Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

Facilities are firing seasoned, higher paid nurses and utilizing younger less experienced nurses. This cost-cutting measure is putting patients at risk, working nursing and support staff to the point of exhaustion, and causing staff to leave the profession.

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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

Specializes in Med/Surg, OR, Peds, Patient Education.

You are correct, wingding, unless a person has been a LPN, diploma grad or AD grad prior to obtaining his/her BSN they come to the hospital with considerable knowledge in academics but with few clinical skills. These newly graduated BSNs need a year of internship under the leadership/mentoring of an experienced RN, with or without her/his BSN.

emb1982 said:
This is not just a hospital problem. I'm working in LTC and we are facing the same issue. Some nurses having over 25 residents to care for with only two cnas. Many of the RNS start looking for new jobs shortly having starting here because they are worried about losing their license.

This. I am in LTC. The patients get sicker and sicker every year, pushed out of hospitals while they are still unstable. And at my facility, most also have psych comorbidities. Our ratio at night is one nurse and two CNAs to 43 patients. And guess what? They are just as sick at night, just as psychotic and violent, and they fall just as much if not more. During the day it's 1 or 2 nurses (about half the time it's still just 1) and 3-5 CNAs for 43 patients. It's insane and totally unsafe. And the only time anyone ever sees someone from nursing administration is if they get disciplined. Staffing is a revolving door, other than the ancient LPNs who have been working there for 25 years and are too scared to leave.

I am generally pro-union, but I think the solutions to this national staffing crisis will have to come from legislation. We need to unite politically and get our voices heard. We are fortunate enough to have the trust of the public and the advantage of numbers; we need to turn that into political capital.

she57 said:
My daughter in law's dad was in the Hospital recently. His IV pump started beeping, he rang the call bell. The CNA came in the room and said she would have to get the Nurse. She then stated that the Hospital planned to send all the CNA's to class to learn how to set and restart the IV pumps. She was a older CNA and said she did not want to be responsible for anything to do with the IV pump, but was told that will be one of her new job responsibilities once she is trained. So yes Nurses are being replace rather quickly. People need to be aggressive with their loved ones regarding medical care and know who is preforming the care.

And you can bet that they will keep having unlicensed personnel do more and more, and all of it on our license with our supposed supervision, while they stretch us over more and more patients -- although how we can be in 50 places at once supervising all the tasks we've supposedly delegated, I'll never know.

I'm almost 3 decades in and I have to say that I have yet to be treated like skilled labor. I can't say that I could do acute care because I haven't done it in so long that I'm no longer qualified but I have been treated quite decently thoughout my career. As has my sister, also an RN since the 80's who went back and got her BSN and then her CRNA and is doing very well.

Maybe my time is coming and I will be treated like crap but so far I've had a good experience. Yeah it's work, but no one anywhere makes my income without a lot of effort.

Dear Gooselady, BSN, I'll tell you exactly how it's done!!! First, the hospital does a "sweep" of current management in an area and bring in all new supervisors and managers. Those supervisors and managers may have little, if any experience. Worse though, is when they hire a manager who is NOT a nurse. In our unit they hired a manager that had his education in business and had proven himself, for his cost cutting measures at another facility. When they decide to cut cost in an area they start looking at all the nurses and productivity. You may be an incredible nurse who has been with the hospital for a long time but, if they view you as "expensive", they will find ways to get you to leave because, they know that they can not fire you for being a bad nurse.

Here are just a few of their tactics...1. They write you up for "policy" violations. That could be anything from wearing colored nail polish to work, not having your TB test done on time or forgetting to clock back in after lunch. 2. They start nit picking everything!!!! They are constantly looking at YOUR charting for errors and omissions. My supervisor tried to reprimand me in front of my peers because, she thought that I had charted something incorrectly. As it turned out, I had been "educated" that morning about a change in charting and how I had charted reflected that change. The charge nurse standing next to her, pointed out to the supervisor that "yes" there had been a change. Did I get an apology? No way!!! Instead, the supervisor asked the charge nurse in a low voice, "Why didn't I get that e-mail?" and slithered away. 3. They allow co-workers (usually their friends) to undermind you without punishment. I had one technical partner REFUSE to bring my patient into the unit so that I could get them ready for surgery. Mind you, she had brought everyone else's patient in. Her excuse? "You could have brought your own patient in and I'm not going to work myself to death". When the supervisor was approached, she turned the situation around to make me look like the bad guy. Interesting note.....This same technical partner was shortly transferred to another area thus, saving the supervisor from having to fire her friend because, everyone knew that this TP was lazy and had complained.

