"Safe Staffing" practices ~ nothing has changed

Editorial Team / Admin · Mar 7, 2015

Why do safe staffing issues continue to plague Nursing practice ?

Because administration views nurses as an expense. It's all about the bottom line, not patient care.

Because nursing sees a lot of infighting (see ADN vs. BSN; ICU nurses should be paid a differential; etc for examples) instead of cohesiveness.

tjmrn · Mar 7, 2015

Rose_Queen ~

That is exactly what I think too.

What is surprising to me, is that nothing has changed, regarding that, since I first went into Nursing ~ 28 years ago.

I find that both difficult to believe and discouraging.

How can the people of a profession which, simultaneously, devotes itself to and prides itself on the concept of "advocacy and caring" be so, profoundly, ineffectual at doing the same for it's own ?

That is astounding to me.

TriciaJ, RN · Mar 7, 2015

Many factors involved. So many workplaces not unionized; makes it much easier to clamp down on the dissenters. Of the ones that are unionized, nurses often don't use the resources available to them. Won't file grievances, won't use the staffing documentation form, etc. Some don't even know who their reps are, or how to get a copy of the contract.

So much misinformation about unions: "I don't want to unionize; I'm a professional." (Apparently if you're getting your breaks, you're just not professional.) I still see so much good-little-girl mentality, so much victim mentality, so much tattling and in-fighting. So many obstacles to organizing.

I really don't know what it's going to take. I hear a lot of grousing about the younger "entitled" generation. That entitlement just might be what it takes to turn the tide for all of us. Meanwhile, I keep speaking up and keep my fingers crossed.

allnurses Guide · Mar 7, 2015

A few years ago my sister was hospitalized at this facility. At that time they had hourly rounding. One hour it was the RN and the next a nursing assistant. A few minutes after my sister dozed off I noticed she was off the monitor so I turned on the call light. 14 minutes later an RN came in. I told her my sister had been off the monitor. She told me, "The charge nurse is supposed to watch the monitors at the same time she relieves us for our meal break. They expect her to be in tw places at a time. I don't even take a break. If we eat or drink in front of the monitors we get written up."

This event happened soon after my sister was discharged. I found out about it when it was put on the web site of the California Department of Public Health:

http://www.cdph.ca.gov/certlic/facilities/Documents/HospitalAdministrativePenalties-2567Forms-LNC/2567KaiserFoundation-LA-RSQI11-LACounty.pdf

I know they had a union then. I believe they are wanting to change which union represents them.

Clearly their facility was not following the law or they wouldn't have been fined.

Here are regulations too many hospitals violate. I think it is criminal to violate the law.

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=%28sc.Default%29

tjmrn · Mar 7, 2015

I probably should have sued my hospital for what they did to me. (I told that story in response on another thread. )

Laws for safe staffing have been passed since that, which I am glad for. Though I'm not seeing that they are having their intended effect.

At the time, I was so burned out from having to defend my lic. and the safety of my patients, I was just glad to be out of Nursing.

Now, I am beginning to realize what a trauma the whole circumstance and it's consequence for me has been.

TriciaJ, RN · Mar 7, 2015

Until we get better at speaking up and communicating our concerns to outside entities, hospitals will continue to understaff. Until the fines and lawsuits start to hurt worse than nursing payroll, they won't get it.

tjmrn · Mar 7, 2015

I remember being advised to fill out ADO's. I also remember thinking, at that time, how that was going to add to the, already too long it takes to get the charting done for my patients. (In the days before computer charting.)

I did fill out ADOs, as much as I thought I could. But it didn't matter.

And, unfortunately, what you say is true.

For those just starting out in their careers, with much to lose at that stage of the game, I can see how doing so feels too risky.

But for those of us, like me, on the other end of that road, it is our voices that should be sounding the alarm and the call.

We, most likely, have the time, experience and risk to venture in doing so.

Then those who are able to can join in.

Like these Nurses in the article I've shared in the post.

But those cries for attention on the issue sound no different than when I was first hearing it two decades ago.

What we say and how we say it, obviously, needs to change if we truly hope to facilitate any real change.

What that is and how that sounds, I'm not sure of.

CryssieD · Mar 7, 2015

Such a shame--the helping professions have always gotten the short end of the stick. Everyone wants top-shelf health care but no one wants to pay for it. Those warm bodies cost money, which is always better spent on some CEO's office furniture, or some Board member's personal hobbyhorse. Until we all agree that nurses are the backbone of American healthcare and that we need more of them present in all healthcare fields, short-staffing will continue to be the norm.

tjmrn · Mar 8, 2015

That there are studies quantifying the cost effectiveness of better patient / RN ratios in measurably "better outcomes" should drive the arguments.

And I think they do on the RNs side of it. But maybe what needs to happen is to cut to the purely economic perspective for the CEOs of these "Health Care Industry" leaders.

What they respond to is profits.

If we can make the statements, based on scientific accounting data analysis, that smaller ratios leads to increased profits, ( That is ... there is an inverse relationship between better ratios and profits ... because better patient outcome, ultimately, costs less ) then maybe the message will be better received and more effectively acted upon.

Put it in a simple diagram accompanied with a basic, but pretty graph that accentuates the profit margins and I think we'd see smiling faces across the board room table.

( ok ... please ... forgive my, somewhat non~professional and sarcastic jest in that last sentence. )

Pearyb · Mar 11, 2015

Having worked before the 'for profit' corps stepped in as well as many years worked for the big corps the answer to staffing issues is most commonly r/t to $$. Its no surprise that the present day patient safety movement so well trumpeted by many is heard off key in many areas. Many nurses tell me the units are now worse than ever, regardless of legislation trying to improve quality of care. You'll find that following the money is the primary mission.

toomuchbaloney · Mar 11, 2015

American health care is ALL about the money as evidenced by our health outcomes as compared to other country's health outcomes.