A little vent about watching a hospital break. I'm still hoping for improvement because I love most of the people I work with....
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I work for a broken hospital. Last year after 50+ years of operation we had a situation that, while not harming any patients, was sensationalized to the point of community leaders calling for us to close. That event was the final straw in a long chain cracks that finally broke a once strong and award winning institution.
Long story short: we used to be known for cutting edge surgical robots use, award winning cardiac care and our stroke center. Fast forward through a decade of corporate mergers, for profit accounting, staffing being cut to the bone, upper level management refusing to make capital improvements while taking yearly bonuses for cost saving and the current healthcare climate and we started to fracture.
Nursing staff was pushed past any reasonable limits, ancillary staff was cut to the bone and we were expected to do the job of two with antiquated equipment and little training. As the decline became pronounced I was a CNA, often being assigned as the only assistant personnel to a full 40 bed unit. A 40 bed unit full of confused, total assist elderly patients. I was in nursing school at the time and watched as the nurses on my unit were run ragged and left in droves. I received my nursing license in the middle of a hiring freeze. A hiring freeze that was blamed for my nurses taking 7 telemetry patients with one CNA per unit but that meant I could not be hired to assist. When I finally got hired as an RN I received 6 weeks of so called orientation as a new grad and 6 months later I was in charge because I had been there the longest.
As experienced nurses left for fear of their licenses and for substantial raises, conditions continued to worsen. At this point infection rates and falls were at an all time high, patient satisfaction was at an all time low and we experienced around 200% turn over in a yearlong period. Our entire hospital was an insane mix of travelers, new grads and a very few seasoned nurses. It was not unusual for travelers to leave after one day. Management response was to berate us for not using AIDET and hourly rounding which would magically fix these issues. The facade was cracking and our patients could tell. The family members knew and asked if we were "short" but we were ordered to lie to hide our abysmal staff ratios. The night that sticks in my mind involved having 6 patients, being charge and "secretary" with 14 admissions to the unit. Pumping multiple units of blood into an active GI bleed with a hgb of 6., starting a heparin drip on a confused patient that kept pulling her IV out, another demented patient that had an order for an NG tube and a gallon of bowel prep that had to be given and the supervisor trying to give me a fresh admit that had critical care orders but ICU was already tripled due to no staff. I gave up that night and started looking for a transfer off that unit.
Around this time the powers that be decided to sell out to another corporation. The "incident" happened and was widely publicized. What was multiple small break in the hospital system was now an open compound fracture with hemorrhage. The media crucified us in spite of state regulatory clearance. The then CEO was given a "no confidence" vote by our board members and left with a whopping one day notice and a fat check. The new owners have been patching up the existing infrastructure as best they can but the logistics of modernizing an ancient structure is daunting.
Even more daunting is the task of rebuilding a nursing team. The reputation for killer workloads and unsafe staffing has made it difficult to get applications from anyone other than new grads, nurses fired elsewhere or people who are relocating. I now work in the ED and hear first hand every day how tarnished our name is in the community. Quality improvement measures and staff training have supposedly cut infection rates and falls substantially but it could be argued that the decrease in census after the news coverage may have improved staffing ratios with the same effect.
Everywhere I turn in allnurses, professional journals, nursing articles I hear "be the change you want to see"or something to that effect. What I don't know is how how this situations changes after this, for better or for worse. Right now I just know it is broken.
