Help- we need a solution. :-(

Jason-ACNP · Apr 26, 2001

Yet again, increasing evidence that the current system doesn't work. It is affecting more and more hospitals every month.

I personally don't know what you could do that would be effective for the long run. I don't think that cloning has hit the mainstream as of yet. It sounds as if years of "doing the right thing" has finally reached the breaking point.

If there isn't enough coverage from travelers, agencies, etc. (and there rarely is anymore), then I would suggest that tbe "angered Gods" get down there to help lighten the task load for the nurses in your unit. If your colleagues are WILLING (key word) to work overtime to cover extra shifts, then those on the board should be more than happy climb down from their thrones and pitch in with what ever they can possibly help with. I really don't know what else could be done in the immediate future. As you said, there simply aren't enough nurses.

Again, this is an issue that affects tens of thousands of nurses nationwide. When does it stop? How much more can they take? When will nurses finally make a stand? Will they ever? Or will the health care system slowly bleed to death?

Originally posted by canoehead:
Our hospital is finally reaching the crunch staffing wise. We do not have mandatory overtime but have always had a loyal staff that would sign up for extras or stay a few hours voluntarily if they saw the next shift needed a hand.

Now the crunch is so bad that we have closed to admissions at least once a week, and the powers that be (the board) is very unhappy. We may lose that option. The nurses that commonly sign up for extras are regularly doing 50, sometimes 60 h per week and getting burned out rapidly. Managers are covering the rest of the time needed and at times getting 70h weeks- this school break was horrible, and we cannot keep it up through the summer.

There are have been no agency nurses available for the past 4 months to come to us, so that is not a viable alternative.

We are looking at rotating extras on a mandatory basis, and in that way getting the extra hours that no one signs up for distributed equally among everyone. That would mean that every 2-3 months a turn would come up and each staff would take a turn at taking an extra shift. Of course voluntary OT would still be available, and those signing up could count that as their turn.

What are some other alternatives, good and bad that other hospitals have been using. What does the staff like or dislike about them? We are reaching a critical point, and need to do something soon. In the past one of the strengths of our hospital has been the way staff and managers have been able to work together and get through a crisis, I would hate to hurt that relationship, but our most dedicated people are wearing out.

**canoehead, BSN, RN** · Apr 26, 2001

Unfortunately in this case I am administration, I like the idea of mandatory ratios and no mandatory OT, but then what do we do with the patients that need care. The board will not allow us to close to admissions any more. Where do we find the nursing hours to cover the floor? Maybe some creative staffing or recruitment ideas are out there.

Keep in mind...we can't compete with $2000 sign on, and $4/h more that neighboring hospitals are offering. Our plus has always been good communication with staff and mandatory OT will ruin that.

natalie · Apr 26, 2001

Canoehead,

It is heading towards critical mass in my small hospital also. It's one where the majority of all staff, all departments, put their heart and souls into the place and there are no bad guys, per se. There is a reasonably good relationship between management and staff.

A few months ago management offered nurses an extra $100 for any 8 hours worked over their scheduled time. It's working for now. It helped to squelch the bad feelings caused by paying agency nurses much more than employees. Money does talk.

In looking toward the future, it's going to get worse. It's at that time I'll have to decide whether I can cut it anymore. I predict my caseload in the ICU will be 4:1. That's double what it was a few years back. And now it is without ancillary staff-no secretary. The hospital abolished that position and it was a very poor decision. If they can't find the nurses, then they will need to keep up with the ancillary staff for nurses.

So I'm predicting having to make a big decision in a year or two and it may just be resigning. I figure I have one more tactic up my sleeve. I can sign daily Protest of Assignment forms and work to provide safe care to the patients. That means I will cut out ALL work that is not related to that. I will NOT fill out the required JCAHO restraint form for intubated patients, I will not fill out lengthy nursing assessment forms, hospital paperwork, etc. I will not answer phones or transport patients. I will leave it to the administration to decide whether they want my brand of nursing care.

fergus51 · Apr 27, 2001

The board will not allow you to close to admissions? What the hell is that? I am sure they'll allow the nurses to get sued when they make med errors after working 70 hours a week. That's just unsafe and disgusting. How can a nurse provide proper care in that situation? Why don't they send more patients to those other hospitals near you paying those fabulous wages until they can get thei own place in order?

Originally posted by canoehead:
Unfortunately in this case I am administration, I like the idea of mandatory ratios and no mandatory OT, but then what do we do with the patients that need care. The board will not allow us to close to admissions any more. Where do we find the nursing hours to cover the floor? Maybe some creative staffing or recruitment ideas are out there.

