Intentionally understaffed with a charge out of staffing, is this normal now?!?

[Aloe_sky]

I’m becoming more and more negative when I walk into work. I love being a nurse and I love working in the ICU, the problem is my unit is INTENTIONALLY short, the whole hospital for that matter. When we want to pick up shifts there are only specific days and we are pulled to the regular floor where we are taking care of 6 floor patients. 

In the ICU now we are required to care for 3 patients no matter the acuity of the patients. We aren’t offered a bonus to come in and if we request to work on days we know we can ease the load in the ICU, we are told we are not needed, if we were scheduled for overtime on those days the ICU has 3 patients each, even with no open bed we are cancelled. 

I'm use to having a code bed open at my last facility, now we “trade out”. 

What also gets on my last nerves is a charge out of staffing, we do not have a rapid response team so the ICU charge out of staffing attends those which are very few. During a rapid response a provider and the RN house supervisor goes also. They NEVER intubate on the floor and they delegate floor nurses to pull meds, since the charge nurse doesn’t have access to the floors medication room. The floor nurse receives a verbal order to give meds so really what is the charge out of staffing needed for? 

I'm told “just in case” the provider isn’t able to go, which in over 1 year has NEVER happened!

I refuse to be charge because I could never just sit there looking at the internet for 12 hours while the other nurses are carrying an extra load. 

These charges are no resources to me, NONE of them help me in anyway and the new nurses that volunteer to be charge, have never worked anywhere before this facility and still ask me for help since I am one of the most experienced. 

The providers are for the most part always on the unit so they are there to answer any questions.

It would be more beneficial for the staff if the charge nurses has to take patients before any nurse is tripled. 1 senior charge nurse always threatens to quit or walk out if we are super short and she has to take a patient. 1 night charge was mad because we were all tripled and he had to take a STEMI patient and said next time he will go home. This has created a toxic environment.

One nurse is “so sweet” because when she’s charge she organizes our patients room, as if I care about that! 

I’m so sick of them getting away with not having to do anything and I’m so sick of the extra load, it’s just weighing on me mentally.

I'm wondering is this the new norm now in hospitals?!?

Are nurses out of staffing common in other hospitals when nurses are short staffed???

[JBMmom, MSN, NP]

We are supposed to be budgeted for a charge nurse out of count in our ICU, but I would guess that it actually happens one shift every six months or so. We usually have to float a nurse to another floor before they will leave charge without an assignment. And we will often have to triple our assignments to float someone to another unit that it even shorter on staffing. We also have to have an ICU nurse respond to all rapid responses/codes, so there are rare nights where someone without an assignment would have been very helpful, but for the most part it's not the best use of resources. I can only imagine how frustrating it is for you, at least most of the nurses in our unit are helpful if they have a lighter assignment.

[mmc51264, BSN, MSN, RN]

I am not ICU, but within my service area (4 units, one is ICU, 2 stepdown) none of the charge nurses take patients unless absolutely necessary and, if there is enough, we are able to have a second charge (like a back-up charge) to help. My hospital is paying insane $$ for picking up extra shifts/OT. 

[Tweety, BSN, RN]

I'm in charge frequently with a 6:1 ratio on a surgical unit.  If there is a chance for the charge nurse to have a lower ratio they decide to pull a nurse to another unit since being in charge with 6:1 is acceptable.  They put lip service into trying to fix it.  I'd like to think they are but an old coworker in good standing is trying to come back and being ignored. 

[Aloe_sky]

On 10/25/2022 at 2:49 PM, mmc51264 said:

I am not ICU, but within my service area (4 units, one is ICU, 2 stepdown) none of the charge nurses take patients unless absolutely necessary and, if there is enough, we are able to have a second charge (like a back-up charge) to help. My hospital is paying insane $$ for picking up extra shifts/OT. 

Thanks! I’m wondering what these nurses are doing for 12hrs?!? on my unit they are Doing nothing for majority of the shift but online shopping!! I can easily sit and do nothing also as one of the most experienced but I refuse because it’s not fair. 

they also cut our bonuses when we pick up and they will let the unit drown before they say they need ppl to pick up. 

[mmc51264, BSN, MSN, RN]

On 10/26/2022 at 12:52 AM, Aloe_sky said:

Thanks! I’m wondering what these nurses are doing for 12hrs?!? 

I am one of one of the charge nurses. You really think we do nothing for 12 hours?  I fill out paperwork for new hires. I do tele audits, hypoglycemic audits, I am on 4 different practice councils and do flowsheet audits. There is discharge planning, working with  providers to do bedside procedures. Helping the aides. I don't sit down. 

[Aloe_sky]

On 10/26/2022 at 10:06 PM, mmc51264 said:

I am one of one of the charge nurses. You really think we do nothing for 12 hours?  I fill out paperwork for new hires. I do tele audits, hypoglycemic audits, I am on 4 different practice councils and do flowsheet audits. There is discharge planning, working with  providers to do bedside procedures. Helping the aides. I don't sit down.  
 

