Why does Nursing put up with short staffing?

OC_An Khe · Jan 24, 2007

The long term culture of Nursing has been to be submissive to authority, both medical and administrative authorities. Those in authority have not been reticent to use this cultural aspect of nursing to their advantage. Thus the less then optimal working conditions in many patient care facilities and the low professional respect some MD's give to RNs. This submissive part of the nursing culture is slowly changing within nursing itself. Those that take advantage of this aspect of nursing culture are really fighting, delaying this change and trying at times to "de-profressionalize" nursing as an independent profession.

In many ways the nursing profession, being mainly female, still is being treated by many, as women in general, were treated by society as if we were still in the early 1900's. The societal changes that have given women a more equal place in society, over the last quarter of a century as a whole, have still not fully taken place within the nursing profession and by those that have control over nursing employment.

RNsRWe, ASN, RN · Jan 24, 2007

I'm still kinda new on my unit, but after having been "forced" a few times to take ten patients on med/surge on nights (trust me, a ridiculous number), I have now decided to refuse. Flat out.

Recently we had a super-surge in admissions and we were not only full, but over-full (stuffing beds into rooms slated for day-use only). And we were staffed for three nurses for 32 patients.

I told the oncoming charge I wouldn't do it. She said SHE wouldn't do it. The outgoing charge said "they've been trying to get someone all day", as if that made a bit of difference. Supervisor shrugged and said "don't have anyone".

Umm..ok. I told outgoing charge that I would just refuse the assignment, I would keep the half dozen patients that I had until the end of the shift, turn in my badge and then go home. She thought I was nuts, and claimed I would be charged with patient abandonment. Informed her that NOT accepting an unsafe load was NOT abandonment; how could I "abandon" patients not yet in my care?? And make no mistake: I would not jeapordize my license yet again by taking that kind of assignment (again). I'd quit first.

Well, long story short: a fourth nurse materialized as a float from another unit, miraculously. Hmmm. Sometimes when TPTB hear that you really, actually, honestly are going to walk out the door and REFUSE, perhaps that's what's needed. People say you can't change staffing, but sometimes I think you can change it for a bit, for when you need it most, by just standing by your guns.

We all had eight heavy patients apiece for that shift, and 1-2 techs. Not the easiest night, but manageable amongst all of us. And I didn't have to quit

anonymurse · Jan 24, 2007

i don't know what you mean by "allow it". if there's no one to work, there's no one to work.

nearly 1 out of 5 rns are not working as rns. conditions and pay are most commonly cited by these rns as reasons for leaving nursing.

imagine, if you will, if conditions and pay were satisfactory. then staffing levels would rise. outcomes would improve dramatically, but the cost of care per patient would rise.

if you can figure out how to make the government, insurance companies, and health care corporations happy with higher costs, why then you'll make us all happy.

but don't try to use better outcomes as a sales pitch. you think they don't already know the best way to improve patient outcomes? you already know their decision on that one.

muffie, RN · Jan 24, 2007

The issue comes up when after assisting on the units for 8 or even 4 hours my job is left undone and then I am behind in my work taking at times days to get caught up. And do I ever get a simple "thanks" from those I help? Nope!

thanks on their behalf

those poor nurses probably were focused on the 3000 things they had to do, couldn't eat/pee/breath if they wanted to, and probably stayed after work 1-2 hours catching up on charting etc.

tell me if i am wrong

tntrn, ASN, RN · Jan 24, 2007

We are currently in mediation for our contract negotiations. Staffing is perhaps the biggest issue, even bigger than pay. We have proposed a method by which each unit and the staff gets to assist is how the staffing is done. That is, have some input as to when to say enough is enough. Management is completely speechless when with that idea. Deer in the headlights.

Now in our hospital, the vacancies are not due to nurses who just call in sick to get the day off. They are vacancies that are posted right after the schedule goes out, in the hope that someone will pick them up. So that is poor staffing, poor hiring, poor retention.

Simply clocking in does not mean you have accepted an assignment. Until you get report, how do you know what your assignment will be or how heavy it is likely to be? At that point, you say, this is unsafe and I won't accept this assignment. We have forms to fill out and I recently stocked my unit, and several lockers full of them. It's a hospital wide problem where I work.

