Why does Nursing put up with short staffing? - page 5
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 24, '07Occupation: RN Specialty: 34 year(s) of experience in L & D; Postpartum ; From: US ; Joined: Nov '99; Posts: 9,721; Likes: 11,860We 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.
Jan 24, '07Joined: Jul '05; Posts: 66; Likes: 13Unfortunately 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 arses 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 arses 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.
Feb 6, '07Joined: Dec '06; Posts: 33; Likes: 19I 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.
Feb 6, '07Joined: Aug '06; Posts: 5Quote from elfinMHi,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.
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.
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.
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.
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
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."
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.
Empower all nurses
Who does this?
We do, we can and we will
let me know how you succeed
Feb 6, '07Occupation: RN Specialty: Bone Marrow Transplant ; Joined: Jan '06; Posts: 8Where 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).
Feb 6, '07Joined: Sep '06; Posts: 1I 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.
Feb 6, '07Occupation: travel RN Joined: Oct '04; Posts: 2I 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.
Feb 6, '07Occupation: WORKING 7-3 AFTER 12 YEARS ON 3-11 NOT REALLY LOVIN IT Joined: Dec '05; Posts: 81; Likes: 7Lets 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....
Feb 6, '07Joined: Jul '03; Posts: 2,937; Likes: 2,388Quote from sdmurfyWhy not hire more nurses? Is it because of budget constraints or because there aren't enough qualified applicants to fill empty positions? Some other reason? I'm seriously curious here, because otherwise the assumption is that surely money could be found SOMEWHERE if more nurses were a priority (eg if it's a for-profit hospital that's making money or has several very highly paid administrators with very generous benefits packages). Or perhaps that poor working conditions or non-competitive wages might be keeping nurses from applying to a particular facility.And, remember to blame the hospital for not hiring enough. Magic wands only work in fairy tales.
More likely, the people who complain about unresponsive management DO work with unresponsive management and house supervisors who complain about staff nurses who don't appreciate how difficult it is to staff a facility 24-7 given call outs, vacations, shortages, etc probably DO deserve more appreciation from their staff. We're generally not addressing the people who are reading these boards even if they are in a similar role. We can educate each other about our perspectives and experiences without discrediting others' perspectives and experiences.
Feb 6, '07Occupation: Student nurse Joined: Feb '07; Posts: 20; Likes: 6Over here the main problem is the lack of funding to fill the jobs, the NHS has put freezes on the jobs so while working for a pittance the current nurses have loads of work! At the same time the consultants are on well over a hundred thousand..its terrible really!
Feb 6, '07Occupation: LPN Specialty: 1 year(s) of experience in Geriatrics/Family Practice ; Joined: Jan '06; Posts: 500; Likes: 333Today I worked in a LTC facility. Originally I was supposed to have 20 Medicare patients. That in itself is time consuming considering charting, doing vitals, dressing changes, blood sugars, and the unexpected fall first thing in the morning. Well then the DON comes up to me and tells me the nurse who is doing the stable non-Medicare patients with no charting is leaving after morning med pass. First of all I have never passed meds to these patients and secondly how can I take an additional 37 patients on top of my 20 Medicare residents? Well needless to say I muddled through and did my very best. But ultimately who would get into trouble if something went wrong, or if something wasn't charted on or who knows what else? Now to top it off I had to send a resident out to ER because he developed a rash from head to toe and when I asked him to take a deep breath in and blow out he said he felt like he couldn't get air in. So of course I'm sitting here now wondering if I did anything to contribute to this rash. Even though I double check my meds before I give them I couldn't tell you for sure that I didn't make a mistake, especially with that many residents. I've been on the floor by myself for 3 weeks and graduated in June. He's not on any antibiotics or any new meds, so I'm stumped. Also the CNA told me she noticed that rash developing a couple of hours earlier but forgot to tell me. I would think if it was anaphylaxis it would of happened alot quicker. Oh well, welcome to the wonderful world of nursing and working short staffed. I don't actually know how long I'll tolerate it before I get scared and quit. But since I am a LPN my options are very limited here in Illinois.
Feb 6, '07Occupation: Critical Care RN Specialty: 14 year(s) of experience in Mixed Level-1 ICU ; From: US ; Joined: Jan '07; Posts: 404; Likes: 1,984"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."
Yes, I do blame the hospital!
Who else sets the standards of care?
Who else sets the salaries? Who else keeps loading more and more work on the laps of the nurses and expect it all to be done in the same period of time and with the same degree of precision, compassion and public-relations worthy dedication?
Watch a hospital provide a truly superior salary and watch the nurses come out of the woodwork. And then have management set the rules...too many illegitimate no shows and you're gone. Too many "sick days" , say goodbye to your salary, they'll be someone waiting in the wings.
Truly pay them for their responsibilities...and they will come.
Provide behavioral parameters..and they will abide.
Allow them the time to practice like they were taught in nursing school--and they will never leave.
But, as long as it's getting done, those steering the ship have no incentive to change things. Until there is a universal hospital acuity tool that will unequivocally show the dollars wasted when over-worked nurses allow the infection rates to increase and AHA standards to be ignored--resulting in extended hospital stays--we are destined to be left re-arranging the deck chairs on the you-know-what.
Feb 6, '07Joined: Nov '04; Posts: 18; Likes: 20One of my favorite sayings is: "What gets done (and how fast) is directly related to who is being inconvenienced."
It's NURSES who are being inconvenienced ... inconvenience a "higher up" and watch how fast things change....