Staffing issues in emergent situations

[Steph1776]

Hello, I am a relief charge on a renal/telemetry unit and recently volunteered to join a CSI group to fix the way our hospital deals with emergent staffing situations. I am reaching out to other RNs to see how your hospital handles these situations in hopes to learn other ways and get some insight/feedback that may be helpful to our hospital. Currently if our unit is staffed appropriately from the matrix but the acuity goes from stable to unsafe we can fill out a form online and call our nursing supervisor for potential additional nursing support. This process does not seem to work, given that in the "moment of craziness" the last thing you are thinking about doing is filling out a form that only goes to the administration (whom are sleeping during the night shift). The next step is to call your nursing supervisor but that doesn't always go very well. Currently the CSI process can be filled out by any staff personal that feels unsafe. There is a process, which begins with the charge nurses who should trouble shoot the situation. Next if the charge nurse is unable to figure out a remedy then the nursing supervisor is to be called. After that, nothing. It is either resolved by the nursing sup or not. Some examples of the situations are unsafe patient assignment where the RN feels her/his assignment is unsafe/too heavy for one nurse. Another would be a code blue or ASAP situation where more staff is needed but not always available. I look forward to learning how your hospitals handles these situations in a pinch. What the process is and if you have a middle person to resolve/troubleshoot issues for the hospital. Thanks in advance!

[NurseOnAMotorcycle, ASN, RN]

We just fill out the form and deal with it. Had several nights where 2 nurses had to run a 40 bed ED alone because of staffing. Providers helped hang IVs, give meds. It was ugly, but everyone lived.

No help ever comes when you need it.

[RNsRWe, ASN, RN]

Ah yes, the much-lauded and rarely effective Form! Blecch. When presented with such a shiny new form that would allow us to document the problem and legitimize the request for help, we all thought "finally, now we have an avenue to voice our need for help that can't be ignored!". Ha.

We filled out the form, called the NS. "I know you have a form, but I don't have any nurses to send you". Ok. But we filled out the form, so someone will know we were drowning, right? Wrong. We were "within our matrix" so the need couldn't be validated by this shiny new form. Pretty much someone had to DIE, we figured, and then there'd be a Throw the Nurse Under the Bus Party in administration.

But we filled out the form dutifully...until we were told "STOP sending us these forms! It CANNOT be as bad as you say!" (after all...no one DIED...so....we must have been hunky dory!)

When the NS knew we were swamped, it didn't take away the need to assign a bed for someone who had been in the ED for 12 hours and NOW was a massive priority for admission with a dx of "migraine" (which could only be relieved by Dilaudid q2h) or "intractable vomiting x 1 day" (think Zofran IV plus Dilaudid). Yeah. THAT was urgent for an understaffed med-surg to take RIGHT THEN.

Ah, good times. So no, I don't hold out much hope for The Form! I do wish you well, though; maybe your luck will be better than ours!

[Swellz]

We don't have anything like that. We can call our supervisor, but chances are rare that they'll have someone to send us, especially if it is based on acuity and not nurse-patient ratio.

[AJJKRN]

My facility sends out a mass text and offers an extra pay practice (like an extra $15 an hour). This used to work quite nicely but census has been busting for the past few years and we can't keep nurses at the bedside anymore.

[AJJKRN]

Does your facility not have a house officer/supervisor?