How does staffing affect you?

Dixielee, BSN, RN · Oct 14, 2004

What do you like about staffing where you work, and what don't you like. Would you change anything?

I am a travel nurse in a busy ER. The staffing pattern is a good one, but it is seldom met. It seems that there are just not enough nurses to go around. They have hired many travelers, have a large float pool, but we still frequently work short. Of course, I would LOVE to have a full staff!

Are there any incentives you would like to get or have gotten?

I guess I don't really understand what you are asking here. Do you mean more incentives to keep staff happy? If so, more money and adequate staff would be a nice start.

How does staffing affect your morale?

Of course when we are short staffed, we can not give adequate care, sometimes not even safe care. Our charting suffers, making me wonder how my charts could stand up in court if an incident were to occur. Our bodies suffer making me wonder how long I can keep up this pace, and our patients suffer because we are giving marginal care. Adequate staffing means we can actually talk to our patients, give them a little TLC, maybe some education and try to meet their physical needs. Adequate staffing means I don't have to worry about losing my licence, my home and everything I have worked for because I was trying to do more than is humanly possilbe. Adequate staffing is the key to keeping the morale of nurses high. Adequate staffing is the key to keeping nurses in the profession and the key to taking care of our patients in the way they deserve. I don't know if management will ever or can ever grasp this important concept. You can only ask us to work leaner and meaner for so long, then things begin to come apart.

When you are short staffed, you work 12.5 hours with no break. I have worked in hospitals that were happy to "pay" you for that extra half hour rather than staff so you can get a lunch break. It is cheaper for them to pay the 30 minutes than find you relief. They seemed surprised that we would rather have the break than the "extra" $10. I worked at one hospital that eliminated the nurses break room and turned it into an office because "the nurses never used it anyway". WELLLLLL, maybe there was a reason we never used it!!

In the early 80's I worked at a large teaching university that did not pay weekend or shift differentials. When the nurses approached admin about beginning to offer one, the hospital administrator met with us and his words were to the effect of..." you knew when you went into nursing that it was a 24 hour, 7 day per week profession, and we should have thought about it then." We knew then, we were in trouble!

I hope others answer your questions, I would be interested in other responses as well.

LVC · Oct 15, 2004

Thank you for your response. The information was very informative, and I really appreciated it. Sounds like you have a lot of experience and a lot of knowledge. Does it seem to you like things have gotten better, or worse?

As far as incentives, I did mean if there were certain things your employer does for staff to keep staff happy, but also, do they use incentives when trying to get more staff recruited to work. Sone examples I have gotten is giving employees gift cards, or coupons for the family, or offering a sign on bonus. I was just wondering if that is something that is done very often.

Again, thank you for your response. I hope that others answer my questions as well.

meownsmile, BSN, RN · Oct 15, 2004

I think most of that stopped a couple years ago. I think retention is maintained by need on the part of staff. With wages not keeping up with inflation, does it really pay to change jobs when you have to start at the bottom of the pay scales? Most people are retaining their positions to maintain their wages if nothing else.

GAgirl · Oct 15, 2004

Our staffing is managed on the HPPD system. This defines how many staff members can work according to how many patients we have on the floor at that time. 1. This includes our clerks. I think it should only count those that provide direct pt care. 2. It does not take into account acuity. This has left us working in an unsafe environment more times than I care to count. I am fortunate to work on a floor with an absolutely wonderful team. We all try to help fill in the holes in staffing when we can without working much over our commitment. We swap shifts and make deals where we can to help out. Incentives? We are a closed unit....we won't ever get pulled to another floor. We also have self scheduling, which helps. More money would be nice, of course, but I doubt that will happen. :uhoh3:

NancyJo · Oct 15, 2004

I have a few questions I would love to get some info for on nurse staffing.
What do you like about staffing where you work, and what don't you like. Would you change anything?
Are there any incentives you would like to get or have gotten?
How does staffing affect your morale?
This is for an assignment I am doing right now in nursing school. Any info I get will be greatly appreciated. Thanks for your time--

