Need advise on staffing problem and employee moral

  1. I was approached by my team leaders yesterday for help with a big problem my ER is currently facing. We currently just employed a new director for our unit that for the past 4 months, has showed little interest in helping our unit, and instead major interest in just helping herself. Our employee moral is at an all time low, and a couple of nurses have already put in their resignation, and more are currently looking for new jobs.

    Work load is consistantly increasing, and stress levels are out of control. Our ER holds 17 beds, and an express care of 5 more beds. Our current staffing includes 4-5 nurses for main ER, 1 nurse for express care, and one team leader nurse for each shift. It is not uncommon for us to work with 3 nurses and a team leader. Many days we cannot even place a nurse in triage, have to close down rooms, and utilize anywhere from 0-2 techs a day on each shift. The other day we say 144 patients! The staff have many fears such as safety, burnout, anger, and staff retention. All of the team leaders including me, are trying to help this problem and our number one goal is employ an extra nurse during our busiest time, 10a-10p, to have a float available. This is not in our budget, but an extreme neccessity.

    Does anyone have any ideas on how to approach administration and what tools would help us in convincing them of our dire need?
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    About TracieRN

    Joined: Jan '07; Posts: 4


  3. by   fultzymom
    I feel your pain! I worked on a skilled unit in LTC. We started to take on a lot higher acuity patients et patients with more serious problems than we used to. I know many people think LTC et skilled units are easy but they are busy as any other place. And along with the higher acuity patients you need more staff et support. Managements does not understand what is going on on that floor! All they see is the bottom line. It gets very frustrating trying to give good care when you have many patients, not enough staff, et not enough hours in the day. I hated the feeling that if I did this for patient X, what was I not going to have time to do for patient Y. Or better yet, when was I ever going to get to go home to the kids waiting for mommy to get home before bedtime? Management was willing to do whatever as long as it did not effect the bottom line. OK! Like that is going to happen. If you find a solution, I'd love to hear it too! I swtiched to MDS in the past six months but the problems are still there on the floor. I try to help out as much as I can out there because I know how they feel but I also have my own job to do.
  4. by   NicoleRN07
    Wow....sounds just like some of the same problems we are currently facing. I wish I had an answer for you, but unfortunately, I don't. It would be so nice if we could just wave that magic wand and make things perfect, but it takes a lot more than that. For weeks now, I have told myself that things are going to get better, but the only way that's going to happen for me is if I make it better, by being more positive at work. When one person comes to work with that "this place sucks" attitude and is complaining, then everyone else will fall right into that trap and complain too, and we become miserable the entire shift. I have made a promise to myself that I am going to go to work thinking and being a more positive person, and maybe, just maybe, life in the ER will be fun again.
  5. by   TazziRN
    Biggest thing is to approach admin as a unit, not just one person representing everyone else. Write down your observations and your concerns without trying to place blame and point fingers. Be objective. Bring up the safety issue and point out that because of poor staffing, pt safety is compromised.

    Good luck.
  6. by   fromtheheartRN
    I agree with Tazzi. The ER I worked in prior to my current job did exactly that. It is a huge task to take on when you are attempting to show and convince that adding a float nurse will improve patient safety as well as be cost effective at the same time. Unfortunately, managers MUST look at the latter. Pt safety (in a perfect world) SHOULD come first, but the reality is the financial bottom line. Things to consider including: What is the turn over rate? How much does it cost to train a new RN in your ER? How many sick calls? How many injuries and cost of lost time from work due to on the job injuries--directly or indirectly resulting from a heavy workload? Of course include the Pt safety aspect, but the holder of the purse strings will be looking at the cost first. Make your case very strong...something that they just can't refuse. You need to show either no increase in cost long term or even a reduction in cost.
    Look for studies in journal articles. Talk to RNs in other ERs and find out how they made the change and what the impact has been (turnover, moral, sick calls, etc). You might consider talking with a dept manager about how they financially justified adding an additional position.
    If you can present a solid case WITH verifiable support to back it, it will not be easy for them to refuse.
    I would definately enlist and delegate every staff member you are able to who cares about your staffing (probably everyone?). I wouldn't attempt it on your own. With a lot of thought, much planning, and ample researching, you are bound to succeed. And to sum up Tazzi's thoughts...keep it professional.
    I applaud your efforts and the willingness to step up and initiate change!
    Good luck!
  7. by   TracieRN
    Thank you, thank you thank you! For all of your support and advise. I love this website! It really is great to have multiple heads involved and opinions when you have questions in this profession.
  8. by   ERJunkieBSNRN

    Your ED sounds almost identical to the one I work in and we have the same issues. We have 17 beds and a trauma bay w/ 2 beds. One thing that I think will really help is to have add'l support staff. We have one medic who floats the entire ER and thus each nurse is pretty much left to do everything alone. For what it would cost to hire one nurse you could hire 2-3 techs. Assign a tech to one to two nurses and that person can run labs, place foleys, perform ekg's, etc. Thus the nurse can focus more on medication administration and higher acuity care. As an example, when I get a patient that comes in w/ chest pain I am doing everything. I get them on the monitor, oxygen. I grab the things I need and start one to two lines. I run and grab the EKG machine. I run the bloodwork to the lab downstairs. I give the medications. If the patient needs a foley or to go to the bathroom I'm the ONE to assist the person. Oops, I forgot I have two to 4 other patients, depending on my bed assignment...i sure hope they're ok! The hospital I work at is one of the busiest in it's "system". It's not uncommon for us to triage 200-300+ patients a day. Many of us are burnt out because we feel like we start getting pummeled as we walk in the door. The jobs I had that were less stressful always had enough support staff.