Disheartened by Administration & need advice

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Hello,

I am a nurse tech and recently transferred from one unit in a hospital to a newly opened "sister" facility within our system. It is called an LTAC (long term acute care and NO, it is not a nursing home). It is essentially critical care for long term patients. We have anything from a guy who fell 30 feet and got impaled on the way down and has multiple fractures and an ostomy, suprapubic foley etc. He's medically stable, just needs to recover long term -- to a traumatic brain injury -- to a woman who had triple bypass and is a CABG. Lots of peg tubes, about 50% on vents, etc. We have OT & PT daily.

RN to Pt ratio is 5:1 and tech ratio is 12:1 and the nurses do plenty of tech work like bathing, turning, cleaning up poo. EVERYONE is overworked. It is easy to be in a pts room for up to an hour -- once gowned and gloved up we can do vitals, accuchecks, turn, clean someone, change an occupied bed, nurses give meds, etc.....and in the meantime there are 11 other pts wondering why the heck they aren't getting a bath or where their pain meds are.....AND we have a lot of family involvement and frequent overnight stays and interaction with pt families. I have NEVER taken the 2 15 minute breaks a day that my hospital docks my pay. EVER. I force myself to take lunch because if I didn't I would go insane. And at the end of the day it is reflected in our patient surveys which then it comes down on our heads.

Our nurse leader is awesome and doing the absolute best with the situation.

The "problem" is the CEO. It seems every decision she makes is strictly on the bottom line $$$. She comes to our unit, smiles, asks how we are doing and what she can do to help, yet it seems that she doesn't actually give a damn about how anyone is really doing. The issues of understaffing get said to her again and again.

One day one of our RN's answered her honestly, "Get me another aide. That's what would make my day better." And the CEO went off, called a team huddle and claimed that we aren't managing our time well enough. The aforementioned RN that spoke up said, "well, _____, why don't you put your scrubs on and show us how its done. show us how to use our time better." Needless to say, that didn't go over well.

We have good nurses & techs who care, who want to give excellent care to pts and who at the end of the day leave feeling that they left short changing someone OR stay 1-2 hours past shift finishing up charting.

I had been working towards going back to get my RN but going through this makes me think healthcare isn't for me after all. I am so disheartened by this CEO and the lack of care for employees. Some nurses say that it is like this all over nowadays and that if they were me they wouldn't go down the RN path.....I do love the field of health and would like to make a positive difference in this realm if possible.

I am all ears to hear from you all -- is it really like this all over?

Thanks,

g

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You are going to have to discern the founding principle of your new institution. If the original idea was to serve a specialized patient population by tapping into their nonutilization of certain insurance benefits, then your founding principles are primarly money-driven, and you are thus constrained in any effort to transform your institution's values system. This doesn't degrade what's going on there and the benefit to the patients, but because insurance company policies, industry regulations, and public legislation combine to create a volatile survival environment, such an institution must be tremendously circumspect about committing to new ongoing expenditures. Internally, there might be threats to survival from patients who prove to be, or become, unplaceable and thus overstay their benefits (i.e., your institution has to eat their bill). Just some possibilities to think about.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

There are good places to work and bad places to work. Just like in any field. There are places that value nurses and what we do, and there are places that see us only as a necessary discipline which is expensive and replaceable. There is no question that employment by a company that is concerned with finances first and quality of care second will be difficult at times. Just be aware that there are employers who have a "different" approach to providing nursing care for their patients. Fiscal responsibility and good nursing management are not mutually exclusive concepts.

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Yes, it IS like that all over! Money is ALL management cares about. Anyone who doesn't agree is either in denial or in management.

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Specializes in Community Health, Med-Surg, Home Health.

I would have to say that it usually is, but what would make a person stick it out is the camradarie of the staff on a unit. I work for a city hospital that operates in a sucky way, however, most of my co-workers are great, I have the respect from my immediate supervisors and we do work as a team.

If I did not have all of the above, then, I would have probably left some time ago.

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Specializes in Med-Surg, Tele, DOU.

sorry but that is nursing. i hate to be so blunt, but it is what it is. i've been around a long time. i've been fired to being "a non-team player", when I called the idiot an "idiot". (The idiot is still acting like an idiot, by the way.) And guess, what, being fired was the best thing that ever happened to me. I was offered 2 more jobs: one with a $5000 sign on bonus, which i couldn't take (too far from the family to drive everyday or 3 days/week) and the other with a stable income and consistent work. (which was closer to the family though less money, benefits, etc. Family is more important in my book any day of the week.)

Heck, even I am walking around still in shock. So are my friends who went through this whole story with me, for that matter.

Anyway, the situation you see is the same as mine. You are the one who has to decide how you want to walk through your situation. It probably will not change. You are the one who will have to change. I personally do not recommend nursing at this point in time however.