I could go on and on. I have been there. Basically, they just wear you down until you don't want to work there any more or they fire you. Either way, in most states you will NOT get unemployment. Your file may not reflect anything bad in particular but, try to get another job in that institution. Trust me, managers and supervisors talk "off the record" all the time. I have applied for 18 RN positions in the large organization that I worked for, for 26 years. Yes, I have had interviews but, no offers. When I have tried to talk to managers as to why I didn't get the position, they either don't return my calls or are quiet and surprised to hear from me. Hmmmmm

Does this sound familiar? If so, start documenting, in detail, EVERYTHING!!!! Dates, times, people involved, EVERYTHING!!!! Get written statements from witnesses, if possible. Talk to people, gain information to back you up. Example: If you're written up for not having your TB test or questionnaire done on time and your supervisor claims that the write up came from HR, talk to HR. Unfortunately, in most cases, HR is NOT your friend. I talked to Employee Health about the issue and gained some interesting information. If you are called to speak to your supervisor or manager, suggest that the meeting take place in an area adjacent to your unit as oppose to their closed office. If that is not possible, have a trusted co-worker come with you as witness to the conversation. Lastly, take your phone with you in your pocket with the video all ready taping, that way you can tape the conversation.

I put up with a lot of nonsense prior to resigning. Don't let yourself be fired. Don't give management that satisfaction!!!!!

Specializes in NICU, PICU, Transport, L&D, Hospice.
DCBW said:
Quote from the OP:

"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."

Couldn't agree more. I SWEAR MBA's and a lot of the methods they teach in business school are going to be the downfall of everything. Here's how I know, once upon a time, (when I was trying to please my parents) I took business school classes. I was HORRIFIED by the things they taught. Such an emphasis on cut throat tactics, profit before people, and hardly batting an eye at questionable ethical practices.

Case in point, I was in a business accounting class in 2009 when this 19 year old classmate of mine grinned snarkily and said, "Well, as a CFO there are ways of making money go your way." This was said within earshot of the teacher and she was looking at him when he said it. I waited for her to correct him, call him out, make a face... anything. But nothing. That tore it for me. I stood up, looked at the teacher and then back at the kid and said, "Are you freakin' kidding me?!?! This is what is wrong with our economy right now! Greedy little bastards are going to business school and finding their sociopathic tendencies nurtured instead of corrected!!"

This letter is so perfect and is exactly what needs to be communicated. Let's hope that soon the suits will grow some hearts and learn to give a **** about something other than money.

I believe that some of the reputable MBA schools have now added additional ETHICS courses to their education on how to amass $$.

Well said! I agree 100%

EXACTLY why I left my ER position...My CEN meant nothing, years of experience...nada..Saving the ER MD on occasion...nada. I think I will just take early SS and "retire". I am not burnt but I have had enough. It would be nice to have a medical staff that would stand up, too.

"Who works like this?". I had one nurse tell me that when she was working on the floor, she often went 12 hours without going to the bathroom. How many lawyers or other "professionals" would do that?

Specializes in Nurse educator,correctional,LTAC,Med/surg Tele.

I have to respond to that post, nursing itself is an amazing amazing profession its the politics that makes things hairy. You have to truly love being a nurse just like a marriage in the best or worst of times through the dark storms and sunny days. I am there for the patients that gets me through. Is it bad right now yes it is, to the point that yes i get chest pains and my blood pressure is through the roof, but that's when you change to another area of nursing to avoid burnout...

Specializes in Family Nurse Practitioner.

Whoever wrote this letter should send it as an op-ed to the New York Times. How to Submit an Op-Ed Article - The New York Times

I do NOT have the answers, but here are a couple points to ponder:

I have seen "unions" mentioned on this thread, but would they really help?

