Major changes & need info

  1. Hello! I am new here and am learning a lot. The hospital I work at has 200 beds. We are experiencing major changes in our little world. I have been looking on the internet only occasionally and do realize that this is going on everywhere. We are one of the last areas to get managed care, although I don't think that is the only reason for our changes (I feel that my hospital is taking advantage of that as an excuse to make a lot of changes and cost-cutting). In the last two years we have had a mass-exodus from our cardiac unit. It is frightening the way I have to work. We are staffed for only 6 patients and most days we have 8 or 9. If we do have another person extra on the schedule, they are usually floated to a "more" needy area than ours. The nurse atient ratio is 1:2 or 1:3, with the cn being one of the nurses. When I type it it doesn't sound any different from the things I've been reading and I'm sure it isn't. But, critical care patients require more nursing care than less acute patients, they pay for it and deserve to get what they pay for. I can usually fit all the technical stuff in my 12 hour shift, although it may be late, but I don't even have time to be an advocate to the patient, or the counselor/teacher they need, let alone chart what I've done (that's usually why I stay over late to get down on paper what I remember). Or have breaks away from the floor or real lunch breaks, you must go get your food and bring it back. It is a 12 bed CCU, on the same floor with a 36 bed PCU. The administration has brought in a consulting firm and they have decided how we can best restructure our hospital's critical care beds. (I'm not sure if the consulting firm or administration wanted CCU/PCU combination or CCU/ICU combination, but we're getting CCU/PCU restructuring.) Each unit is separate at the moment with a cn each. In two months we will be one unit with one cn. There will only be 29 beds total, all private. And ventilator patients (with who knows what else) in the PCU area, which are regular rooms with no way to visually see the patients unless you are at the door or in the room. There are plans to train these PCU nurses in these two months to care for these patients (although they went through the same training I did, I just have more experience).

    Have any of you went through similar major upheavals in your hospitals? We are told that the ones of us who will tough it out will be much happier by the end of the year. I have been very receptive to all the changes, although reluctantly. I have been dumped on one too many times and have applied for another position. I realize the grass isn't really greener over there, just a different shade.

    Also, some nurses on my floor have asked about unions. I have found the websites for OPEIU and Teamsters. Have any of you tried these? Know of any more? We did have a union at our hospital early in the 90's, it didn't work out (they went on strike, never got a contract, were replaced, and some felt that those in union positions sold the union out) and was dissolved - can't remember the name of it, but then the rn's weren't allowed in it because there was a vote among ALL professionals (ancillary departments included) and the vote didn't pass for us. It was more a factory based union and that just doesn't work for a hospital. I can't get to the point where I can not feel an obligation to go in to care for my patients . Although, there are days when I would just love to call in sick because I dread the day soooooo much. How can nurses go on strike and not go in to work? The only thing that comes to my mind is an informational picket, where I can meet my moral obligations and feel I am doing everything I can to care for the patients, but letting my voice be heard. Does anything like that ever work with unions? I am planning to post, in my unit, the addresses of legislatures for my area, and encourage letters to them for legislation for safe staffing levels. I am also going to post this web-site and others, as more of us are computer-able. Any advice, comments would be greatly appreciated.

    I have been a nurse for several years, and can't imagine working like this for another 30-40 years (I know they'll raise the retirement age again, before I get there). Know of any job that makes comparable wages ($17/hr)? I am tired of ******** to my co-workers, because I realize that doesn't get any of us anywhere. And, I am looking for any information I can get to get us, at my facility, on a more productive track. Thank you!!!!!!

    [This message has been edited by justanurse (edited January 08, 2000).]
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  2. 8 Comments

