staffing issues

staceyp413 · Jul 16, 2006

Will your facility allow for agency staffing?

You could also put together a proposal that includes the cost of orientation due to the rapid turnover of staffing and include in the proposal the cost to the facility of just one error.

I don't know if your administrators would go for it or not but you could do a mini staff satisfaction survey and show the results to administration as it will directly correlate with your turnover?

I am very fortunate that our facility will support us getting agency staffing and for the most part those who have worked with us have done well. Our goal is to also get our staffing numbers up but as with most institutions just when you're about to get up to staff someone leaves, gets ill, etc ( I don't mean this in a negative way, just part of life). I think we will continue to have this problem as the shortage of nurses continues and then opens so many new opportunities for staff to choose from.

maryk650 · Jul 22, 2006

I think this is a nationwide problem. Most nurses change jobs because of the staffing issues but find it is not much better anywhere else. The hospital I work has major staffing issues, but jobs are not filled unless they are posted by Human Resources, which is not very often. The pay is not very good, and if you want to transfer internally, it usually involves a pay cut. Who wants to go to another dept. and take a cut in pay? There is not even increased pay consideration for transferring to a specialty area. At present, I am a House Supervisor who wants to transfer to the ER. I would have to take a 12% cut in my salary to transfer. Nonetheless, I am seeking employment elsewhere. I am very uncomfortable because of the liability involved in working with the staff that I have. I supervise RNs, LPNs, and CNAs that usually have 10+ patients per shift on Med/Surg plus any admissions that may come in on the shift. Sometimes the CNAs have 16+ patients apiece. I have complained to Adm. multiple times, but so far nothing has been done. When the managers make their monthly schedules, they even schedule short- staffed because there are not enough nurses to work. They do not enforce the sick call policy, and the sick call is way out of hand. I have also complained about this multiple times and have gone so far as to let the CEO know how bad it is. I still have not gotten any feedback. They do the surveys but do not do anything about the situation. I think this puts the staff and the patients at risk. The nurses have gone as far as refusing to take admissions because of their workload. The Manager comes in to work (if you can call it that) for a few hours and then leaves. Any suggestions?

icare4icu · Jul 22, 2006

Have you tried agency or registry and even travelling nurses.

llg, PhD, RN · Jul 22, 2006

Either the upper-level administration is going to support you or not. Your supervisor and HR should be helping you to solve these problems. If they are not doing so, there is not much you can do. Of course you can be emotionally supportive of the staff and abuse yourself to try to work extra hours to fill the holes in the schedule yourself, but that is not the answer.

Do you have a boss who is supportive of you? Is he/she offering you both suggestions and concrete assistance in solving the long-term problems? Did you receive an adequate orientation to your new management position to prepare you to deal with these issues? Does your employer provide you with the ongoing education and support you need to deal with the problems? If so, then work with them to solve the problems. If not, resign.

Such bad problems will not be resolved unless the hospital (administration, board of directors, etc.) is willing to take the steps necessary to improve working conditions. Nurse sacrificing their health and sanity to "keep things afloat" aren't really helping. They are giving the Board justification for not spending the money needed to really improve things. Tell your boss that you don't feel you can improve things without his/her support, appropriate education, etc. You can go back to being a staff nurse there or you can go elsewhere, whichever feels best for you -- but don't perpetuate the problems by putting up with it. Too many nurses have done that in the past -- and that's how the problems got to be so bad in the first place.

Good luck. Let us know what you decide.

