Hospital nurses - is it really that bad?

inshallamiami · Jul 21, 2013

I KNOW there are managers who visit this forum. I would love to hear their side. I would love to hear them defend themselves. Why don't they speak up? Cowards

lmccrn62, MSN, RN · Jul 22, 2013

So here I am a manager and no coward. If anyone would like to walk in my shoes on a daily basis please feel free. Much of what is stated here is what I hear on a daily basis. I find that more complain rather than having some kind of solution. I cannot fix all the evils that exist in healthcare.

I have been a nurse for 30 years and the last 10 years in management. Nursing has changed over the years and it is not always for the best of anyone including the patient. Obama-care is not going to get the end result that is intended. Patients whether they have insurance or not will still not seek care and be non-compliant. Perhaps patients that refuse care and be compliant should not get any care at all.

Insurance companies- They manipulate the hospitals by promising them money for their initiatives. No one cares that the staff and management will have to jump through hoops. So now we are responsible for CHF education, Diabetes management and insulin drips and coverage for those that have high sugars but not necessarily diabetic. Because they have some study that says it improves outcomes even though there are just as many studies that conflict.

Patient Centered Care- Oh yes! While i appreciate the patient and family involvement it does not require that my staff and I are verbally and physically abused on a 24 hour basis because you are unhappy with your brand-new private room and a very nice couch that your family can sleep on. Why do you feel that you can leave your children with the sick patient because you have something better to do? You can call the kitchen at anytime and they will deliver you a meal. The patient rooms are converted into a one bedroom apartment where families bring all the luxuries of home in. My favorite 24 hour visitation.

HCAHPS and Press Ganey- I hate this! While there are times that families have the right to complain about a truly bad experience why are we held to a standard that you meet the highest standards or your facility is at risk for losing millions of dollars in reimbursement. SO now its hourly rounding, safety huddles and 3 hours daily of my time to see patients and ask them if they are loving our 5 star hotel.

Employee engagement- Another hot spot. I am tired of this one. It never fails that the staff that are the most unhappy answer this and find it appropriate to bad mouth their boss because they have chronic issues (excessive tardiness, numerous medication errors, excessive absenteeism, playing on the computer and cellphone the whole shift, cannot get along with their peers because they are miserable and the list goes on). It is also the employees responsibility to be part of the solution rather than part of the problem. I now have to come up with ways to keep you all happy? How about management engagement?

Breaks- What are those? I have no clue if I get a chance to sit and eat I am doing work over my lunch. Going to the bathroom doesn't exist.

Meetings. I go to endless meetings listening to how bad reimbursement is and how cuts are going to happen and then they ask us not to talk to staff cause its highly confidential. I am given the budget and expected to stay in the black. Every bit of OT needs to be justified and staff get mad when you ask them to give a reason.

Beepers/cell phones- I feel like I am being tracked constantly being needed by someone. I am tethered 24/7 to the job.

Vacation- I have staff that get more vacation then I do and I have 24/7 responsibility.My vacation and holidays are not my own either I am at your disposal!

Falls and other errors-Another nightmare for the manager. I am questioned by everyone to assign blame and must investigate each incident. Peer review committee requires the manager to present the case rather then the staff that were present.

Physicians- No accountability for anything. They can be abusive, ignore recommendations from the staff, refuse to answer their pages and try to kill patients because they do not know any better.

Restraints- God forbid! We wouldnt want to imprison patients and try to protect them from themselves. We need to provide sitters, escape alarms, hi/lo beds and of course keep the rails down.

Staffing- 5:1 ratio with a tech. not bad. The nurses each are relieved for a break. When census fluctuates we need to cancel staff. There is no reason to keep extra. No extra work is being done and staff are more inclined to sit and chat.

Thank you's- I get none by anyone (staff or administration) Do I need them? NO! I come to work and do my job and my reward is my paycheck.