Keep in mind...we can't compete with $2000 sign on, and $4/h more that neighboring hospitals are offering. Our plus has always been good communication with staff and mandatory OT will ruin that.

Mijourney · Apr 27, 2001

Hi canoehead. It sounds like a very difficult situation indeed. I got out of the hospital setting years ago, because I saw the slippery slope after DRGs was implemented. Hospital staffing shortages have never been, in my opinion, appropriately addressed by nursing, the government, management, board of directors, or anyone else. And now I'm afraid that increased demands for health and medical services from the aging boomer population and our aged parents and grandparents are going to completely bankrupt the system.

If not already done, would a change in the way staff is scheduled help? I know that some places do a combination of 8 and 12 hour shifts to keep things going. I feel that it would also help if hospitals would consider instituting a weekend Baylor program to at least try to get that end covered. I know that Baylor is expensive. But isn't it also expensive and potentially more costly not to have enough staff to provide care to the patients? Best wishes.

Jason-ACNP · Apr 27, 2001

Exactly.... When I worked as an RN, I was told on numerous occasssions (in various hospitas on traveling assigments) that I would be receiving a fourth patient (in a high acuity ICU) when I had my hands full with three patients. I simply said, "No I'm not. You will find another unit, or that patient will be transported to another hospital". Most of the time the outcome was a sense of respect from my colleagues. Your nurses clearly aren't lazy if they are willing to work overtime. Part of it is a safety issue. Yet, for administratiion (the board), it's a money issue. Too damn bad. If you choose to, it really can be that simple. You can't drive one hundred miles on one gallon of fuel. It's the law of physics. Yet, they are trying to get more out of your nurses than they have to give (mentally and physically). It defies common sense, as well as ethical and saftey issues. Please, for the sake of nursing... Just say no. It dosen't appear that they are in a position to terminate you. But for they sake of argument, if they were going to fire you, take national guidelines regarding pt/nurse ratios to your nearest competent attorney.

QUOTE]Originally posted by fergus51:

The board will not allow you to close to admissions? What the hell is that? I am sure they'll allow the nurses to get sued when they make med errors after working 70 hours a week. That's just unsafe and disgusting. How can a nurse provide proper care in that situation? Why don't they send more patients to those other hospitals near you paying those fabulous wages until they can get thei own place in order?

Travel_RN · Apr 27, 2001

Originally posted by canoehead:
Our hospital is finally reaching the crunch staffing wise. We do not have mandatory overtime but have always had a loyal staff that would sign up for extras or stay a few hours voluntarily if they saw the next shift needed a hand.

Now the crunch is so bad that we have closed to admissions at least once a week, and the powers that be (the board) is very unhappy. We may lose that option. The nurses that commonly sign up for extras are regularly doing 50, sometimes 60 h per week and getting burned out rapidly. Managers are covering the rest of the time needed and at times getting 70h weeks- this school break was horrible, and we cannot keep it up through the summer.

There are have been no agency nurses available for the past 4 months to come to us, so that is not a viable alternative.

We are looking at rotating extras on a mandatory basis, and in that way getting the extra hours that no one signs up for distributed equally among everyone. That would mean that every 2-3 months a turn would come up and each staff would take a turn at taking an extra shift. Of course voluntary OT would still be available, and those signing up could count that as their turn.

What are some other alternatives, good and bad that other hospitals have been using. What does the staff like or dislike about them? We are reaching a critical point, and need to do something soon. In the past one of the strengths of our hospital has been the way staff and managers have been able to work together and get through a crisis, I would hate to hurt that relationship, but our most dedicated people are wearing out.

Travel_RN · Apr 27, 2001

I am a travel nurse and read the posting and was concerned for fellow nurses. I mentioned it to the recruiter with agency that I am working with which is AAA Medical Staffing. My recruiter seemed concerned and interested said "you could email me at [email protected] to see if the agency could assist you with nurses."

Originally posted by canoehead:
Our hospital is finally reaching the crunch staffing wise. We do not have mandatory overtime but have always had a loyal staff that would sign up for extras or stay a few hours voluntarily if they saw the next shift needed a hand.

Now the crunch is so bad that we have closed to admissions at least once a week, and the powers that be (the board) is very unhappy. We may lose that option. The nurses that commonly sign up for extras are regularly doing 50, sometimes 60 h per week and getting burned out rapidly. Managers are covering the rest of the time needed and at times getting 70h weeks- this school break was horrible, and we cannot keep it up through the summer.

