extra patient, we will be "let go" by the company.i feel that we are being threatened into taking an extra patient but we're waiting to see what's going to happen next...anyway, i'm leaving this company soon.
  12. by   twotrees2
    Quote from CNSgradstudent
    I am currently a nurse in a recovery room at a surgery center. We have experienced a large turnover due to the PRN pool they have established. The PRN nurses make several more dollars an hour, do not have the added assignments of keeping the center running and can work if and when they want. When they are working PRN in other centers around town, we resort to using the Agency nurses, which is even more money and the same issues of not having the added wrokload of daily assignments. How are we as nurses who are employeed by hospitals and corporations going to encourage them to have retention strategies and how do we make management understand our perils. They think if we have a "warm body" everything should be OK with the work load. I am in graduate school and I am doing my research on the use of agency(prn) staff and the retention of RNS. Any feedback is greatly appreciated.
    well - take my old place- i worked prn- but i only worked for them - i worked when i wanted AROUND what they had available ( not that i ever had any trouble gettying the number of hors i wanted) yet they deciede after 2 yrs they need to require me to work THEIR schedule and so they lost a up to 12 - 14 day a month nurse - thier loss.................... i was more than a warm body- knew the facility and poeple and rules- i knew the workload and voiced very loudly in regards to how they treated thier regular staff- guess they decided if they made me regular id quit whining but instead i just quit.
  13. by   twotrees2
    Quote from bjlyst
    i'm not sure where you get your information. but, here's a reality for you. if you go to work and clock on, then turn around and leave, it is considered abandioning your patients. which is against the law. which means that you loose your job and probably your license, which in turn makes staffing even shorter.

    i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.
    around here they can take you for abandonment if you dont show up or call in within ThIEr GUIDELINES ( BE IT 2 OR 4 hours depening where you work) sorry for caps - anyhow- check each state cause if they want to get to the nit and gritty theyd have the fuel....

close