  3. by   Joy Parson
    well you are not alone by any stretch of the imagination!!!!i work on a cardiac/renal/respiratry "special"care unit. saturday i was the relief charge nurse and i had to give my nurses 7 pts apiece. they all griped and so did i but i got no where with staffing because our outdated grid said we had enough. we are going to do a time study on some of our more critical pts and see if that will help us get more staff.a hospital here in tulsa has voted in a union so we are waiting to see if it helps.we also have vents on our floor and peritenial dialysis pts and cardiac cath pts. so you see we have a variety of acuity.i hope things get better for you and for us too!
  4. by   nikki norton
    I AM AN ER NURSE AT A 36 BED HOSPITAL. I HAVE BEEN AN LVN FOR SIX YEARS AND JUST GRADUATED FROM RN SCHOOL. I WORK 7PM TO 7AM. FROM 11-7 I AM THERE WITHOUT ANOTHER SOUL. I CALL THE DR,LAB X-RAY ETC... WHEN I NEED THEM. I CAN CALL TO THE THIRD FLOOR IF I NEED ANOTHER NURSE, IF THEY ARE NOT SWAMPED. I HAVE TO TRIAGE,GET ALL OF THE DEMOGRAPHIC INFO,START IV'S PUSH ALL OF THE MEDS,MIX THE PIGGYBACKS,WRITE ALL OF THE REQUISITIONS AND WE HAVE LOST RESPIRATORY COVERAGE AT NIGHT UNLESS WE HAVE A VENT PT SO WE HAVE TO DRAW AND RUN OUR OWN ABG'S DO ALL OF OUR OWN BREATHING TREATMENTS, AND EKG'S.WE ARE A TRAUMA DESIGNATED FACILITY. WE HAVE BEEN ON A RAISE FREEZE FOR TWO YEARS. WE HAVE NO RETIREMENT. OUR INSURANCE ISN'T PAYING WHAT IT IS SUPPOSED TO. TWO OF OUR GURNEY'S BELONG IN THE SMITHSONIAN. THEY WON'T LOWER. TWO OF US HAVE HURT OUR BACKS TRYING TO GET PT'S ON THEM, NOT TO MENTION THEY ARE UNSAFE FOR THE PTS. THEY HAVE HOLES IN THEM AND I'M SURE THEY HAVE YEARS OF BLOOD AND URINE IN THEM. ADMINISTRATION SAID WE WOULD HAVE THEM IN TWO WEEKS TWO MONTHS AGO. THE HOSPITAL HAD PROMISED TO PAY TUITION REIMBURSEMENT, THEN CUT ME OFF THE LAST SEMESTER. NO REASON WAS GIVEN. I LOVE MY JOB. I LOVE WHAT I DO AND I LOVE THE ER, BUT THE BEURACRACY IS KILLING ME. OUR LITTLE HOSPITAL IS SCREAMING FOR COLLECTIVE BARGAINING. I DON'T KNOW HOW TO ACOMPLISH IT. I CAN'T SEE HOW THINGS HAVE GOTTEN THIS BAD.
  5. by   lisa tudor
    Originally posted by justanurse:
    Hello! I am new here and am learning a lot. The hospital I work at has 200 beds. We are experiencing major changes in our little world. I have been looking on the internet only occasionally and do realize that this is going on everywhere. We are one of the last areas to get managed care, although I don't think that is the only reason for our changes (I feel that my hospital is taking advantage of that as an excuse to make a lot of changes and cost-cutting). In the last two years we have had a mass-exodus from our cardiac unit. It is frightening the way I have to work. We are staffed for only 6 patients and most days we have 8 or 9. If we do have another person extra on the schedule, they are usually floated to a "more" needy area than ours. The nurse atient ratio is 1:2 or 1:3, with the cn being one of the nurses. When I type it it doesn't sound any different from the things I've been reading and I'm sure it isn't. But, critical care patients require more nursing care than less acute patients, they pay for it and deserve to get what they pay for. I can usually fit all the technical stuff in my 12 hour shift, although it may be late, but I don't even have time to be an advocate to the patient, or the counselor/teacher they need, let alone chart what I've done (that's usually why I stay over late to get down on paper what I remember). Or have breaks away from the floor or real lunch breaks, you must go get your food and bring it back. It is a 12 bed CCU, on the same floor with a 36 bed PCU. The administration has brought in a consulting firm and they have decided how we can best restructure our hospital's critical care beds. (I'm not sure if the consulting firm or administration wanted CCU/PCU combination or CCU/ICU combination, but we're getting CCU/PCU restructuring.) Each unit is separate at the moment with a cn each. In two months we will be one unit with one cn. There will only be 29 beds total, all private. And ventilator patients (with who knows what else) in the PCU area, which are regular rooms with no way to visually see the patients unless you are at the door or in the room. There are plans to train these PCU nurses in these two months to care for these patients (although they went through the same training I did, I just have more experience).

