Why does Nursing put up with short staffing? - page 2
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... Read More
Jan 23, '07Occupation: RN Joined: Nov '03; Posts: 4,389; Likes: 153Quote from TazziRNSo I'm supposed to risk my license by taking a dangerous assignment on behalf of management and other nurses? That is ridiculous.I understand your feelings but how does this help the short-staffing problem? This would make it even more dangerous for the few nurses who are already working that shift.
Short staffiing is not a legal defense if you accept the assignment and something goes wrong so ... it's ridiculous to expect anyone to put their license on the line like that. Sorry, but I've worked too hard for that license to jeopardize it.
California's ratio law has proven that hospitals can staff properly when they have to. If they don't want to staff properly and, therefore, increase your liability risk then, you pretty much have to walk to protect yourself.
:typingLast edit by Sheri257 on Jan 23, '07
Jan 23, '07Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415I tolerate some short staffing issues on the basic principle that I am there to help patients, and I will do the best I can in given situations. However, I can only do what I can do safely based on my skills and experience...and I do NOT go beyond that! If I need to simply get more help, I ask...and typically I can get that...if it is impossible..I say so!
BUT...I will only do that for a time...I am flexible, but there is a limit! People seem to know that about me thank goodness! I stick in there very well when things get rough, but only for so long...then I get down right logical and very much patient and staff advocated! Fine..a few days of overflow...okay..but more than that...not going to happen beyond what I can physically and mentally handle safely!
When things get too far (well actually shy of 'too far' because complaining at the point of too far isn't listened to at all!), I speak up and say what I feel. Luckily I am smart enough to know there are a few people in a facilty you should know...mine currently is hospital. Your Supervisors, your pharm, your kitchen! The supers are the ones I hit on this one and I tell them frankly...."trouble is brewing, stop it now before it gets too big!".
Thankfully I have a nice disposition and people generally hear what I have to say (A gift I say!). They listen! And while we do have short staffed days...the admin really tries hard to not have that happen...and understand if staff (not just nursing) all the sudden get "ill" after too long! Go figure, you can only run on 1/4 a tank going 60 miles per hour for so long before you come to a sudden stop!
This is a real threat lately...for some reason our small community hospital is seeing record numbers....too many for the nursing staff, MD staff, and rooms!!!!!!!! Probelm is...you can't turn away any pt in the ER..and some need admit! We are actually getting what I typically called "stripped!" (as in a screw that has been screwed in so tight that is strips instead of doing any good). IN fact tonight they had to open up a wing that is going through construction just to accomidate the flow...and nurses? I don't know where they pulled them out of..but minimum coverage...and hard work BIG TIME!
Now this we can allow from time to time..but give it a week and you won't have any RN's left on the schedule due to illness!!!!!!!!!! Thankfully my company knows that...and is really honestly trying..and all staff is aware and is thanked for it in many ways (from free food, to pizza or dinner being catered in, discounts to stores, free massages, free nights at the coast in a nice hotel...and so on!).
So basically...I work in a great hospital, and I appreciate the administration very much..and in return I expect my limitations to be respected...and so far excellent! Yeah, sometimes I have to pull far more than I want...but the thing is...is it mandatory...or just helping out when times get rough? Thankfully for me...it is when times get rough!
Jan 23, '07Joined: Jun '05; Posts: 1,745; Likes: 2,511The answer to this question is in the book "Nursing Against the Odds" by Suzanne Gordon. I have just finished reading this book and Gordon has done lengthy, in depth research into the staffing issue and discusses the many angles and issues. If you seriously want to know the answer then get this book and read it.
By the way, it is ultimately very depressing and has actually changed my outlook and the way I practice. I do of course always put pt and staff safety first. Gordon has researched nursing and hospitals for many years and is an easy read, very enlightening.
In spite of how sad the situation is, I am still glad I am a nurse
Jan 23, '07Joined: Oct '00; Posts: 8,790; Likes: 8,616The nursing shortage stems from the fact that many of us can't or won't work in the hospital environment today. There are lots of nurses, but what is it, only 2/3 are actually working as nurses? So they don't put up with it, they walk away. Admin uses the nursing shortage as an excuse, and where there are enough nurses they threaten to fire or replace staff if they stand up for safe care.
