Blue collar treatment with white collar expectations

[wordstew]

All nurses in the United States have been socially engineered by the system to accept this type of treatment.

Most nurse policy is written nurses who have a disconeect from the average working nurse and don't usually practice real day to day nursing for which they are writing policy for.

Policy writing nurses are not the ones getting the forced overtime, working holidays and dealing with increased patient loads.

I think nurses as a whole we should advocate for nurses who actually work the job to be writing policy for it, not a nurse that had thier last patient care experience 20+ years ago.

How many of your upper management nurses are getting forced overtime and working weekends and holidays???????

[wordstew]

You're a Registered Nurse!!!!!

You are a highly skilled professional. We really need you there's a nursing shortage you know.

Oh by the way!!!!

Even though you are already licensed We want you to increase your educational level.

You will have to work weekends holidays and of course forced overtime.

You will have quite alot of responsibility and paperwook to go with it.

We do consider you a white collar professional and have great expectations of you.

Welcome aboard glad to have you hope you enjoy your first day!!!!!

Oh, by the way me Jones is incontinent x2. We wouldn't dare ask any other medical professional in the building to clean him, they would just refuse and quit. So you have to do it.

Don't get your uniform dirty because you will probably get forced tonight.

Welcome aboard

[Ariesbsn]

OK Timothy, how do you make that happen? I work in an ICU. Our ratio is suppose to be 2 pts to 1 nurse maximum and pts on CRRT are 1:1. We also have open visitation, which has come to mean family members out the wazoo following you around. Then there is the unwritten, but official policy that we aren't allowed to refuse an admission just because we don't have enough nurses to care for the patient.

3 weekends ago, we started the shift 3 nurses short. The nurses who had the patients on CRRT also had another patient. I started the shift with a pt on an insulin gtt, who had schizophrenia, was restrained and still climbing out of bed. My other pt, on the opposite side of the unit, was on the vent, unsedated, thrashing, and coherent enough to realize that if she scooted down, she could reach the tube. Her pressure was in the 190's. At 2000, I was given a pt on a dopamine gtt who looked horrible and who had a MAP of 48. I was told that I either had to take that patient or the admit.

Monday morning in our staff meeting, we were told that yes, we have worked short but our level of care hasn't suffered because our Press Ganey scores were good and we had no cases of VAP or infected lines. Our manager said that really, there was nothing he could do. There was just nobody to hire. He said he could contract someone from an agency, but if our census dropped, regular staff would be put on call because you have to pay the agency person, even if they don't work.

In addition to providing nursing care, we also have to empty our own garbage and laundry (day shift refuses, but night shift has to or we hear about it), and stock our own supplies. This includes the linen which we have to refold to get it to fit in our cabinets. We draw our own labs, which is fine if the patient has a central line, but when they are a stick, it is time consuming and difficult. We don't have a CNA so we do our own baths, I&O, and accuchecks. It isn't unusual to have patients that weigh 400-584 pounds. Our computer system is wireless and frequently loses the connection so you have to chart the same thing several times. We also just got a letter saying that while the hospital is making money, it wants to make more money so we need to be careful with staffing.

So how does a group of people barter with an institution where the CEO said it is cheaper to get new nurses than to fix the ventilation problem in the ICU that causes severe asthma exacerbations?

[ZASHAGALKA, RN]

OK Timothy, how do you make that happen? I work in an ICU. Our ratio is suppose to be 2 pts to 1 nurse maximum and pts on CRRT are 1:1. We also have open visitation, which has come to mean family members out the wazoo following you around. Then there is the unwritten, but official policy that we aren't allowed to refuse an admission just because we don't have enough nurses to care for the patient.

3 weekends ago, we started the shift 3 nurses short. The nurses who had the patients on CRRT also had another patient. I started the shift with a pt on an insulin gtt, who had schizophrenia, was restrained and still climbing out of bed. My other pt, on the opposite side of the unit, was on the vent, unsedated, thrashing, and coherent enough to realize that if she scooted down, she could reach the tube. Her pressure was in the 190's. At 2000, I was given a pt on a dopamine gtt who looked horrible and who had a MAP of 48. I was told that I either had to take that patient or the admit.

