Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

[allnurses]

This article was written by a member on allnurses. Due to the controversial and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system.

An Open Letter to Hospital Administrators

I am an experienced nurse that has watched many of my very talented colleagues leave the bedside due to the changes that have taken place in healthcare as of late. I have seen staff cut to the minimum, while patient acuity and nurse to patient ratios increase. I have seen support staff break down in tears because they have not been able to do their jobs properly. I have seen staff pushed to their breaking point, all the while administration stays in their offices, or in the meetings, determining yet more ways they can cut our resources. I see your salaries raised to ridiculous amounts, while we are denied cost of living increases, housekeeping is cut at night, and our benefits cost more, while the services are decreased.

I see our retirement cut while at the same time, the amount matched continues to be diminished or non-existent.

I see ways in which we are constantly blamed for declining patient satisfaction, increased patient falls, late medication administration, all the while we are asked to do more with less. I have seen you fire experienced staff and hire less experienced, cheaper, staff. I have seen that new staff break down because they have no resources, no experience to draw from and I have seen patients suffer from that inexperience. I have seen codes increase, inappropriate admissions to floors, transfers to higher levels of care, all because no one was there initially to advocate for a higher level of care for the patient, to begin with.

I still see you in your office. I do not see you on the floor. I see you with your graphs, your pie charts, your questions about readmission rates when I had already advocated for that patient to stay longer but was simply laughed off by doctors and not supported by you. Yet, somehow, I need to be on a committee to fix the problem.

I am now required to work extra shifts, because staff are getting sick due to stress, or leaving completely because they are tired of dealing with things. I see you develop a culture of fear, where our jobs are at stake and threatened at every turn. Yet, you still look to me for solutions.

"How can we do more with what we have?" I am asked.

My answer: There is no way to do more. We are at our limit. You are losing nurses as fast as you are gaining them, at a time when we need to be building up our profession when the baby boomers are just starting to become a factor in our healthcare environment.

My answer to this is simple. It is time to get real and start valuing your employees. If you want to be reimbursed for patient satisfaction, increase your services. Staff departments with what they need - enough nurses, enough aids, monitor techs, secretaries, ED techs, whatever. Then you will see positive results. Falls will decrease. Medication errors will decrease and medications will be given on time. Patients will get the treatment they deserve and patient satisfaction scores will improve. Your reimbursement will improve and you will stop losing money. Everyone wins: most importantly, the patients.

We need to stop the assembly-line mentality of medicine and return to the service mentality.

Yes, we are a business. But any business that has ever done well has not done well by decreasing the services to people or by mistreating its staff. Otherwise, healthcare facilities are going to see more of the same and suffer more financial penalties, less high-quality staff, and patients will suffer.

I was talking with several of my colleagues just the other day. All of us had many years of experience. Many had been at the bedside for over 20+ years. Many are leaving the bedside due to the unsafe conditions they are seeing. They just don't want to be a part of it. Perhaps this does not scare you, but it should. You must not be a patient yet.

For a follow-up article, please go to Nurses Fight Back! Why Some Hospitals are Despicable

Hospitals Firing Seasoned Nurses_ Nurses FIGHT Back! _ allnurses.pdf

[joanna73, BSN, RN]

When it's time for me to enter a nursing home, i'll be taking a pill. If the care is this poor now, I shudder to think how care will evolve in 40 years. No thank you.

[jadelpn, LPN, EMT-B]

Secretperson said:

...But do not get pissed when you lose your job because you never secured it through improving your worth and creating a reason or need to keep you employed.

Quote

Here's the thing--if one is employed by a small community oriented facility that was just fine with LPN's(and for some ADN's) for 20+ years, everyone working within scope, things just fine, then the next week we are "mentoring" the very nurses who then take our jobs (doing the same job as we have done, after all, we taught 'em) and that our "worth" was never, ever a question. Nor the reason we are employed. In all seriousness, are you a working nurse?!

In any event, I am not talking level one trauma centers/ICU's here (although for those who work those facilities/units bless you!!) however, my "worth" has never been in question, although the powers that be would like us all to think that it is.

