Does this happen at your hospital? (Staffing related.)

[nfdfiremedic, BSN, RN]

Greetings,

I am hoping to find out a bit about hospitals in other parts of the country and their staffing situations. I keep reading about difficulty nurses are experiencing finding jobs and, with that in mind, I'm curious if this problem exists as well in those areas where jobs are hard to come by.

I am a manager in a very busy ED. We see around 160 patients a day, which ends up being around 50,000 per year. We are a trauma center, an accredited interventional cardiac/chest pain facility, a stroke center, and pretty much an everything else center too. Our ED has 32 beds, of which 3 are in the trauma bay, and 7 are an "Express Care" area that runs twelve hours a day during peak hours, and 22 are regular ED beds. The hospital above us is licensed for only 176 inpatient beds.

Every Friday afternoon, one of the floors in the hospital is closed down. They reopen it on Monday or Tuesday. This results in massive, catastrophic, distaster-level ED overcrowding every weekend. It's not uncommon for our ED to be stuck with as many as 20-25 inpatients for the entire weekend, leaving us with no rooms whatsoever to see "real" ED patients. As a result, wait times are high, left without being seen rates are high, patient satisfaction scores are low, and staff are worn out and frustrated leading to poor staff retention.

When ED leadership asks senior hospital administration about this problem, we are told there is "no staff" for the floor that is closed on weekends, but that "they are working on it." As far as I can tell, they have been "working on it" for a long time. Some senior staff say they have been "working on it" for 15 years. The sad fact is, ED staff are being mandated every weekend to help, the department is in a weekly disaster/diversion state, and the vast majority of staff are utterly dissatisfied with their jobs. It's hard to walk through the department without finding at least one computer open to the job listings screen.

Does this happen to you too? Do these parts of the country that are not hiring actually have enough staff to meet all of their needs, or are they doing things like this to avoid having to hire/to save money?

[RoyalPrince]

No this is not common. You as the manager need to address it to the CEO if CNO is not helpful. This is a hoarding ER situation and as a manger if ever it hit the fan you will be canned.

[nfdfiremedic, BSN, RN]

Unfortunately, I'm in their offices on a regular basis alongside my physician medical director, and we continue to be told they're "working on it." I'm running out of options here, there is no higher level for me to take it to.

[classicdame, MSN, EdD]

you have to show them how this is COSTING money. OT for your staff? is your staff paid per diem for their position which means they are more expensive than general floor nurse? Are you diverting patients? Is there a risk of non-compliance with EMTALA law? What about patient satisfaction? MD satisfaction? (wanting their patient on the floor - not ER MD's). Ask what are the barriers now and see if people can come up with ideas to overcome them. Is there a Board of Directors??? Look for JC and BON standards pertaining to continuity of care, etc. or even competencies the floor nurses have that ER nurses may not have. Obviously someone needs to make it worth their while or they will continue status quo. As far as they are concerned it is working.

[TrafalgarRN]

Also i would say is this is inhumane, greediness and lack of empathy. What kind of corporation do you work for? This almost sounds like a county hospital(no pun intended) since i doubt that a for profit concerned with money, reputation would standby with unsatisfactory reviews from patients. I have never been to an ED where a patient has been held down there for more than 24 hours waiting for a bed. In my ED by the time the patient has been there for 20 hours all the high ups are calling asking whats going on and pressurizing the hospitalists to either admit the patient or make sure that the patient is going home soon. I work in a department where we hold a max of 4 patients on some nights; e.g for ETT or Pthal or Social Work consult. I work in a 25 bed ED with 15 Hallway gurneys if needed seeing a 100-120 patients a day plus we have a "Fast Track" open from 1000-2200 and; no trauma though plus a Minor Injury Clinic open 5 hours a day.There are days especially during winter when we are clogged and if the census hits atleast 60 and we are admitting many or we are getting overwhelmed we have to page our director and also administrator on call who have to come in and handle the crisis; that means they have to open up extra beds; call in extra nurses e.t.c

I simply believe that the management doesn't care or want to maximize profits while hurting the community they serve. 15 years of saying we are looking into it is just plain stupidity. How about the doctors in charge of this place stomping their foot on the ground and say they can't work under such conditions? What does the medical director/ Physician in chief have to say? And what about nurses putting in a petition stating that if this is not rectified then they will quit? I know things are tough with jobs but i am tired of corporations making money but not caring about the staff, patients and their reputation in the community. And last but not least who runs this hospitals? Physicians ? Or who is this senior management?

[Liz, RN]

This is absolutely crazy! I'm sorry u have to put up with it...

[Isabelle49]

When our ED became full, the nurses in PACU would be called in to keep the patient/ in the recovery room, so as to free up space in the ED. I sure wouldn't want to be in bad shape and be taken to an ED that can't care for me cause they don't have room.

Does your hospital ever refuse emergency care when the ED is full? This could be a big problem, esp if the hospital is receiving fed funding - is Hill-Burton still funding?

[June55Baby]

This is a "through-put" issue and Joint Commission has standards that apply to patient flow.

I'm sure your patients are not "satisfied" with this arrangement either and poor patient staisfaction scores will definitely impact your reimbursement from Medicare.

[Turtle in scrubs]

We do not have any floors close for the weekend. Our ER census increase over the weekend and, like you, we would have a hard time accommodating admissions if we closed a unit. This sounds like a big mess.

In our area there are plenty of nurses looking for work who can't get hired. I'm sure that varies form place to place.

I think classicdame has it spot on. Change won't happen unless they see the benefit. Sounds like you are in a rough spot. Good luck!

[anotherone, BSN, RN]

The units they close are staffed during the weekdays right? Don't those nurses have to work weekends?

[chevyv, BSN, RN]

Sounds like a nightmare and lawsuit waiting to happen. Your poor staff and you as well. I'm a floor nurse and can't imagine how any manager can walk through and not feel sickened by wanting to help your staff and not being able to. It's a sad way to burn out. It also doesn't sound like it would be too hard to fix but it must eat into profits. These are the times when I want to see those upper management come in and work! I am so sorry and very happy to not have to work in that setting.

[guest64485]

I agree with Classic, you have to show them that this is costing money. Gather up all the data and show how many patients in the ER are basically inpatients over the weekend (to show that another floor would routinely have census over the weekends), and give the data on how many patients are walking out without being seen (lost revenue) and give the numbers on how much overtime is on the weekends, vs weekdays (reducing this number would free up funds to staff another floor). Give the data if you can on staff satisfaction and exit interviews showing that weekends are hurting retention, which costs the hospital money

Without hard data, they don't seem like they'll make any changes. The only other option I can think of is a show of force, such as looking into having a union/NNOC-CNA step in.