Why does Nursing put up with short staffing?

Tiwi · Feb 26, 2007

Why does nursing put up with short staffing?

1. Nurses know that their role is important, that no-one can replace us on the floor, and that ppl still have to be on the floor to care for pts regardless of the amount of staff. So we do our best, even if the situation is dangerous for staff and pts.

2. I think nurses are also more likely to "put up" with it, due to a mindset that we just 'should'; we've always done it, its part of our history. It needs to change.

3. Senior staff are either hampered by financial constraints, managerial decisions from "on high", or just the plain lack of nursing staff throughout the industry, so they too must "put up" with it.

3. Many ppl in the community aren't attracted to nursing, which also decreases the amount of staff available. I understand that the mean age of nurses is increasing, and I think I read somewhere that we are now about 35 - 40yrs of age? Don't quote me on that...Also here in Australia, and I can't imagine that it would be different in the US, violence perpetrated towards nurses is close to that of police officers. Why do we tolerate that?

Just some thoughts...

synesthete · Mar 5, 2007

I haven't read all the replies so forgive me if I repeat information that has already been provided. On January 4th of this year the Safe Registered Nurse Staffing act was introduced into congress. This proposed bill will mandate safe staffing on all shifts and on all units of medicare reimbursed hospitals. The staffing levels will be established by registered nurses in conjuction with the chief nursing officer of said medicare hospitals. This bill also addresses public reporting of staffing, civil monetary penalties for failure to comply and whistlerblower protection It is S. 73.
Thanks

Where can I find this law, and how can nurses find out about the hospitals contingency plan? Any information you can give me would be much appreciated.

Hoozdo, ADN · Mar 5, 2007

Where can I find this law, and how can nurses find out about the hospitals contingency plan? Any information you can give me would be much appreciated.

Unfortunately, if you google it, you will see they have been trying to pass this since 2003. :crying2:

laughing weasel · Mar 5, 2007

It is only abandonment after you take report. If the ratio is unsafe you have the right to refuse if the hospital doesn't want to call agency for help they do NOT consider your position necessary so why risk your liscence.

BBFRN, BSN, PhD · Mar 5, 2007

http://thomas.loc.gov/cgi-bin/query/z?c110:S.73.IS:

Here is the overview of S.73

http://www.aacn.nche.edu/Government/pdf/Billlist.pdf

And here is the list of nursing- related proposals currently before the 110th Congress.

RNsRWe, ASN, RN · Mar 5, 2007

And I just came across someone at my hospital who thinks that by clocking in, we are accepting an assignment, and refusing an excessive number is abandonment. :uhoh3: Seems there are alot of fallacies out there about what nurses "have" to do regarding assignments.

Set her straight on that one: clocking in means I am WILLING to accept an assignment, not that I have ALREADY accepted an unmanageable one, sight unseen! If I see that the census has me slated to take ten or more patients, I don't care WHAT the acuity is, I'm not even thinking about taking report until the supervisor has assured me that we have an additional nurse coming in. And when I see that additional nurse, and know what MY number will be, then fine.

Actually, I can't swear to it, but I don't know that even taking report is "accepting" an assignment: how can you legally be accepting responsibility for a patient load if you don't know what those patients are (what their acuity is, what their needs are)? Seems to me, if I'm taking report on nine patients and at the end of the assignment I see that it's not do-able for me, I should be able to tell charge nurse (who won't want to hear it) or call supervisor and say "not happening".

I'm tired of hearing "that's just how it is on this unit" and "So and So did 12 patients last week". Don't care. I know how many I can safely work with, and since So and So KNEW it wasn't safe for her to take that load but she was willing to do it because "everyone does it sometimes" (not because it was safe, mind you), then that's her license she's about to lose. Not mine.

That's why there's unsafe ratios. Nurses who allow the pressure tactics and bogus threats to force them to do the insane. Can't you just see the lawsuit bred out of a nurse being fired for NOT accepting an unsafe assignment? I can't, because I can't imagine the hospital that would open themselves up to that. They'd rather cow you into believing that you have no choice in the matter. Hogwash.

Gennaver, MSN · Mar 5, 2007

I am wanting to get a little feedback as to why Nursing (in general) allows short staffing to be an issue? I am on our research committee at work and would like to get an idea of where to take my project. I would like to find an answer to the problem and not just more complaints. Thanks in advance for any insight.

I have nothing to contribute to your question but, more questions to add.

Why do nurses put up with shift and weekend diff and overtime and so on rather than to ask for an outright Salary? Just give me a salary, either a straight hourly one that is decent or a yearly one then do not throw nickles and dimes at me for ot or shift diff.

Gen

RNsRWe, ASN, RN · Mar 5, 2007

I have nothing to contribute to your question but, more questions to add.
Why do nurses put up with shift and weekend diff and overtime and so on rather than to ask for an outright Salary? Just give me a salary, either a straight hourly one that is decent or a yearly one then do not throw nickles and dimes at me for ot or shift diff.
Gen

Because there will always be harder shifts to get coverage for, and facilities are willing to pay more for those shifts than they are for easy to fill ones. At my facility, lots of nurses want day shift. They get a base rate of pay. Nights, however, require far more baiting, and therefore we get extra $$ per hour. Do I "put up with it"? No....I want and expect it! :)

Why do I want hourly pay (not salary) plus differentials? Because I want to be paid for every single minute I work, as I do now, and because I AM willing to work hard-to-fill shifts, I will take the extra cash, thank you. Definitely not "nickels and dimes" where I am!

Sheri257 · Mar 5, 2007

And I just came across someone at my hospital who thinks that by clocking in, we are accepting an assignment, and refusing an excessive number is abandonment. Seems there are alot of fallacies out there about what nurses "have" to do regarding assignments.
Set her straight on that one: clocking in means I am WILLING to accept an assignment, not that I have ALREADY accepted an unmanageable one, sight unseen! If I see that the census has me slated to take ten or more patients, I don't care WHAT the acuity is, I'm not even thinking about taking report until the supervisor has assured me that we have an additional nurse coming in. And when I see that additional nurse, and know what MY number will be, then fine.
Actually, I can't swear to it, but I don't know that even taking report is "accepting" an assignment: how can you legally be accepting responsibility for a patient load if you don't know what those patients are (what their acuity is, what their needs are)? Seems to me, if I'm taking report on nine patients and at the end of the assignment I see that it's not do-able for me, I should be able to tell charge nurse (who won't want to hear it) or call supervisor and say "not happening".
I'm tired of hearing "that's just how it is on this unit" and "So and So did 12 patients last week". Don't care. I know how many I can safely work with, and since So and So KNEW it wasn't safe for her to take that load but she was willing to do it because "everyone does it sometimes" (not because it was safe, mind you), then that's her license she's about to lose. Not mine.
That's why there's unsafe ratios. Nurses who allow the pressure tactics and bogus threats to force them to do the insane. Can't you just see the lawsuit bred out of a nurse being fired for NOT accepting an unsafe assignment? I can't, because I can't imagine the hospital that would open themselves up to that. They'd rather cow you into believing that you have no choice in the matter. Hogwash.

Obviously this can vary by which state you're in but, this is what the California BRN says about patient abandonment, just as an example:

http://www.rn.ca.gov/practice/pdf/npr-b-01.pdf

For patient abandonment to occur, the nurse must first accept the assignment thus, establishing a nurse-patient relationship. Then the nurse must severe the nurse-patient relationship without giving adequate notice to the supervisor so that nursing care can be provided by others. In my nursing program, we were taught that four hours is reasonable notice.

Not showing up for work or refusing the assignment is not considered patient abandonment. However, while you wouldn't be charged with patient abandonment, this doesn't necessarily prevent the employer from firing you (especially if you don't show up for work), which the BRN doesn't have jurisdiction over.

In my California nursing program, we were taught to do the following if we ran into an unsafe assignment. Give them the four hours notice to find somebody else or bring in help and, simultaneously ... file an incident report stating that the assignment is unsafe. This puts the liability on the hospital, not you, if something goes wrong.

This way ... you're protesting the assignment, protecting yourself and giving them adequate notice while simultaneously not giving them any cause to fire you.

Again, I don't know how this would work in other states, especially "at-will" states because in California, once you get past probation, you can't be fired without cause.

But this is what we were taught to avoid problems both with employment issues and the BRN.

:typing

Ariesbsn · Mar 5, 2007

I think the sad truth is we work short staffed because we are told we have to by management and our charge nurses. I work in an ICU and we were told by management that ICU can't refuse to take a patient just because we don't have the nurses to care for the patient. WOW, if that ain't a law suit waiting to happen, nothing is.

Saturday, as a prelude to telling people what their assignments were the person doing charge said "OK, here are your assignments and they suck. Don't ***** about it because there is nothing I can do." We were 3 nurses short and still got 2 admits.

Management frequently shoots us in the foot with their ideas. :confused: Twice in the 2 years I have been there, they have opened new sections or expanded existing sections and not had enough staff to cover the new additions when they started filling the beds.

Then there is the "rapid response nurse" position that they created. This is a nurse that any floor can call if they have a patient that is going bad, is acting different, or needs IV access. This nurse can follow protocol and either resolve the problem or get the pt to ICU if needed. They didn't hire any new nurses, they just assign one nurse from our barely adequate pool of ICU nurses as RR for the shift. Well 99% of the time, the RR sits on their butt and surfs the web. Saturday there were 2 calls for IV starts in 12 hours.

