This came up recently. We were woefully understaffed at the hospital (I hear you out there: "NO! Say it ain't so!") It was potentially dangerous. I figured we could maintain the status quo but that any admissions would be impossible (already short a nurse and would be short 2 nurses according to the staffing grid if another person came in.)
Told supervisor we had to do something in such situations - could we block remaining beds when we were already working short? Told that management states they are never to refuse an admission as long as there are beds, regardless of staffing.
I worked for a hospital ER last year that had to go on Internal Disaster due to insufficient staffing for the ER and other hospital units. Of course, it never stops the patients coming in through the front door or by BLS ambulances. We were a county hospital and it used to anger me that private hospitals would call trying to transfer their patients for higher level of care when we were overwhelmed and understaffed. We would accept some of these patients and find out the severity of their conditions were greatly exaggerated. It was also ironic that the units upstairs could have insufficient staffing for the nurse to patient ratios requiring us to hold patients in the ER for sometimes days, forcing ER nurses to be out of ratios with a combination of critical, tele, and med/surg patients. Where's the logic in this?
I forgot to mention that a friend of mine who worked on LDRP at the hospital I'm currently at was relating a story about a group of hospitals that decided they no longer would except MediCal patients a few years back. This forced all the pregnant women in the area to our hospital which still accepted MediCal, but didn't have the capacity to handle all these women in labor. They ended up setting up beds in the hallways with those little portable curtains (that don't really allow for very much privacy) and had women laboring in the hallway!
I worked for a hospital ER last year that had to go on Internal Disaster due to insufficient staffing for the ER and other hospital units. Of course, it never stops the patients coming in through the front door or by BLS ambulances. We were a county hospital and it used to anger me that private hospitals would call trying to transfer their patients for higher level of care when we were overwhelmed and understaffed. We would accept some of these patients and find out the severity of their conditions were greatly exaggerated. It was also ironic that the units upstairs could have insufficient staffing for the nurse to patient ratios requiring us to hold patients in the ER for sometimes days, forcing ER nurses to be out of ratios with a combination of critical, tele, and med/surg patients. Where's the logic in this?
Michelle
I remember those days (b-r-r-r-r!). One year (the day after Christmas), a flu epidemic swept through our community, and the floodgates of HELL literally opened up. We had people stacked up in private rooms and in the hallways and alcoves like sardine cans. They were all desperately sick, and myself and one other nurse did nothing but start IVF's and hang piggybacks...all day long. Did they divert? Hell, no! No logic there, either!
We routinely close beds for staffing. Sometimes for four hours other times for the entire shift. If the supervisor can't get the pt's out then we triple assignments in critical care and bump the ratio up for the step down units and floors, then refuse assignments to the next shift. You did your part by sucking up the extra pts. Nursing admin. is weak and the hospital admin is clueless. Start by filing unsafe assignment paperwork to your DON. Proceed up the chain. They'll back down if you have a union. If you don't [have collective bargaining]get it. If you can't [organize] then threaten to turn your DON into the state board for unsafe work assignments [use established nurse to pt ratios or your staffing acuity system] and your hosp admin to the NLRB for unsafe workplace. If they don't listen then turn them in. Always, always, always document the unsafe work loads and any incidents such as falling out of bed or late medications due to short staffing. Build a list for every floor and unit. Get professional help by contacting a union. They do anything to help hoping you will organize. Remember you are the pt advocate. In the court of public opinion nurses rank above most everyone, including physicians and pharmacists. Use it to your advantage. Besides, we're nurses, we really do care!
I guess when you think you have it bad, there is always someone that has it worst. I can say that central Florida hospitals had to divert many times last year (code purple, I think it was called). This was highly unusual. All the nurses actually pulled together and started refusing to take a new admission after they maxed out (according to State regs). I do feel sorry for the ER nurses, but on the floors, once the patients are admitted, we are responsible in a different way. The attorney doesn't say "It's okay that you had too many patients and gave that medicine 1 1/2 hours late". Like some of the others mentioned, no matter how much of a bonus including up to $22/hr for RN's, we still were often understaffed or staffed to the max. So many are leaving nursing jobs and the field, so that is giving more leverage to administration.
shell911rn
68 Posts
I worked for a hospital ER last year that had to go on Internal Disaster due to insufficient staffing for the ER and other hospital units. Of course, it never stops the patients coming in through the front door or by BLS ambulances. We were a county hospital and it used to anger me that private hospitals would call trying to transfer their patients for higher level of care when we were overwhelmed and understaffed. We would accept some of these patients and find out the severity of their conditions were greatly exaggerated. It was also ironic that the units upstairs could have insufficient staffing for the nurse to patient ratios requiring us to hold patients in the ER for sometimes days, forcing ER nurses to be out of ratios with a combination of critical, tele, and med/surg patients. Where's the logic in this?
Michelle