llg

rstewart · Jul 22, 2006

Either the upper-level administration is going to support you or not. Your supervisor and HR should be helping you to solve these problems. If they are not doing so, there is not much you can do. Of course you can be emotionally supportive of the staff and abuse yourself to try to work extra hours to fill the holes in the schedule yourself, but that is not the answer.
Do you have a boss who is supportive of you? Is he/she offering you both suggestions and concrete assistance in solving the long-term problems? Did you receive an adequate orientation to your new management position to prepare you to deal with these issues? Does your employer provide you with the ongoing education and support you need to deal with the problems? If so, then work with them to solve the problems. If not, resign.
Such bad problems will not be resolved unless the hospital (administration, board of directors, etc.) is willing to take the steps necessary to improve working conditions. Nurse sacrificing their health and sanity to "keep things afloat" aren't really helping. They are giving the Board justification for not spending the money needed to really improve things. Tell your boss that you don't feel you can improve things without his/her support, appropriate education, etc. You can go back to being a staff nurse there or you can go elsewhere, whichever feels best for you -- but don't perpetuate the problems by putting up with it. Too many nurses have done that in the past -- and that's how the problems got to be so bad in the first place.
Good luck. Let us know what you decide.
llg

In my opinion this advice is 100% correct; Do yourself a tremendous favor and heed every single word.

Pediatric Critical Care Columnist · Jul 22, 2006

In my opinion this advice is 100% correct; Do yourself a tremendous favor and heed every single word.

DITTO!!!

Our unit is faced with the universal staffing shortfall issue most shifts, and like the OP said, when the census is down, the "extra" staff is pulled. Meanwhile, regular full time staff are being denied their statutory holiday days-off-in-lieu and people are also being denied their vacations. We too are not permitted to block beds due to staffing reasons, but in our unit, management does NOT ever do patient care, not even break coverage. The usual method of dealing with short-staffing is to move patients around so that assignments can be doubled with no regard to workload or acuity. We have a laundry list of other issues that contribute to our staffing problems that will never be addressed by the current administration, meaning that the number of dissatisfied people grows exponentially and the list of people leaving does too. Since the beginning of the year, we've hired more than two dozen new nurses and at least eight never even finished their orientation before deciding they couldn't possibly work in our unit. One injured her back the second week she was off orientation and was out for three months.

Your decision will come down to whether you are ready to stay and fight for what you know is right, or if you walk away and leave it for someone else to deal with.

gradcare, LPN · Jul 28, 2006

I think this is a nationwide problem. Most nurses change jobs because of the staffing issues but find it is not much better anywhere else. The hospital I work has major staffing issues, but jobs are not filled unless they are posted by Human Resources, which is not very often. The pay is not very good, and if you want to transfer internally, it usually involves a pay cut. Who wants to go to another dept. and take a cut in pay? There is not even increased pay consideration for transferring to a specialty area. At present, I am a House Supervisor who wants to transfer to the ER. I would have to take a 12% cut in my salary to transfer. Nonetheless, I am seeking employment elsewhere. I am very uncomfortable because of the liability involved in working with the staff that I have. I supervise RNs, LPNs, and CNAs that usually have 10+ patients per shift on Med/Surg plus any admissions that may come in on the shift. Sometimes the CNAs have 16+ patients apiece. I have complained to Adm. multiple times, but so far nothing has been done. When the managers make their monthly schedules, they even schedule short- staffed because there are not enough nurses to work. They do not enforce the sick call policy, and the sick call is way out of hand. I have also complained about this multiple times and have gone so far as to let the CEO know how bad it is. I still have not gotten any feedback. They do the surveys but do not do anything about the situation. I think this puts the staff and the patients at risk. The nurses have gone as far as refusing to take admissions because of their workload. The Manager comes in to work (if you can call it that) for a few hours and then leaves. Any suggestions?

You are not on your own this is an international problem. I frequently am faced with the prospect of having to find staff at short notice for a busy ICU. I am lucky in that I am able to call on part time staff to do extra shifts (costs less than agency, better flexability for the staff and you have someone who is already familiar with the practices and expectations of the unit as opposed to an agency who may not be familiar with our practices.) Is this an option for you? Where we do run into trouble is staff working for longer and harder than their physiology and psychology can take and taking sick leave after the need for extra staff is resolved. That said my bosses are pretty understanding and seem to be willing to take finacial hardship and losses in exchange for not appearing in the papers to the point where I have had up to 4 staff on overtime for up to 12 hours. If this post is wide of the mark I am sorry however its intent was to let you know that your experience is probably similar to NUMs and DONs worldwide.