Here's where the kool aid is drunk.....for a statement such as "In the end what nurses hate about business will continue to eat away their jobs, unless nurses figure out that nursing can be treated like business and be competitive." I don't like the idea of any nurse working in poor conditions so someone else can make lots of money. I don't like the idea that a job that was fine for someone other than a Masters was fine yesterday, but not today. And as a Master's prepared nurse, one would think they would be offended that they paid a high cost of education to endevour to research, policy change, whatever it is that Master's prepared nurses do, and then end up being paid very little to replace a highly paid seasoned nurse. Just sayin.

If the outscoring continues at the rate of just about every job in a facility from nurses to EVS to administrative tasks, well, then none of us will have a job to pay for the hundreds of thousands of dollars in student loan debt we have acquired......

If I wanted to be a business person, I would be.

I think that the Bill Gates of the world would tell you a good foundation made him a billionaire. Pretty basic computer programming stuff that created an empire.

[Markfoster]

I have worked in the medical field for 23 years and have watched this type of weeding out of experienced staff.There thinking is the biggest cost in the budget is staffing,so they want to get more work done with less staff and to pay less by hiring less experienced personal.I had a conversation with some coworkers and there explanation was a new nurse or tech they can train them how they want to.Most hospitals are sacrificing great patient care to save a buck .

[JenniferSmith]

I've always felt that nurses (the same could be said for any health professionals) who are in senior management roles and have little to know patient contact should have days where they are buddied with a clinician and they work 'on the floor' - so that true understanding develops as well as relationships with all staff. So we minimise us and them - mind you this is everyone's responsibility

[NotReady4PrimeTime, RN]

Guttercat said:

One day, you walk into your hospital and realize you don't recognize anyone, and that everyone seems to have between one and five years of experience.

This is nothing new.

Ask the Boeing Corporation.

This is exactly where my unit is now. I work part time due to some personal and health issues; my rotation is really unbalanced so I have stretches of as many as 16 days where I don't work at all. When I go in after those stretches, there are new faces every single time. Most of them are very inexperienced and are working unsupervised and unsupported in a very high acuity environment. I would guess that 2/3 of our staff are quite green. And it's showing in our patient outcomes.

Nurseilusgirl said:

As a Chief Nursing Officer I have to disagree. I care about my staff and about what they think and feel. I am their advocate and I can guarantee that all of my nurses would tell you that I am thier biggest advocate and that I have thier back. I will agree that often administration is out of touch. That is why I make it a point to get out to the floor and help as much as possible. I will cover for lunch and I have even covered full shifts when there were staffing problems. I understand your frustration but please don't think that no one in administration cares because that is simply not true.

It's wonderful that you're able to support your staff and to "get your hands dirty" from time to time. But what about the manager who isn't able to do any patient care, even the routine? Who can't sit at an ICU bedside and simply keep a patient in the bed while their nurse takes a bio-break because s/he lacks the experience and training to do so? Who can't be put in charge of the unit to free up an experienced nurse to take a critically ill admission because s/he "isn't an ICU nurse" and "doesn't know the patients"?

Chaya said:

That's what it felt like for me at a former job...even wile telling myself I must be paranoid I felt Like they had me in their crosshairs and I was only delaying the inevitable (think nature shows on TV where the pack of wolves single out, surround, and bring down the deer). No recognition was given in numerous situations in which I had gone above and beyond to rectify safety issues, ensure my patients and their caregivers fully understood their discharge instructions and how to follow up and when to get more urgent help get, reach out to new staff-but you can bet every instance of critical judgement on my part was second-guessed by TPTB, even If I handled these situations the same way as those in higher favor. The thing is I was so traumatized and felt so worthless I was unable to imagine obtaining a position anywhere else with the kind of referral they would give me that and I became paralysed when it came to finding any other situation that would get me out of there. I know-no one else can make you feel anything. I'm sure that sounds bitter; that's something I'm still working on. And I realize I'm mourning the loss; every so often I'll be in a situation where the "inner nurse" kicks in and I say "Damn, I was good!" I miss it.

