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.

[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

[citylights89, BSN, RN]

Same thing I was thinking, although it's not quite that bad yet, though

Are you by any chance in downtown Houston? Because that is happening in the hospital I work for. I love my job and the people I work with and my patients but there were a few bad patient related events throughout the hospital that they were on the verge of losing CMS funds and closing down.

[KRVRN, BSN, RN]

My gosh, how very sad.

I have no frame of reference, I am lucky. My unit has such good retention that I'm only halfway up the senority ladder of >100 staff. I am over 15yrs. Multiple, multiple 20+ yr employees.

[Brenda F. Johnson, MSN]

Very well said. I think that as hospitals have become mega businesses correlates with the downfall. I work for a major player and over the years have seen the huge difference in raises (if they give one), quality of equipment, staffing, attitude. However, they seem to be top heavy with managers who make too much let alone the higher echelon who make millions,

[LadyFree28, BSN, LPN, 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.....

Become a healthcare activist-connect with others here and become involved; TPTB WANTS us to remain divided and not be united; they FEAR educated, smart professionals that know their labor rights and CMS regulations and hospital economics; when you get together and push back, they KNOW that they have to get their act together and pack their bags and go home.

I just had collective bargaining negotiations yesterday, my story and our stories of the lack of disrespect, disregard for patient safety,-including not allowing nurses to be properly oriented to critical care units, or even allowing new and new to practice nurses the ability to expand their educational base, and even the disregard for safety was at the heart of our discussion, along with proper work life balance. The management team slid the policy in place with the intention of the status quo-a classic tactic; they didn't know what they were getting into when 25 plus nurses were representing their fellow nurses. We are in for this fight.

[kbrn2002, ADN, RN]

Very well said. I think that as hospitals have become mega businesses correlates with the downfall. I work for a major player and over the years have seen the huge difference in raises (if they give one), quality of equipment, staffing, attitude. However, they seem to be top heavy with managers who make too much let alone the higher echelon who make millions,

I am with you on the complaint about places that are top heavy with management. I work in a SNF and while I know that LTC is probably the most heavily regulated area of health care I still fail to understand how my facility can justify a DON, an ADON, 3 unit managers and 2 MDS coordinators in management positions while we bedside nurses are floundering due to lack of staff.

To put this in perspective, we are a smaller facility at slightly over 80 beds and the ratio of management to bedside nurses is 7 managers to 3 bedside nurses. This overload of management isn't even taking into consideration the fact that we also have 2 administrators, one for the facility overall and a separate administrative position for the memory care unit.

[Deepinthegame]

It's the Norm , it's about Money

[NursesRmofun, ASN, RN]

Poll closed - but...I would agree that all healthcare is somewhat broken....and, for some reason, some facilities still profess to care about the community they serve while trying to work their staff into the ground, skating to stay safe.