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

[anon456, BSN, RN]

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.

My manager does the same sometimes and it's great. However, the bottom line is that she shouldn't have to. The higher-ups should budget for enough nurses to be on hand at all times, barring a disaster or emergency.

[trinitymaster]

This has been discussed for years. Most nurses are not brave enough to unionize. You have to march and chant to no end. You have to be willing to give notice that you plan to participate in a strike. You absolutely must not work the floor because you feel guilty. You must be willing to be fired, ostracized, and blackballed.

Yes, nurses who are topped-out at their facility, such as myself, will not be in a for-profit organization any longer than is needed to replace them with a younger nurse. It is "OUR" fault for what is happening. National Nursing Unions are needed and we all must be willing to hold hands and sacrifice everything that we have to.

[Jukeboxhero00]

People people, you have to play to the gods that govern admins- JCAHO! When you have staffing safety concerns file a complaint with the joint commission or even Medicare. If you have a legitimate case and present your fact well along with evidence based research to support it you will make progress. I have been a buisness owner as well as a nurse in healthcare. I have been in the same situation. You will never win this standing toe to toe with admins. From the back office point of view things like benefits represent almost 30% of your revenue right off the top. Staff is the biggest expense of any company. CMS is the biggest payor source in healthcare and they only pay about 60% of the number THEY determine is appropriate for compensation- how screwed up us that! I'm just saying that admins jobs arnt just golf games and dinner parties. I agree with the plot of nurses, but admins have report their numbers to partners, their bosses, boards, and investors and they are never going to just give up the cost control game- their job depends on it! BUT if a regulatory body mandates it- then the heat is off them, their hands are tied. They don't hate us, but they do have to protect their jobs too and, unfortunately, due to something I refer to as the MBA phenomenon, numbers are the name of the game right now and they only look at the short term (i.e. quarterly, monthly semi-weekly). Lobby your state boards of nursing to mandate staffing ratios as well- be a part of the fix! Just know this... Everything comes with a price and I promise you aren't going to see corporate healthcare just hand over there own cheddar. Wages will be adjusted, as will benefits if we fight for staffing and as far as firing vets goes as a team you have to stand united. If one is fired maybe sure 20 hand in resignations and clearly state why. Just my 2 bits for what it's worth.

[avengingspirit1]

1 3:05 pm by imenid37

Quote

"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.

Quote

Well said. But I recently read a post from a new RN grad who was told by their interviewer that Associate and Diploma nurses are comparable to technicians. This is the type of idiotic thinking that was spawned by the BSN push and is being perpetuated by those sitting in ivory towers who either never worked on a nursing floor or haven't for quite sometime. All RNs regardless of what program they graduated from have something to offer and can learn from each other. It's the individual that makes the nurse, not the degree.

[pattyd50]

While doctors are a separate entity and make corporations BIG BUCKS. They are not layed off or fired for NOT bringing in the cash value patients to the corporation age related or not. Nurses on the other hand just work and do their jobs, they get as much done as humanly possible. Nurses stay overtime often to make sure they don't miss a thing if they can at all help it. There is no reasonable option for nurses to prevent burn out because the higher ups think they know nurses jobs better than they do. I extend an open invitation to those higher ups and spend one week following nurses and see if they can manage to keep up with the over abundance amount of work all Nurses do. No matter the ending credentials in our education status....LPN, RN, BSN, Masters, ect. Floor nursing is by far the hardest job and nurses deserve to be treated with more understanding and RESPECT for the jobs we do. Undercover Boss come to the "medical side" see were the truth lies. Then they can say they have walked in our shoes.

[nursesue2013, ADN, BSN, MSN]

I graduated 2 years ago, a later in life nurse. I always thought I wanted to work in the hospital setting. After hearing many of my classmates talk about many of the points in this article, I am so glad I ended up where I did. I always wanted to be a pediatric nurse and I ended up in a pediatric immediate care facility. Got the best of both worlds, peds and a great place to work. I don't think I would consider working in a hospital unless things really do change. I just wish I knew what it would take to get the necessary changes made! I really do worry about patients in the hospital setting.

[mclennan, BSN, RN]

Guys. It's not just in the hospitals with bedside nurses!

In my short 8 years as an RN I am seeing this same "blood from a stone" mentality in clinics, day surgery centers, LTC, SNF, rehabs, dialysis, private duty, home health, agency and case management!

So often I hear bedside nurses say they want to get out of the hospital setting and into a desk job. Let me tell you ladies and gents, the same problems outlined by the OP are as rampant in case management as anywhere else! The insurance companies, workers comp, medical groups and utilization management companies where all these dreamy desk jobs are SLAMMED with patients and RNs in these positions often have no ratio laws or unions to protect them. Many of us are operating under TOTALLY unrealistic expectations and UNSAFE conditions.

Management screams compliance, compliance, compliance......then loads their nurses' panels and queues with over 100, 130....150 patients!!!! And if one audited chart is the tiniest bit out of compliance/regulation it is the NURSE who gets written up! They set the experienced and certified nurses up to fail, then bring in less experienced nurses they can boss around and pay less. Yes it's happening outside hospital environments too!!!!!

[LadyFree28, BSN, LPN, RN]

mclennan said:

Guys. It's not just in the hospitals with bedside nurses!

In my short 8 years as an RN I am seeing this same "blood from a stone" mentality in clinics, day surgery centers, LTC, SNF, rehabs, dialysis, private duty, home health, agency and case management!

So often I hear bedside nurses say they want to get out of the hospital setting and into a desk job. Let me tell you ladies and gents, the same problems outlined by the OP are as rampant in case management as anywhere else! The insurance companies, workers comp, medical groups and utilization management companies where all these dreamy desk jobs are SLAMMED with patients and RNs in these positions often have no ratio laws or unions to protect them. Many of us are operating under TOTALLY unrealistic expectations and UNSAFE conditions.

Management screams compliance, compliance, compliance......then loads their nurses' panels and queues with over 100, 130....150 patients!! And if one audited chart is the tiniest bit out of compliance/regulation it is the NURSE who gets written up! They set the experienced and certified nurses up to fail, then bring in less experienced nurses they can boss around and pay less. Yes it's happening outside hospital environments too!!!

Well said.

It's a systematic problem indeed.

I remember there was a post here that one of the issues we discussed was how nurses, idealistically should be not included in the budget; my viewpoint was based that be should billed based on acuity and acuity measures, which is a part of HCAPS, which was passed in 2004 and systematically was filled out until 2008, and there are measure that acuity has to be assigned per nursing measure, this is to be done in every setting.

We can turn this on our ear by utilizing research models to measure the amount of time spent on patient care and measure what acuity is really being presented in doctors offices, LTC, skilled nursing, home health and hospices, and correlate that nursing care IS the revenue, and should be billed as such.

WE, as nurses drive positive outcomes; we must get involved enough to have the data, have a solution and challenge funding and ensure that correct appropriations are in place; we need to have a plan that ensures proper ratios based on acuity, proper funding for wages, and clinical ladder opportunities that ensures that their is proper input in operations.

[applewhitern, BSN, RN]

I get sick of the newer, younger, inexperienced nurses getting all the promotions. They come running to the older, experienced nurses with questions, help, etc., because they don't know something, or don't know what to do, yet they are the ones who get the glory. That makes me sound mean-spirited, and I am not, I just get down when the new-grad nurse gets all the praise, promotions, etc., while we older, experienced nurses are ignored.

[Pauline RN]

Sad but true that this nurse hit the nail on the head. Administrators don't care how or why they cut costs, even if it means putting patients at risk. I've seen this trend developing over the past 15 years. Great nurses have left the profession for just that reason.

[applewhitern, BSN, RN]

One thing we have noticed is that the new-grad nurses are coming in with a BSN, mostly, but they cannot "hit the floor running." They have learned nothing but theory, and require lengthy orientations, and even then, many cannot perform simple nursing skills. We hear a lot of "I've never seen that!" even with simple, everyday stuff. It seems like hospitals could afford to keep their older, experienced staff cheaper than continuously teaching/orienting new nurses. Our raises are frozen, but we can orient someone for months on end.

[Sunsetter]

I think all nurses feel the same and it feels like our hands are tied. Just yesterday I needed to bounce something off an more seasoned nurse, when I looked around the unit, I realized I was the most seasoned nurse there with only 2. 5 years experience, how sad is that???

I have never been much of a union person, but I think this may be the route to go for patient safety.