Good luck

debbyed · Jul 29, 2006

I work on a unit based staffing comm. Our ER is self scheduling. It used to work really well until theybuilt us a larger ER. :eek: We had some problems staffing the old one and filled in with staff.

Now it is insane. At 7 PM I am supposed to have 12 nurses, I had 6. :angryfire This was after agency had been called and all our nurses were offered DOUBLE TIME,

Our staff is just burnt out. We use agency's, we have used travelers, we even import nurses from the Phillipines.{These nurses however take 6-9 months of training, But than They have a 3 year contract that starts after orientation stops.}

Our Nursing Director of the ED quit to move higher on the ladder:lol_hitti about this time last year. Our Nurse Manager :banghead: abruptly quit last week. We have a new director :bowingpur comming in at the end of August :welcome: so we are hoping she has some ideas because we are dying. The light at the end of the tunnell is dimmer that it has ever been, and the administration expect the Clinical Leaders :smackingf to pick up the slack. HOW??? any suggestions.

And yes:trout: I'm one of the idiots that just worked almost 60 hours last week. But I can't go on either.:zzzzz

9moreyears · Aug 2, 2006

Thanks for all your comments and support. Advertising for more nurses this weekend. Hoping and praying I can keep enough nurses that I have to train the new ones. I do not feel as if I am doing a good job and I don't quite know how to fix that. I am not sure what help to ask for. As far as agency, our nurse recruiter says maybe somebody coming, but the background check for them is formidable.

leggera · Aug 4, 2006

ciao.

i am an italian head nurse.

i don't know the staff situation in usa.

i wuold like to have your opinion about my standard staff.

my ward has 25 beds, cardiological patients,

i have 13 rn.

morning 3

afternoon 3

night 2

working hours in a month for each person around 160.

is it different in USA?

thank a lot and sorry for my simple english.

lena

Turk182 · Aug 14, 2006

Before leaving for work, I sat down to find some help with what is evident to be a monumental problem everywhere. I've been a manager for almost 1 1/2 year now, and feel like I'm not making any headway either. We are a small hospital, one floor, and we take everything we possibly can. Often we have patients who qualify for a CCU step down unit, along with post/ops, internal med and those "social" admissions because the doc knows the family and won't say "no" to the uneccessary admission.

Our census fluctates so crazily there is no way to predict. We will literally have 8 patients one day, and discharge 6 of them home, only to admit 8 that night and by the day after we are at 13 or 14. I know that sounds like nothing to the bigger hospitals, but the nurse's at our hospital are the lowest paid in our "competative region", have the oldest and least amount of equipment to do their job. They are pulled regularly to the attached nursing home when our census drops. This makes them angry (understandibly so since the nursing home staff finds out what our census is and then calls out sick) and then they start calling out sick as well.

I'm researching ways to put together a proposal to show the CEO and board of directors ( who get this, the President used to be the manager of our direct competition.... and now we are being forced to "partner up" with them...although they seem to reap all of the benefits and we've seen not one thus far) . How do we show them that nursing is a profession, just as much as the physicians and just as important? My floor knows that I'm consistent and that I do deal with employee problems like fake sick days, unsafe employees and they appreciate that, but that only goes so far. They feel like the "step child" of the hospital since I'm not allowed to pay a nurse to be on call to come for those days we are hit with a lot of admissions or discharges,etc. I can honestly say I don't know of a clinical manager in our hospital who doesn't regulary works the floor. The best part of everything... I've just been told that I have to be able to present to JCAHO ( who comes in 3 months or so) a "back up plan" for just this sort of thing. How do you come up with a plan when you are down 2 night nurses, have only enough day nurses to cover the shifts ( hope no one gets sick or wants to take a vacation)? I let my mouth get the best of me when I responded to this "request" for a back up plan and said I'd just let JCAHO know they could ask the CEO and board since they won't give the $ the nurses rightfully deserve ( we are well behind market value ). Hell, a Perdiem nurse makes exactly 1.00 dollar less than I do. Seriously, any ideas?