    Have any of you went through similar major upheavals in your hospitals? We are told that the ones of us who will tough it out will be much happier by the end of the year. I have been very receptive to all the changes, although reluctantly. I have been dumped on one too many times and have applied for another position. I realize the grass isn't really greener over there, just a different shade.

    Also, some nurses on my floor have asked about unions. I have found the websites for OPEIU and Teamsters. Have any of you tried these? Know of any more? We did have a union at our hospital early in the 90's, it didn't work out (they went on strike, never got a contract, were replaced, and some felt that those in union positions sold the union out) and was dissolved - can't remember the name of it, but then the rn's weren't allowed in it because there was a vote among ALL professionals (ancillary departments included) and the vote didn't pass for us. It was more a factory based union and that just doesn't work for a hospital. I can't get to the point where I can not feel an obligation to go in to care for my patients . Although, there are days when I would just love to call in sick because I dread the day soooooo much. How can nurses go on strike and not go in to work? The only thing that comes to my mind is an informational picket, where I can meet my moral obligations and feel I am doing everything I can to care for the patients, but letting my voice be heard. Does anything like that ever work with unions? I am planning to post, in my unit, the addresses of legislatures for my area, and encourage letters to them for legislation for safe staffing levels. I am also going to post this web-site and others, as more of us are computer-able. Any advice, comments would be greatly appreciated.

    I have been a nurse for several years, and can't imagine working like this for another 30-40 years (I know they'll raise the retirement age again, before I get there). Know of any job that makes comparable wages ($17/hr)? I am tired of ******** to my co-workers, because I realize that doesn't get any of us anywhere. And, I am looking for any information I can get to get us, at my facility, on a more productive track. Thank you!!!!!!

    [This message has been edited by justanurse (edited January 08, 2000).]
    Hey you aren't alone, none of you are. Nursing isn't like it used to be, that is for sure! We don't have time for anything.
    I am a correctional nurse. We have been contracted by the state. I have worked this job for 7 years and I have seen 3 different contract companies. You start over whenever the contract person changes. It really was getting bad. We decided a few years ago to go union. We voted the AFSCME Union in. They represent our officers, so we did that. We recently got our contract, negotiated for over a year and representing 12 prisons that has a contract with our vendor. So far we are please. We will reach parity with the State nurses soon. It will be a big jump in money. We do the same job, so we should get the same money. AFSCME stand for Amerian Federation of State, City and Municipal Employees. You might give it a shot, if they are in your area. Let me hear from you!

    Love to hear from any nurses out there!
    E-mail me--Lisarn
  6. by   Tara
    Sorry you are feeling so frustrated? Unless I am reading your letter incorrectly, a ratio of 1:2 or 1:3 doesn't seem all that bad. I am curious if your charge nurse takes a patient load. If not then she should. It would be more helpful for the unit. She shouldn't necessarily take the largest load. She is there for a resource and final decision making if necessary. I imagine all of the other nurses are capable of making most of the decisions effecting there patients. Again though the ratio seems OK. I have worked a floor MEd-Surg and the units and I find the units are easier. I think if most of the other nurses really knew that and were not fearful of the extras and just learned more about it, that they also would love to have a ratio like yours and not 8-10 on a general floor with constant running back and forth between all of those rooms.
  7. by   justanurse
    Tara,
    I am the charge nurse. And, many days I take 1:3 load just like everyone else. Some of those days I also have to be educator when competencies need to be done and secretary when orders need to be taken off, not to mention being on the code team. I also get to be the know-it-all resource person for the unit. Yeah, I'm frustrated. There are only about 2 days a month that I don't have to take a patient load and everyone still expects me to help them just as if I'm free as a bird, with no other responsibilities. It used to be 1:2 and the charge nurse was free to help out, and the patients weren't even that bad. More patients are sicker than they ever used to be. You're right a 1:2 and 1:3 doesn't sound bad, until you add in the acuity. Then it sucks. Yeah, and I've worked the floor before when I've had to take 10 and 12 patients on an evening shift, that was bad too. There's a big change coming to my unit, and an even bigger one for me, it's just a matter of when for me. Thanks for all the feedback, everyone!
  8. by   jtfreel
    Boy did you ever hit a tender spot! It has taken me years and a lot of experiences and observations to even begin to have any real thoughts about your concerns. Nursing, unfortunately, is NOT the angel of health care who's worth is universally recognized and who's value is a given. To many organizations, nursing is a COST CENTER to be carefully controlled, defined and managed.
    On top of this is the reality that nursing is populated with many dedicated, committed, educated, caring, compassionate individuals who are sincerely professional and usually possess high personal and professional standards. How do you meet the needs of this group AND control them at the same time? For many other professions and organizations, that was a quandry. Unfortunately, with the best of intentions, this was assisted by many well meaning changes. JCAHO has continually placed more and more requirements on institutions which have translated into more and more documentation and review requirements placed on the staff RN. At the same time, managed care and the need for financial profits pressured organizations to squeeze more and more out of less and less staff. Coupled with this is the reality that the primary "customer" for many health care organizations is NOT the patient, but the physician. To further complicate matters, the presence of and the role of the registered nurse is required in acute care facilities by law. ( I have heard CEO's and CFO's even discuss this necessary evil!) The reality is that nursing and staff nurses in many facilities are powerless in the big picture. Now back to control: we can't let them know that. So hold them accountable for everything. Promote empowerment opportunities, teamsmanship and excellence guidelines. Few nurses will realize that whoever allows empowerment...can also take it away. Why do you think that the CNO position is viewed as short term? The CNO tries daily to balance the needs of the PATIENTS, with the staffing requirements to meet these needs, considering the needs of the staff, the physician culture, the regulatory guidelines and the financial realities of the organization.