On the flip side, I took report at 3 pm yesterday from an RN and a resident, who'd gotten report from another nurse at 2:45. The two I got report from had not actually even seen or cared for the patients, but management was so hot to send someone home early, that's what they did. So essentially the report I got was hearsay. Talk about nickle and diming. The way I figure it they saved about $20 by sending the nurse home 30 minutes early. And maybe not that much.

ICU_floater · Jan 24, 2007

Unfortunately my experience is that we vote with our feet and leave because we're not empowered to become a part of the solution. Then we gripe, then we're exhausted, then we're disgruntled, then we leave. Saying stay in there and be part of the solution is NOT always feasible as our licenses sit with the flame under them waiting to spontaneously combust:roll

We all have war stories, but why don't we post more on how we solved the good ones? Success is what we need to hear more, not focus on the negatives which run prevalent.

We all work our orifices off, do the best we can when short... look inept, incompetent (still smiling) don't pee (get UTI's), don't take breaks... eat crappy food, give report and apologize profusely and show up the next day... until we leave.

I went into management because I knew what didn't work and I'd fix it... well surprise... 80 hr. weeks could not fix things...I'd work, come back and staff and the staff was STILL disgruntled because shortages and issues were not easily fixed, or fixed at all.

I learned that in management; I needed EVERYONE to not only point out what was bad, and not only offer solutions.... but pony up and join groups, become committed to solving their issues... and hang in there as it takes 6 months to change a single form, but by GOD hang in there and take on your personal issue and see it through.

this is not purely a management issue... we all have to find our own pet peeve or project and create change, no matter how the process stinks... along the way... log barriers in the process and let someone else, or you, sign on and fix that.... together in time we Can do quite a bit.

However, we will still be short, work our orifices off and this will happen. It's the facility that denies me the opportunity to become part of the resolution that I bail on them. The one that takes eternity but follows through I stick it out and try my hardest to not be negative, or keep it to a minimum.

And yep, this morning just signed on for the open visitation ICU committee- I can't trust management to gets things right (not meant negatively)... if I want it a certain way... MY way has to be in the process. and yep, I'm working short, with all new staff and I'm exhausted. Where I am.... has potential. The newbies see me fighting for them for change and I hope they'll join in at some point too. I don't know that we can expect more from ourselves....

but when someone complains, I sure do ask; "how would you fix it"... and suggest the route for them to follow that. If I'm irritated enough I just might remind them to be part of the solution, not the problem- then point the way.

TNNurse92 · Feb 6, 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

Margaretm · Feb 6, 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.

Hi,

It is about time we as nurses start looking at the core of the nursing issue and finally address the real issue of our profession, for that I salute you.

I think if you and or your institution are looking at the cause of the tolerance of "short staffing" this is a great begining to address the state of our profession indeed.

(1)

Nurses are as a whole inferior beings and act as such, statements like "I am only a nurse" tell the world what we think of ourselves. Have you ever heard a lawyer, doctor say "I am only a lawyer, doctor etc" We do not own our profession therfore we will continue to "be only." The truth is we as nurses are far superior to most other professionals, we imporivize, we cover for inefficient doctors, inept supervisors, yes work short staffed, advocate for patient's, keep abreast of the medical regime, keep abreast of our patient's needs and as they say the list goes on and on.

(2)

Most nurse do not advocate for themselves and short staffing is but a very small part of the state of our profession. However if we really deal with this issue it may be the crucial vehicle that finally gets us on the road to empowerment as true professionals.

(3)

Our beginings were humble "handmaiden if the physician" we agree, however we can if we give ourselves permission move beyond that label, it is time

(4)

There have been many strides to advance the practice of nursing over the years but it has only created division among us, for example NP programs.

NP are recognised as practitioners in their right but RN's remain perceivd as "lesser than."

(5)

Our profession has been put upon historically and we act like true survivors of a group that has been abused, used, disrespected, and submissive.

We attack each other, "eat our young" and generally forget where we came from once we have any role of empowerment.

The Solution

Empower all nurses

Who does this?

We do, we can and we will

Good luck

let me know how you succeed

GatorNurse84 · Feb 6, 2007

Where I work, we don't want to put up with short staffing. However, we have a staffing grid to follow. If we have a certain number of patients, we can have a certain number of nurses. Nurses have complained that the grid needs to be fixed bc it can leave us short and is not always safe to go by the grid. However, if the charge nurse doesn't go by the grid, she will definitely hear about it from management. There have been times where we've had more nurses than the grid says and we've kept them. We have to justify ourselves, but we can't get away with that all the time. I sure wish they would stop looking at the number of patients and think about the acuity (bc we do have a system where we classify the patients based on their needs to determine the acuity score).