Monday morning in our staff meeting, we were told that yes, we have worked short but our level of care hasn't suffered because our Press Ganey scores were good and we had no cases of VAP or infected lines. Our manager said that really, there was nothing he could do. There was just nobody to hire. He said he could contract someone from an agency, but if our census dropped, regular staff would be put on call because you have to pay the agency person, even if they don't work.

In addition to providing nursing care, we also have to empty our own garbage and laundry (day shift refuses, but night shift has to or we hear about it), and stock our own supplies. This includes the linen which we have to refold to get it to fit in our cabinets. We draw our own labs, which is fine if the patient has a central line, but when they are a stick, it is time consuming and difficult. We don't have a CNA so we do our own baths, I&O, and accuchecks. It isn't unusual to have patients that weigh 400-584 pounds. Our computer system is wireless and frequently loses the connection so you have to chart the same thing several times. We also just got a letter saying that while the hospital is making money, it wants to make more money so we need to be careful with staffing.

So how does a group of people barter with an institution where the CEO said it is cheaper to get new nurses than to fix the ventilation problem in the ICU that causes severe asthma exacerbations?

Let him get new nurses and see how easy it is.

There are good, or at least, decent jobs out there.

If enough nurses simply refuse to tolerate such situations, they will cease to exist.

The power is in YOUR court. No matter what your CEO says, it's easier for YOU to get a new job than it is for HIM to get a new nurse.

Sometimes, it takes proving that point.

Besides, lateral transitions from one critical care unit to another normally involve better salaries as you are not so directly subject to bracket creep and in that it would normally mean a sign-on bonus.

The question becomes, are you so comfortable at this facility that you accept untenable situations? Or, do you use the power of the marketplace, where YOU are a precious commodity, to negotiate better working conditions?

Your CEO lied to you. It is NOT easier for him to replace you than it is for YOU to replace HIM. In doing so, you directly do yourself a favor, and indirectly do your current co-workers a favor by proving this point to management.

I wouldn't work at a facility such as you describe it. THAT would be unprofessional. The question is: why are YOU still there?

Being a good nurse is not always the same as being a good employee. Regarding professionalism: professionalism is where YOU draw THAT line.

But you don't have to quit. Get a backup plan in place and then simply refuse such assignments. You'd be quite surprise how extremely unwilling most hospitals are to directly fire nurses (especially since they know full well that it takes, on average, 78,000 dollars to replace a functioning critical care nurse with another, including the costs of recruiting, bonuses, training, and overtime to make up the loss). I think you might be pleasantly surprised that you DO have the power to refuse such assignments. Even if you don't, and they fire you anyway, then use your back-up plan and be confident and steadfast.

Ultimately, and it may seem unfair, but the hospitals are NOT patient advocates. That duty falls to YOU. How is accepting such assignments in keeping with your patient advocate obligations? BEING a patient advocate IS a PROFESSIONAL obligation.

I'm not just giving you trite advice. I HAVE quit critical care jobs for similar reasons, twice now in my career. The result: I NOW work for an employer that respects me, and in whom I respect as well.

My pay is among the highest cola adjusted salaries in the nation, it is hospital policy that CCU nurses are not required to float, and our ratio is strictly 2:1. We are ASKED to take a third patient at times, but that is always, ALWAYS subject to our input as to whether or not it would constitute a safe assignment. They have given us some leeway on that issue, and we give THEM some. I take a third patient about once every other month. And then, ONLY by my consent, and that consent is based on evaluating my total assignment.

This job didn't just fall into my lap. I had to search for it.

~faith,

Timothy.

[llg, PhD, RN]

...

There are good, or at least, decent jobs out there.

If enough nurses simply refuse to tolerate such situations, they will cease to exist.

The power is in YOUR court. No matter what your CEO says, it's easier for YOU to get a new job than it is for HIM to get a new nurse.

Sometimes, it takes proving that point.

....

I wouldn't work at a facility such as you describe it. THAT would be unprofessional. The question is: why are YOU still there?

Being a good nurse is not always the same as being a good employee. Regarding professionalism: professionalism is where YOU draw THAT line.

