How to Successfully Advocate for Better Staffing

[SilverBells, BSN]

As nurses, staffing seems to be a widespread problem, but it's one that we shouldn't have to accept.  Lately, I've been trying to come up with ideas to help better staff my own unit.  

Today, I explicitly told the DON and schedular that with the growing number of patients and rising acuity, my unit requires 2 nurses and 2 aides at all times.  I was given various reasons as to why this was not possible.   I expressed understanding but then also pointed out we should not have any Hoyer lift or assist of 2 patients on my unit if not enough staff are available.  Again, this didn't go far, and of course there were reasons why these patients couldn't be transferred over to the better staffed unit.  

I am at a loss for how to go about resolving this.  I am trying to figure out a way to provide better staffing that doesn't involve expecting me to be a manager and a floor nurse at the same time.  

A couple of ideas:

1. Document every time a resident puts on their call light.  This will demonstrate how frequently residents are requiring staff attention. 

2.  Document behavior/mood notes every shift on residents that require an excessive amount of attention from staff.  

3. Make a list of ALL the tasks needed for each resident.  There are over 500 items on the TAR for nurses alone, which is too much for one nurse

Any ideas? Has anyone ever successfully advocated for better staffing with good results? 

[Davey Do]

I truly appreciate your perspective and plans, SilverBells, however being pessimistly realistic, your energies will be for naught. To overplay a mindset: Nurses are for the population they serve and administration is for the money.

Whenever there was inadequate staff and I was overwhelmed, I trimmed the fat on my responsibilities. If a duty was not vital to patient care and pertinent documentation, it didn't get done.

My method probably did little to get adequate staffing, but it allowed me to keep some of my sanity.

[JBMmom, MSN, NP]

16 hours ago, SilverBells said:

Has anyone ever successfully advocated for better staffing with good results?

I would say the short answer is no. But really, it's usually only when there's enough pressure on management to make changes that there's any chance. The complaints of one person, no matter how rational and accurate they are, are unlikely to make much difference to the people focused on profits. The real losers in these situations are the patients. As Davey pointed out, corners end up needing to be cut, and it's really the extra things we *wish* we could do, but don't have the time and resources for that end up being lost. With all the things you already have on your plate, you made your argument and got no response, spending your time making lists to make the same argument again is not likely to help you. Unfortunately there are very few places that aren't facing similar situations to yours these days. 

[Hope21]

I’m curious- what were the reasons admin gave for why they can’t hire more help or transfer patients? Are these the same people that are allowing a nurse manager to constantly be absent from her job? 

[SilverBells, BSN]

3 hours ago, Hope21 said:

I’m curious- what were the reasons admin gave for why they can’t hire more help or transfer patients? Are these the same people that are allowing a nurse manager to constantly be absent from her job? 

Long story short, census is apparently too low for more staff on my unit.  As for the room transfers, apparently they would somehow affect payment to the facility, although I'm not sure how.  Unfortunately, documenting on call light usage and patient demands didn't go over too well either.  So there's probably not much to be done other than working on deciding what absolutely needs to be done,  and what can wait or even not be completed. And yes, this is coming from the same individuals. 

[Hope21]

This doesn’t sound like good management if they are refusing your requests for help and not making the staff they do have show up and do their jobs. I would look for a different place. While you explore other options, you need to prioritize. The 500 tasks for nurses- the majority of them probably aren’t critical for patient care. Focus on what is critical for patients and what absolutely has to be documented, like @Davey Do has done in the past. 
 

Why are you having to be a floor nurse and a manager? Is this all of the time or only when you are short staffed?

[SilverBells, BSN]

1 hour ago, Hope21 said:

This doesn’t sound like good management if they are refusing your requests for help and not making the staff they do have show up and do their jobs. I would look for a different place. While you explore other options, you need to prioritize. The 500 tasks for nurses- the majority of them probably aren’t critical for patient care. Focus on what is critical for patients and what absolutely has to be documented, like @Davey Do has done in the past. 
 

Why are you having to be a floor nurse and a manager? Is this all of the time or only when you are short staffed?

Covering the floor is sometimes the only option when short staffed, but it seems like we're short every day. It's difficult to look for other jobs working Monday through Friday when most job interviews take place.  I'm usually too tired on the weekends to put out any job applications too.  The only way it might work would be to take a week of PTO dedicated to job searching.  

With that said, you're probably right about many of the 500 TAR tasks not being essential.  For example,  some of the orders will state to call the FDA for side effects of Tylenol or senna; I'm guessing that nobody has time to be calling the FDA. 

[hppygr8ful, ASN, RN, EMT-I]

My response to your posts is always the same. Don't ask just walk away. You will always have staffing issues but IMHO LTCs are the absolute worst when it comes to staffing.  This is because they operate under a different staffing model than Acute care facilities. Use your education to get into position where you can be respected - Once you obtain some solid boundaries you could even become a good manager and "Be the change you want to see in nursing." Sadley this will be a largely futile effort as the profit driven model for healthcare does not see nurses as assets but rather as a cost to their bottom line.

Hppy

On 4/9/2022 at 7:56 AM, hppygr8ful said:

My response to your posts is always the same. Don't ask just walk away. You will always have staffing issues but IMHO LTCs are the absolute worst when it comes to staffing.  This is because they operate under a different staffing model than Acute care facilities. Use your education to get into position where you can be respected - Once you obtain some solid boundaries you could even become a good manager and "Be the change you want to see in nursing." Sadley this will be a largely futile effort as the profit driven model for healthcare does not see nurses as assets but rather as a cost to their bottom line.

Hppy

Well stated. 

 

[Been there,done that, ASN, RN]

On 4/7/2022 at 9:14 PM, SilverBells said:

As nurses, staffing seems to be a widespread problem, but it's one that we shouldn't have to accept.  Lately, I've been trying to come up with ideas to help better staff my own unit.  

Today, I explicitly told the DON and schedular that with the growing number of patients and rising acuity, my unit requires 2 nurses and 2 aides at all times.  I was given various reasons as to why this was not possible.   I expressed understanding but then also pointed out we should not have any Hoyer lift or assist of 2 patients on my unit if not enough staff are available.  Again, this didn't go far, and of course there were reasons why these patients couldn't be transferred over to the better staffed unit.  

I am at a loss for how to go about resolving this.  I am trying to figure out a way to provide better staffing that doesn't involve expecting me to be a manager and a floor nurse at the same time.  

A couple of ideas:

1. Document every time a resident puts on their call light.  This will demonstrate how frequently residents are requiring staff attention. 

2.  Document behavior/mood notes every shift on residents that require an excessive amount of attention from staff.  

3. Make a list of ALL the tasks needed for each resident.  There are over 500 items on the TAR for nurses alone, which is too much for one nurse

Any ideas? Has anyone ever successfully advocated for better staffing with good results? 

Silver.. hang it up. Those are all excellent ideas.. to prove that more staffing is required. ( by the way, documenting those ideas will take away from patient care.)

Stop beating your head against the current walls you are within. 

Find a better position.

[amoLucia]

1 hour ago, Been there,done that said:

Silver.. hang it up. 

Stop beating your head against the current walls you are within. 

Find a better position.

SB - soooo many of us have already said this in all your past postings that it's like dripping down the wall! You seem not to care to listen and take heed, so it's your choice to be miserable. 

With your MSN, you have more value elsewhere. But you'll ignore that too.

[FNPtobe2020, MSN]

SB? Why are you still at this job? It’s sucking the life out of you: you try & make suggestions to upper management to no effect. My advice is to leave this place. It’s NOT the only game in town! You’ve got a masters degree now! Use it!