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

[avengingspirit1]

Just one more note to add. I am putting the finishing touches on an article I plan to send to the news media in my area as well as outlets such as CNN and fox news about what hospitals, especially those in my area are doing to try to drive out the most skilled and competent nurses. I don't give a you-know-what about retribution anymore as I am already probably on the blacklist for articles previously printed on this topic. So I have nothing to lose. So I am putting all you venal, prevaricating so-called nursing leaders and hospital management phonies on notice. You can fire a nurse, blacklist a nurse; but you can't silence a spirit.

[dbeech]

Thanks for this spot on article ! I have been a nurse since 1998 and I recently resigned from my position of 9 years in the operating room . I began my nursing career in geriatric nursing, but always had the desire to work in a hospital. I started as a float nurse primarily working on med surgical units then settled in a unit that took on Pediatrics as well. I was the only nurse this one particular eve that had Pediatric experience and I already had 7 patients to tend to when I receive a call from the Nursing supervisor that they wanted to give me another patient from the ER, a 6 month old with a respiratory infection....I told the supervisor I couldn't safely accept the child that I already had 7 patients . She told me that the hospital did not have a min nurse/patient ratio and that I had to take the child...I refused and told her she would be putting the child and all my other patients at risk and I was making it known in the presence of my colleagues, that if something went bad it would be on her shoulders. Well the ER faxed report on the child because I refused to take a verbal report and that was the end of my Floor nursing...I moved on to perioperative nursing until July 2nd of this year. My shift was from 6:45am until 3:15pm but due to the lack of staff most days my 8 hour shift would turn into a 10hr or 12 hr shift and then there is the call, starting at 10:30 pm until 7am during the week to having full weekend call ! needless to say staff dropping left and right getting injured, out on stress leave, having elective procedures just to get rest from the stress. The complete lack of respect and concern for the staff by administration/management is disheartening. The culture in the Operating room by management and some surgeons is abusive and administration continues to turn a blind eye. The lack of ancillary staff is forcing nurses and surgical techs to be the cleaning personnel as well, having to clean MRSA and VRE exposed rooms then off to tend to the next (clean) patient. I wonder if the CEO of the hospital was to have surgery do you think he/she would want to be next one in line to be taken care of after I cleaned the MRSA/VRE Operating Room ? Hmmm ?

Now the colleagues that I have worked side by side with for 9 years are bitter that I gave my resignation the beginning of summer and stated I was inconsiderate and felt I could have waited until the fall after summer vacations were over because since I left all my call is being forced on them....How about turning your hostilities to the hospital administrators and the corporation they are the people making the cuts...I'm just the nurse who will no longer take the unsafe hostile working conditions. My sanity and my family is worth more than any amount of money. Signed Fed up Perioperative Nurse

[robinbird]

This nurse eloquently said everything that I could not put into words for the past few years. I recently quit my job after 10 years because of the working conditions and the absolute insanity that had been occurring. I became a travel nurse where I can do my job and not be involved directly in the politics. I posted this on Facebook a few weeks after started working as a travel nurse:

"As I sit here in my RV at my travel assignment, I reflect on the last few months of my life. I love my assignment here. Yes, there are problems (or I wouldn't be needed here). It hammers home my realization of the dysfunction of the organization that I worked for for so many years. The corporate machine that has been lubricated with sand. Someone remarked to me the other day, that there are two mechanisms at work, one wonderful (the staff and the providers) and then there's the corporation. The corporation is destroying itself and its MOST VALUABLE ASSET, its people. My fear is that the staff and providers will leave and patient care will suffer. But just as its necessary for the addict to hit rock bottom before he get help and recovers, this organization is on a downward spiral, imploding and self destructing. I only hope that the ones I've gotten to know, like and love will not suffer."

Robin

[Footballnut]

I've been a nurse for 41 years now, all in the hospital setting. When I was in school getting my BSN in the 70s the talk then was that at some time a BSN would be needed as entry level. So this is nothing new. That being said, I continue to respect anyone who is a caring and experienced nurse with a different degree. And I heartily disagree with laying off people who are doing their job well when the rules change midstream.

Health care has always been a business. I have been mindful of that over time. So over the years I have tried to keep myself marketable as a bedside nurse. I have also tried to keep the business perspective in mind when management doesn't do exactly what I want and take it with a grain of salt.