...

This job didn't just fall into my lap. I had to search for it.

~faith,

Timothy.

Great post, Timothy. I don't always agree with you (and I am not sure about refusing assignments), but I am definitely in agreement with the main message of your post. I quoted some of my favorite lines.

I also have a great nursing job and I get weary of people thinking that I am "lucky" to have it. Yes, a little luck was involved -- but mostly, I made my luck. I worked very hard and made lots of sacrifices to get the career I have. It didn't just fall in my lap, either.

[Spidey's mom, ADN, BSN, RN]

I agree that Tim's post is great and that is how I handle my career as a professional nurse.

"I wouldn't work at a facility such as you describe it. THAT would be unprofessional. The question is: why are YOU still there?"

This was my thought as well.

steph

[misscece]

Look, there's obviously huge problems when it comes to what nurses are expected to do in relation to what the compensation is. It is high time that nurses realize that WE ARE THE COMMODITY here. It also takes a group of nurses banding together to bring change. As long as you have those nurses who will take unsafe assignments, be pressured into coming in on their off days, failing to speak up even when they feel what they are being told/being forced to do is wrong - the harder is will be for us to get ahead as a profession.

In my opinion aside from the obvious recruitment vs. retention issues that is so obvious to everyone but management, there is also the problem now of patient satisfaction vs. staff satisfaction. Hospital administration has everything upside down and until we demand that things be turned around, we will continue to be treated as blue collar workers. WE ALL HAVE COLLEGE DEGREES - let's use our noggins and try to work together on creating change. The relationship between staff and management is no different than any other bad relationship - they do what they do BECAUSE THEY CAN. Once nurses start making our own demands and sticking to our guns as a whole, things will turn. This is no easy task, but unless we are willing to continue to be treated this way, there has to be a change.

[gauge14iv, MSN, APRN, NP]

In my opinion aside from the obvious recruitment vs. retention issues that is so obvious to everyone but management, there is also the problem now of patient satisfaction vs. staff satisfaction. Hospital administration has everything upside down ...

But the whole happy/safe/healthy patients thing STARTS with happy/safe/healthy nurses and nursing environments.

And THAT isn't about what's legislated, mandated, bartered at the union table - it's about what WE are willing to put up with, it's about what respect we create for ourselves. Unions will destroy respect and relegate nursing to the blue collar role hospitals WANT us to be in - to a vocation. Unions will never create for nursing the respect that a white collar educated professional earns and deserves.

Study the VA hospitals in detail - real detail - if you want more thoughts on union nursing. I don't see those VA nurses being respected by administration. In fact the VA nurses I have known complain even more vehemently about that issue than their non-union "civilian" counterparts. I havn't been impressed. It's another schtick in my numerous encounters with union working environments.

[misscece]

never said anything about unions, my friend. i've never worked at a union hospital and don't know how necessary they are. but i do know that until nurses stop accepting lessening standards in how we are being treated as professional employees and keep accepting more and more demands from administration in everything from our workload to our benefits, we will continue to be pressed. if management were to focus on the well-being of their staff - all the rest would fall in place.

[Ariesbsn]

OK, let me preface my answer to some questions with background information. I graduated from nursing school in December of 2004 and this is my first job as a nurse. I did my capstone clinicals there and what I saw on day shift didn't even hint at the things in my original post. I also accepted "tuition reimbursement" and owe the hospital 4160 hours or I pay back the balance of what I owe with 10% interest that began to accrue at the time I signed the paperwork. I am down to 1213 hours (not that I am keeping an excel spreadsheet or anything).

The question becomes, are you so comfortable at this facility that you accept untenable situations?

I am not comfortable, nor have I been since shortly after I started orientation to the unit. I have talked to my manager since my 8th shift of orientation when I was told I "had" to be on my own for the last 9 hours of the shift with 2 patients because we were getting an admit and my preceptor had to take it. His response has been that he is in the process of hiring new staff and that I shouldn't worry about my license because I would be held to a "reasonable nurse" standard should something go wrong. I just needed to make sure my interventions were "reasonable nursing" interventions.