I've walked that road too. The deep excoriating pain of being betrayed by the very person who could explain - but not necessarily condone - your actions is all but unbearable. To know that one error in judgment - saying something one should have kept quiet - can destroy an otherwise exemplary career is startling in its sting. The lingering effects of such an incident are almost worse than formal punishment; the loss of one's self esteem may be permanent and the feeling of entrapment is hard to overcome.

TexasBlaze said:

Like any industry, for-profit entities are seeking to fill positions with the lowest cost employees that they can in order to maximize profits, and healthcare is not an exception. And yes, there are managers who are given mandates, against any sort of ethics, to cull their higher wage staff. This has become more onerous due to recent changes in Medicare and Medicaid reimbursements and penalties enacted under the Affordable Care Act, and hospitals are not seeing the reimbursements they once received. Hospitals are sold to corporations, merged into large systems, and shifts in management occur as a means to try and utilize the least amount of personnel to achieve the most profitability. Look at most job descriptions for hospital administration and they are seeking someone with project management experience in addition to a healthcare background.

Unfortunately, this isn't entirely true. As joanna73 remarked in a previous post, the same type of "rightsizing" is happening in Canada where healthcare is not a for-profit enterprise. Provincial governments are the single payors in Canada and although they like to say they're at arms-length from the provision of care, that's a mis-statement. They are at the mercy of their economies and treat every ministry the same. So if they want a 10% budget reduction from every other public service, they want a 10% budget reduction from healthcare too. Also, as joanna73 has pointed out, the vast majority of employed nurses in Canada are unionized. But that only protects us to a certain point. The collective agreement may say that all vacant positions must be posted and outline rules for the dispensation of those postings, but there's nothing in the agreement that says the vacancy has to be filled. So simple attrition will provide some budgetary savings. The whole thing is smoke-and-mirrors though. When staffing is reduced and ratios increased, there's an imperative to downgrade levels of care in order to make the ratios work. So an ICU patient who isn't quite ready for transfer to a lower level of care will have their level of care reduced while in the ICU - ICU nurses are specially trained, so they should be able to provide care to more patients of higher acuity than floor nurses, right? Wrong. ICU nurses still only have the same number of minutes in their shifts. Anyway, that was a tangent... The level of care is reduced artificially, the nurse misses the subtle signs of deterioration and suddenly that patient is arresting. Or the nurse doesn't have time to perform basic care - dressing changes for example - and now the patient who should have been going home is now in the ICU with sepsis. So where's the saving?

TexasBlaze said:

So what is the solution? In Texas, we have Safe Harbor when you and your patients are placed in an unsafe situation. Evoke it when you are at risk. There is a trend towards not-for-profit hospital systems which have better staffing ratios and higher patient satisfaction survey results on the HCAHPS Hospital Surveys. Then there is the power of your voice. Call and write your local legislators on their website submission forms, by email, and by writing them a letter to send by surface mail. Let them know your concerns as a healthcare provider and always, always vote. Apathy does nothing if you do not get out and make your voice heard. You can take action by contacting your representatives without fear of retribution from your employer to advocate for secure, safe working conditions for you, and for your patients.

Virtually all of the collective agreements in Canada have some sort of provision to report unsafe situations. And virtually all such reports are downplayed by the manager to whom they're directed. As well, submitting a report makes the nurse filing it a target for retaliation in some form, be it a public dressing-down, a private "chat" where the nurse's self-esteem is shredded beyond repair ("Nobody else has a problem with that assignment so if you felt unsafe it must be YOU.") or just a long string of really nasty assignments. Let's face it, no manager is going to willingly agree that s/he left the unit so short-staffed that it was unsafe. Ever.

As far as political action goes, public officials will only act on something that directly affects them in some way. There are a large number of people who know nothing about what happens in hospitals, LTC, SNF, rehab or any healthcare workplace who feel that we brought all of this on ourselves by being greedy and demanding to be paid decently for the work we do. They use "healthcare worker" as a pejorative and believe we're all overpaid and under-worked. So what's an extra patient or two in your assignment? You're getting paid a lot of money for clocking in so get on with it.

I have voted in every election - civic, provincial and federal - since I reached the age of majority. But I only have one vote.