Management has also decided we will be responsible for stocking our own rooms and this includes refolding our linen to get it to fit in our closets, as well as emptying our own trash and dirty laundry.

I work nights and the latest thing to come to pass from management is that every Weds and Sunday, night shift has to change all the tubing, luer hubs, and IV site dressings. It doesn't matter if they are less than 24 hours old.

Oh yes, they are cutting our incentive pay for overtime as well as the shift differentials for working nights and weekends. So much for regular staff picking up when we are short.

As far as what the ANA states regarding patient abandonment, that is all fine and dandy. However, the state board sent out their publication with the comment that refusing to take an assignment could constitute abandonment and that we, as nurses, shouldn't work in institutions that require us to take unsafe patient assignments.

Nurse retention is another problem. The horizontal aggression in our facility is horrid so nurses frequently leave. When I started, I was one of 15 new ICU nurses. At the 6 month point, I was the only one of that group left. I have been chewed on enough by these nurses that I put in a request for a transfer to ED.

From what I hear, it is worse at other hospitals.

I talked with my husband about paying for a consultation with a nurse attorney so that when I have to refuse an extra patient or they float me to a unit with patients that I haven't been trained to take care of, I can say "On the advice of my attorney, I am going to decline that experience." I feel the need to do this because I had my manager, who was an ICU nurse 2 years ago, tell me that as long as my nursing actions were deemed "reasonable nursing actions" I wouldn't lose my license if something went wrong with one of my patients and they died due to my lack of experience. It may well cost me my job, but like another person said, I worked too hard to get my license to lose it.

Gennaver, MSN · Mar 5, 2007

Because there will always be harder shifts to get coverage for, and facilities are willing to pay more for those shifts than they are for easy to fill ones. At my facility, lots of nurses want day shift. They get a base rate of pay. Nights, however, require far more baiting, and therefore we get extra $$ per hour. Do I "put up with it"? No....I want and expect it! :)
Why do I want hourly pay (not salary) plus differentials? Because I want to be paid for every single minute I work, as I do now, and because I AM willing to work hard-to-fill shifts, I will take the extra cash, thank you. Definitely not "nickels and dimes" where I am!

Then give those working off shifts a higher salary to start with, not nickles and dimes or dollars for shift differential.

I think we are selling ourselves short, (then again I am not yet a nurse, merely been a tech working alongside nurses for 15+ some odd years).

edit: then again, I am very aware that my thoughts are not common and I respect yours...yet, I also want to see nurses as being seperate from the actual Hospitals as are the doctors. I would love to see hospitals trying to attract and reward nursing and nurses to have billing rights and so on...we are not vocational we are professional...

Gen

RNsRWe, ASN, RN · Mar 6, 2007

Then give those working off shifts a higher salary to start with, not nickles and dimes or dollars for shift differential.
I think we are selling ourselves short, (then again I am not yet a nurse, merely been a tech working alongside nurses for 15+ some odd years).
edit: then again, I am very aware that my thoughts are not common and I respect yours...yet, I also want to see nurses as being seperate from the actual Hospitals as are the doctors. I would love to see hospitals trying to attract and reward nursing and nurses to have billing rights and so on...we are not vocational we are professional...
Gen

I understand what you're saying, but maybe when you're in that situation (become a nurse and work as one) you might feel differently. Maybe not, I don't know.

Another thread, in the Poll forum I believe, asked whether nurses preferred salary to hourly pay. It was overwhelmingly hourly-preferred.

Thing is, I've had salaried positions that paid nicely. And in those positions, I ALWAYS worked far more hours than I was told I needed to upon hiring! And when one looked at the number of hours spent on the job versus the paycheck at the end of the week, one had to question if it was worth it. Ultimately, I decided it was not.

Hourly pay means I get paid for every minute not only when I work my regular shifts, but am eligible for some pretty tasty incentives when scheduling goes bad and I am called to come in extra shifts or extra hours per shift. If I were salaried, there'd be no incentives, period.

And don't imagine that everyone would simply be paid at the higher dollar amount off the bat, as you suggest: hospitals ARE a business, and basic business sense says you pay the going rate for the basic job and offer greater incentives (ie: CASH) when they need more from their employees than the employee is obligated to give. They would never in a million years start paying at the rate it would take to get hourly nurses to give up that incentive.

Salary is appropriate for some situations, but in an industry where demand far outweighs need, it doesn't make sense to even think about cutting off that financial advantage. Unless, of course, you're a hospital and think you can pay a LOW salary -- and competition would eliminate them very quickly from the running.

By the way, curious about something: upon graduation, you will newly be joining the army? Isn't that unusual at age 40? I thought they didn't even take that age...? Maybe I'm dating myself, LOL!