My facility, like many, has increased staffing ratios in all departments in response to the economic pressures. Meanwhile, the Joint Commission continues to mandate supposed safety concerns, with mostly extra documentation demands and other inconveniences. They fail to address the elephant in the room, nurse/patient ratios.
I think bedside nursing has become less safe. From the ER point of view, we are less able to safely monitor patients, there is more friction with the inpatient nurses as they are too bogged down to receive patients. There is a cold war going on between some of our ER nurses and floor nurses, causing a big distraction and detracting from teamwork for the greater good.
Meanwhile, we're getting ready for the Joint Commission inspection and are going to be temporarily inconvenienced by their nonsensical edicts. No IV buckets to be left out on the counters of the nurses station, and other rules that are so minor compared with the real problems that we are dealing with. Of course, like other facilities, we have to spend money to hires nurses to make sure that our charting pleases them, that we fill in the many mandatory charting prompts to their satisfaction.
Nursing has become a bureaucratic mess, bogged down in more and more red tape than ever before. All this to be accomplished with fewer nurses at the bedside, and more nurses behind the scene. Insurance companies and the government are running things, and hospital administrators focused on the bottom line. If we keep going down this road, I think we are going to implode.
No, it's not the same everywhere. It's 6:1 at my hospital. Neuro med tele. I actually like my job. It's not perfect but I'm glad I found a good starting place for my career. But then again, it's hard to throw me for a loop. I'm hoping I can make through my first year without crying.
Specializes in orthopedic/trauma, Informatics, diabetes.
We are 4-5:1 on an ortho unit. Usually if we have 4, there is no aide. I think a lot depends on fiscal health of hospital. I have classmates that work at smaller hospitals and they have 6-8:1 on a med/surg unit. With or without and aid that is scary.
More and more frequently they are giving us 3 patients in ICU. It is becoming very dangerous in my unit. I am leaving and will miss everyone I work with, but glad I am leaving this dangerous environment before something horrible happens. There have already been incidents with patients extubating themselves/aspirating and it took the nurses a while to even get in the room and realize what was going on. Our managers have been fighting for us, but charge nurses now have to call house supervisor when doing staffing. There is no consideration given to patient acuity, it is strictly a numbers game. I mentioned in a previous post we are also responsible for ICU patients in overflow beds and those holding in the ER. Those aren't counted for staffing. If not for the teamwork of the awesome nurses in our unit, there would be way more adverse events than there already have been. Not to mention, when critical patients are transferred out of our facility (usually a 3-6 hour round trip) , unless they are life flighted, nurses have to go with them. The rest of the staff is responsible for their patients while they're gone.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I think this line of thinking is dangerous.
Money and the outcomes are connected. Especially in this era of pay for performance.
Are there greedy administrators ? Sure
Are there greedy nurses and doctors ? Sure
There are both greedy people, and people who want to do the right thing in this world.
If the administrators and evil money grubbers werent running a budget (somewhat*) effectively healthcare would be FAR more of a mess than it is. Especially with the way the economy has been in recent years.
In the economic model in the united states its not viable for organizations (hospitals included) to just spend money as they please without consequences.
That said there are ABSOLUTELY big wigs who are (probably) overpaid. But thats just because someone thinks theyll provide that kind of value to their organization
The amount of $$ spent in the USA, the percentage of our GDP spent upon health care in the USA is phenominally high. Conversely, we have some of the poorest health outcomes on the face of the planet. So is that how, in your opinion our outcomes and money are connected? More and more money = poorer and poorer outcomes?
Yet you believe that my line of thinking is dangerous?
The amount of $$ spent in the USA, the percentage of our GDP spent upon health care in the USA is phenominally high. Conversely, we have some of the poorest health outcomes on the face of the planet. So is that how, in your opinion our outcomes and money are connected? More and more money = poorer and poorer outcomes?
Yet you believe that my line of thinking is dangerous?
Although I agree our system in inefficient, to say that we have some of the poorest outcomes on the face of the planet is quite sensationalist.
