Guidance on Staffing Models Please

[Clever_Alias]

Long-time lurker, first time reader. I have worked almost a year on a busy cardiology unit., and am still unfamiliar with many things that don't involve bedside nursing.

A consulting company was brought in last fall and implemented a new master staffing plan. The said plan has been a disaster, and patient safety is severely compromised. We have a unit-based council that has tried every approach we can think of, the most obvious being combining our two 15 beds units into a single 30 bed unit, and cross-training our unit secretaries as techs. Frankly,everything we have tried to do to improve patient care has just made matters worse. Physicians are angry because because the nurses station is empty when they round, nurses are fried and getting sick. Many are leaving in droves and physicians openly say they would not want to be treated here.

Two of our nurses met with our CEO last week to discuss the issue, and he asked why they thought the model was not working for us when it has worked for other facilities. We believe the high acuity of our patients is a contributing factor: it is not uncommon to have an assignment of 4 patients, two on cardiac drips, one post cath, and one who is a confused patient who is on Lasix and also a fall risk. And some days we will take a fifth patient as well.

Our CEO noted we seem more like a step-down type unit than a med-surg unit, and the model is based on typical med-surg patients. Several of us are wondering what places who successfully use this model are doing we aren't. The problem becomes finding information on this, a report, essay, journal article, anything to find out how floors similar to ours are run safely. Can anyone give me guidance on where to start looking? Or how units with similarly complex patients are staffed? We feel an assignment like the one described above is overwhelming especially as we also now function as unit secretaries, squeezing in faxes, answering to phone, putting toner in the copy machine while trying to assess, medicate, educate, and chart on our patients. Are we unreasonable in feeling that way? Is this the norm?

Any suggestions would be welcome. We are planning to brainstorm more ideas, but would like to avoid re-inventing the wheel if possible.

Any cluelessness is merely a by-product of being a new grad, and I have plenty of ketchup of anyone feels like taking a taste of a tender young RN. Please leave the fingers, I need them them to chart. (A joke actually, never been so much as nibbled by my co-workers. Or maybe I just was too busy trying to do my job to notice.)

Thanks again.

[jadelpn, LPN, EMT-B]

Hire CNAs, let the unit secretaries do their jobs. Hire per diem 1:1 sitters for the fall risks. Hire as many per diem, part time, weekend only nurses as you can. And don't forget the LPN! They can be instrumental as well.

Try team nursing for the less critical, and for the critical cardiac drips--1 RN to 2 patients seems about right.

[Libby1987]

I'm skeptical that this model is actually working as well at the other facilities as they are leading you to believe.

[ponymom]

You nurses and your unit-based council need to just go to that CEO and repeat the following:

"For Christ's sake Mr. CEO, we don't need no stinking consulting company, what a waste of time and money when the answer IS. SO. OBVIOUS. Look, can you not see how rediculous it is to train the secretaries as techs, and then have the nurses function as secretaries" (really, that whole situation is soooo laughable if not downright sad) "lt ain't workin Mr. CEO, just look at these docs that are pissed because there is no one to round with them, secretaries who should stay behind their desks and the overworked nurses putting toner in the damn copier. Seriously, would you really want your own mother treated here? Why don't you just freaking hire some more people!? I mean Good God...! We are even having trouble finding information on how this so-called 'model' works because (wait for it...) THERE ISN'T ANY."

Of course we all know this is not likely to happen as nursing doesn't really seem to do itself any favors, but this is truly what needs to be done.

Good luck with whatever happens.

[Clever_Alias]

Thanks to all for the input. I'm going to try to get traction for the team nursing approach. We are supposedly hiring a new tech for days and a couple of RNs, but that doesn't solve what is now a staffing crisis. In an effort to save money, each day doesn't have enough slots when we sign up to allow to the unit to be staffed if our census is full. So we then send out the SOS begging people to come in at call rates, which makes no sense to me. If you want to save money, why pay people time and a half? But I'm new and perhaps there's a logic I don't see. I'd rather not think it's just epidemic of stupidity, but that is my first impression.

I would like to just meet with the CEO and say "Seriously? I've seen junior high concession stands that were better run." He reportedly said he would look into maybe staffing us more as a step-down type unit, but would have to look at the numbers. Under this system, step-down units get more bodies.

At least my first year is almost up and I too can start filling out applications.

Thanks again.

[whichone'spink, BSN, RN]

This is why we need laws to set minimum staffing ratios. If we leave it up to individual companies whose sole intent is to make a profit, of course they'll cut whatever is a drain on their bottom line, which we are.

[Jules A, MSN]

This is why we need laws to set minimum staffing ratios. If we leave it up to individual companies whose sole intent is to make a profit of course they'll cut whatever is a drain on their bottom line, which we are.[/quote']

Nurses who are willing to continue working under these unsafe conditions don't do themselves or nursing in general any favors either.