    And, in my opinion, Nursing is not very good about promoting the profession or its value (diploma vs BSN vs AD: still raging). We are still having articles and research attempting to PROVE that we are a profession. Add to this confusion the fact that nursing students are graduating with less and less clinical preparation (which is forcing the organizations to provide preceptorships, to demand that existing staff orient/train new grads, or accept the "eat their young" mentality) and you have the recipe for stress.

    I love this profession and refuse to give up on the right of patients for quality professional nursing care-even when the "bottom line" is the profit margin, the need for meeting JCAHO and other institutional standards, and the need to stay current in a rapidly changing field.
  9. by   tremmi
    Originally posted by Tara:
    Sorry you are feeling so frustrated? Unless I am reading your letter incorrectly, a ratio of 1:2 or 1:3 doesn't seem all that bad. I am curious if your charge nurse takes a patient load. If not then she should. It would be more helpful for the unit. She shouldn't necessarily take the largest load. She is there for a resource and final decision making if necessary. I imagine all of the other nurses are capable of making most of the decisions effecting there patients. Again though the ratio seems OK. I have worked a floor MEd-Surg and the units and I find the units are easier. I think if most of the other nurses really knew that and were not fearful of the extras and just learned more about it, that they also would love to have a ratio like yours and not 8-10 on a general floor with constant running back and forth between all of those rooms.
    No tara: 1:2 isnot bad, but try 1;3 with a vent and a swan and a balloon pump and coding patients and arterial sheaths to pull after PTCA's. I can handle l:2 but l:3 is awful. Not only do you have the patient to take care of but the paperwork of 3 patients in an ICU setting is different. Plus when I work the floors, we have aides to empty urinals and do baths and make beds and answer call lights. In ICU, you do it all. There is no aid, at least not in our ICU and at night there is no clerk, so an admit is done by one of the nurses while the other 2 actually deal with the patient. I worked a telemetry unit for 2 years and had 12-14 patients at night and managed to get everything done. My 3 ICU patients make me late most days.

  10. by   Tara
    Yes, I understand 1:3 is challenging at times. I have worked it myself for many years in a large hospital with many vents etc. I am just saying I feel nurses who work on the general floors have it worse. I find it is easier to focus on the needs of 2 or 3 easier than focusing on the needs of 8-12. I currently work in a procedure based area and feel it is one of the best places to work. It is busy and we often stay 3-4 hours late. Working until all the procedures are done. I understand your frustration with the difficulties in getting all the needs taken care of however, I also know that
    it is rough every where. All patients have special needs and the unit nurse is usually more apt to fullfill the needs of a few than the floor nurse. I went to the unit because, for me it was easier despite what people who have never worked in a unit may think. Have any of you ever worked in a procedural based area such as a cath lab?
    It is busy everwhere

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