However when it comes to patient safety issues I have been relentless. When staffing ratios are unsafe or shaky I document the situations as they occur and send a note or a letter to the people that have responsibility for making the decisions. My notes are few and far between but after describing the situations exactly my note usually ends with "fortunately no one was hurt this time" along with specific suggestions for how to improve. There's no way I'm going to try to shoulder the burden of compromised patient safety by myself. Administration has generally been smart enough to find ways to change once they are put on notice.

I have not been laid off yet. There have been layoffs from time to time over the years depending on the economy and prevailing hospital needs and practices. I was sad to see staff laid off last year, some of whom had 30 years of experience. To the hospital's credit cuts were made across the board in every department, not just nursing. There is no doubt that hospitals and other institutions are going to continue to try to find ways to meet their bottom financial line.

We as nurses need to be smart about how we change as healthcare delivery continues to change in our country. Hospitals, insurers and government are all looking at other countries where healthcare is delivered much more cheaply with better outcomes. It looks like the strategy at this point is just put the squeeze on staffing and cut back dollars thinking we can just figure this out somehow. We as nurses need our best minds out there showing how we can promote health and save lives by changing our approach to illness, wellness and healthcare delivery. We need to sell it to the people who make the decisions. If we don't do it someone other than a nurse will be doing it for us.

Who among us has the vision and ability to lead us in this quest? I am guessing it has to be a mix of the experienced nurses and the young ones who still think all things are possible.

[imintrouble, BSN, RN]

There's barely a skeleton crew at the hospital where I work. Multiple nurses "on call" every shift because of low census.

There's a formula used to decide who gets to work and who doesn't. It's not new, and I always considered it pretty fair.

But the "on call" nurses seem to be the older, highly paid nurses every day, every shift. Honestly I don't know how it's happening since the formula hasn't changed.

At the risk of sounding like a conspiracy theorist, I think management deliberately schedules certain people on certain days, so that it's always the same higher paid nurse's turn.

[LadyFree28, BSN, LPN, RN]

Footballnut said:

I've been a nurse for 41 years now, all in the hospital setting. When I was in school getting my BSN in the 70s the talk then was that at some time a BSN would be needed as entry level. So this is nothing new. That being said, I continue to respect anyone who is a caring and experienced nurse with a different degree. And I heartily disagree with laying off people who are doing their job well when the rules change midstream.

Health care has always been a business. I have been mindful of that over time. So over the years I have tried to keep myself marketable as a bedside nurse. I have also tried to keep the business perspective in mind when management doesn't do exactly what I want and take it with a grain of salt.

However when it comes to patient safety issues I have been relentless. When staffing ratios are unsafe or shaky I document the situations as they occur and send a note or a letter to the people that have responsibility for making the decisions. My notes are few and far between but after describing the situations exactly my note usually ends with "fortunately no one was hurt this time" along with specific suggestions for how to improve. There's no way I'm going to try to shoulder the burden of compromised patient safety by myself. Administration has generally been smart enough to find ways to change once they are put on notice.

I have not been laid off yet. There have been layoffs from time to time over the years depending on the economy and prevailing hospital needs and practices. I was sad to see staff laid off last year, some of whom had 30 years of experience. To the hospital's credit cuts were made across the board in every department, not just nursing. There is no doubt that hospitals and other institutions are going to continue to try to find ways to meet their bottom financial line.

We as nurses need to be smart about how we change as healthcare delivery continues to change in our country. Hospitals, insurers and government are all looking at other countries where healthcare is delivered much more cheaply with better outcomes. It looks like the strategy at this point is just put the squeeze on staffing and cut back dollars thinking we can just figure this out somehow. We as nurses need our best minds out there showing how we can promote health and save lives by changing our approach to illness, wellness and healthcare delivery. We need to sell it to the people who make the decisions. If we don't do it someone other than a nurse will be doing it for us.

Who among us has the vision and ability to lead us in this quest? I am guessing it has to be a mix of the experienced nurses and the young ones who still think all things are possible.

Well said.

I'm glad we are still having this discussion, however, when are we going to start talking and planning solutions???

[tnbutterfly - Mary, BSN]

The discussion is continuing on in a new article that was posted by a member in response to this thread.

Go to Nurses Fight Back! Why Some Hospitals are Despicable to share your input.

[IrishDragon]

Footballnut has been drinking the kool aide. Yes there is not much new in healthcare as a business: its do more withless as usual. Business leaders make the decisions and expect nursing to make it a reality. Too bad they don't understand that while we can do it all (from respiratory to housekeeping) patients are better cared for by a team. I started in this business 40 years ago as a nursing assistant. I was the eyes and ears for my team leader, the RN, and together we knew more about our patients and took better care of them. We don't need more techno, we need more heart at the bedside.

[Ryn RN]

National Nurses United has made some tremendous strides.

[avengingspirit1]

jacksonvillelpn said:

Would you like to know where those young, inexperienced RNs are coming from, and why they are so compliant? They have spent the last month plus one week in a local nursing home, where they spent the first month in orientation, and the last week dumped into a rehab unit were they were asked to care for any where from 12 to 30 SUB-ACUTE rehab patients with IV antibiotics, g-tubes, wound vacs, and a plethora of high tech issues that the hospital dumped way too early. They RUN out the door with NO notice and head straight into the arms of your administrators, willing to offer them twice as much money( which is still nothing for hospital work) fewer patients, and a promise that their high acuity patients will shortly be shipped out to the nursing homes they just left. Thank Medicare, Obamacare, and your elected officials who 1) Know LESS THAN NOTHING about healthcare, 2) are in the back pockets of your administrators and 3) think they're getting top-of-the-line health care at Walter Reed. HaHaHa...we get the last laugh there, anyway.

You're spot on. You can also thank all the sanctimonious jackasses we have for nursing leaders who supported the ACA when even those (all Obama supporters) who pushed the bill through to become law admitted they didn't know what was in the law. It has been reported in the journal, Medical Care that people are putting off seeking treatment for even severe problems due to the higher deductibles and out of pocket costs. By the time they are finally forced to seek treatment, the severity of their illnesses have increased along with the costs of treatment.

Thanks jackasses; you've done wonders for the betterment of healthcare.

[Ryn RN]

dbeech said:

Thanks for this spot on article ! I have been a nurse since 1998 and I recently resigned from my position of 9 years in the operating room . I began my nursing career in geriatric nursing, but always had the desire to work in a hospital. I started as a float nurse primarily working on med surgical units then settled in a unit that took on Pediatrics as well. I was the only nurse this one particular eve that had Pediatric experience and I already had 7 patients to tend to when I receive a call from the Nursing supervisor that they wanted to give me another patient from the ER, a 6 month old with a respiratory infection....I told the supervisor I couldn't safely accept the child that I already had 7 patients . She told me that the hospital did not have a min nurse/patient ratio and that I had to take the child...I refused and told her she would be putting the child and all my other patients at risk and I was making it known in the presence of my colleagues, that if something went bad it would be on her shoulders. Well the ER faxed report on the child because I refused to take a verbal report and that was the end of my Floor nursing...I moved on to perioperative nursing until July 2nd of this year. My shift was from 6:45am until 3:15pm but due to the lack of staff most days my 8 hour shift would turn into a 10hr or 12 hr shift and then there is the call, starting at 10:30 pm until 7am during the week to having full weekend call ! needless to say staff dropping left and right getting injured, out on stress leave, having elective procedures just to get rest from the stress. The complete lack of respect and concern for the staff by administration/management is disheartening. The culture in the Operating room by management and some surgeons is abusive and administration continues to turn a blind eye. The lack of ancillary staff is forcing nurses and surgical techs to be the cleaning personnel as well, having to clean MRSA and VRE exposed rooms then off to tend to the next (clean) patient. I wonder if the CEO of the hospital was to have surgery do you think he/she would want to be next one in line to be taken care of after I cleaned the MRSA/VRE Operating Room ? Hmmm ?

Now the colleagues that I have worked side by side with for 9 years are bitter that I gave my resignation the beginning of Summer and stated I was inconsiderate and felt I could have waited until the fall after Summer vacations were over because since I left all my call is being forced on them....How about turning your hostilities to the hospital administrators and the corporation they are the people making the cuts...I'm just the nurse who will no longer take the unsafe hostile working conditions. My sanity and my family is worth more than any amount of money. Signed Fed up Perioperative Nurse

It's not just peri-operative, it is in all fields of nursing! That is why so many seasoned nurses are leaving! Admin just doesn't get it! Unfortunately, the people left behind are the ones who suffer.

[NurseD, BSN,RN]

If the author's name was not to be published, why is the bio listed at the bottom?