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.
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.
Sincerely,
An anonymous nurse on her way to burn out and orthopedic surgery who will NOT give up on this profession.
Specializes in Med/Surg, OR, Peds, Patient Education.
Having worked for a non profit hospital, I can tell you that the staffing issues are similar to the for profit institution where you are employed. The CEOs in non profit hospitals, and there are many, too many in "management" positions, make exorbitant salaries, and wield tremendous power.
Sad to say but that very well written letter would fall on deaf ears. Sad to say the hospital, LTC, Home Health, whatever health care administrator this letter is directed towards just does not care. The bottom line is their budget, their salary, their bonus. It stinks and I don't know what if anything can ever turn it around.
Getting tired of working with no raises while I know darn well all the nursing management members are getting their raises and bonuses. I have no idea what the company CEO makes but I'd be willing to bet it's more than the annual wages of every employee in my building combined. It's sickening.
I have been a nurse for 25 years and I have seen how nursing have dropped into a black hole of despair and I do not see it getting out or any better. You have made very valid points and wrote a great letter; unfortunately, the only people are hearing you are all of us the nurses.
I hate to add this to your well taken points, but some of the problems you mention are our own faults, We as nurses do not stand up for one another and have a collective voice. We have to stop doing the unsafe bidding with a smile and follow our nurse practice act. Instead, we work as factory worker turning patients out on an assembly line: and not a professional nurse with a college education with standards of evidence base patient care.
We must collectively take a strong stand and say no this is not how this work, this is not how any of this will work. and I can/ will not work like this under these conditions. It will only work collectively in all workplaces and states. there must be a solidarity of voice for our rights as nurse and humans within the workplace. Then and only then will your letter and our voice be heard.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
Over the years, I've seen more and more management in hospitals. Each layer of management gets a salary -- usually far more than the bedside nurse makes -- and benefits plus a nice office with nice office furniture and artwork on the walls. The bedside nurse -- if she's lucky -- gets a locker in a crowded locker room. And perhaps a mailbox big enough for a folded paper or three. But the really sad, frustrating part is that with the addition of more and more management is the addition of more and more "Advance Practice Nurses". We have "Nurse Leaders" whose entire job seems to be going to meeting after meeting to discuss how the staff nurse can do more with less, how to educate the staff nurse on picking up this piece of someone else's job because that someone else "doesn't have the time" or "lacks staffing" to continue doing it, what additional "safety policy" can be put into place to prevent further errors like the one that occurred last week because the nurse who was trying to change the rate of a heparin drip was assaulted by a family member (who assumed she was decreasing the fentanyl drip) while she was doing so, how to educate the nurse on filling out the new paperwork that is being required because someone on the medical side wants to do another study and thinks it would be so much easier to just have the nurses fill out additional paperwork rather than have to mine the charts himself to find the (already charted) data he needs, or how to spin mandatory overtime because the department chose to hire two more "nurse leaders" instead of three staff nurses who might actually be able to do the job the "nurse leaders" are trying to tell everyone how to do. These "nurse leaders" also get a salary, benefits, an office, office furniture and art work.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I have been a nurse for 25 years and I have seen how nursing have dropped into a black hole of despair and I do not see it getting out or any better. You have made very valid points and wrote a great letter; unfortunately, the only people are hearing you are all of us the nurses.
I hate to add this to your well taken points, but some of the problems you mention are our own faults, We as nurses do not stand up for one another and have a collective voice. We have to stop doing the unsafe bidding with a smile and follow our nurse practice act. Instead, we work as factory worker turning patients out on an assembly line: and not a professional nurse with a college education with standards of evidence base patient care.
We must collectively take a strong stand and say no this is not how this work, this is not how any of this will work. and I can/ will not work like this under these conditions. It will only work collectively in all workplaces and states. there must be a solidarity of voice for our rights as nurse and humans within the workplace. Then and only then will your letter and our voice be heard.
So why is "union" such a dirty word on this forum?
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.")
If I were assaulted and fired for pressing charges against an assaulting family member and got fired...I would be contacting an attorney, EEO and anyone else I could think of, including and especially the News people. If the assault was bad enough, the threat of being fired would not be enough to scare me and I do believe that I would win against an employer that not only did not protect me from violence but one that would fire me for demanding justice.
Ok, a bit over-the-top but I am tired of the biggest bullies being the bosses/corporations that hire us. I thought that in America we already faught for and won better working conditions but it seems as though we, as a nation, are steadily falling backwards.
If the public knew why we were slow to answer lights, did not do anything for their pain (in LTC institutions and the new federal regs for dispensing), didn't get immediately to that altered lab etc, and if they knew how many, many, many times we saved their lives (collectively) despite all that we are against, they would be afraid. Very afraid. And they would opt to fight for nurses loudly rather than relegate us to being 'just a nurse' or in stressful times, that 'bleepity bleep nurse didn't do X, Y or Z'.
