hospital staffing shortages and the effects on nurses and your license

nurseeboo · Sep 14, 2000

Originally posted by sammy26:
I am new to this forum but found it to be very enlightning and informative, not only have I read some very interesting view points but found the support is incredible.
My question and concern is on the issues of hospital staffing shortages, not overall but on a daily basis. We are taught in the Nurse Practice Act to never except an assignment that we can not "handle" or is unsafe, but yet each and everyday we are put into positions to either take on the assignment or hit the road....and then what kind of reference for a job will you get?
I recently have encountered to such experiences, amongst many others, that have affected the nurses license due to these circumstances....one in which a nurse had a pt load, because of lack of nurses that day, and she was unable to keep up with the charting in a timely manner...the pt's were taken care of no problem there, but she was written up and it was sent to the board of nursing examiners for review and her license is now being looked at under severe scrutiny because she should have not excepted the assignment and her charting should have been done...on time....ha ha ha...how many of us out there have that luxury? When this was explained to the board examiners that it is a very common event, and most nurses don't have the opportunity to keep up the charting because they are busy taking care of the patients, but the charting does get done....her reply was, "well under the nurse practice act it is your responsibilty to make a formal complaint about the other nurses as well....or you could get into trouble for not reporting it" darned if you do and darned it you don't.....what do you do in that instance? The reality is as it is...not to try and make this lengthly but the other day, I work in a Labor and Delivery unit, we had 15 deliveries in a 12 hour period with 5 nurses....3 c-sections, one being an emergency due to the fact the nurse was in a c-section and unable to watch her other pt. there was no one to help, we all had at least 3 pt's which by the way is against the guidelines....and there were other problems as well that day due to lack of staffing and pt load...my main problem with this is of course the poor pt care, but also that these 3 nurses who busted there butts all day, no lunch, no break.....etc. got written up by the supervisor. What the heck is going on here? Who is our advocate...not the hospital, not the supervisor, not the state nursing board, and certainly not the ANA (there to busy deciding who to elect to be treasurer and secretary. What, where, and when do we get the support we deserve....we are professionals for gosh sakes! I just can't seem to understand how this can continue and at the expense of our licenses....who is on our side....who protects us when we stand up and say "no" I can't take another pt. and we get fired and black balled....we are guilty until proven innocent...I feel so strongly in my heart that there has to be a stand! We need to speak out....this is not about money for gosh sakes...I know alot of people who make as much as nurses and they don't have to worry about their licenses being threated, or their jobs, or most of all hurting an innocent pt that can't get the care they need because we don't have enough staff....please if anyone has any input into this matter....and I know your out there, lets speak out....we have that right! Factory workers have louder voices and peoples lifes, licenses, and careers aren't at stake... I would love to hear from anyone with any input whether you agree with me or not...it weighs so heavy on my mind...I just want to scream out! Sammy

nurseeboo · Sep 15, 2000

Sammy, I read your feelings about the nursing shortage with great interest. I'm new to this forum also, but I see this as a great way to not only vent our feelings but to get other nurses' opinions on our opinions and feelings. I also get very angry with the lack of staff and the decreased care we can give our patients. I sometimes think we need to be superhuman to make all these sacrifices such as missing meals and running our butts off. It is not the patients' fault and yet they are least likely to understand why they are not getting better care.

It does seem unfair that a nurse may be disciplined by the board of examiners simply for not charting in a timely manner unless this delay led to a legal or ethical problem or harmed the patient, and if the charting was not done before she left work that day.

You also said you were assigned a patient load that was higher than the allowable number. If this number was set by the hospital you have objective evidence to show that pt. care was compomised. If those 3 nurses were "written up" and appeals were denied, maybe they need to find a safer hospital to work in.