So through all my rambling what is the answer? There is none! There is no magic in nursing. As a profession we have to join together and fight for ourselves. With letting insurance companies and and the government determine our worth and get what we need so that we can provide the quality care we know we can provide.

mclennan, BSN, RN · Jul 22, 2013

I wanted to drop in to say, CA is not the dreamland many think it is. Yes ratios do provide some measure of protection to floor nurses in hospitals but they don't apply to all nurses.

I worked for a year for a street level ambulatory clinic of a major hospital that's Magnet & JACHO certified blah blah. These clinics were their training grounds for resident docs, saw exclusively under/uninsured patients and ER overflow. They raked in huge reimbursements from MediCare/Cal and write offs for the rest. These clinics were an expansion of the hospital that made them look like they cared for "the community." Ha.

Because we were not med surg/floor nurses, ratio laws didn't apply. We saw 75 to 100 patients come through the doors every day, & there were 4 nurses & one CNA to take VS, med recon & hx, room and assist the student docs, of which there were usually 12-20 crowding around. We worked 8's, were expected to accurately and perfectly document everything and never do OT, not even 5 minutes. If we swiped in 5 mins late we were written up. 8's often turned into 10's. We were required to take breaks, but every day, there'd be that last resident doc struggling to stitch up a cut or finish a Pap & at least one RN had to be present per policy. I took many "lunches" that consisted of jamming a protein bar down my gullet and gulping an energy drink. Or, we'd hide sandwiches in our scrub pockets and sneak bites between patients, or on runs to the utility/supply room. God help us if anyone called off. Float nurses refused to work there. Everyone had chronic UTIs & migraines.

This company also put us through a month of totally unnecessary orientation. They even made ACLS holders "re-take" "their" ACLS so the bookkeepers wouldn't have to keep track of all the differing expiration dates! And yes this included 2 hours of financial info from the CEO, who was clad head to toe in Armani. We received little booklets with "scripts" to answer JACHO surveyors. Creepy, sad stuff.

I quit after a patient in Oxy withdrawal grabbed the family member of another patient and put a knife to their neck. We called Security (from the hospital) and they never showed. We called the local police, they came and busted the guy & took him away. Our manager (a 36 year old guy with RN/MBA who'd worked less than a year as a nurse) actually disciplined the nurse who called the cops - because it wasn't "protocol" to call the PD for a "disruption" like a guy waving a knife around screaming & threatening to kill people!

It's the only job I've ever walked off. I saw how little this place valued the nurses' basic bodily safety, like the bottom Maslow layer.....and handed my badge & keys to the NM, right then and there. He chased after me as I walked away, yelling "are you serious? Are you serious?"

You bet I was. Ratio laws or not, I won't work for a company that puts protocols & policy compliance above basic safety. I'm in case management now - and thank DOG I have a sweet desk job now and am far, far away from the hospital.