Maybe you don’t, those aren’t requirements at my facility. Like I said, I have been asked to do charge and refuse. The charges don’t help the aides, they don’t help the nurses. They literally sit, do nothing and get paid. We are assigned 2 charts a week to audit. They have no involvement in the hiring process. if a patient is being transferred, it is the house supervisor that is responsible for that. If the provider tells us of a patient that they are admitting, the house supervisor is responsible for working with bed assignment. 

I can easily ask the provider the patients information to look into the patients chart. The charge nurses aren’t even seasoned enough to know what’s an appropriate admission or not. The patient may have been in the ED for DKA 15hours and not look into whether it was resolved. Not even know to look at labs to bring it to the providers attention. Some seasoned nurses don’t even question admissions, they just say a bed is booked and tell us the patient information. This is why whoever is open to admit has to look into it themselves. 

it still stands that at my facility, charge nurses are a waste of resources. Would be better for everyone if they were required to take patients.

On 10/25/2022 at 5:10 PM, Tweety said:

I'm in charge frequently with a 6:1 ratio on a surgical unit.  If there is a chance for the charge nurse to have a lower ratio they decide to pull a nurse to another unit since being in charge with 6:1 is acceptable.  They put lip service into trying to fix it.  I'd like to think they are but an old coworker in good standing is trying to come back and being ignored. 

A lower ratio makes sense, my old facility as charge I would get the easiest assignment. 

[JKL33]

On 10/26/2022 at 12:52 AM, Aloe_sky said:

I can easily sit and do nothing also as one of the most experienced but I refuse because it’s not fair. 

You could always choose to accept charge assignment and then keep things well organized and actively help others. You could choose to take an assignment or partial assignment if you think that's the way it should be, or find other things that aren't being done and address those problems if there is extra time; go ahead and raise the bar if you feel there is a problem. That would also mean that at least some of the time one of these other nurses whom you feel are abusing the position would have to be in an assignment while you're in charge. Sounds like good times, I say go for it. 

Typically charge nurses doing what they are supposed to be doing is not as easy as it sounds. Your place has poor management of this situation.

On 10/26/2022 at 12:52 AM, Aloe_sky said:

they also cut our bonuses when we pick up and they will let the unit drown before they say they need ppl to pick up. 

The main answer to that is to not pick up. Sounds like they don't want to give anything in return for having their needs met.

There are certain problems or certain points in time where you realize that others aren't going to change things. It really is up to you to change yourself, change what you accept, change what you do, change something. I would say both of the problems you have mentioned will require this.

It's your choice - you can either just say that what others are doing isn't fair, or you can do the charge role and highlight the discrepancy by doing a good job, then go home and sleep well at night.

With staffing, if you're tired of picking up or tired of the staffing being jerked around, make your decisions accordingly; don't pick up if it isn't worth it to you. If you're tired of working short and there's no end in sight then consider your other options.

I realize this sounds kind of brusque but I learned somewhat the hard way that others didn't care about the things I did and I wasted a LOT of valuable life being upset about it, when all along the right answer was just for ME to make an actual move.

Good luck.

[RNperdiem, RN]

Before Covid, our charge nurses never took a patient assignment and nurses had one or two patients. 

The post-covid staffing shortage meant that charge often has a full patient assignment and nurses are often given pairs when ideally one patient should be a single assignment.

Staffing is getting better over time as more nurses have finished orientation, but problems remain. Often staffing will pull a nurse to float to an understaffed unit leaving the original unit short. The staffing office workers are not nurses, and getting them to understand ICU realities sometimes meaning calling the manager to back us up.

[barcode120x, RN, NP]

2 hours ago, RNperdiem said:

Before Covid, our charge nurses never took a patient assignment and nurses had one or two patients. 

The post-covid staffing shortage meant that charge often has a full patient assignment

Ah, the good ol days. It was very rare that we would get pulled to take patients as charge and if we did, staffing/management would try and shift patients around so that we would get the "easier" team so that we could still do our charge duties.

Then covid hit as everyone knows and now, the norm has been to pull the charge and expect charge duties for that extra $1.50. Though my place has been somewhat decent at trying to staff the units (I.e. offering better incentives for picking up extra shifts). But, like other places, this doesn't fix the root problem of just being understaffed. When I left bedside in August to pursue my next career, I felt guilty leaving my team behind. Normally we staff 8 nurses and 1 charge nurse on a full unit and when I left, that put the team down to 5 nurses and down 1 charge nurse scheduled for my weekend.

[MaxAttack, BSN, RN]

Short answer - No, it's not normal.

Smells like HCA. Get out.

[OUxPhys, BSN, RN]

Man Im jealous reading some of these posts. When I was working bedside we never had a free charge. We were expected to do charge while juggling a full assignment. Granted, it was lower acuity but still.