But the real issue here is the nursing shortage which so many hospitals are feeling right now. The short-term solution may not be easy for administration to solve any more than it is for the nurses"in the trenches" to accept nor the patients to understand. There are the money constaints that hospitals face with decrease funding for Medicare pts and the problems with HMO denial of payments. In addition my hospital cannot hire enough nurses because there aren't enough applying. Hopefully, the hospitals do not have to lower thier standards for hiring just so they can fill vacant positions. We can also blame the change in the working status of women. Years ago women were told they were only fit to be teachers, secretaries and nurses, or to stay at home. Now there is a big interest among women in the high paying computer and science fields and society is rewarding this interest with more equality in pay. Nursing programs are stressing the ambulatory setting more than hospitals because much more emphasis in medicine is on prevention and home care. Where does that leave those who want to stay with inpatient care? I find the only things I can do are to learn stress-reduction techniques, channel my anger by talking to my supervisor and, if necessary, documenting problems that I experience, and understanding that we all, administration and staff alike, are in this together and need to work together. I am a "flex" nurse so I work all over the hospital. Every floor is short nurses. But I have a very understanding nursing director who listens to her staff and helps them to find ways to work with the shortage and not against the system. If your institution is not working with the nurses by listening to their complaints, concerns and stresses, and trying to do what they can to help you in your patient care, then you need to find a different place to work. It IS your license. In the meantime, Sammy, your concern for your patients is admirable. I hope you can work through your anger and document, document, document everything that happens because of lack of adequate staffing.

Even if documentation doesn't get the results you want, without it it's your word after the fact against administration and patient complaints. I hope this helps.

Originally posted by sammy26:
I am new to this forum but found it to be very enlightning and informative, not only have I read some very interesting view points but found the support is incredible.
My question and concern is on the issues of hospital staffing shortages, not overall but on a daily basis. We are taught in the Nurse Practice Act to never except an assignment that we can not "handle" or is unsafe, but yet each and everyday we are put into positions to either take on the assignment or hit the road....and then what kind of reference for a job will you get?
I recently have encountered to such experiences, amongst many others, that have affected the nurses license due to these circumstances....one in which a nurse had a pt load, because of lack of nurses that day, and she was unable to keep up with the charting in a timely manner...the pt's were taken care of no problem there, but she was written up and it was sent to the board of nursing examiners for review and her license is now being looked at under severe scrutiny because she should have not excepted the assignment and her charting should have been done...on time....ha ha ha...how many of us out there have that luxury? When this was explained to the board examiners that it is a very common event, and most nurses don't have the opportunity to keep up the charting because they are busy taking care of the patients, but the charting does get done....her reply was, "well under the nurse practice act it is your responsibilty to make a formal complaint about the other nurses as well....or you could get into trouble for not reporting it" darned if you do and darned it you don't.....what do you do in that instance? The reality is as it is...not to try and make this lengthly but the other day, I work in a Labor and Delivery unit, we had 15 deliveries in a 12 hour period with 5 nurses....3 c-sections, one being an emergency due to the fact the nurse was in a c-section and unable to watch her other pt. there was no one to help, we all had at least 3 pt's which by the way is against the guidelines....and there were other problems as well that day due to lack of staffing and pt load...my main problem with this is of course the poor pt care, but also that these 3 nurses who busted there butts all day, no lunch, no break.....etc. got written up by the supervisor. What the heck is going on here? Who is our advocate...not the hospital, not the supervisor, not the state nursing board, and certainly not the ANA (there to busy deciding who to elect to be treasurer and secretary. What, where, and when do we get the support we deserve....we are professionals for gosh sakes! I just can't seem to understand how this can continue and at the expense of our licenses....who is on our side....who protects us when we stand up and say "no" I can't take another pt. and we get fired and black balled....we are guilty until proven innocent...I feel so strongly in my heart that there has to be a stand! We need to speak out....this is not about money for gosh sakes...I know alot of people who make as much as nurses and they don't have to worry about their licenses being threated, or their jobs, or most of all hurting an innocent pt that can't get the care they need because we don't have enough staff....please if anyone has any input into this matter....and I know your out there, lets speak out....we have that right! Factory workers have louder voices and peoples lifes, licenses, and careers aren't at stake... I would love to hear from anyone with any input whether you agree with me or not...it weighs so heavy on my mind...I just want to scream out! Sammy

bunky, BSN, RN · Sep 15, 2000

Sammy, Sammy, Sammy! Of course we likely all agree with you! The job enviro is filled with danger to us and our patients, not to mention our licenses. No one does stand up for us. It's up to us Sammy.

McPeg · Sep 16, 2000

Sammy,

Five years ago (or maybe more now!), some very foresighted nurses organized a march on Washington to raise public awareness to what was happening in our hospitals. Remember that? There is an organization called the "Florence Project" that started on-line a few years ago with the same intent, raise public awareness, organize nurses to advocate for patient and nurses rights. They tried to get nurses nationwide to rally on May 1st every year for the past few. The response has been dismally diappointing. I helped try to organize one in my area. It pretty much flopped. They have a website you can reach at www.florenceproject.org. They have a downloadable "Assignment despite Objection" which might me helpful to you. I suggest make several copies and keep them at work so you can fill one out and submit it to your manager on those horrific days you describe. Make sure you keep a copy. Our unit was filling out incident reports when we felt conditions were unsafe and staffing insufficient. Management told us we're not allowed to do that anymore unless someone is injured!

