Help! My staffing ratios are aweful

BETSRN · Feb 12, 2005

Hello all-
This is my first posting and I'm hoping this site might be helpful. I am a relatively new nurse manager promoted from within (I used to be an LDRP nurse on my floor). I absolutely love my unit and only took the job because I thought I could make a difference. However, about a year ago we had massive budget cuts and we lost our acuity system. We now staff like a med/surg unit where the number of nurses we are "allowed" is based on the number of patients present at 0500 and 1700. Many of my nurses have given it their all, but are burnt out and overworked. They are taking upwards of 6-7 mother baby couplets regularly, 3-4 high risk monitored patients, and 2-3 labor patients. Insulin gtts, Mag, high risk doesn't even come into play when making their assignments because with our patient population, almost all are high risk. I know for a fact that our current staffing patterns do not fall within AWHONN guidelines, but have been speaking on deaf ears when it comes to administration. I am now starting to have a mass exodus (I can count 8 people that have left in the last 6 weeks). It just makes me sick because I love this unit and I love the people I serve. Not to mention, all the people leaving just ends up making my ratios worse for those who are choosing to stay and stick it out. The average staff nurse doesn't know how hard I am fighting, and quite frankly I'm ready to give up all together . Nursing admin keeps saying "benchmark" what other hospitals do (which I have done before), but no changes have ever come to fruition.
I'm wondering if any of you can give me feedback as to whether or not you staff with 'core staffing', use an acuity system, what your ratios are etc etc. Please help.

We are an LDRP and we keep within the AWHONN guidelines. We do 1:1 in labor and usually have no more than4;1 M/B. WE also have clean GYN's at times and our triage varies in numbers.

Your sitaution sounds very unfortunate and I can see why you are unhappy! VERY unsafe! It sounds as if your unit is bigger than ours.

Have you taken a trip down to see your risk manager as yet? I'd go from that tactic. Also, how are your patient satisfaction surveys? As much a you love your unit, maybe it is tim to take your skills and go elsewhere!

Jolie, BSN · Feb 12, 2005

I agree with Bets. If risk management can't or won't help you, then you are probably not going to be able to change things.

Remember that in healthcare, s**t truly does run uphill. Meaning that you are legally responsible for what happens on your unit 24/7, even if you are not present. If you believe that potential liability is becoming an issue (and clearly it is), then it is time to do what is necessary to protect your license. You clearly care tremendously about your staff and patients, but you will be of no good to any of them if you have to spend your time and efforts to defend yourself and your license when some forseeable train wreck occurs on your unit.

You are in the un-enviable position of having responsibility for the operations of your unit, but not having the authority to do what is necessary to ensure quality healthcare. I was in a similar position as a manager of a NICU, and chose to step down before something came up to bite me in the butt. I liked the hospital and continued to work there as a staff RN, but made it clear in my resignation letter that I would no longer be responsible for the actions of anyone other than myself, as the administration had made it legally inadvisable for me to do so.

Good luck!

babyktchr, BSN, RN · Feb 16, 2005

Hello all-
This is my first posting and I'm hoping this site might be helpful. I am a relatively new nurse manager promoted from within (I used to be an LDRP nurse on my floor). I absolutely love my unit and only took the job because I thought I could make a difference. However, about a year ago we had massive budget cuts and we lost our acuity system. We now staff like a med/surg unit where the number of nurses we are "allowed" is based on the number of patients present at 0500 and 1700. Many of my nurses have given it their all, but are burnt out and overworked. They are taking upwards of 6-7 mother baby couplets regularly, 3-4 high risk monitored patients, and 2-3 labor patients. Insulin gtts, Mag, high risk doesn't even come into play when making their assignments because with our patient population, almost all are high risk. I know for a fact that our current staffing patterns do not fall within AWHONN guidelines, but have been speaking on deaf ears when it comes to administration. I am now starting to have a mass exodus (I can count 8 people that have left in the last 6 weeks). It just makes me sick because I love this unit and I love the people I serve. Not to mention, all the people leaving just ends up making my ratios worse for those who are choosing to stay and stick it out. The average staff nurse doesn't know how hard I am fighting, and quite frankly I'm ready to give up all together . Nursing admin keeps saying "benchmark" what other hospitals do (which I have done before), but no changes have ever come to fruition.
I'm wondering if any of you can give me feedback as to whether or not you staff with 'core staffing', use an acuity system, what your ratios are etc etc. Please help.

This is my first reply...and all of the posts are intriguing to me. This one I felt the need to say something about. Working out of standard is NEVER a good thing. There is NO defense if something goes wrong. I don't understand why administrations do not understand this. The ratios you describe are frustrating to me and I am not even working them...I can't imagine what your staff is feeling. I agree that risk management should get involved with you. Perhaps they can convince someone to listen. Deaf ears are abundant though. I sympathize with you....God knows I have worked out of standard before....and not only is it scary...but the care given is substandard and the patients ultimately suffer. Good luck to you...I hope someone will listen.

RN4mommy's · Feb 16, 2005

Thanks to all for the feedback. Yes it is an aweful situation. I guess all I can really do at this point is continue to work the floor when I can to lighten their loads and continue to protest and document...document...document! :crying2: Thanks for the risk management advice. That is an awesome angle that I hadn't thought about pursuing. I also finally have a meeting tomorrow with the director of HR which I hope is a first step. At least they are agreeing to meet with me which is more of a response than what I have ever gotten before. Another approach I have used in the past few days is $$$ since we all know is the only language admin understands. I figured out the average cost to replace the people who have left will be $550,000!!! My point to them will be that it would have been and will be less expensive to keep a few extra nurses around to comply with ratio guidelines, opposed to staffing us with bare bones, burning everyone out, and having a mass exodus. Wish me luck tomorrow as I will probably want to lodge myself across the table at them, but we all know that won't get me anywhere :rolleyes: