Help- DON lies and cuts staffing

[Nurse Beth, MSN]

Dear Nurse Beth,

I am an RN at a long term care facility. At the facility we have been experiencing deliberate understaffing. I learned that the ADON has been talking constantly to the administrator and encouraging her to cut back staffing on the sub acute unit. Which is very dangerous. Patients are already suffering because of it.

She lies and tells her we sit around doing nothing, when we don't even have time to take breaks most times. What is the best way to go out handling this situation? I spoke with DON and administrator but it they won't listen. What else can be done? Need advice please!

Dear Needs Advice,

Long term care facilities are notorious for inadequate staffing and overly heavy workloads. Not only does reducing RN coverage endanger patients, but it creates moral distress for nurses. Unfortunately, there is little to no regulation in terms of nurse-patient ratios in long term care.

Overly heavy workloads can result in nurses taking shortcuts, and documenting care that wasn't given in order to keep their jobs. This work environment messages that paper work is more important than patient care. The appearance of providing care is more important than providing care. With nurses stretched to their limit, there are bound to be more patient falls, CAUTIs, and medication errors.

In your case, the ADON herself is influencing the administrator to cut staffing. It's one thing for administrators to cut staffing, but it's reprehensible for a nurse (ADON) to be the one responsible for cutting staff. Where is her conscience?

For her to go so far as to lie and say that the nurses are sitting around doing nothing means she is somehow strongly motivated.

She may be seeking favor or hoping to gain in some way by these misrepresentations.

You have already spoken to both the DON and the administrator and they have turned a deaf ear. That means they are not going to provide safe staffing based on the feedback of you, a staff RN. They do not welcome or respect your input.

Do you really want to keep working there?  If anything happens, such as a sentinel event involving patient harm, do you think either one of them will stick up for you?

I hope you are able to get out of this situation before something bad happens. In the meantime, keep notes for yourself such as "requested additional staff, refused" and "unable to change all dressings due to short staffing, supervisor notified", or whatever it is you were not able to do. Also document when you do not get a break.

Best wishes,

Nurse Beth