inshallamiami · Jul 22, 2013

So here I am a manager and no coward. If anyone would like to walk in my shoes on a daily basis please feel free. Much of what is stated here is what I hear on a daily basis. I find that more complain rather than having some kind of solution. I cannot fix all the evils that exist in healthcare.
I have been a nurse for 30 years and the last 10 years in management. Nursing has changed over the years and it is not always for the best of anyone including the patient. Obama-care is not going to get the end result that is intended. Patients whether they have insurance or not will still not seek care and be non-compliant. Perhaps patients that refuse care and be compliant should not get any care at all.
Insurance companies- They manipulate the hospitals by promising them money for their initiatives. No one cares that the staff and management will have to jump through hoops. So now we are responsible for CHF education, Diabetes management and insulin drips and coverage for those that have high sugars but not necessarily diabetic. Because they have some study that says it improves outcomes even though there are just as many studies that conflict.
Patient Centered Care- Oh yes! While i appreciate the patient and family involvement it does not require that my staff and I are verbally and physically abused on a 24 hour basis because you are unhappy with your brand-new private room and a very nice couch that your family can sleep on. Why do you feel that you can leave your children with the sick patient because you have something better to do? You can call the kitchen at anytime and they will deliver you a meal. The patient rooms are converted into a one bedroom apartment where families bring all the luxuries of home in. My favorite 24 hour visitation.
HCAHPS and Press Ganey- I hate this! While there are times that families have the right to complain about a truly bad experience why are we held to a standard that you meet the highest standards or your facility is at risk for losing millions of dollars in reimbursement. SO now its hourly rounding, safety huddles and 3 hours daily of my time to see patients and ask them if they are loving our 5 star hotel.
Employee engagement- Another hot spot. I am tired of this one. It never fails that the staff that are the most unhappy answer this and find it appropriate to bad mouth their boss because they have chronic issues (excessive tardiness, numerous medication errors, excessive absenteeism, playing on the computer and cellphone the whole shift, cannot get along with their peers because they are miserable and the list goes on). It is also the employees responsibility to be part of the solution rather than part of the problem. I now have to come up with ways to keep you all happy? How about management engagement?
Breaks- What are those? I have no clue if I get a chance to sit and eat I am doing work over my lunch. Going to the bathroom doesn't exist.
Meetings. I go to endless meetings listening to how bad reimbursement is and how cuts are going to happen and then they ask us not to talk to staff cause its highly confidential. I am given the budget and expected to stay in the black. Every bit of OT needs to be justified and staff get mad when you ask them to give a reason.
Beepers/cell phones- I feel like I am being tracked constantly being needed by someone. I am tethered 24/7 to the job.
Vacation- I have staff that get more vacation then I do and I have 24/7 responsibility.My vacation and holidays are not my own either I am at your disposal!
Falls and other errors-Another nightmare for the manager. I am questioned by everyone to assign blame and must investigate each incident. Peer review committee requires the manager to present the case rather then the staff that were present.
Physicians- No accountability for anything. They can be abusive, ignore recommendations from the staff, refuse to answer their pages and try to kill patients because they do not know any better.
Restraints- God forbid! We wouldnt want to imprison patients and try to protect them from themselves. We need to provide sitters, escape alarms, hi/lo beds and of course keep the rails down.
Staffing- 5:1 ratio with a tech. not bad. The nurses each are relieved for a break. When census fluctuates we need to cancel staff. There is no reason to keep extra. No extra work is being done and staff are more inclined to sit and chat.
Thank you's- I get none by anyone (staff or administration) Do I need them? NO! I come to work and do my job and my reward is my paycheck.
So through all my rambling what is the answer? There is none! There is no magic in nursing. As a profession we have to join together and fight for ourselves. With letting insurance companies and and the government determine our worth and get what we need so that we can provide the quality care we know we can provide.

Wow. Tho I don't agree with all that you say, I appreciate that you took the time to give your opinion. In retrospect I shouldn't have called all management cowards. Name calling isn't right. I apologize for that

