Dear Hospital Administrators

Wrote this as an op-ed for a newspaper (think NY Times or the Wall Street Journal) in a moment of frustration and decided not to submit since it probably wouldn't be published. The audience is the general public.


  • Specializes in Family Nurse Practitioner. Has 10 years experience.

Dear Hospital Administrators,

Hello, from one of your high or low performing hospital's staff nurses.

Who? Oh right...the nurses who keep my hospital running but I don't even see what's in front of my face, that's who.

The abused, the yelled at, the under compensated, the stressed out, and over worked nurses.

Yes, all of the above is true.

Nursing shortage?

Your outer excuse for not allowing your nurse managers to post and fill staff nurse positions which they ask for weekly.

Nurses don't bill for services. Too bad for us, because if we did, we would be treated better. We are lumped together with the dietary aids, housekeeping, and those who stock the storeroom. Easy to fire and replace at will.

Healthcare is a business, people. Hospital administrators don't care about you; they care about your money. Doctors and nurses do care about you, but they are just caught up in the system. So what do we want from you, our boss' bosses?

We want reasonable expectations from hospital management and we want someone to be on our side. We don't want another lunchbag or pen for nurses week; we want our voices to be heard. We want to feel like we own the hospital and not just work there.

Patient satisfaction is huge, but it's not because hospital administrators care about their patients. They care about the reimbursement tied to patient satisfaction. They will make the job of their nurses harder to please their customers or patients. This makes the nurses unhappy because they can't do their job as well and their satisfaction with their job lessens. Add this on to other on the job stresses and your nurse retention rate suffers. Which probably doesn't bother you that much, since nurses are replaceable, right?

If you want to improve customer satisfaction you must make sure your nurses are happy. Ask any nurse and this is what he or she will tell you. Happy nurses equal happy patients. The majority of you are in violation of labor laws which allow your hospital's nurses to get an uninterrupted break each shift. From my personal experience, which you lack, the only way this will happen is if you staff for a relief nurse on each unit on each shift who is there solely to cover other nurses when they take their well deserved breaks.

Staffing is another issue which is in your control. Hire more nurses and lower your ratios! No nurse should be taking care of seven plus acutely ill patients. It is not safe.

I'm an ER nurse. I have seen the abuse against nurses from patients. Screaming, yelling, hitting, biting, spitting, profanity, sexual comments/groping, twisting arms, throwing objects, and punching are just some of the experiences nurses go through daily. This has to stop. This should not be tolerated. There should be zero tolerance for this type of violence and assault. If this were to happen outside of the hospital, charges could be pressed. Every hospital should take this type of abuse seriously. All cases of rude, inappropriate, and dangerous behavior should be reported immediately and a police officer should be available at all times to file a report about the occurrence and see if charges can be filed. There are laws in place protecting healthcare workers. Many hospitals have police officers staffed in the emergency department and following up on such cases can be an extension of their role.

I hope you take these points into consideration and make nursing better for us.


An anonymous nurse on her way to burn out and orthopedic surgery who will NOT give up on this profession.

8 Articles   2,803 Posts

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Chisca, RN

745 Posts

Specializes in Dialysis. Has 39 years experience.

The incidence rate for violence against health care workers is more than triple the rate for all of private industry (15 per 10,000 full-time workers versus 4 per 10,000 workers, according to the Bureau of Labor Statistics).


20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 26 years experience.

Well written! I am sorry to believe, this will make no difference, for the "offenders" will never see themselves in such a letter and they have no care for the plight of nurses.


944 Posts

Our hospitals are in crisis mode regarding employment because the Governor has raised taxes and cut funding on hospital's in our state.

Over 40 million dollars in 5 year's has been taxed from our hospitals. Additionally, on average 40 million dollars a year of funding is usually cut from hospitals. In addition, to medicaid and Medicare cuts from federal funding. It's ridiculous.

Specializes in LTC Rehab Med/Surg. Has 16 years experience.
The incidence rate for violence against health care workers is more than triple the rate for all of private industry (15 per 10,000 full-time workers versus 4 per 10,000 workers, according to the Bureau of Labor Statistics).

An eye opening statistic. I'd like to see rate of prosecution in health care and private industry.

Probably even more eye opening.

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

Not relevant. I deleted it.


553 Posts

Has 5 years experience.

They care about their money. When a med mistake happens, no one is looking at them, they are looking at the nurses. Their faces aren't seen.


411 Posts

It's not just patients behaving badly, it is also their families and friends. And generally, no one is EVER prosecuted for assaulting nurses, and (at least where I worked before) you could lose your job for pressing charges against a visitor (made the hospital "look bad.")


177 Posts

Specializes in Med/Surg, OR, Peds, Patient Education. Has 30 years experience.

You cannot lay all the blame on federal funding, although, that is certainly a large part of the issue. Have you looked at the numbers of hospital administrators, directors, and other "management types?" Since I retired, ten years ago, these numbers have increased, exponentially at the hospital where I was formerly employed. At the same time of the increase in administrators, the numbers of RNs, actually caring for patients, decreased.

jrbl77, RN

250 Posts

Specializes in Med Surg, Parish Nurse, Hospice. Has 46 years experience.

Very well written-this is why I no longer do bedside patient care.


57 Posts

Specializes in Critical Care. Has 42 years experience.

IIn Washington State it is considered a third degree assault...

"A person is guilty of assault in the third degree if he or she, under circumstances not amounting to assault in the first or second degree:

(i) Assaults a nurse, physician, or health care provider who was performing his or her nursing or health care duties at the time of the assault. For purposes of this subsection: "Nurse" means a person licensed under chapter 18.79 RCW; "physician" means a person licensed under chapter 18.57 or 18.71 RCW; and "health care provider" means a person certified under chapter 18.71 or 18.73 RCW who performs emergency medical services or a person regulated under Title 18 RCW and employed by, or contracting with, a hospital licensed under chapter 70.41 RCW;"

It is the same law that protects police officers, judges and firefighters, among others.


26 Posts

The author of this article is correct on many fronts. I can directly tie the nursing shortage to when for profit hospitals took over hospitals. Nurse staffing is the most expensive part of a hospitals budget, but instead of cutting executive salaries, for profit hospitals get rid not only of nursing staff, but ancillary staff as well, which makes the RN's workload even harder. These hospitals set their RN's up to fail by giving them an untenable and unsafe workload, computerized charting systems that take more time than their worth, and corporate doesn't allow any changes to this. RN's just have too much to do and too little time to do it in because of decreased staffing. This leads to increased stress on the RN, and when these unrealistic expectations are not met. When RN's are increasingly dissatisfied and stressed they leave the profession, and find other jobs that are more lucrative and have less stress. That's a win-win for the RN, but a huge loss for the patients.It's true that a happy nurse equals a happy patient, but for profit make that almost impossible.

When a for profit hospital is looking to save money they flog the heads of department or nurse managers to keep costs down below budget. These department heads then flog their staff by cutting staff, ancillary personnel, supplies, and increase the nurses workloads. When after a herculean effort the department does come in under budget, who enjoys the fruit of the RN's labor, not the nurse. The CEO makes an obscene bonus and the department heads or nurse managers enjoy a bonus as well which they don't share with the staff. Hospital's are quick to blame RN's for the medication errors, nurses getting ebola and anything else that they can think of instead of fixing the problems they have caused, and taking responsibility for the chaos that they have created. At one for profit that I know when patient satisfaction was down, not for anything that the nurses has done. the nursing staff was punished by taking 0.5% off of their annual merit raise. Is it no wonder that nurses are leaving the profession in droves, or unionizing so that they can get necessary protections for their patients. Talking about quality patient care is easy for these huge hospital systems, but rarely delivered.