If I were going to school right now, I certainly wouldn't be going to nursing school. I highly recommend OT and other disciplines. Heck, right now I wish I were a pastry chef and a seamstress but that's another topic somewhere here on the board.

Anyway, best wishes with your decision.

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Sorry, but I'm disheartened right along with you. We often run a 28 bed unit with less than 2 techs, no secretary, and each nurse taking 5 patients, many of whom are stroke patients and totally incapicitated, but demanding nontheless.

What always floors me is that the administrators will come back with this old line: "studies say that lower staffing does NOT lead to increased patient dissatisfaction." I'd like to know what study that is, exactly --

We are always, always overworked. A nurse or two has already left before their contract was up, and none of us who were hired and precepted there want to stay indefinitely. We all really like each other, but the workload is just inhumane.

I could never be in management -- I couldn't sleep at night, nor live with myself knowing what my work does to other human beings.

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I hate to say it but I am only 17 and know that is the way it seems to be. At my last job our adminstrator only cared about the money as well. I would get so dang angery about how the "bosses" didn't actually care about our residents or us as employees! There were many evenings when there would be three of us to care for and put 60 residents to bed! I was always supposed to get off at 10 but rarely got out of there by 11 or 11:30...just to get up at 7 and rush to school to do it all over again! I am afraid sometimes that nurses are the only ones that really care!

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Specializes in Management, Emergency, Psych, Med Surg.

A can only assume that the facility you work for is a for profit facility? Is that correct? If so, then welcome to health care according to corporate America, making a profit off the backs of sick people.

Second of all, you just may have a CEO who is an ass. And some of them are. They are bottom line. They want to look good to the people who sign their paycheck and they want to keep their jobs. If they can keep costs down, that is the best way to do it.

Remember, the further up the food chain you go, the more unstable your job is and if you don't meet the requirements of your boss, who ever that is, your fired. For her, there is not disciplinary process. It sounds like she is simply not an advocate for the staff or the patients.

Now if you want to change this, you might be able to do it, but you are going to have to do some work to make it happen. First of all you have to do some research on like kinds of units and what their staffing ratios are. You might be able to find this on the web or just be calling the managers of these units. Then, if there is a national organization for facilities like yours, see if they have established a national staffing standard.

Second, research any mishaps that you have had on the floor like falls. Have there been things on your unit that could have been prevented with more staff (falls, skin breakdown, use of restraints).

Their is now the national trend of hourly rounding to check on all patient to see how they are doing. You can find information about this on the internet.

Next, if your facility is JCAHO accredited, go to their web site and look up the standards that apply to your unit and see if you are meeting those standards, if now why.

Now, get all this material together and write a proposal to administration on why you need more staff and the benefits of such, using data to back it up.

DON'T GET MAD--GET PRO ACTIVE

WELL BEHAVED WOMEN RARELY MAKE HISTORY

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Diane,

Thank you for your reply. Our facility is non-profit so I'm guessing our CEO is just an ass :) I appreciate your response as to how to get pro-active!! I love it and will follow up. Since I've been there we've had two falls ;( and yes, skin breakdown though honestly we are turning, cleaning, putting on the proper ointments and dressings, documenting, etc. It's just unbelievable to me how much work goes into all of this. But your ideas will help me not feel so helpless in all of this.

:)

g

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Diane,

Thank you for your reply. Our facility is non-profit so I'm guessing our CEO is just an ass :) I appreciate your response as to how to get pro-active!! I love it and will follow up. Since I've been there we've had two falls ;( and yes, skin breakdown though honestly we are turning, cleaning, putting on the proper ointments and dressings, documenting, etc. It's just unbelievable to me how much work goes into all of this. But your ideas will help me not feel so helpless in all of this.

:)

g

Sounds like there are some good things going on at your place of employment. Sounds as if you all work together most the time and the people you work with are pretty decent. Also, you said you have a good nurse leader. With many of these types of post I tell people to run for the hills. However, I wouldn't say that in this case. I think that there is hope for this unit. I would even take a job on a unit like this because I don't mind being worked hard if I have a good people around me and decent nurse manager. I worked for a short time on a unit just like the one you describe once. I had great people to work with and we had a good nurse manager, still we worked HARD. At the time I cried and moaned about how hard I worked. It was an intermediate care unit in an acute care hospital, people too sick for LTC but not sick enough for hospitalization. It was only opened for 13 months and the hospital it shut down. The patients had multiple system problems, required huge amounts of care. The unit was in the red from day one. Turns out, no insurance of any kind would reimburse at anything near what it cost to take care of these complex patients. For once I am sticking up for management, it wasn't their fault they had to close it. After the unit shut down I came to realize that it was a good gig. Sorry for talking about my own experiences so much, I know this thread is supposed to be about you.
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