Management at my hospital, like a lot of places, upped nurse ratios throughout the hospital. I'm in ER where there is a huge emphasis on getting admitted pts upstairs. But now the floor nurses have higher ratios. The charge nurses now must take pts. They took away a designated admit nurse. Now, to top it off, the techs can no longer to accuchecks because of some new state regulation.
Yesterday I had a pt who came into the ER at 9:30 AM. She was marked for admit at around 11:30. Then we had to wait for a room. Of course the floors can't get rooms available until they discharge. Waited forever for that, then the room was dirty, then they changed the room assignment, and that one was a terminal clean, then the nurse was busy, after I sent the SBAR yet again because their printer was not printing right. Then the admit doc decided to change the pt to Tele. Then waited for a room, then it was dirty, SBAR sent, report given. Room a terminal. Finally, after 9 PM the pt went upstairs. The pt and family were so patient, I really had to reassure them and keep up a positive rapport though.
90% of our flow problem is because upstairs doesn't have enough help! And some of my crankier ER colleagues will then take a self-righteous attitude toward the floor nurses, severely resenting them for being on lunch when they want to give report. Yet, there is no designated charge nurse who can take report. Yeah, lets turn on one another instead of naming the true cause.
Specializes in Ambulatory Surgery, Ophthalmology, Tele.
ARGH....why WERE we understaffed??? Then again, it's not "understaffing" if it's now your New Matrix. Now it's just the new standard ratio.....and it's not working.
I wish I could call it insanity, but honestly, it's just what I'd call Modern Floor Nursing. And a primary motivator for my leaving it behind a few years ago.
This......
I wish I could find the clapping/applauding smiley
Long term care is the same way. I have 31 patients. They are constantly on us for getting off on time. With 8 diabetics, two tube feeders, several wounds, and an ARNP who writes numerous orders after 8 pm, it can't get much crazier. If someone falls, or there is admission, then everything goes down the tubes. They won't let the CNAs take the blood pressures for us. They tell us to leave work for the midnight shift...yeah sure :-)
Specializes in Management, Med/Surg, Clinical Trainer.
Then management has lots of meetings to try to figure out how to make water into wine. What new policy can we implement to make three loaves of bread and two fishes feed a crowd of 5,000?
Hmmmmm.....
It is a sign of the times. The patients are trying to determine if they are covered at all. And the hospitals are trying to figure out how and what they will be reimbursed for.
Until this ACA stuff settles in....look for things to keep hitting the fan.
Specializes in Management, Med/Surg, Clinical Trainer.
It's amazing how many cuts keep having to be made, and how often that comes from staffing. It may benefit the bottom line, but it doesn't benefit anyone else! The patients suffer, morale suffers, nurses and other staff can get downright destructive if it gets bad enough... It just baffles me how this continues in this trajectory. There has to be point at which someone (on a board) goes, "Wait a minute... Maybe we need to try another approach..."
The staff, especially nursing staff, is the most costly expense. At my facility nursing takes up 81% of the budget, and that is why it is always looked at first as a way to balance the increase costs and decrease in reimbursements.
I think the problem with nursing is they still have not figured out a matrix that works.
I think the problem lies in administrators and higher ups refusing to lower their salaries and cut their own budgets. Nurses are what make a hospital work and run smoothly. Period. Ugh.
Also, OP, thank you for having perspective. The grass is never greener, it's sucks for everyone involved.
I'm also disappointed to see charge nurses and administration not listen to their floor nurses concerns over patient safety. We're on the front lines every single day. We know the acuities. We know what's going on with the patients. When we say "I cannot take another patient," for the love of all that is holy, please LISTEN.
We have the same problem..is this common problem in everyplaces. Im work in ED department, with 15 bed ( 4 ACUTE, 4 sub acute, 2 pediatrics, 3plaster room, 1 RR, 1 isolation room) with 4 nurse, stressed getting higher when the patient come almost in the same time, and still another pt wait to go up waiting for discharge room. REally make stress. Stuck in ED, and every pt and their family getting frustated too.but sometiwes why another department always have a trunk when we transferred a new patient, really dossapointed
its not always about how many physical patients. It really should be more about pt acuity. I have had 8 and have had a great day then the next day have 5 and it was brutal.
things will not improve until the word profit and the phrase healthcare are separated.
also, I do not want to hear any whining from places that have voted against unionization
Sounds like my hospital; maybe we work in the same facility (lol).
Nurses, aides, clerks and all staff members need to unite and present your unit issues to management as a team in a requested staff meeting. I actually put together a meeting like this for my med-surg unit that starts in few hours. We shall see if any changes are made.
Always document specific unit situations/staffing problems; especially when a patient's safety is put in jeopardy. Management never likes those letters! Med errors, increased falls, increased infections, lack of patient education, family complaints all lower HCHAP scores.
Also, nurses and aides love to complain about all issues but never follow through and show up for the management meetings and present the problems in a professional way. There are only two employees on my unit who consistently attend union, committee and staff meetings (one is myself). RN's and aides, please take a stand, document and present this issues to your management (even contact your local government officials, senators, ANA or write your hospital CEO a professional letter)! Remember nursing school vocabulary:"Chain of Command".
It's really frustrating that high level hospital administrators don't understand our staffing problems; they don't care and are still getting huge yearly bonuses (that we don't know about). I'd love to see my CNO or CEO work on my unit with eight patients (four of them on contact, two with c. diff).
The staff, especially nursing staff, is the most costly expense. At my facility nursing takes up 81% of the budget, and that is why it is always looked at first as a way to balance the increase costs and decrease in reimbursements.
I think the problem with nursing is they still have not figured out a matrix that works.
Nursing takes up 81% of your facility's budget!?!? If that's true, it's a miracle that your facility manages to keep the doors open at all! I'd be shredding nursing employment contracts at a pace fast enough to make an Enron executive jealous.
However, I find it far more likely that you bent over and obtained that "statistic" rectally or you are just woefully misinformed about the expenditure breakdown at your facility.
Specializes in Emergency Department; Neonatal ICU.
Love the original post!
And not to mention that, in addition to staffing matrices that are inadequate, there is nothing built in for the dementia/confused patients requiring a sitter. No staff for it but better not let them fall!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
It's amazing how many cuts keep having to be made, and how often that comes from staffing. It may benefit the bottom line, but it doesn't benefit anyone else! The patients suffer, morale suffers, nurses and other staff can get downright destructive if it gets bad enough... It just baffles me how this continues in this trajectory. There has to be point at which someone (on a board) goes, "Wait a minute... Maybe we need to try another approach..."
This is exactly why the curent glut of nurses was created. To give nurse employers the abiliety to increase ratios and cut nurses pay and benifits without fear of haveing an unstaffed unit. A few years ago when most hospitals had a variety of open positions all the time managment didn't dare do such things our their nurses would vote with their feet and the hospital would be left high and dry.
nursefrances, BSN, RN
1 Article; 601 Posts
This......