Substandard Healthcare d/t high Patient to nurse ratios

To whom it may concern:

I am writing this letter because I have most recently encountered the most horrid, eye opening experience of my entire 10 year career as a registered nurse. Throughout my career I have loved being a nurse, in fact I have devoted my entire life to taking care of patients. I do not pretend to not have made mistakes, because I have, as I am only human. However, I consider myself to be very knowledgeable, competent, and above all proficient in the care that I provide to my patients. I pride myself in my ability to assess a patient and collaborate with the physician in order to provide the best care possible to my patients. It makes me feel good to see patients get better and go home to their families.

Most recently I felt I needed growth and change in my career and I accepted a position as a nurse manager over the intensive care unit and medical surgical floor at a small hospital in Arkansas. I had worked there 8 years ago and didn't think I was going in to the job blind or naive. It had not been an easy job as a staff nurse 8 years ago and I knew that things were going to be hard. I believe the exact words from the CNO I interviewed with were "Its going to be rocky for the first 6 months". This was an understatement to say the least. I was also told that she wouldn't anticipate that I would have to take patients that often as it was staffed pretty good considering that their average census on the floor was 20 and 4 in the ICU. I was told that she didn't want me to staff she wanted me to manage so that I could correct the issues at hand.

The first 3 days of my job were overwhelming but ok, the second week was terrible. This is when I began to notice that the problems at hand were so awful not only with the nursing staff but throughout every department and every process they employed.

All of the nursing staff on my floor was disgruntled and disconcerned with everything. Patients were showing up to the floors unannounced with no orders. Nurses were at the desk, there was a patient who was sent there to die and was dieing with no nurse at her bedside. I had to tell the nurse to call the physician and then instruct them to stay with the family and still she never got up to stay with the family. Some of the nurses were shouting profanities at the desk. One of my nurses was so emotionally unstable all she could do was stand at the desk and cry. The nurses had one free charge RN and the 3 LPN's had 10 patients a piece. One man who was actively having a heart attack in the doctors office was sent over as a direct admit by wheel chair escorted by unlicensed personnel to our ICU. The nurse was not trained properly and did not know he was having a heart attack and the man died. Pharmacy only was open until 6pm without night coverage. The nurses were only allowed to get stat or now orders from a thrown together medication closet if they needed medications for their patients. So if you didn't have a routine medication at night, sometimes the patient just did not get the med. It would be charted on the medication sheet as "MED NOT IN DRAWER". Sometimes there was only one nurse in the entire facility at night with access to the medication closet and that was the ICU nurse who was alone with 4 or more patients.

The first two weeks of my job they called me day and night, I couldn't get any sleep. The 5th through the 8th day of my job, I had no RN coverage on the floor so I had to staff with absolutely no orientation to the paper work or the floor. I might stay on the phone for 6 hours of my day trying to call people in but still no coverage and the people that were coming in were working everyday, some had 120 hours in one pay period. While I was trying to care for patients, I would have to try and call in people or deal with sometimes 20 or more phone calls.

I kept telling my self that it would get better, that I would hire people. Everyday there were callins, No call - no Shows and there was no one to call in or no one would come in. Absolutely no RN applications. Most often I only had one RN on the floor to assess 28 to 34 patients. One day I caught an LPN trying to hang blood on a patient (which is against policy) And she said, "Well if I don't do it, it won't get done. The RN says she doesn't have time".

Two days ago, I was called to a meeting in which I had to leave to help the nurse on the floor who said that she had 5 admissions at one time and that the emergency room called to send another patient. The nurse told them that she was the only RN on the floor and the other nurses had 9 and 10 patients a piece and she couldn't take that patient right then. At that moment two paramedics presented to the floor with a Man that was dripping in sweat, grey in color and short of breath with a heart rate of 133. They had brought an unstable patient to the medical floor with absolutely no nurse to nurse report.

I escorted them to the room and began to admit the patient but started to realize how unstable he was and immediately called the physician. The local surgeon came to see the patient and agreed that the patient shouldn't be on the floor and needed to be shipped to a higher level of care.

After, getting this man settled in, the admissions just kept coming in. Because I was concerned about not having staff to care for these patients I called administration to inform them that we were not adequately staffed to provide the appropriate care for these patients. We were told to admit until we were full. Later, that night the floor was completely full with 35 patients and only 3 nurses and one nurse's aide to care for these patients. While these 3 nurses had 11 patients a piece, one of their patients was beating

His wife, and then attacked one of my nurses. Numerous things were going on but still the nurses were doing the best that they could under the circumstances.

I was under the impression that the unstable man was to be transferred as soon as possible but to my surprise he was still on the floor the next day more unstable than the day before. I had come that morning to staff in the ICU where we had six patients and only two nurses (another nurse and my self). Soon after I came in I was called away by the physician of the unstable man who wanted to complain because so many orders were overlooked on him throughout the night. The man was not transferred because the doctor could not get an accepting physician and was subsequently moved to the ICU where I assumed his care.