Unforunately our staffing usually stinks. We have a wonderful director who worked her tail off over the last several months and recruited several RNS,LPN's and CNA's, had our staffing pattern changed and we were jumping for joy!:balloons: That was short lived, now we have apparently became the float pool for the rest of the hospital. :crying2: We are right back to where we started. Staffing has a direct impact on my morale. Although I try not to let my patie nts know how bad things are, they have to know. Care is minimal. It seems myself and my coworkers just spend our time running from room to room getting done what you can. I cherish the rare occasions that we are staffed adequately and I can take that extra time to just talk with pt.'s WE send out surveys after discharge and you can pretty much figure out how we were staffed at the time of that pt.'s stay. It seems the most frequent c/o are that the nurses are too busy and spend too little time with them. :nono:

Dixielee, BSN, RN · Oct 15, 2004

"Does it seem to you like things have gotten better, or worse?" ...Definately gotten worse over the years. There have been shortages before, but I think this one is here to stay.

"As far as incentives, I did mean if there were certain things your employer does for staff to keep staff happy, but also, do they use incentives when trying to get more staff recruited to work."....Many hospitals are offering sign on, relocation bonuses, longetivity bonuses, etc. There a lot of things they could do to retain nurses. One would be to take away a lot of the frivolous paperwork that we have to do. Have adequate housekeeping so we don't end up cleaning rooms, recruit community volunteers to help feed patients who can't feed themselves, or just be "goofers" for us. Make sure they hire unit clerks for

EVERY shift. Someone needs to be there to answer the phone, the call lights, keep the charts organized etc. So many hospitals think they are not needed at nights. WRONG!! I understand in Calif where they moved to mandatory staffing rations, the hospitals said, fine, we will decrease the ratios and get rid of ancillary staff, so nurses end up doing what other services would have done. I worked in one hospital who announced huge layoffs. They said not to worry, it would not affect nursing. WELL...they did not lay off any nurses, but they did lay off all the transporters, the kitchen staff that passed out trays, the phlebotomists, CNA's, clerks etc. So you know who ended up picking up the slack??? Nurses of course, because we can do it all! Well, we could if you don't add patient care to our plate as well. Oh well, you get the picture.

Antikigirl, ASN, RN · Oct 15, 2004

I have a situation more like Dixielee, and it is getting worse. I am a part time nurse because of my family...but lately I have been working full time with no benifits because they have a rule that you have to be full time for 3 solid mnths before you qualify and they make sure I am shy at least once in each month grrrrrrr! But the reason is that we lost a nurse to an on the job injury and she had to fight it in court..she settled and part of her settlement was to leave her employment there. So they asked me if I would switch to full time, I said no I couldn't...so they did it to me anyway yet made sure I was one day shy a month from qualifiying...nice of them wasn't it!

We also have a shortage of CNA's and now they are hiring non-licenced care givers. That would be dandy if my facility didn't have 120 patients and ONE nurse on duty per shift! Our caregivers pass meds, do all care...and it has to be overseen by the ONE RN and delegation and assignment of tasks! I think it is not right, but the state says according to the new definition of 'assisted living' that it is okay. Okay...so when did assisting living facilities get to have over 3/4ths of their patients high medical need??? Now hardly any staff!!!!

I basically wish to get the heck out of there pronto, but I am trying to buy my first home, and need that money and 2 year employement to get a good loan...so I am rather stuck. Plus our market out here has NO lack of nurses...yet no one wants to work with geri's (I don't either...never did...but I needed the job after hunting for 8 months). But I am getting to the point that I need to do some real hard research to see if my gut instinct is correct and the situation at my work is borderline dangerous for my clients~! And since the non licenced caregivers have come, there has been a major increase of med errors, falls, skin tears/bruises, and we have had thefts...not just of personal items in residents rooms, but narcotics as well! (the nurses do NOT have the med cart keys because there are 12 carts..the caregiver on duty has them so they are responsible...cool for me since I didn't like having the key to them all when we had a theft and they looked at me too...so we nurses gave up that responsiblity pronto! Let the admin handle that!!!).