I also want to remind my colleagues, fully socialized medicine means lower compensation for nurses.
A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system
Sensationalist?
Perhaps you could publish a link which supports you notion that USA nurses will take a cut in pay if we adopt a Medicare for all sort of system.
Nurses in the US currently do the best. This will most likely change, since the profession is definitely on a downhill course. Note the average hours worked by nurses in the far right column, which US nurses do work fewer.
Personally, I do think we'd do better with an integrated medical care system that is less consumer oriented, but concentrates on outcomes and accountability, and includes sensible rationing of expensive care for futile cases or non-compliant patients. That does not seem to be the course that our current system is on. Instead it wants to pander to consumers and insurance companies in a patchwork that is complicated and inefficient. I don't think Obamacare is helping that.
With the right system, I wouldn't mind taking a pay decrease. I'd rather make a little less and have more tolerable and healthy working conditions.
Specializes in Med Surg, Perinatal, Endoscopy, IVF Lab.
Acute care nursing is most definitely becoming more unsafe. Nurses are expected to do more and more with less and less... We're expected to chart and chart and sometimes double chart stuff... they add more and more "forms" to that list.... they give us more patients with higher aquity and no aides to help... OH and then we have to babysit EVERY other department to make sure all of our patients "stuff" is getting done in a proper and timely manner. There's talk of getting rid of PT and Respiratory Therapy and putting that on the nurses too. Then to add insult to injury, we get reprimanded if we don't clock out in the allotted 8 minutes and have to get DON approval for any extra time spent on the unit to do anything. It's flat out ridiculous. We are more concerned with customer service then saving lives. It's a sad state of affairs.... I don't see it getting better any time soon.
The Joint Commission and the State Representatives who do the Nursing Home Inspections are a joke. You show up, stay for 3 days. The administrators of these places have it down pat. At Nursing Homes they pull everyone from their jobs (Housekeeping, Laundry workers, Maintenance and have them feeding patients, answering call bells and whatever else needs to be done. When they leave it goes back to normal, with patients waiting hours to be fed cold food or not be fed at all. The Joint Commission works the same way. They send in people who walk around with the Administrators. Do they really think these people come out of their offices to see what is going on or lift a head to help change a patient, start an IV or anything to help. They like most officials are paid to look, carry a clipboard, and make recommendations on something they stay 3 days looking at. The whole medical structure is no longer about patient care, it is about money. I am close to retirement and have seen it all. A lot of Nurses work hard to ensure the health and safety of their patients. People have asked me about reporting things that they see. That is considered professional suicide. Ask anyone who has ever done it.
If the general public could see what I see on any given day, we'd have a whole new industry in health care. The nurse for hire who'd accompany patients to the hospital, to make sure nobody killed them during their hospital stay.
I'd sign on for that job.
You can have that job. Look up the Professional Patient Advocacy Institute. Lots of nurses doing this. I spoke at their conference once.
Realize that this is the real reason no one wants new grads. Given staffing models, if they can be called that, you have to have the experience to even attempt to do what they want you to do. If you are inexperienced, you will be in a deep hole right out of the gate.
Specializes in Critical care, tele, Medical-Surgical.
I read all the posts in this thread. It is an excellent start. There is an assessment and diagnosis of the problem.
Next a plan is needed. One item needed is sufficient nurse staffing.
Because hospital reimbursement is lower for a patient readmitted within 30 days of discharge so nursing administrators may pay attention and even help direct care nurses advocate for safe staffing with administration.
Hospital by hospital and state by state. We need to educate the public to ask how many other patients they share their nurse with. Insist on excellent staffing. Doesn't management love the word "excellent"?
THELIVINGWORST, ASN, RN
1,381 Posts
No, it's not the same everywhere. It's 6:1 at my hospital. Neuro med tele. I actually like my job. It's not perfect but I'm glad I found a good starting place for my career. But then again, it's hard to throw me for a loop. I'm hoping I can make through my first year without crying.