How are staffing issues at your facility/department?

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 5, 2011

Really just depends. I've been in a smaller facility for a few years now and I find that the staffing is better than it was at the larger facility I used to work at. Staffing is pretty much an across the board concern for most nurses no matter where they work.

made · Oct 5, 2011

I work at a LTC facility. One side is Retirement Living the other side is Nursing Home. Most of the time I am on NH side and it is 65 high need residents with 2 RPN's a charge RN and 4 PSW's. On the RL side there are 31 residents, 1 RPN and 1 PSW. I think alot of errors are made due to the fact that there are so many residents and not enough hands to go around. But, what are ya gonna do!!

DookieMeisterRN · Oct 5, 2011

We rarely work short. I work in a unionized magnet facility and think this makes a difference in our staffing.

dudette10, MSN, RN · Oct 5, 2011

I wish staffing wasn't ratio-based. Ratios tell you little to nothing about how much work a patient requires. Hear me out here...and, surprisingly, I'm not talking about acuity.

I've worked PMs, and I'm working nights. On my unit, you can look at the admit/discharge book and see that PMs gets the brunt of admits and discharges...sometimes every nurse gets at least one admit and the first nurse to get an admit will get a second one. Nights gets the second heaviest (admits only, and usually every nurse gets an admit), and days gets the lightest (few admits and hardly any discharges).

Now, let's look at the regulatory changes that are coming for 2013 re: readmission. One of the items that has been identified as having an impact on readmission is discharge teaching. This is a huge nursing responsibility. In addition, getting the home meds for the reconciliation is also a huge nursing responsibility. Both are equally important to ensuring that the patient is taking the right meds during hospitalization and after discharge!

How many times has a patient complained that they don't know which meds at home they should continue to take and which new meds need to be in their regimen? It can be confusing for a patient when you have a home med list at admit that's as long as my arm...and often, there are one or two that the patient isn't sure about.

I spent 30 minutes with a family one night going over each med. This was during my orientation when I wasn't taking a full load and my preceptor was picking up my slack. The daughter was very intelligent, and she was still confused. She asked all the pertinent questions. I pointed out that the discharge list was all-encompassing of the meds her mother should continue to take, pointed out the change in dosage for a couple, and emphasized those that shouldn't be continued and when the next doses were due.

If a shift that gets slammed with admits and discharges is staffed on the same ratio matrix as the other shifts, something has got to give. We are not only responsible for the care in the hospital, but we also need to be cognizant of what treatments they came in with and what treatments they are leaving with. That takes time. Time that ratio-based staffing doesn't take into account.

And, if we truly can cut down on 30-day readmissions by getting a full picture of the continuum of care at admit and discharge, then teaching our patients on the changes in their care when they leave may mean keeping them out and better reimbursement....$$$$$$.

imintrouble, BSN, RN · Oct 5, 2011

Nursing is cut to the bone where I work. The sups get out their calculators, and shuffle numbers to arrive at a magical number that is supposed to adequately cover the nursing needs of the floor.

Nursing hours are cut. Cna hours are cut.

Quarterly meetings by the CEO proudly announce how much money the hospital is making. While putting my health and license in jeopardy.

classicdame, MSN, EdD · Oct 5, 2011

A few years ago the Texas Nurses asso sent a survey out to TX nurses asking for input regarding staffing. More than 6000 responded (about 1/10th of the nurse population) and most stated they were NOT in favor of ratios since one patient can be too many if the circumstances are right. TNA lobbied for a staffing law and now hospitals are obligated to have safe staffing committees that report to Admin of that facility bi-annually. The "front line" workers have good ideas and we have been able to create some changes. I do not see how the situation can be resolved completely, as no one can predict daily census, but the more input from the workers, the better IMHO.

itsmejuli · Oct 6, 2011

I work in a unionized rehab unit, we do not have staffing issues. :) The only time we work short is if we can't find someone to cover a shift.

We have a mix of 12 hr and 8 hr shifts so most days between 3pm and 7pm there is a "float" nurse. This works out great, especially since we often have discharges and admissions daily. The "float" nurse completes any paperwork that didn't get completed on the previous shift.

MomRN0913 · Oct 6, 2011

I'm afraid it is, and it has strongly discouraged me from continued bedside care, especially in ICU. I've heard the norm in the ICU I used to work in is becoming 3:1! In an ICU. And sick patients. With the NA's constantly being pulled. My ex coworkers told me how bad and exhausting and stressful it is getting. I was going to work PRN, but it is not really tempting me.

If I were to work bedside again, I would probably go with a unionized facility, and heavily do my research first.

RNperdiem, RN · Oct 6, 2011

ICU at my hospital means every nurse has only 1 or 2 patients.

Usually there will be a charge nurse without an assignment, a CNA or 2 and a unit secretary.

If there are callouts, my hospital has a large flex team. If that is not enough, then the charge nurse calls begging the off duty nurses, or the assistant managers can staff.

There is a reason I have survived in my unit so long.

Unfortunately med-surg and some other departments suffer the brunt of not enough staff.

nola1202 · Oct 6, 2011

:gtch::sstrs::dzed: That about says it. ROFLMAO!

anotherone, BSN, RN · Oct 6, 2011

med surg- very short frequently. i mean everyone takes 1-2 more patients . no aides or a 1 aide for the floor. some shifts were very scary due to the poor staffing. very.