Why does Nursing put up with short staffing? - page 8

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

  1. by   BBFRN
    Quote from bjlyst
    i'm not sure where you get your information. but, here's a reality for you. if you go to work and clock on, then turn around and leave, it is considered abandioning your patients. which is against the law. which means that you loose your job and probably your license, which in turn makes staffing even shorter.

    i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.

    not true- at least according to the ana, and most nurse practice acts.

    "patient abandonment is . . .
    a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others. refusal to accept an assignment (or a nurse-patient relationship) does not constitute patient abandonment."

    in other words, you have to get report on these patients first. it has been established that the nurse is not accepting the assignment by merely clocking in. this may, however constitute "job abandonment," which is quite different. don't let your superiors fool you into thinking the 2 are the same.
  2. by   BBFRN
    Quote from bjlyst

    i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.

    And I were you, I would refute this as well. Why is it abandonment for YOU to turn around and clock out, but not if THEY clock out and go home, leaving you with that patient load? I believe in some states (and this is true in my state) that nursing management can be held accountable if something happens to one of your patients if they leave the facility to be staffed like that. I would speak to your state BON about this.
  3. by   mystcnurse
    Quote from tencat
    So 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.
    That's what an agency nurse does. What if we were ALL agency nurses
  4. by   Indy
    For me the question is becoming less "why do I put up with short staffing" and more "how do I respond to this deliberate short staffing and still keep my job?"

    Basically my facility now says it's got budget problems. We were adequately staffed during the JCAHO thing. A couple of times we might have been said to be overstaffed. Hmph! I was one of the "extras" one night - just there to help out and I'll be danged if I didn't work my tootie off. There was a code and a ICU transfer, two separate highly acute cases, within the first hour. It took having an extra nurse there to recognize the very sick lady who was in respiratory failure, d/t the code having prettymuch scrambled the beginning of the shift.

    I know it's anecdotal... and maybe I'm just weird in that I can't go to work and not work, if not really hard, then at least steady through the shift. It's hard for me to sit still! I've charted standing up some nights.

    So after the JCAHO thing the flu season hit next. And we had nurses out left and right with cold, flu or that horrible GI bug. Yuck. So we were barely adequate, with higher acuity. No problem, we know why, so we worked hard and thought whew! sometime in january. Hah!

    Next up ... now we have the "budget cuts" deal going on. Can we catch a break and just have adequate staffing? WTH. I still haven't been able to calm down long enough to have a word with our DON or ADON yet; don't wanna barge in and issue ultimatums and show my arse. So for the last week I wasn't in the dungheap end of staffing and we had a good week. But I had to watch people I care about (fellow nurses) go in there and deal with ridiculous acuity, understaffed, and feel bad that I haven't spoken up on their behalf. On nights they have enough to cover, they are now low censusing someone to make it not quite enough.

    I don't mind taking a larger load when the hospital's full, everybody's sick, the ER has a 4 hour wait and people are vomiting all over the waiting room, etc. I'm not allergic to hard work, and I'll do what it takes to get a crisis under control. But for the love of pete, expecting people to work like that all the time is just plain heartless. And when you hire enough new grads, and train them, for night shift, and get 'em to the phase where they are comfortable enough to work it, then start calling off your experienced nurses so your new grads can come this close to a nervous breakdown, well that's not excusable.

    So my answer for right now, is I'm ******** but I'm not talking to management yet. And the facility is gonna wind up paying me overtime for 13+ hour shifts when I wind up being dumped on, and I think I'm due soon. I'm also thinking I'll keep a track of what's not safe that can be written up, such as meds more than an hour late, etc. and while I'm charting, at 8 am, I'll merrily sit there and write up all the variances too. You have to put a "recommendation to prevent it from happening" at the bottom: safe staffing levels.

    The rub though, is that after the flu season hit, our dayshift managed to keep their staffing at a level that is close to ICU levels. 5 nurses for 14 patients... God if I had that at night, the place would be spic n span in the morning! You might not need a housekeeper! Secretary? Nah, we're good thanks! We could have patients bathed before breakfast, backrubs done at night, etc. instead of passing on dirty, restrained, confused, lonely ole folks like we do sometimes. Anyhow. /rant off.
  5. by   LeahJet
    Quote from Rnandsoccermom
    Because people are more afraid of losing their job than they are of losing their license.

    You just said a mouthfull.
  6. by   moodychick
    I agree with most of what all of you have said. I, too, work in an ER that is short staffed all the time. (except when JACHO comes!) The acquity is very bad these days and you never get lunch or a potty break! But, how do we attract nurses these days? More pay, more incentives? If we get more pay, the CEO's will want more pay!!! At our facility, the CEO gets a new car every year and the hospital pays for his rather large eloquent home!!! Not much left to trickle down to the help!!! I have refused to take more than what is safely designated as a nurseatient ratio; but, other staff get upset with me! I have no answers. I just know that management is so ineffective. The whole place is unsafe!!!
  7. by   piper_for_hire
    The CEOs will want more pay regardless of whether or not nursing gets more pay or not. Not sure how that factors into anything. Attracting more nurses is a trivial matter - all you need to do is pay better and they will come. This is true of any profession.