There are have been no agency nurses available for the past 4 months to come to us, so that is not a viable alternative.

We are looking at rotating extras on a mandatory basis, and in that way getting the extra hours that no one signs up for distributed equally among everyone. That would mean that every 2-3 months a turn would come up and each staff would take a turn at taking an extra shift. Of course voluntary OT would still be available, and those signing up could count that as their turn.

What are some other alternatives, good and bad that other hospitals have been using. What does the staff like or dislike about them? We are reaching a critical point, and need to do something soon. In the past one of the strengths of our hospital has been the way staff and managers have been able to work together and get through a crisis, I would hate to hurt that relationship, but our most dedicated people are wearing out.

-jt · Apr 28, 2001

Originally posted by canoehead:
we can't compete with $2000 sign on, and $4/h more that neighboring hospitals are offering. Our plus has always been good communication with staff and mandatory OT will ruin that ]

Does management ever wonder why they cant get nurses? Could it be the working conditions at that facility??? The problem is not short-staffing. The problem is administration not addressing the real problem - conditions that result in people not wanting to work there, which then leads to short-staffing. Saying they have no money to be competitive is their number 1 problem right there. How then do they expect to attract people to work for them?

The logical conclusion is they will not be able to attract staff & will end up short staffed.

why are the RNs standing for this situation & why arent they doing something to help themselves? what about asking those nurses what THEY are doing to help their own pts in this situation. Unionized nurses have found solutions & we have the means to get them, have put them into place in many many places & anyone can read about how we're doing it on the frontlines facility by facility if they want to learn too. They can also have the UAN/ANA come to their facility to give them more info & help them more formally - but they have to invite them in.

http://www.UANnurse.org/

http://www.ana.org/dlwa/barg/index.htm

Have those nurses called the ANA & asked for guidance in any of this? Have they called any RN union to guide them in becoming an equal voice in finding the solutions? Have they even just gotten together & said "NO we arent working like this anymore!" Have any of them just done an old fashioned sick-out?

Apparently the agency nurses have said they arent taking it anymore cause even they wont go to that hospital to work. Doesnt anyone wonder why? Administration is just looking at the result of the problem & trying to fix that without loooking at whats causing that result or fixing those causes.

When the nurses stop accepting the situation - things will change. Have they notified the newspaper, the public, their risk management dept, their nurse managers, the CEO or even their State Dept of Health of the situation & that they will no longer allow it to continue? Or have they just accepted that the hospital has no money to fix things or make improvements that would draw nurses to that facility? The solution to the problem can be achieved only when that excuse is NOT accepted. No matter who does what for nurses, as long as they accept the excuses, nothing can be accomplished.

There is a recruitment problem at that hospital - fix the horrendous workplace conditions & provide financial & other incentives to entice nurses back to work. They can get creative - they can offer flexible shifts, job-sharing, no shift rotation - (if such a thing even still exists) - pay for experience, education & specialty certification, offer 100% tutition reimbursement... the list goes on.

But you need to get together to make administration see that. The point is ANA nurses and any other nurses who have been in this situation can give you all the info, ideas, direction & guidance & tell you step by step what to do & will - but YOU have to be willing to do it. Otherwise, the hospital will just play on your sense of guilt & duty to the pts, tell you they have no money & you will kill yourselves trying to cover staffing gaps & working mandated ot.

Whats the solution? Reorganize the finances so you can spend some money improving the conditions in the workplace; re-prioritize, place a value on experienced staff & recruiting them, show how much you believe in that value by putting your money where your mouth is. If you dont, then expect the problem of short staffing to continue. But nurses dont have to wait for the hospital to decide to do this on its own. They can force the issue.

I doubt very much (because experience tells me) that redirecting funds to pay nurses, improve conditions & offer recruitment incentives would bankrupt that hospital. But if those nurses were unionized, the hospital would have to show them the facts & financial data that would support their claim. In other words, they cant just say it, they have to prove it. If they cant prove it - we dont believe it.

That includes showing how much they spent on painting, carpeting, landscaping, the consultant fees, catering budget for the MDs, the fake trees in the lobby, new pictures for the public relations office, the CEOs birthday party, the fountain in the courtyard, the VPs salary, etc. Before they could say any increase would bankrupt them, they have to look at all these other expenditures, prioritize & redirect funds if they really want to solve the problem.

Being unionized would give the nurses the authority to obtain these records. Let the hospital prove that it cant be competitive or let it find a way to redistribute funds in order to become competititve. Being competitive is what makes our business world go round.

If you want to survive you better find a way to be competitive or you will never find the solution to your problem.

good luck.