I Work For A Broken Hospital

[TheCaptain]

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.

[MsNurseMS]

unfortunately this sounds a place i used to work at as well! honestly, i remember wanting to get my hospital experience, but now i feel so jaded. it all comes down to the money, nurses are over worked and many times underpaid. little support and lack of resources to improve our skills because the bottom line is cutting costs and more money for higher ups (admin). it's very frustrating, but i think i will focus on community health and education and prevent people from getting into hospitals in the first place. after all, PREVENTION and PROMOTION of health is where it's at.

[kalevra, BSN, RN]

I hear what you are saying. Many hospitals are trying to exist in modern America's current healthcare corporation. Let us all be honest, profit is what drives business and hospitals are another form of business venture.

It is not like people actually have a choice in what hospital they receive treatment form. People do not have a set price menu available to them so they can compare and contrast services form different hospitals. People can not "test-drive" a hospital. People do not get a "refund" if unsatisfied with their service or customer experience.

[Davey Do]

Thank you for your article, TheCaptain, it was great! Good responses!

I no longer feel alone. We share the same misery and I can't see the forest for the trees.

In the Autumn of my career, I feel like I cannot fight City Hall, so I CYA. I provide the very best Nursing care I can, document, and notify those in charge of their responsibility.

However, I am being proactive, in the middle of dealing with some serious Patient safety concerns with an apathetic administration who merely wants to look good on paper. So, for the first time in my career, I'm informing outside entities after following the chain of command and getting bupkus. Who knows where this road will lead?

It wasn't always like this. Sadly, the great Hospitals that I once worked with no longer exist. They were closed down or sold to For Profit organizations.

But maybe someday, things will be okay again.

Somewhere over the rainbow.

[rntravlon]

I can sympathize - the place I work at seems to suck out part of your soul as you walk through the doors. If you are one of the "golden children" you can do no wrong even if that means you are giving mediocre care or just missing the sick / not sick. I refuse to give less than the best care I possibly give even if it means having to buck the system and being told about it quite often

[citylights89, BSN, RN]

I feel like I could've wrote this article. It seems like this is an issue everywhere.

[Palliative Care, DNP]

The last hospital I worked in before grad school was like this as well. The real cherry on top was when administration told us we should feel fortunate to have jobs.

[JayHanig]

We're here to help!

[she244]

The biggest problem I see in the Medical Field is the hiring of Non- Medical people who come in from working in the Corporate World and think you can run a Hospital or Clinic the same way a Business Company runs. They have no idea you are seeing people at one of the worst times in their lives. No one come to the Hospital or Clinic unless they need Help! Greed from Corporate Minded People cuts to the core of each Nurses heart to not have the medical supplies or staff needed to actually care for Patients. I myself work for a place that will remodel waiting areas, put plants in the hall for someone to water at $200.00 a week. Have old wooden tables with plastic coverings that are splitting, but gives raises to Management. But refuses to buy a vital sign machines, needed equipment or even update the old manual blood pressure cuffs that are worn out. Worked in a Hospital that had a bad reputation. Used to defend the Hospital making excuses until my sister went in with a kidney stone, and now is disabled due to the negligence of the Nurses and Doctors taking care of her. I checked her feet when she complained of pain. When she complained to them they put ted hoses on her feet. No one checked the pulses in her feet after surgery to have stents placed in the kidney. Had developed an abdominal aneurysm, cutting off circulation to her feel. Vascular surgeon had to take her back to surgery. This is a woman who had worked a 12 hour shift standing on her feet prior to going to that Hospital. So now I do not recommend that Hospital to anyone. Even though I worked there for 11 Years.

[JayHanig]

When I worked in Charlotte 3 years ago, we called that hospital Rock Kill. I sent my family to CaroMont or to CMC Pineville.

Every family member that went to Piedmont died either there or within a month.

We're here to serve!

[fragricola]

Most hospitals have a toxic nursing environment due to our present sick healthcare system that is based on profit and cost. I left hospital nursing long ago ( after 15 years ) to work in a medical office. Sick of seeing nursing administrators doing nothing for the deplorable nursing conditions that existed and of allowing established nurses to "eat their young" as new nurses were hired and ultimately, after being abused for a year or two, left for better conditions. Nurses are their own worst enemy as they will not unite nationwide and raise a voice so loud and so strong that no hospital administrator/legislative body can ignore it.

[TheCaptain, ASN, BSN, RN]

Thank you all for the responses and the support!!!! I know that many places are like this. I believe it that it is the rule rather than the exception right now and it scares me how many of you are experiencing the same things. I am involved the the state nurses association, the ENA, Nurses for Change and several other groups. I want to improve things but it is a daunting task. I have considered becoming an administrator but I love bedside nursing and I don't want to become the thing I despise.....

[dedicated_2b_RN]

i am a student nurse OMG this article hurts my soul Why is it that non medical administration personal are being allowed

to destroy the nursing profession. and put patients lives in jeopardy i have a few rhetorical questions

WHY is the NURSING profession that is one of the largest professional working groups in the world just allowing this to happen

there is a potential voice that would be heard around the world if it was implemented

next question is it fear of reprisal or just plain apathy that lets this continue at such an alarming rate ?

next question is the affordable care act the cause or the cure this is not a combative question i don't understand it

and i wish someone who does would explain it to me thank you all for hearing me out on this