While caring for this man in the ICU it was noted early on that he was in very critical condition with potassium of 8, in acute kidney failure and with a very high heart rate of 144. The surgeon was notified to place a central line, while I was assisting the surgeon with this procedure; they were attempting to extubated another patient from the ventilator. The patient began to decompensate and was immediately placed back on the ventilator, at which time another patient arrived from surgery with a Blood Pressure of 70/30. Almost minutes after receiving this patient we were brought another patient from the floor that had to be immediately intubated and placed on the ventilator. While this was going on another patient was hemorrhaging and receiving blood, while a diabetic patient was in the room next door.

While all of these things were happening there was no one but me and another nurse, no one to answer the phone, no one to put orders in the computer until 2 pm that day. They stayed for about two hours and helped put in orders but then left.

During this time, the CNO, the administrator, the assistant administrator, and the CFO were on a plane to Florida for a meeting. The person left in charge, THE HUMAN RESOURCES DIRECTOR came to the ICU and was notified that the criticality of the patients warranted at least 4 nurses and that the doctor's office was sending us another patient with a possible heart attack. I conveyed to him at this time that I did not have the staff to care for these patients adequately in the ICU or on the floor and that it was critical for the safety of the patients and the nurses to stop admitting.

Mentally and physically exhausted, I reported off to only two nurses that night and went home. I arrived home at 9pm and went to bed, at 1am they were calling me saying that they were moving patients to the obstetrics floor as overflow and continuing to admit and that the CNO had called from Florida and instructed them to continue admitting. I told them on the phone that I was sorry but I quit. It was completely out of my control.

How disheartening to know that this happens all the time at various institutions around America. How sad it makes me to see that hospitals are more concerned with their census and how much revenue they can generate than to provide quality care to patients and a safe work environment to their staff.

And what even saddens me worse is the fact that the patients trust their lives to us and are so unaware and mislead of how unsafe the conditions are. People are paying millions of dollars and furthermore, our own government is paying millions of dollars for unsafe, substandard healthcare.

Why should the hospitals care? They are making millions and billions of dollars and we as nurses are placed in a catch 22 from the get go. We show up for work, we can not leave because it would be abandonment. We cannot refuse because it would be insubordination. But, instead we are forced to work out the shift in these conditions and take the chance of being charged or even sued for negligence. Does this seem right to you? It doesn't to me. I mean your damned if you walk out and your damned if you stay. Who should be accountable in this situation? I mean, do you think we want to walk in to conditions like this? We are forced to deliver such minimal care that it is dangerous. Even a competent nurse can only do so much, we are not super human.

We as nurses became nurses because we care. We did not go to school for the money, it's good but not good enough to expose our selves to disease and biohazzerdous material 1000 times a day. It seems to me that the nurses and the patients are both suffering.

Now, I have had to quit a job without notice. It may seem like I have no work ethic but instead I think otherwise. I have a lot of ethic. I have an obligation to provide safe care. I am accountable for my own actions. If the environment I work in is unsafe then I have to say " NO ! I WILL NOT PARTICIPATE IN SUCH SUBSTANDARD CARE". "I WILL ONLY PROVIDE CARE IF I HAVE SAFE WORK CONDITIONS, SO THAT I CAN PROVIDE GOOD QUALITY CARE TO MY PATIENTS."

THERE WOULD BE NO CARE FOR PATIENTS AND NO HOSPITALS TO PLACE PATIENTS IN IF IT WERE NOT FOR NURSES. WE ARE THE EYES AND EARS FOR THE DOCTORS. WE AS NURSES ARE HEALTHCARE.

In my whole entire career, I have been placed in several bad positions. But never have I been so terrified that someone was going to die and my license was on the line. I have never made a complaint, but I did this time. We all say don't rock the boat, don't make waves. Well now is the time to speak out, rock the boat, and blow it out of the water.

There is a nursing shortage and this is why. Hospitals have gotten by with this for years. They even take advantage of the situation because they know the nurse is stuck there the entire 12 hours.... Its Just one more shift covered for them. It is time for the government to step up and institute safe nurse to patient ratios. Hospitals do not staff by acuity. They staff by numbers.

Are you comfortable going to the hospital as a simple number instead of the criticality of your illness? I certainly am not.

The government has to do something about this. It cannot wait. We cannot just slap these hospitals on the hand and say oh ok, you screwed up. There are people's lives in jeopardy and nursing is also suffering.

It is time for nurses to get up, speak out and make a stand! It may be unprofessional to quit a job with out notice but I feel it is more unprofessional to provide substandard care. It is not about a paycheck, it is about lives being saved.

PLEASE HELP ALL OF THE NURSES MAKE HEALTH CARE SAFER!

Sincerely,

Just one concerned nurse wanting to make a difference,