Nursing bulletin boards all through cyberspace are filled with stories like yours. Until nurses start fighting back instead of walking away, I don't see much hope for improvement. (Our passive agressive behaviors as an oppressed group would make great study material!)

The California Nurses Association is a great example and real leaders in patient and nurse advocacy. Visit their website. There is information on their site regarding legislation at the federal level to ban mandatory overtime. I encourage you to download a copy and take it to your Congressman for his support.

The articles in the Chicago Tribune have sparked a lot of dialogue. This was my response to them:

I've been an RN since 1971. We have been in a crisis in our hospitals for several years now. When I read the first article by the Tribune on 9/10 I thought finally, it's going to come out. I thought finally, the public would hear how unrealistic the expectations of what a nurse is capable of handling in 8-12- or (God forbid you get mandated! ), 16hrs, is unrealistic, inhuman and unhealthy to the nurse as well as patient. I thought finally, the health industry, insurance companies, executive, etc. would be exposed for the greedy bastards they are. I thought finally, the public would learn how they have devastated our hospitals and driven more and more excellent, dedicated nurses out of the profession because they cannot in good conscience continue to work under this horrible system. I thought finally the stoic few who march into our hospitals on a daily basis, to care for our sick and dying, only to crawl out exhausted, demoralized and dejected, will be vindicated and rewarded for their dedication. I thought wrong. Instead of getting to the heart of what's wrong with our health care system, instead of exposing what has created a work environment that nurses are fleeing in droves from, the Tribune seems to be on a "bash the nursing profession while they're down" spree. There is a world-wide shortage of nurses. Are your articles going to enhance the nursing profession's appeal as a career choice to those out there that may be considering it? If not, the next time your family member needs a nurse I hope your cross trained.

Nursing Spectrum (on-line @ www.snursingspectrum.com) also has a bulletin board with much dialogue going on. One very fed up nurse is trying to organize a one day nationwide sick out! I think that is a bit extreme. I posted this there:

Maybe now is the time with all this momentum building to try it again(a nationwide day of unity. If on the same day, same hour, every off-duty nurse gathered with others in their closest major city across the country to hold a prayer vigil for patient safety and better working conditions, and at night with candles, that's always pretty dramatic. Think that would raise public awareness and get the attention of the media and some politico's? Wish we could organize it before the election! Maybe just maybe the time is coming that nurses are finally ready to take a stand. I hope so.

el · Sep 16, 2000

Organizing to help orchestrate a change is a great idea and one that everyone needs to try to commit to in one way or another. However, in the meantime you need to protect yourself and your license, and advocate for your patients. When we are extremely unsafe where I work, and literally there is not enough staff to give basic care for example the people that need assistance to eat will not get it, I call the Nursing Supervisor. The usual answer is there is no help to send, I learned in school you can't refuse an assignment, but you can document that you have made the appropriate people aware. I ask the Nursing Supervisor for her name and the name of the Administrator on call and I tell her that I know they can do nothing about it, but I need to document that the appropriate people were made aware of the unsafe conditions (and I use the word unsafe). Often, miraculously help in the form of a nurse appears, but if help doesn't appear, I document on every patient in my assignment the time and the names of the people aware and that I reported unsafe conditions (again document the word unsafe). I also encourage all the other nurse's to do the same. If anything ever happens God forbid, the first question you will be asked is if the Supervisor and Administrator were aware. You can't answer of course, everyone was aware, although we know that is true, it won't hold up. However, if you can say yes, at the beginning of my shift the Nursing Supervisor was made aware and she reported that the Administrator of the Hospital was aware, you will have a leg to stand on. When things happen like people get written up or reviewed by the board, be specific in asking what you can do exactly to not have it happen to you. Chances are they will say alert the person in charge and document. They may tell you to call your local State Board of Nursing, or the State Board of Health, whatever the answer is do it. If you get fired, for documenting and reporting the truth, it is illegal, but more importantly it is time for you to move on. Take very seriously your responsibility to advocate for your patients, and leaving at the end of our shifts crying is not helping them. Be strong, be honest, and whatever happens after that will most likely be for the best.

pickledpepperRN · Sep 18, 2000

Originally posted by nurseeboo:

You said it!