My manager had been an ICU nurse until 2 weeks prior to my starting my orientation on the unit. If you ask any of the nurses about him as a nurse, they say he was an excellent nurse. I knew him from my clinical time there and am very comfortable with him, which means I'll plop myself in a chair in his office and unload my woes.

When I have spoken to my PCC or the charge nurses about my discomfort with taking another patient and have been told that I need to become comfortable with it, or gotten the "if you don't take it, someone else will have to." My concession, until I found this site, has been to take a stable patient from another nurse and let them take the admit.

Or, do you use the power of the marketplace, where YOU are a precious commodity, to negotiate better working conditions?

What I hear from my co-workers is that none of the other hospitals in the city are better, in fact, most of them are worse. It doesn't make sense to jump out of the frying pan and into the fire.

The question is: why are YOU still there?

1. I believed my manager when he said staffing would be getting better. However, people are leaving as quickly as they are getting hired.
   
2. This is my first job as a nurse. It behooves you to stay at least 2 years at your first job, or so we were told in school.
   
3. It took me 2946 hours (I work weekend option, 48 hours a month) to realize that not only were things not getting better in our unit, they were getting worse.
   
4. In many ways my first nursing job has been like growing up in an abusive situation. If all you know is abuse, and you get told by family that life on the outside is worse, you accept what you have. You need to experience "good" or hear enough people say that what you are going through is NOT the norm to realize that not only is there better, but you deserve it. Had it not been for this site, I would not have known that it wasn't the same everywhere else.

If enough nurses simply refuse to tolerate such situations, they will cease to exist.

How do you get them to refuse to tolerate the situations? Unless a group of people refuses, it is too easy to label the ones that do as trouble makers or say that they aren't team players.

llg, I believe in making your own luck, I just need to figure out how to make mine. In the process, I want to better the field of nursing if I can.

[Indy, LPN, LVN]

Our unit is currently going through this as well. The old nurses who will stay there years on end, will put up with whatever management throws their way and counsel the new ones on having "strength of character" to persevere through the severely (purposely) understaffed times, but they will not refuse assignments or demand help, or do anything as a group.

THAT is why I am searching for another job. Our most senior nurse resigned due to the bruhaha that erupted when she did demand some help one evening due to a ridiculous staffing situation. (I'm not in ICU, I'm on tele floor.) Our managers are gone by 5 pm and a dayshift person does the staffing for night shift. Depending on what person, you have the possibility of getting an arrogant, cowardly jerk doing your staffing who will simply say "no" to any request for help. They'll do this knowing that they have low censused someone to put you in the dangerous situation, with a nice little smirk.

So anyhow. I saved my money. I have 3 months of expenses sitting aside that I'd love to use to pay off my car, but I'm waiting on that. So far I have not seen the assignment that makes me go home and refuse report. But I have put apps out elsewhere, and am following up on them. Our unit has become, as a whole, more "compliant" since that nurse quit, followed by one more.

I don't know what will make people act as a group, and I'm so tired right now that I don't care; I just have to answer for how I act.

[banditrn]

Our unit is currently going through this as well. The old nurses who will stay there years on end, will put up with whatever management throws their way and counsel the new ones on having "strength of character" to persevere through the severely (purposely) understaffed times, but they will not refuse assignments or demand help, or do anything as a group.

I recognize the type - but I don't call that 'strength of character' - I call that being management's floormat!

I'm an older nurse, but I was never one of them - it was like they got some kind of perverse pleasure out of being dumped on. And I got really tired of hearing about it. And management knows just how to handle that kind of person - give them a little hug, tell them what a saint they are, then unload all the crap onto them.

[nsgshortage]

Roadstew and sweetie,

What you guys are saying is the Plain and Simple Truth!!

Total Blue collar treatment with a white collar smile. Don't you just love "nurses" who say how great nursing is and how much they love it when they last punched a timeclock or signed off a MD order 20 years ago??

I can't figure that out.

No wonder nurse retention is at an all time low. You don't fully understand the real world of nursing till you are working in it.

They won't be able to hang on to any decent nurses anymore if they don't change their attitudes.