SatkinsRN said:

I've noticed (in my limited experience) that hospitals that are owned by Fortune 500 companies, whose primary reason for existence is to make money for their shareholders, simply SUCK! The equipment is shoddy, they do not value having an educated nursing workforce, nurses have little voice in the governance of the facility, and nurses are literally worked like dogs-except that most compassionate people will actually let a dog drink some water, eat some food, and have time to "do their business." I'm curious to know...what are other nurses' experience with for-profit versus not-for-profit facilities?

Sounds VERY familiar, except for the Fortune 500 part and the dividends for the shareholder part. My hospital has the outcomes it has because the front line staff, from physician to diet aide, make it happen in spite of the challenges we're faced with. I was a patient in my hospital 18 months ago and although I received adequate care and recovered as I should, I couldn't wait to get out of there and come home... so I could sleep, take analgesics when I needed them and not when they were scheduled, and where I could eat toast that wasn't made hours before and "rethermalized".

[SweetSong]

kbrn2002 said:

That is sad that they won't at least grandfather in their own grads. Depressing thought to give your entire career to one facility for them to basically say screw you at the end.

Wait until the patients get wind of the policy. Many would say that the higher education of nurses will mean they should be able to give absolute without exception excellent care which, even if you endeavor to do this daily, sometimes is just not possible especially when working added hours with added pressures and added responsibilities let alone added patients. Let the lawsuits begin.

[AlphaM]

My hospital recently purged lots of nurses and yes mostly experienced well paid nurses, when administration was asked why they were down sizing the only reply was to deny they were down sizing, instead they said they were "right sizing", the play on words made me feel like vomiting. There's only so much BS anyone can take.

[SweetSong]

So your choice would be to abandon the poor, the unemployed, the uninsurable, the uninsurable CHILDREN of anyone to let economic factors take their course? Since no one else has stepped forward to solve this problem, what was done had to be done. Yes, I voted for change in the for-profit, greedy and money-driven health care industry. Oh, and by the way, this problem has existed for a VERY long time. Nurses and other health care professionals were fighting for recognition and respect LONG before PRESIDENT Obama was born....NONE of this problem comes from Obamacare. Read your history.

[ORNurseCOS]

I haven't read all 17 pages but the majority. I don't believe a Union is the answer personally, but PUBLIC EDUCATION.

To get the results we all want you have to educate THE PUBLIC....an educated patient is a hospitals nightmare.

The public needs a tag line to latch onto to make them understand what is going on....a slogan of the movement of sorts.

I say push PATIENT/NURSE ratios, it could be the driving force of the movement.

Things will stay business as usual unless the patients understands what is going on....when they need care they will call and ask "what is your nurse/patient ratio?"

[memarc]

This article is spot on!! I left one health system that kept on taking and taking and not giving the nurses anything not even raises or matching our 401k's or anything. And they taxed our 10 dollar gift card the decided we didn't need it anymore. Yet the CEO had a huge pay raise every year and bonus. They also want Magnet status but won't pay for your schooling to get your BSN. Whereas another system a couple miles down the road the nurses are under a union and are paid much much better and are matched 2/1 for their 401 and so on. Get raises. Have much better staff to patient ratios. Believe me if I wasn't a nurse I would be afraid for those that didn't know what to fight for!!

[Rose_Queen, BSN, MSN, RN]

Couldn't help seeing that a lot of new members are commenting on this article- welcome to all of you and glad that this is getting a lot of notice!

[jacksonvillelpn]

This also holds true in nursing homes/rehabs. And those hot-out-of-school-and-can't-get-a-job-in-a-hospital nurses? After orientation they work on their own for a week and run for the door, costing the facility $$$ in wasted training. The facilities are adding vent and cardiac units, with little to no change in the usual 1 CNA to 12 patients and 1 nurse to 20-24. Rx for disaster. Oh, and PRN nurses? Gone...they cost too much. Overtime is cheaper. A few years ago a doctor friend of mine warned that the way things are going, the healthcare system is destined to implode upon itself. Hopefully there will be enough nurses to come behind and pick up the pieces.