What have they done to our public schools? Are our children better educated? How about government employees? What are your thoughts on the DMV? It seems that unions maintain a "good enough status quo," they get pensions that no body else has anymore, and incompetent employees can't be dismissed (unless they kill 3 other coworkers while on the clock). Yet, our property taxes increase, other taxes increase, we all pay the price for lifetime retiree health coverage.

Just look what it has done to the price of college tuition. Strikes won't help. There are staffing companies that are prepared to bring in foreign nurses with in 24 hours of the announcement of a strike. Yes, a lower grade of care, but still good enough to keep the doors open.

What is the ratio of providers to administrators? Maybe 2%?

Remember the "Occupy Wall Street" Movement and the "2%"? That is what you are up against; the "Medical Industrial Complex."

At Tenet, in Redding, California, patients weren't just hospitalized, they underwent heart surgery. An investigation would reveal that in many cases, they had no serious cardiac problems whatsoever.

In 1997, the FBI found evidence that Health Corporation of America (HCA) executive salaries hinged on meeting financial targets such as growth in admissions and surgery cases. The FBI also discovered that HCA had been keeping two sets of books—one to show to Medicare, a second that contained the real numbers. Ultimately the investigation would reveal that the hospital chain had been bilking Medicare while simultaneously paying kickbacks to physicians who steered patients to its hospitals.

CBS' Sixty Minutes look at Health Management Associates (HMA) a for-profit hospital chain that, according to its employees, has relentlessly pressured its doctors to admit more and more patients regardless of medical need in order to raise revenues.

Quote
We talked to more than 100 current and former employees and we heard a similar story over and over, CBS correspondent Steve Kroft reported. Emergency room physicians were told that if they didn't start admitting more patients to the hospital, they would lose their jobs. The orders came from the top.

Perhaps the best ally to have are your patients. There are hurdles faced in getting them on board. In this era of the ACA, many see providers as advisors and they ultimately want to make the decisions that affect their healthcare. Are providers ready to give up that control?

How many unnecessary tests, labs, and imagings do patients face as a CYA? While most providers do all they can for their patients, treat them with respect and dignity, all it takes is one person and one bad encounter to taint the entire stay. How many times have clerks have been introduced to the patient as "doctor?" Is a patient asked to allow medical students in the exam BEFORE they are allowed in? How many students does a patient want in a room for an exam?

How many unnecessary catheterizations are there? How many times was a curtain not completely closed (if closed at all when a patient was exposed)? Does every provider knock on a patient's door and wait until they are told to come in (or is it 2 knocks on the door as you push it open)? If you are called in to chaperone, observe, or assist with a procedure, do you introduce yourself to the patient and ask permission to participate in their healthcare? How often do you ask patients if they have a preference in the gender of their providers? How often are there options to be had (I.e. male nurses)?

Have you ever seen a physician behaving badly and looked the other way because they were a "star surgeon," brought in millions in revenue, or were afraid you would lose your job for speaking up? How many coworkers talk about patients amongst themselves on social media? Have you ever heard coworkers say, "Did you see the ____ on ____ (name of the condition the patient is being treated for) in room ___?"

Again, most providers treat their patients with respect and dignity, but it just takes one...

Tenet, HCA and HMA are just three examples of corrupt for-profit hospitals. (Source: Health Beat Blog) After defrauding Medicare and hurting patients for years, these chains are caught, and pay a huge fine. No one goes to prison. Frequently they change the name of the chain, paint the front door, hire executives who are cronies of the former management team, and start all over again.

This is why patients now see themselves as consumers; attempts to protect themselves financially and physically (see Tenet above).

There have been ethical debates about "who's best interest physicians look out for;" the patient's, hospital's (healthcare system's), insurance company, or their own. Nurses are caught between all those forces with the addition of the physicians too.

Perhaps a national effort to get patients behind the nurses by focusing on the patient. That would include taking on administration by exposing practices like those at HMA, not only reporting bad physicians, but refusing to be party to their practices, helping increase the number of male nurses, etc.

Then again, there is always a move into management...