I would type a form or handwrite one and make several copies saying, "As a patient advocate I am accepting this assignment under protest becaust due to short staffing it is unsafe. ANY HARM THAT COMES TO PATIENTS DUE TO THIS STAFFING IS THE RESPONSIBILITY OF THE MANAGEMENT OF THIS HOSPITAL"

All nursing staff willing to sign should sign two. Put the date, unit and shift on top. One would be given to management, ask the person giving the assignment to sign. The next day off make copies for all who signed and send one to the board. I know it sounds like a lot, but you need to protect your patients and your license. HOW DARE THE STATE BOARD NOT DISCIPLINE THE LICENSE OF THE NURSING ADMINISTRATOR GIVING UNSAFE ASSIGNMENTS. THAT IS WHO SHOULD BE REPORTED!

I have done this with mixed results. Regardless of the results it can save your license. Imagine the press if they tried to take your license when you had dozens of these as proof you warned the hospital and State Board of the chronic , planned short staffing?

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[This message has been edited by spacenurse (edited September 18, 2000).]

John_G · Sep 18, 2000

hello all!! To all seasoned/veteran nurses you should know its not appropriate to document anything in a patients chart except information regarding that patient Ie: short staffed, working conditions unsafe etc.. (Thats not really the point I'm making) There is a form that we're all familiar with called the "Incident Report" This form is what you need to be documenting your saftey concerns, who you called, who you talked to what they said..etc. Because these forms get forwared on to nursing managers..risk management etc. Its not enough to document in a chart that you did this(at least not for me). If I'm truly concerned about staffing:Patient ratio I Leave as big of a paper trail as I possibly can. If something happens to one of my patients on my shift and you get called into court, I want the nursing manager who put me in that predicament explain why they did that especially after I called them expressing my concerns which are now documented in a incident report and sittiing in the hands of the prosecutor. Just my opinion.

pickledpepperRN · Sep 18, 2000

The Assignment Despite Objection form on the Florence Project site (or the one I mentioned above) do NOT go in the chart!

They may be in addition to the incident report. If your hospital sues you or you are reported to the Board the incident report cannot be used for your benefit in court. Yor need some proof you told the administration the assignment was unsafe so the legal responsibility is THEIRS not yours! Of course chart only facts relating to the patient, BUT protect your license. Why should a good nurse be lost to all of us potential patients because of ignorant or untruthful management. You MUST be able to prove you informed them! In writing! They just might take you seriously.

Always protect confidentiality by leaving out patients names etc.

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BROWN_KK · Sep 18, 2000

I must admit that in many ways your post goes hand in hand with my post on floating in another category. With my experience over several institutions I have worked with very different groups of nurses, although I find that most are willing to put up with the conditions you speak about. In my new place of employment I have found that the common answer to my concerns about staffing and floating, from both staff and supervisors, is "this is the real world". I get the impression that they would never take into their hands the fight for their professional rights and the fight for patient care. There is such a different undertone than where I came from..........the nurses just ended a very long strike. Truly they were people who felt strongly about their contribution to the hospital and who continually have members in Sacramento fighting for the legislation that affects us. Unfortunately, they seem to be in the minorityand I feel hospital administration will keep taking advantage of our fear and on top of that there are companies who bring in our colleagues with the lure of "BIG MONEY" to break the strikes meant to forge new ground. That is how important keeping us at bay is to the administrations out there. They put aside the "budget" to pay exhorbitant wages to strike breakers thereby tearing at the self esteem and professional worth of their long time, valueable employees. Money is not the only issue. It is clear that they mean to hold us down any way they must. We must protect ourselves any way we can from this or we will be defeated by our apathy. On the other hand, we could have an amazing voice! Look at the work we do...........Are we not strong, capable and intelligent? The public needs to see us that way too. But first maybe we need to convince ourselves.

purplemania, BSN, RN · Sep 19, 2000

Nurses are in the unique position of being employed and contracted at the same time, due to our license requirement. Perhaps we should raise public awareness by unionizing. Will that make us look more "professional"? There is a limit to what a nurse can expect in compensation but there is no limit to what is expected of her/him in performance. I am interested in a nurses union if only for a powerful voice.

pickledpepperRN · Sep 19, 2000

Instead of the handwritten one I like the assignment despite objection the Florence Project has for downloading. With the current (industry created) shortage (remember layoffs?) it seems better to risk your job than your license

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