Robshee · Feb 6, 2007

I have been a nurse for a total of 36 years, first as an LPN, (2years) now an RN. Many of us put up with short staffing because we do not want our patients to suffer by leaving. If I leave my unit and patients that is abandonment. If I leave nursing I let myself and my profession down. The shortage is bad enough. What can we do to encourage more people to enter nursing? Not by bad mouthing the job!I love being a nurse! The Administrators look at the bottom line and not the impact on the front line. We need to stick together and brainstorm on some ideas how we can handle the old do more with less.

sdmurfy · Feb 6, 2007

I am a traveling house supervisor and I don't believe that management deliberately short staffs any nursing unit. I have worked in states across the country and staffing is always an issue. I am currently working in California which has state required staffing levels. The hospital where I work has even done the state requirements one better and improved the state requirements, i.e. the state requires 4:1, the hospital staffs 3:1. At least that is the plan and it works out sometimes. But a lot of times it doesn't. I have personally made multiple calls to replace staff. One hospital where I worked had 25 registries and some nights I would call all 25 and get ONE nurse. Most shortages are caused by nurses - sick calls, absences, no shows, and of course, vacations. NOT saying nurses shouldn't call in sick or take vacations (I have no tolerance for no shows - and yes, it happens far too often) but it does stress sometimes limited resources. If you have 7 nurses for one shift and one is on vacation, you have six left. If possible, you get a nurse to cover that vacation shift. Then you have 3 of the 6 or 7 nurses call in sick, where are you supposed to get nurses to replace them? Please don't say call off duty nurses, I have and that is successful one out of 100 calls. Agencies? Told you I've called 25 to get 1 nurse. Oh, and don't forget the other 10 -20 units in the hospital who also had call-ins. Now give me the nurse who thinks staffing is inappropriate and leaves. The rest of the nurses, patients, and I are going to have a lovely night.

And, remember to blame the hospital for not hiring enough. Magic wands only work in fairy tales.

Sorry for being "testy". Just spent a weekend trying to cover for multiple call-ins and 2 no shows. Started with a bare minimum (hospital sent a lot of staff to do training for new computer system) and had 12 call-ins, 3 of the 6 scheduled for ICU and 2 of the 5 for L&D.

Another viewpoint from a very tired and frustrated house supervisor.

anniev · Feb 6, 2007

Lets see where I work at .. they want it all done the "right way" have mock surveys to prove that.. The numerous office staff crawl out of wood work to heip,,,only then and on a real survey. Get it done on your time and NO overtime! And you better be taking your lunch break,,,its your own fault if you can't manage your time any better then that! and don't complain if you didn't get a break either ,there will be decipinary measures taken! Oh yeah NO overtime! Make sure you write your orders, call the Dr, check the labs,pass the meds the right way ,30cc h2o flush before you bolus 5cc between each med(all 10 of them and the blood suger check and vitals) Oh my God! you touched the bed with your gloved hand ! quick wash and reglove its the policy here! I see you have fingernails...that is not allowed here. Did you chart on all your weekly charts.. all the therapies? the behaviors? MDS needs this or we don't get paid we don't get paid you won't get paid.You are not paying enough attention to your Stna's they are not doing everything the right way this is your responsability to make sure they do it all . by the way the Stna's are reporting you, you don't help them enough! It's about the money to management, I would love to get to spend time helping with hands on..know my co-workers better and do every thing by the book, and feel that managment supported me..that will never be.. I am crazy cause I still love being a nurse and taking the best that I can care of my residents even if I don't get a break and miss almost all my lunches..........The managment will make their $$$$$$$$$$$$. this is just a little part of how it feels to work the floor. Do you think someone wants to come in on their days off to this,, you heard no OT you will get sent home early if you have over 40 hours leaving your co-worker to finish by them self...I will not do it to them....I will work only my scheduled hours.

Everyone I work with feels the same. as long as the call off is through the week, they all fight about it but if no one will come in they make the office nurses take turns,, only because they are afraid state will come in but even then they only work the floor till 1000 and pull the treatment nurse to the floor, so then we have to add all the tx then....