I know from being on the floor as well as, being on management side what we do and at times, how little we have to do it with. I am stunned many times by what I have been expected to do (essentially put a person on life support in a LTC facility with a 10L O2 tank...yes, it happened, take care of 100 patients, take a 28 patient load and accept 3 - 5 new admits with at least 3 trachs and various levels of acuity...throw in a few mid-level wandering alzheimers patients on top). And more impressed with the ingenuity, tenacity, strength, courage, love and patience that I see nurses use to get through the day...many days. Too many days.
Many nurses have complained over many years with only a few states added this to state law.
A malpractice insurance has added a rider for injury on the job, but several states have high enough incidence of nurse violence that they exempt the rider.
In response to Ruby Vee, I did not know that union was such a bad word on this forum. However, many states will not have a union within the hospitals ( not naming any names/states ) but even if you do not have a union; each nurse has a voice. The only way to stand is together! I have been a lone ranger in my personal nursing career and said NO I will not do that or GO there. the assignment is not safe, it is against the nurse practice act......but it worked for the protection of my patient and license. The policy for the unit did not change and the staff sunk more into despair. They can not fire a whole unit ( most hospitals do not have enough nurses applying ) They will listen to the nurse voice if it is all nurses and is loud enough to stop the production of lining their pockets.
Over the past 2 decades. Like many of the previous posts, I've seen growing layers of management. Now instead of 1 director and 1 manager for each unit. We have a CNO, a divisional director, a manager for each floor, a team leader for each floor, a charge nurse, then the lowly staff nurse. I see people with 1-2 years of experience promoted into leadership roles, not because of their experience, but because they are "Yes" people. They make poor decisions because they haven't actually done it.
The staff on the front line is viewed as the lowest of the low. The most disposable. Management can walk out on Friday afternoon, leaving the staff so low that it creates unsafe working conditions. And WHO is held accountable when there are falls, errors, or patient complaints. Yes, that bottom of the totem pole staff nurse. Cut the nursing assistants because, the staff nurse can do TOTAL care on 6-7 acutely ill patients.
Experienced staff aren't valued and promoted into leadership roles because they have actually done the work and administrators don't want nurse advocates in nursing leadership.
Experienced nurses are leaving, replaced with inexperienced new grads being managed by inexperienced nurses. These same hospitals are striving to attain magnet status.
Pouring out money hand over fist on stupid things, yet, cutting back on actually staffing to safe levels.
Over the past 2 decades. Like many of the previous posts, I've seen growing layers of management. Now instead of 1 director and 1 manager for each unit. We have a CNO, a divisional director, a manager for each floor, a team leader for each floor, a charge nurse, then the lowly staff nurse. I see people with 1-2 years of experience promoted into leadership roles, not because of their experience, but because they are "Yes" people. They make poor decisions because they haven't actually done it.
The staff on the front line is viewed as the lowest of the low. The most disposable. Management can walk out on Friday afternoon, leaving the staff so low that it creates unsafe working conditions. And WHO is held accountable when there are falls, errors, or patient complaints. Yes, that bottom of the totem pole staff nurse. Cut the nursing assistants because, the staff nurse can do TOTAL care on 6-7 acutely ill patients.
Experienced staff aren't valued and promoted into leadership roles because they have actually done the work and administrators don't want nurse advocates in nursing leadership.
Experienced nurses are leaving, replaced with inexperienced new grads being managed by inexperienced nurses. These same hospitals are striving to attain magnet status.
Pouring out money hand over fist on stupid things, yet, cutting back on actually staffing to safe levels.
Over the past 2 decades. Like many of the previous posts, I've seen growing layers of management. Now instead of 1 director and 1 manager for each unit. We have a CNO, a divisional director, a manager for each floor, a team leader for each floor, a charge nurse, then the lowly staff nurse. I see people with 1-2 years of experience promoted into leadership roles, not because of their experience, but because they are "Yes" people. They make poor decisions because they haven't actually done it.
The staff on the front line is viewed as the lowest of the low. The most disposable. Management can walk out on Friday afternoon, leaving the staff so low that it creates unsafe working conditions. And WHO is held accountable when there are falls, errors, or patient complaints. Yes, that bottom of the totem pole staff nurse. Cut the nursing assistants because, the staff nurse can do TOTAL care on 6-7 acutely ill patients.
Experienced staff aren't valued and promoted into leadership roles because they have actually done the work and administrators don't want nurse advocates in nursing leadership.
Experienced nurses are leaving, replaced with inexperienced new grads being managed by inexperienced nurses. These same hospitals are striving to attain magnet status.
Pouring out money hand over fist on stupid things, yet, cutting back on actually staffing to safe levels.
CHESSIE
177 Posts
Having worked for a non profit hospital, I can tell you that the staffing issues are similar to the for profit institution where you are employed. The CEOs in non profit hospitals, and there are many, too many in "management" positions, make exorbitant salaries, and wield tremendous power.