LadyFree28, BSN, LPN, RN · Jul 22, 2013

So here I am a manager and no coward. If anyone would like to walk in my shoes on a daily basis please feel free. Much of what is stated here is what I hear on a daily basis. I find that more complain rather than having some kind of solution. I cannot fix all the evils that exist in healthcare.
I have been a nurse for 30 years and the last 10 years in management. Nursing has changed over the years and it is not always for the best of anyone including the patient. Obama-care is not going to get the end result that is intended. Patients whether they have insurance or not will still not seek care and be non-compliant. Perhaps patients that refuse care and be compliant should not get any care at all.
Insurance companies- They manipulate the hospitals by promising them money for their initiatives. No one cares that the staff and management will have to jump through hoops. So now we are responsible for CHF education, Diabetes management and insulin drips and coverage for those that have high sugars but not necessarily diabetic. Because they have some study that says it improves outcomes even though there are just as many studies that conflict.
Patient Centered Care- Oh yes! While i appreciate the patient and family involvement it does not require that my staff and I are verbally and physically abused on a 24 hour basis because you are unhappy with your brand-new private room and a very nice couch that your family can sleep on. Why do you feel that you can leave your children with the sick patient because you have something better to do? You can call the kitchen at anytime and they will deliver you a meal. The patient rooms are converted into a one bedroom apartment where families bring all the luxuries of home in. My favorite 24 hour visitation.
HCAHPS and Press Ganey- I hate this! While there are times that families have the right to complain about a truly bad experience why are we held to a standard that you meet the highest standards or your facility is at risk for losing millions of dollars in reimbursement. SO now its hourly rounding, safety huddles and 3 hours daily of my time to see patients and ask them if they are loving our 5 star hotel.
Employee engagement- Another hot spot. I am tired of this one. It never fails that the staff that are the most unhappy answer this and find it appropriate to bad mouth their boss because they have chronic issues (excessive tardiness, numerous medication errors, excessive absenteeism, playing on the computer and cellphone the whole shift, cannot get along with their peers because they are miserable and the list goes on). It is also the employees responsibility to be part of the solution rather than part of the problem. I now have to come up with ways to keep you all happy? How about management engagement?
Breaks- What are those? I have no clue if I get a chance to sit and eat I am doing work over my lunch. Going to the bathroom doesn't exist.
Meetings. I go to endless meetings listening to how bad reimbursement is and how cuts are going to happen and then they ask us not to talk to staff cause its highly confidential. I am given the budget and expected to stay in the black. Every bit of OT needs to be justified and staff get mad when you ask them to give a reason.
Beepers/cell phones- I feel like I am being tracked constantly being needed by someone. I am tethered 24/7 to the job.
Vacation- I have staff that get more vacation then I do and I have 24/7 responsibility.My vacation and holidays are not my own either I am at your disposal!
Falls and other errors-Another nightmare for the manager. I am questioned by everyone to assign blame and must investigate each incident. Peer review committee requires the manager to present the case rather then the staff that were present.
Physicians- No accountability for anything. They can be abusive, ignore recommendations from the staff, refuse to answer their pages and try to kill patients because they do not know any better.
Restraints- God forbid! We wouldnt want to imprison patients and try to protect them from themselves. We need to provide sitters, escape alarms, hi/lo beds and of course keep the rails down.
Staffing- 5:1 ratio with a tech. not bad. The nurses each are relieved for a break. When census fluctuates we need to cancel staff. There is no reason to keep extra. No extra work is being done and staff are more inclined to sit and chat.
Thank you's- I get none by anyone (staff or administration) Do I need them? NO! I come to work and do my job and my reward is my paycheck.
So through all my rambling what is the answer? There is none! There is no magic in nursing. As a profession we have to join together and fight for ourselves. With letting insurance companies and and the government determine our worth and get what we need so that we can provide the quality care we know we can provide.

^I admire your post. :yes:

I believe this us a vent post in originality, however, I agree to a point of empowerment; I do believe we have MUCH power at the bedside, and autonomy to be assertive in the form of delivery of care within reason, ratio planning, etc. I entered healthcare when it was turning into a business, closer to 2000 in my area, and still enjoy this career after 13 years; I wouldn't enjoy it if I didn't respect everyone's role or take being assertive and an advocate. Instead of potential accusations of blame, I turn it around take the lead on setting the tone of collaboration, issues related to parties involved with the healthcare team and the family; I did hourly rounds as a part of my practice BEFORE it was mandatory; and I usually had a 6-8:1 ratio. I have my elevator speeches, my education and common sense, and an assertive personality to boot...I also know people are people; some with such ulterior motives and bigger issues than the patients I care for; I cope by treating them as my patients, even creating nursing diagnoses as well; I even had to do this for myself at times-it has made me a better, HAPPIER, and more content person to be a problem solver...works 85-95% of the time, and I'll take that. :yes:

With that said, we do really need to be the change that we seek, even after a good old fashioned vent...for me, in my career, a vent was the ball rolling for change, success, and satisfaction. :yes: