How do you lose your license??

emmy27 · Aug 6, 2015

If their workload is at a point where they regularly can't finish all their assigned work, or where patient needs go unmet for extended periods despite their best efforts, they're almost certainly feeling overwhelmed and burned out. Few people are going to be comfortable saying to your face "The standards you've set are unrealistic and I can't meet them," though. That's usually what "I'm afraid of losing my license" means. That staff knows that sketchy stuff is going on or dangerous conditions regularly exist, usually because of severe understaffing.

If some of your nurses seem to always get everything done, and others don't and are saying they're afraid they'll lose their license- you may be hearing the desperation of people who know that some staff *are* falsifying documentation to appear to meet performance standards, and/or that the actual patient care on the ground isn't up to snuff, no matter what documentation looks like. I've seen this happen and it's a scary situation to be in as an employee, knowing that you could lose your job for acting ethically when others are charting fraudulently or skipping tasks to try to pacify management.

slauren · Aug 6, 2015

I am one of those nurses. The reasons are frustration that I'm overwhelmed with 25+ patients and that yes, I'm not providing the care that I feel my patients deserve. I prefer to do preventive care for my patients - stay on top of things before they happen - but when you have 4/5th of the shift just alone doing med pass, accuchecks, and tube feedings, you can't sit down and fully assess the patient's needs. Throw in the trach care, dressings, meds that need to be reordered, and you have no time to do anything extra. It frustrates me when I have to pass things on in report and cross my fingers in hopes that the next nurse will follow through.

What I wish my LTC/Rehab would do is better employee training. I was a brand new nurse, had maybe 5 days of orientation then set out on my own. Orientation should consist of check offs that the employee should have been taught and then proven to understand (quized or demonstrate). But as a manager, I think it would be better to see what your nurses may have to suggest.

xoemmylouox, ASN, RN · Aug 6, 2015

Many times when nurses say this they say it out of fear and frustration. They are scared they are going to kill someone or at least seriously harm them. Often it is because management expects a nurse to do more than is possible. Other times it may be that the nurse is not confident in their skills. Either way the problem should be addressed ASAP. If not the facility will end up with a high turnover (expensive) or falsifying of documentation/cutting corners (dangerous). Unless there are nothing but drama queens and whiners as staff there is a serious problem. It is unlikely that multiple staff members would say this if there wasn't a real issue.

Conqueror+, BSN, RN · Aug 7, 2015

I would like to add that you can smply be working in the wrong place at the wrong time (hurricane Katrina comes to mind). I have seen nurses served up to prevent a lawsuit, to save a Drs butt, and because they simply ticked off someone with enough authority to screw them over badly. There is a common misconception amongst the general public and nurses that it is hard to end up in fron of the BON. It really isn't. Liability Insurance people.

LadysSolo · Aug 7, 2015

I occasionally said that when I felt that staffing levels were insufficient to safely meet patient needs (being expected to infuse chemotherapy and blood on several patients while providing total care for seven patients with one nursing assistant per 14 patients,) (including blood vitals, q 30 minute IV site checks on chemo infusions or sitting doing IV push chemo.) I found that since I rarely complained, when I did management usually found an additional staff member. It always was about patient safety whenever I complained.

nurseprnRN, BSN, RN · Aug 7, 2015

If you go to your state board of nursing website you can usually look up the actions taken on licenses by the BoN. Most people who really lose their licenses have done things like steal narcotics, steal from patients (jewelry, money, property...), violate terms of their restrictions they got after previous actions (usually for drug offenses, working under the influence of drugs/alcohol), willfully violating scope of practice (usually documented repeatedly), and the like. If your staff aren't doing things like that, they don't have much to worry about in terms of loss of licensure.

Management has the obligation to provide safe staffing. If staff is worried about too much overtime and not being paid for work done due to poor staffing, they should contact their state division of wages and hours (or whatever it's called in your state) and speak to someone there. If they are worried about omissions and poor care due to unreasonable workload, they should contact the facility licensing agency, perhaps via the state ombudsman if they don't know the best place to call, immediately.

No Stars In My Eyes · Aug 8, 2015

If their workload is at a point where they regularly can't finish all their assigned work, or where patient needs go unmet for extended periods despite their best efforts, they're almost certainly feeling overwhelmed and burned out. Few people are going to be comfortable saying to your face "The standards you've set are unrealistic and I can't meet them," though. That's usually what "I'm afraid of losing my license" means. That staff knows that sketchy stuff is going on or dangerous conditions regularly exist, usually because of severe understaffing.
If some of your nurses seem to always get everything done, and others don't and are saying they're afraid they'll lose their license- you may be hearing the desperation of people who know that some staff *are* falsifying documentation to appear to meet performance standards, and/or that the actual patient care on the ground isn't up to snuff, no matter what documentation looks like. I've seen this happen and it's a scary situation to be in as an employee, knowing that you could lose your job for acting ethically when others are charting fraudulently or skipping tasks to try to pacify management.

Like, like, like, like, like.

I used to wonder how the other nurses had time to sit at the nurses station at the end of the shift and NOT be scrambling to get all the paperwork done. Suspicious to me. Had to be shortcuts taken or tasks ignored, or something. Time-management has nothing to do with it IMHO.

Ldla1234 · Aug 9, 2015

I do not work in a LTC facility, and i am not yet a nurse, but I am a nurse tech on an IICU floor and I can tell you it is insane. We have 16 patients (beds are always full with patients waiting for admission). There are 4 nurses and 2 techs iF we are fully staffed wich is rare. Generally we have 3 nurses and 1 tech or no techs because they call out a lot. Most of our patients are total care, but either way we are a step down unit so there is soo much to be done. As a tech my job is to:

Prepare rooms for new patients

Transfer or discharge patients

Vital signs every 4 hous for every patient or more often as requsted by the nurse

Document intake/output every 4 hours

turn patients every 2 hours

Insert/remove foley caths

Glucose monitoring for all diabetic patients

deliver diabetic snacks

Transport and return patients from dialysis

Bed bath for every patient every day (if paitent refuses must try on second shift)

Change linens every day

ambulate patients or transfer from bed to chair or vice versa

feed patients

take and pick up specimens to and from lab

assist to bedside commode or bed pan

answer call lights

anything else requested by nurse staff

Our floor is crazy busy. The time passes so quickly it makes my head spin. I am lucky that my floor has computers in each room but i have to sign in and out and document every single time i am in a room. Things can also be slowed immensely when we have multiple patients with C diff, hepatitis or some other issue requiring dressing in and out of a room. I get behind on most days. It seems impossible. Sometimes by the time I am done making my rounds for vitals, Its time to start over! It literally takes 4 hours to get through 16 rooms. I can not imagine having 25 patients, and I am just the tech! I imagine that the nurses at this facility feel that the patient load is way too much. I dont know if they have techs or nurses aids to help them, but without them I would think it unrealistic to think a nurse could care for that many patients the way they would like to.

Nursetonp · Aug 10, 2015

Like, like, like, like, like.
I used to wonder how the other nurses had time to sit at the nurses station at the end of the shift and NOT be scrambling to get all the paperwork done. Suspicious to me. Had to be shortcuts taken or tasks ignored, or something. Time-management has nothing to do with it IMHO.

When I worked in the hospital,we had this one charge nurse who gave her buddies all of the "easy" patients (selfs, walkie-talkies) basically anyone that maybe got a med or two, or was leaving for a test or surgery all day, etc... That way they could sit at the desk talking. After constantly getting dumped on, a few of us questioned it, and were basically told that she'd been on the unit a long time, and was doing what she felt was best. I quit 2 months later.

KalipsoRed21, BSN, RN · Aug 11, 2015

"If their workload is at a point where they regularly can't finish all their assigned work, or where patient needs go unmet for extended periods despite their best efforts, they're almost certainly feeling overwhelmed and burned out. Few people are going to be comfortable saying to your face "The standards you've set are unrealistic and I can't meet them," though. That's usually what "I'm afraid of losing my license" means."

Excellent and accurate response! I do mostly ER and floor staffing as a traveler and this is what "I'm afraid of losing my license" means at most of the hospitals I've worked at as well. I would also like to add that it seems to me in all aspects of hospital life management has some crazy expectations when it comes to what nurses should be able to accomplish in a shift. I say this as a nurse who has worked at 7 - 10 facilities in multiple states, so it isn't just one particular manager that has this issue. It is a country wide problem....except for maybe in California. Some of the better places I've worked at management tracked how frequently nurses clocked out on time and put in place better programs for meal coverage so nurses could have a truly 30 minute work free lunch. Those two things are HUGE!!! If you could find a way to track those and get it to where your staff were able to leave on time (not having to stay after and document) and have a true 30 minute break in the middle of their shift then you will have achieved a more accurate expectation of work load for an RN at your facility.

LPNtoRNin2016OH, LPN · Aug 12, 2015

When I state "I am afraid for my license", I actually am. Someone said a few posts back but if there is a major mistake that occurred on your shift -- one that happened clearly because you were overwhelmed with 30 high needs patients, the facility/MD involved are going to do everything they can to pin it directly on you (general you) and only you. I have seen it happen and have seen good nurse's careers suffer greatly and one time a license nearly provoked. I left LTC because of this, I never personally experienced it, but I have experienced being asked to do the impossible and crying in the bathroom because you have no idea how you could possibly provide safe care to that amount of patients. I loved loved loved my LTC patients but I was tired of being a work horse with no water breaks. Not sure why management across the board feels like it is acceptable to put such unrealistic demands on it's staff but then scratch their heads over high turn over rights and low patient satisfaction scores.