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

[SubSippi]

You'd think all these people with business degrees would be able to appreciate the benefits of implementing long term solutions to financial issues. Spreading health care workers too thin and getting rid of the people with bigger paychecks might save money right now, but I just don't see how it isn't costing more.

This isn't a new concept...

[Salisburysteak, BSN, RN]

JHARPER13 said:

I blame O'butthead and Obama care for the hospitals push to save money. They don't have a choice. Those of you that voted for this "change"....I blame you too. You wanted it, you got it.

These issues have been going on long before the POTUS was elected and will keep on happening long after he is gone.

[Sisyphus_01]

ACTIONABLE ITEMS:

Every nurse on here who agrees with these issues can click the following links and be directed page where with a mouse click you can show your support for improved patient to nurse ratios and improved working conditions. There is absolutely no excuse, the links to the site below makes it so easy.

A suggested letter to your congress person or senators is already written for you, if you'd like to write your own you can, or just send it as is, every voice matters even if it's just sending the form letter provided on the site. Perhaps some of you can copy and paste the posts you made on here and and weave them into the form letter? I would run them through word and do a spelling and grammar check first because typos happen *LOL* but these posts have been compelling and very poignant.

Click the links below, indicate your location, and the site will direct you to the form.

Click below to show support For:

HOUSE RATIOS BILL - HR 1907 (sponsored by Schakowsky)

National Nurses United | Send a Letter to Congress Urging them to Support the Safe Nurse Staffing for Patient Safety and Quality Care Act

Summary of the bill and more info:

https://www.congress.gov/bill/113th-congress/house-bill/1907

Click Below to show support for:

National Nursing Shortage Reform and Patient Advocacy Act - S. 739 (sponsored by Boxer)

National Nurses United | SENATE RATIOS BILL - S. 739 (Boxer)

Summary of the bill and more info:

https://www.congress.gov/bill/113th-congress/senate-bill/739

[Farawyn]

Secretperson, welcome!

I don't think anyone is debating the education of a nurse being important and necessary. MOST floor nurses I know are there not because they can't find other jobs, most are there because they are still in nursing for traditional patient care, the reason most of us have gotten into nursing in the first place. I am the ONLY one of my friends without a higher degree in nursing. My friends all have their BSN, many with or going for their Master's.

To lie this problem on the shoulders of the 20 year bedside nurse is lazy on your part.

[tacomaster]

@Gooselady,

Here is an example since you asked for one. A 30 year experienced nurse that I work with was called into the manager's office and given a write up and wasn't given an opportunity to refute the charges. A write up is stronger than a verbal. I believe two write ups are a termination. What was her offense? The lab tech who drew blood on her previous shift left the tourniquet in the patient's bed and the day shift nurse found it (not sure if that nurse told the manager or what). The manager wrote her up for "patient safety" because she is "responsible for items left in patient's bed". I read the write up and was really shocked. Good thing is the manager left a few months later and the nurse was able to get it removed.

[PhillyRN78]

Let's be honest, hospital administration does not care about it's nurses or even its patients. It's all about money and accolades and ratings and looking good to everyone else. Anyone that thinks different is very naive. It will always be this way. It will never stop but the only way to at least lessen the severity of it is to become unionized. Every hospital should have unions.

[JHARPER13]

But now it is much much worse because of the affordable care act. Any doctor or administrator will tell you how the ACA has devastated them financially. Small hospitals are having to merge with larger hospitals or close their doors. They are having to save money in any way they can just to stay afloat

[Honey1]

A great article. Recently a friend of mine was fired from a hospital because he couldn't meet the goal scores on Customer Satisfaction, Financials AND Employee Satisfaction. I think you can achieve any 2 of those but achieving all three will require something different in the administration offices.

[KathyDay]

I've been an RN for 45 years this year. I'd like to chime in on this conversation. For the past 6 years I have been a volunteer Patient Safety Advocate. I do this because my own father died of a preventable Hospital Acquired MRSA infection. 440,000 people die every year, because of preventable healthcare harm. All kinds of issues factor in, but I honestly believe that many of these deaths, and many disabilities are related to lousy Hospital staffing. This open letter to administration should travel. I think it should be sent to every State Hospital Association, to every State Health department, and to Federal level organizations like CMS, DHHS, and the CDC. At the same time, it should be sent to all of our local newspapers. When this information gets traction in the Media, we can make a difference. This is a factual, heart felt expose of exactly what is happening in too many hospitals in the US. Hospital administrations are focused on money and their own outrageous salaries. Regulators are focused on certain measures, that are all important, but none are focused on the people....RNs, who make or break these measures, and patients who benefit from safe care. RNs at the bedside can and will determine the patients outcome....whether or not patients will get better without complications or accidents, whether or not they will learn how to care for themselves, whether or not they will require readmissions, etc. Without proper staffing levels, this whole scenario becomes a set up..and impossible dream...of giving safe high quality professional nursing care. Who here is willing to take the reins and do what is necessary to bring attention to this ongoing and never ending debacle of understaffing and overworking RNs. I'd suggest a first step of the author sending this letter as an op ed to their own local newspaper, and allowing any or all of us who are following it to do the same. Shine a light on the dirty truth of what is happening inside our Hospitals.

[aladennis]

How do we change this? NOT by wringing our hands and bemoaning the situation. We actually have to act ourselves. Nobody will do it for us. Do what? you ask? Become a mover and shaker. Get on the hospital's board and make the changes from there. Easier said than done I grant you. Each hospital will have its own rules and laws, but check out your local situation and get moving. I the last election there were 7000 votes cast and i lost by 7. Yes. that's seven! If i had changed the minds of 4 voters I'd be on the board. Another RN actually won her election but because of a newly enacted law she decided to keep her job and not serve. For more insight on this see Al Dennis For Commissioner in 2012: OH! THE STATE OF WASHINGTON PASSED A LAW JUST FOR LITTLE OL’ ME? AWW, GEE, YOU SHOULDN’T HAVE.

WE CAN DO THIS!!

[imenid37]

"Get real nurses the rumors of increased educational requirements started in the 70's."

So here goes.As I said, I am spent. I do have an MSN, a post-MSN, three certifications, and hundreds of CNE over almost 28 years. I have never even worked anywhere else but in the hospital setting. I did Jr. Volunteer and my 1st paid job was helping to feed patients at age 16. I am not a bragger, but I can say truthfully, that I have always been the nurse who goes the extra mile for education and excellent patient care. I support education for folks, but we have to facilitate it. It isn't that people are "lazy" and do not seek opportunity. Often they do not have the time or $. As nurses, you see we are often giving so much. It is not just on the job, but to our families and others. Sometimes as we age, this is happening more and more. It can be to our own detriment. The nurse who doesn't go to a conference may be giving $ to her elderly parents or raising a grandchild. What if an organization paid for an 8 hour conference every year for an RN. What if an organization gave a nurse 4 or 8 hours a week to use to complete their BSN degree? I know many offer money, but often time is tight too! The 25 year old MSN-CNL has some great skills, but there is a lot she can learn from that 50 year old ADN grad who has 25 years of experience! They could actually learn a lot from one another. This doesn't happen because hospitals and individuals draw a line. The two nurses may feel threatened by one another. People can can come to know each other and get past that often times. But... when a facility draws that line and makes one "preferred" and the other a "burden" AND uses $ to do it, there is no getting over it.

I do have all of the education and still nursing is not as satisfying as it once was. What I see is plain sad.

"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."

Since healthcare has become such a financially driven "business" anyone who speaks for better patient care first, not fiscal management has had their voice muted to some extent. Nurses have been doing more with less for years. The difference now is all of the satisfaction related reimbursement. You would think better patient care and better nurse-patient ratios would be the answer for patient safety and satisfaction. Ofcourse, if you think like a nurse it is. If you think like a market driven MBA, nurses are a "cost" of doing business. I look at all of the nurses dinged for often "minor" errors or not being "welcoming" and go ????? Why, because we have physicians who make often very potentially and actually serious errors and are overtly rude and see them have comparitively little consequence. Yes we also want physicians to be cheery now. If they are not, then they are not held nearly as accountable as nurses. Why is that? Well who bring in the $ and who costs $ for the facility? It really is all about$ and that is very sad.

[classicdame, MSN, EdD]

I am not sure administrators "don't care" but are at a loss of how to fix things with no resources. Per our CPA, we are lucky if we collect 27 cents for every dollar billed. But the OP had it right. We are at a tipping point. It will take a breakdown in the system in which many people suffer to get the right attention.