Do you think acute care nursing is becoming less safe?

[Emergent, RN]

My facility, like many, has increased staffing ratios in all departments in response to the economic pressures. Meanwhile, the Joint Commission continues to mandate supposed safety concerns, with mostly extra documentation demands and other inconveniences. They fail to address the elephant in the room, nurse/patient ratios.

I think bedside nursing has become less safe. From the ER point of view, we are less able to safely monitor patients, there is more friction with the inpatient nurses as they are too bogged down to receive patients. There is a cold war going on between some of our ER nurses and floor nurses, causing a big distraction and detracting from teamwork for the greater good.

Meanwhile, we're getting ready for the Joint Commission inspection and are going to be temporarily inconvenienced by their nonsensical edicts. No IV buckets to be left out on the counters of the nurses station, and other rules that are so minor compared with the real problems that we are dealing with. Of course, like other facilities, we have to spend money to hires nurses to make sure that our charting pleases them, that we fill in the many mandatory charting prompts to their satisfaction.

Nursing has become a bureaucratic mess, bogged down in more and more red tape than ever before. All this to be accomplished with fewer nurses at the bedside, and more nurses behind the scene. Insurance companies and the government are running things, and hospital administrators focused on the bottom line. If we keep going down this road, I think we are going to implode.

[toomuchbaloney]

These are the woes of a health delivery system more concerned about money than outcomes. As long as the people running the system are financially motivated and view nurses as an expensive evil that needs to be minimized in order to insure there is enough money for big salaries and bonuses for administrators, we will function this way. They are allowed to ignore the data and evidence which speaks to the need for adequate nurse staffing in order to improve outcomes, because they don't really care about outcomes. The health professionals care about outcomes, administrators care about money.

[RNsRWe, ASN, RN]

These are the woes of a health delivery system more concerned about money than outcomes. As long as the people running the system are financially motivated and view nurses as an expensive evil that needs to be minimized in order to insure there is enough money for big salaries and bonuses for administrators, we will function this way. They are allowed to ignore the data and evidence which speaks to the need for adequate nurse staffing in order to improve outcomes, because they don't really care about outcomes. The health professionals care about outcomes, administrators care about money.

Will never forget being told when I was still a shiny fresh new grad that nursing was an expense, not an income generator....and we were lumped into the same "expense category" with housekeeping.

Yeah, I felt valued.

Since we didn't bill for our services like the "providers" did (we didn't really provide anything?) we were just an expense that had to be kept to a minimum. And it hasn't changed, just gotten worse Yeesh.

[mhy12784]

These are the woes of a health delivery system more concerned about money than outcomes. As long as the people running the system are financially motivated and view nurses as an expensive evil that needs to be minimized in order to insure there is enough money for big salaries and bonuses for administrators, we will function this way. They are allowed to ignore the data and evidence which speaks to the need for adequate nurse staffing in order to improve outcomes, because they don't really care about outcomes. The health professionals care about outcomes, administrators care about money.

I think this line of thinking is dangerous.

Money and the outcomes are connected. Especially in this era of pay for performance.

Are there greedy administrators ? Sure

Are there greedy nurses and doctors ? Sure

There are both greedy people, and people who want to do the right thing in this world.

If the administrators and evil money grubbers werent running a budget (somewhat*) effectively healthcare would be FAR more of a mess than it is. Especially with the way the economy has been in recent years.

In the economic model in the united states its not viable for organizations (hospitals included) to just spend money as they please without consequences.

That said there are ABSOLUTELY big wigs who are (probably) overpaid. But thats just because someone thinks theyll provide that kind of value to their organization

[Esme12, ASN, BSN, RN]

IN one word...yes.

[VANurse2010]

I think it is, but my sympathy is limited given the hostility of nurses and the general public both toward unions and universal public coverage.

[emtb2rn, BSN, RN, EMT-B]

I think it is, but my sympathy is limited given the hostility of nurses and the general public both toward unions and universal public coverage.

But union representation for ratios aren't truly applicable to ERs as mandated ratio limits don't apply here, correct?

I agree with the OP, it's dangerous and getting more so with each incremental belt tightening.

[imintrouble, BSN, RN]

Yes, it is more dangerous.

If the general public could see what I see on any given day, we'd have a whole new industry in health care. The nurse for hire who'd accompany patients to the hospital, to make sure nobody killed them during their hospital stay.

I'd sign on for that job.

[VANurse2010]

But union representation for ratios aren't truly applicable to ERs as mandated ratio limits don't apply here, correct?

I agree with the OP, it's dangerous and getting more so with each incremental belt tightening.

Mandated ratios don't apply anywhere outside California, unless you have a contract that says otherwise. Contracts don't happen without unions.

[Nurse SMS, MSN, RN]

Yep. I see it in just the three years I have been an RN. What was 1:3 on a 36 bed PCU with three techs is now 1:4-5 with two techs and higher acuity.

[BSNbeauty, BSN, RN]

Short answer: yes. Another reason I left acute care.

[Emergent, RN]

It just seems like administration won't allow any wiggle room any more. Then, add in any Murphy's law complication, and you have a sentinel event. Those are often caused by over pressured healthcare workers, exacerbated by communication failures.

So, the Joint Commission, rightfully, tries to encourage better communication systems, minimize hostile working environments, mandate check off lists. But, they cannot create more time in a 12 hour shift by making another check off list, or another education unit on AIDET and SBAR. In fact, many of their well intended mandates seem to obstruct the work flow in the unit and contribute to sensory overload of the nurse.

I believe simplifying the workspace and mandating adequate staffing would improve pt safety.