  8. by   Rnandsoccermom
    Another thing to remember is that the nursing dept. is the largest part of a hospitals budget. That's why they go after us first. Nickel and dime their budgets to death.

    It never includes them (administration). Many places give them bonuses for for their performance as well. When the going gets rough all they care about are their jobs and bonuses.

    We don't walk because are very easily manipulated by the "you can't leave the patients without a nurse" mentality. Firemen and policemen walk when they have to, to get what they need. Emotions are left out of it, women let guilt eat them alive. Male dominated professions don't give in when it comes to money. And there's your answer as to why the hospital admin. won't give in either-male dominated. Nothing against men, just the way it is.
  9. by   interleukin
  10. by   Cynjon
    The nursing shortage is just one symptom of a much larger health care problem.

    Several years ago I worked as a house supervisor. I learned a few interesting things.

    The county I was in had 5 hospitals. Reported profits ranged from negative 6% to 15%.

    Each hospital paid JACHO around 24 thousand dollars to survey them on the same things that the state and Medicare surveyed them on. How much preventive care could be provided for this money?

    One hospital closed due to inability to pay its bills. The bankruptcy papers reported over 30 million in debt.

    Drs admit patients and order additional tests to cover their backsides. They are afraid of being sued.

    Families insist that "everything" be done for the terminal patient. I've always wondered how insistent they would be if they had to pay 10% of the costs after the patients are diagnosed as terminal? Except for hospice care, of course.

    Every baby must be born perfect or someone has to PAY!

    Families insist that Granny be admitted, though Granny isn't any sicker but the family wants/needs a break and can't/won't spend the money for private care or can't find safe reliable care.

    No one has pay for the error of his or her ways. Alcoholics receive liver transplants, smokers get lung transplants and the overweight, high cholesterol, and non-exercising heart failure patients get a heart transplants.

    The hospitals in the county footed the bill for an extra 60 nursing students per semester at the local colleges. They could only accept 30 due to a shortage of instructors.

    Patients use the ED as their primary care provider because they don't have insurance or have inadequate coverage. Guess who pays? Each hospital in my county reported providing approx 5 million dollars a year in un-reimbursed or charitable care.

    Drinking and driving.....need I say more?

    Nurses are getting older, average age 45. Schools aren't turning them out as fast as we retire.

    Women have more career options. We are no longer limited to teaching, nursing and secretarial work.

    As a society we expect that all of our ailments, even those that are self-inflicted be treated and cured at whatever cost necessary. Do you think that if we had to foot more of the bill we might take better care of ourselves?

    You will notice that none of the above has anything to do with hospitals trying to save money.

    Our healthcare system has serious problems. We need to figure out solutions before there is no one to care for us when we are in need.

    We need to recruit more young people into nursing and figure out who will teach them

    We need to figure out a way to hold healthcare workers accountable for negligence and malpractice without having to resort to a legal system that continues to drive up costs without making our systems any safer.

    We need to figure a way to provide basic preventive care and treatment of minor or chronic problems in order to decrease hospitalizations.

    We need to be involved in addressing these problems or the nursing shortage is not only going to get worse, it may be the least of our problems.
  11. by   ZootRN

    We need to recruit more young people into nursing and figure out who will teach them

    I don't know how about recruiting more young people. The problem is to make them stay.
  12. by   tomtom101
    Dear Tazzi ,

    Where ever that prayer came from ,I have to tell you it is hilarious ! Surely someone will whine about it- ( "Statistics show that 15% of domestic abuse victims are men,and many more don't admit to it,whah whah,etc." ) .Tough ---- for them. Jonathan Winters got it right with something like,more than nuclear arms ,plague or anything else ,what frightens him is a person w/o a sense of humor.
    My wife doesn't read allnurses , so maybe I'll just quote the 1st sentence to her ,though. HA HA HA HA HA HA HA ! !

    God bless You for a Much needed chuckle.

    Happy St. Valentine's Day !

    But only my Wife gets a V Day card--if I can find it among all these Binder&Binder papers.

    Sincerely , and freezing in 4 Corners,

  13. by   Calgon-take.me.away
    okay,,let's take last night for example. Here in PA we have a major snow/ice/sleet/whatever else it can think of storm. We started out with one CNA for the facility. Granted it is a very small (70) bed LTC, but with 2 LPN, 1 RN 1CNA,,not doable or most importantly safe. Roads were terrible, people trying to get there, DON downstairs in her office, Admin in her office, they all left at 3 and okay,,,where we to go for this.
    The "dress up nurses" need to come out of their office, don a set of scrubs and get in there and HELP. Not just deligate, but get some gloves, and get into the thick of things. We did make it thru the night, meals in rooms, ect, but thank goodness no falls or crash and burns. Had some people eventually make it in. But,,,we all pulled together and kept them safe, warm, fed, and clean.