Yeah...I feel I have hit rock bottom most of the times with my current employer, and as soon as the loan is approved and house is built...I will be seeking other employment like crazy...lets just hope I make it that long!!!!!!

I was hired as a admin nurse, to check over charting and do consultations with staff, education for caregivers, and monthly MAR checks...now I am purely a floor nurse for 120 people per shift, and babysitter for 14 caregivers, and on weekends..the administration as well...and you can only do so much and be safe, and they are really pushing the envelope on us nurses there!

Nurse Ratched, RN · Oct 15, 2004

At my hospital, they are short in total numbers of staff members, but they almost always manage to have enough floats or beg enough people to work extra to meet the staffing matrix. Given certain patient safety issues, however, whether or not the staffing matrix is approriate to meet levels of patient acuity is highly debatable.

As for myself, I refuse to be the finger in the dike with new holes sprouting daily. The answer to staffing issues is not perpetuating and worsening the problem by burning out your staff. There is, simply put, not enough money or any other incentives that will get me to work more than my already-sufficient number of hours.

plumrn, BSN, RN · Oct 15, 2004

Amen to that! When I work my fulltime shifts at the all-out, fast pace we are set up for, I am so tired my first day off, I really need that day of just rest. If I pushed it and worked extra, I'm afraid I would not be able to stay in nursing. I rarely agree to an extra shift. Higher-ups don't understand that. They sometimes work long hours, too. But, sitting behind a desk, or in meetings, or long lunches in nice restaurants for meetings, is much different than running your legs, and your brain at full speed for 12.5 to 14 hours/day.

Dixielee, you have some great ideas there. Good post, and right on target.

NancyJo, we here have the same problem. A nurse can only be in one place at a time, and are stretched way too thin. Some pts pick up on this, but a few, I'm afraid, just get the impression nurses don't care ('or they would of come quicker when I called'), or maybe they think we are just lazy. The nurse gets all the venting/blame sometimes.

Bottomline, if we had sufficient staff to give the best of care, AND get out on time every shift, I could work as a nurse until retirement at my current hospital. Just me, but I could give a little on salary, if I knew that I could have a satisfying day at work, and be able to stand up to the rigors of nursing until I decide to retire. Throwing more money at me may help me tolerate conditions a little longer, but I guarantee it won't be enough for very long.

BeenThereDoneThat74, MSN, RN · Oct 15, 2004

what do you like about staffing where you work, and what don't you like. would you change anything?

i like the fact that i can never have more than 4 pts (it's a 4 bed unit). i don't like the fact that we always have the potential to be left alone (and it happens, the worst was 1:3). admin (not my nm, but the covering sups) likes to say 'well you only have 2 or 3 pts.', but do not take acuity into account. these are high acuity pts, and if you leave me alone with 2, i have no one to help me at all (except a useless aide). :angryfire

i also don't like when my nm breaks her butt to adequately staff the unit, and the night or weekend covering sup makes the decision to float. when we're short, these same sups will turn around and say 'well your nm didn't adequately staff your floor, and there's nothing we can do about it now. :angryfire

are there any incentives you would like to get or have gotten?

incentives? maybe 'combat' pay if we're left short, or asked to come in last minute or work extra (i'm per-diem, so i never reach 1 1/2 time). maybe even a free lunch ticket or movie tickets, or something to show they appreciate what you've done.

how does staffing affect your morale?

i think staff starts to resent each other when people take advantage of 'sick' days and leave the unit short, or when certain people do not pull their weight to pick up extra shifts (some people just cant). there is definitely unit to unit rivalry where i work, as some units seem to float more often than others, and some units think they are exempt from floating (nicu claims they can't take care of any other kind of pts., but can i take care of a nicu pt?)