Patient Safety low priority

[JessRN]

I work at a rehabilitation hospital that is owned by an international corporation. The facility has a fully equipped gym on one floor and a 51 bed inpatient unit on another floor. Our patients are usually in four main categories, neurological (CVA's, brain injury, guillian barre, spinal cord injury), pulmonary, orthopedic, and general debility.I have been employed there since february of last year.

In the past 6 months I have seen how our administration, along with our medical director, have cut costs at all cost, and as a result our patients have been the ones who end up paying for this.

Most recently our administrator mandated that full time employees would have to take involuntary days off due to our low patient census. However these days were only given to our nursing staff. (the majority of therapists are paid salary) This contributed to an even greater decline in nursing staff morale that had already been hit hard by the incorporation of a new documentation system that limited the amount of paperwork LPNs could do and increasing the amount for the RNs. Even though each are responsible for the care of the same amount of patients daily. As a result of the mandate the majority of our PRN staff have quit or obtained employment elsewhere. We have also been admitting patients that are inappropriate for a rehab setting, yet our medical director and our DON both defend that this is false :angryfire

This past week our census finally started to increase and we reached a full 51. On Thursday our DON was aware of the number of discharges and admissions planned for Friday and the number of nursing staff scheduled to work. This was the day my day shift rotation was scheduled to return also ( I am charge nurse for our rotation, there are 2 day & 2 night rotations we work 12hr shifts). One of the LPNs was scheduled off for vacation, and the DON did not make an effort to call someone in until that day. All of our prn workers were already working at their other jobs and no one from the other rotations would come in. Therefore we had three RN'S, one LPN, five cnas, with a unit secretary only on 2 of the three days we worked. Each cna was assigned to 10 patients, except for one that took 11. I was assigned to 12, another RN to 12,the other RN to 13, and the LPN to 13 on friday, by Sunday we had 12 a piece. We currently have 1 trach pt., and another pt that has an unmanageable ostomy requiring numerous drsg changes, not to mention our brain injury patients. During these three days we sent 4 pt's to the ER 911; one with a PE that was admitted, one impending resp. distress that was admitted, and two CVA pts with neuro status changes thet returned after lees than 4hrs. Each nurse, including myself, only got a lunch on sunday, and we all stayed over 30mins-1hr after each shift. (The night shift was staffed the same way, only they had 2 LPNs and 2 RNs)

This incident alone, because there are plenty others, is horrible. How can the nursing staff make the administration see how important we are to the facility? We are the only dept., other than resp. that are there 24hrs a day. Our nurse to pt ratio is ridiculously unsafe. I am 22, and have only been licensed as an RN since last March. How can someone of my status make a change? I try to talk to my director about these situations but she does very little to improve them. She also uses comments that seem to have come directly out of a therapeutic communication chapter from a psych nsg. textbook. I currently have to have full time employment & health insurance so I don't want to risk losing my job. And I also really enjoy rehab nursing.

I would greatly appreciate any suggestions to help change things.