On a smaller scale, if you come in to a poorly staffed shift you are assured that this is a one time thing, and they really need you to just get through the shift, and if you leave patients and your fellow workers will suffer (all true). Only a grinch would walk out on that, and lots of nurses know they cannot be replaced if they are ill so they come in sick. But then...you make it through a few shifts short why wouldn't TPTB try to decrease staffing and maximize their profit?
Maybe we could manage to work straight out if people and their needs were predictable, but when one crisis sends your workday into a tailspin it's easy to burn out, become jaded and dread coming to work. I can find a crappy job I hate in lots of places, with a quarter of the responsibility, and no one dies.
Jan 23, '07Joined: Apr '06; Posts: 356; Likes: 644I don't understand why the "White Coat Nurses" are not asked to work when we are short staffed. We have lots of RN's who never touch a patient and have fancy titles. QA, ID, NM, IV, CI (you get the point). When I am told the supervisor called "everyone" and no one can come in I question it. I ask about these licensed professionals and if they were called in to work. All I get is a blank stare. Why can't these nurses help out in a crunch? Are they too good to do bedside care?
And what about agency nurses, just a phone call away. Used sparingly at best. Why? Dollars and cents!
If the OP wants to know why we tolerate working short staffed it is for fear of losing our licenses to abandonment.
Jan 23, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003I have a decent manager. She comes in early, before night shift leaves, and looks to see how we did. It's a struggle some mornings to have good things to say! Some nights are horrendous and I think she does understand that we have to vent, and when she shows up, it looks like a good time to voice some frustration.
I try to separate the issues when I do complain. Equipment, staffing, or acuity, or perhaps just some drama-making visitors? What one thing contributed most to the urge to run out of there screaming? If it's staffing, I don't hesitate to say so. Four or five months ago I had a series of nights staffed so badly that after 3 nights I left on the verge of tears and told the NM that the staffing wasn't doable. It's doubtful I even made any sense; you know sometimes you get so tired and stressed that what comes out is gibberish but what you mean is HELP! We had a repeat of that situation on one particular night, with the bad staffing, the high acuity, the late rounding doc who wrote orders on half the unit, no secretary, etc ad nauseum. I told my NM that I couldn't come back to that staffing, knowing I was due back the next night. I got better staffed the next night and it was still busy as all heck, but it was a great feeling to know I got what I asked for.
Problem I have is, why should things get to a point where the nurse is ready to leave for things to change? We have a lot of things in our unit and our facility that seem to be good for retention; yet every year we recruit a half dozen or so new grads and lose a few of 'em within their first year. I'm on the fence as to what the issues are. There are some with unrealistic expectations, some who didn't want to be in telemetry but took the first job offer, some who can't seem to do the job no matter what (those are rare but it happens), some who get overly caught up in "shift wars" type drama and decide to leave. I just think that staffing plays a part in escalating whatever other problems people have with work; however, if people don't stick around the staffing is not going to get better!
There's no point to this rant... I don't really have a solution.
Jan 23, '07Occupation: RN - staff nurse in "the trenches" Specialty: 3 year(s) of experience in Med/Surg; Psych; Tele ; Joined: Aug '04; Posts: 397; Likes: 264Well, another point to look at is, what is the charge nurse doing on your unit. I say this because on some units at my hospital, the charge nurses are frequently expected to take patients if the staff is short. However, on my unit, the charge nurse really does not do this. But the day charge nurse is indispensible. She is always asking if you are ok and making herself available to help, especially if you have not had time to get away for lunch. One really nice thing the eve charge nurse does is our admissions - very nice! I bring all of this up because when I was orienting to this unit last June, a senior staff nurse told me that the staff was not supposed to have more than 6 patients on days and that the charge nurse has to start taking patients if the census/staff ratio starts to go beyond that.
I did get a little perturbed the other weekend when I worked as the designated weekend charge nurse was not there and had one of the senior staff nurses doing charge. Well, the nurses ended up with 7 patients and she did not take any patients. Some of my fellow nurses were really griping about that and I was right along there with them.
So, I think that part of the answer could be in units sticking to set guidelines as mentioned above in paragraph #1. I also like what another person said about recruiting the other nurses who are hired there for some reason other than bedside nursing, if it gets too bad.
The worse thing I've experienced at my hospital is having to float to one of those short-staffed units from 7-3, only to have to come back to my unit and start all over with brand new patients from 3-7 - now that is aweful!!!
Jan 23, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003On my unit, it's rare that dayshift is staffed well enough for the charge nurse to not take patients, but it can happen. On nights the charge takes a load right along with the rest of 'em. That's the reason I count my 3 nights a week as valid exercise time, and don't feel I need to join a gym! I run my bootie off! There are units in our facility that use the traditional charge role, but ours doesn't. Add to that I typically will assign myself a patient if I know from report or experience that they're gonna take up all my time regardless of who their nurse is. (That is, if I think they're really heavy or they have giant road signs pointing to a crash.)
Doing charge without patients would be ... really odd. But it sounds almost nice.
Jan 23, '07Occupation: returned nurse Joined: Nov '98; Posts: 7,097; Likes: 5,237Please don't try to switch the blame for short staffing from the managment to the staff nurse. Over the years I have witnessed managment use many techniques to deal with nurses who protest short staffing and it is not pleasant. Managment uses threat of firing to actual firings as well as going to BON with trumped up charges. Also more subtle methods are used like appealing to nurses team spirit or making it be known that persons who do not have team spirit will not be considered for promotion or desk jobs. It is nasty out their and nurses need advocates not more people to add to their burdens. By the way it has been pointed out that the great nursing shortage of the last 10 years is nothing more than nurses talking with their feet. I left my last job when I was talked living with a temporary reduction from 6 nurses to 5. When I realized the temporary staff reduction was actually permanant and sometimes we would be working with 4 nurses I protested loudly which resulted in me being asked to resign. THAT IS NOT THE FIRST TIME I GOT IN TROUBLE FOR PROTESTING BAD STAFFING. So don't come around here asking me why nurses put up with bad staffing.
Jan 23, '07Occupation: RN- TELE Specialty: Adult Tele ; Joined: Jul '06; Posts: 20; Likes: 11Thank you everyone for your input. It seems everyone knows the problem, but what do we have to do as a whole to make the change. Granted an individual nurse trying to take on management is a sitting duck. Doctors have managed to united themselves, without unions, as a profession to gain respect from the hospitals. How can we take that model and apply it to our own profession, and are more nurses ready to do that than not?
Jan 23, '07Joined: Nov '06; Posts: 8wow reading all of these posts makes me think that I have it pretty good. I work in Minnesota and the hospital that I work at has a 4:1 ratio on days and evenings and a 6:1 ratio on nights. It would be crazy to think of taking up to 7 patients during the day. It's busy enought with 4 as it is.
Jan 23, '07Occupation: FNP Specialty: 15 year(s) of experience ; From: US ; Joined: Jun '04; Posts: 1,834; Likes: 263Quote from elfinMDoctors are not hospital employees. In order to apply their model to our profession without unions, we would need to separate from the hospitals and work as consultants/independent contractors rather than employees.Thank you everyone for your input. It seems everyone knows the problem, but what do we have to do as a whole to make the change. Granted an individual nurse trying to take on management is a sitting duck. Doctors have managed to united themselves, without unions, as a profession to gain respect from the hospitals. How can we take that model and apply it to our own profession, and are more nurses ready to do that than not?
Jan 23, '07Joined: May '05; Posts: 1,591; Likes: 2,159Quote from RN4NICUSo why don't we do that? It seems that everyone in the realm of direct medical care IS an independent contractor except nurses and CNAs. How come we can't all become independent and bill for our services the way others do? Just wondering. I guess that's a topic for another thread.Doctors are not hospital employees. In order to apply their model to our profession without unions, we would need to separate from the hospitals and work as consultants/independent contractors rather than employees.Last edit by tencat on Jan 23, '07 : Reason: Veering off topic