Is it really this bad every where?

[SunDazed, BSN, RN]

I have to ask myself more and more, is it really THIS bad every where? I have stayed with the same employer through the pandemic though have changed jobs twice within the organization. That speaks to how long the pandemic has raged on as by union contract we have to stay in a position 6 months before we can apply for another.  Part of why I have stayed is that it is a rural area and there are few options. I briefly explored returning to hospice, but they did a bait and switch on the job I applied for and seemed to think by limiting me to one offered position that I would just accept it. No. 

My hospital employer has really piled on the stress at work. Short staffed in the pandemic, they expected us to come in on our days off (or work from home) on preparing for a transition to Epic. Not everyone learns well in a self guided online situation. Requests for an option to have a classroom option where ignored. Requests to have be given classroom time during regular working hours was ignored.

The switch over to Epic happened with extra support on hand for two weeks, but there was no one in admin or management prepared to anticipate all the workflow changes that would come up. Still silent. No one speaks to anything except billing codes. The big concern is the patients be in the right bed charge code at 2300, though only case managers can change it... and they aren't working at 2300. The second big thing was charge capture for nursing procedures. Whatever.

The same week that we switched to Epic, they changed food service providers. I don't know how it all went down, but now the food service portion of the hospital has less than half the employees they did previously. Some meals are coming up in takeout continuers and the patients receive cold food. No one is picking up dirty trays when trays are used. They just stack up on the unit. There is no one refilling cups and lids in the unit pantries. Or there are cups and lids that don't match. There is irregular stocking of juice, pudding, etc. We don't always have applesauce or pudding for patient medication passes. We don't have juice when someone's blood sugar bottoms out. And for goodness sakes sometimes there is no coffee! 

And not a word. Not a word from managers or admin to acknowledge the chaos. In the early days of the pandemic they tried to make a big change in unit functions for one of the med-surg floors based on customer feedback. It was a disaster and led to many of the experienced nurses leaving for other units. Now we have patients leave AMA because of breakfast not coming until after 10am. How in the hell did we get here? Then they changed the name of the unit I work on in the computer so they could expand the kinds of patients that could be bed boarded there. They did not tell anyone about the new name. That led to no food being delivered because the kitchen just assumed our unit was closed again (as had happened in the past), and had environmental services searching the hospital for the new mystery room numbers. 

We still have covid cases in this county that keeps us in one of those purple tiers. Our numbers of hospitalized Covid patients have finally dropped below 20 a day. I am grateful we never had to make use of lounges or lobbies to house patients, but could administration be more blind to the consequences of their actions? 

Administration must be getting bonuses for some of this stuff, as they do not care what the down stream effects are. Who are these people? Would they want their loved ones to have cold food in the hospital? Or no food? Bizarre. We just received the invitation to do the quarterly survey on work place satisfaction. Not sure that admin will be pleased to to see those results. Can it affect their bonuses and thus future decisions? Who knows?!?!

I will give it a few more months, but I will also start preparing to move out of this area. Hard to know where to go. What are the questions to ask before taking a job? Believe it when I say, I will be interviewing them more than they will be interviewing me. 

[MountainGoatRN, BSN]

I've noticed some similar things you describe.  One thing that has ramped up significantly at my place is the domination of travelers, more of them than regular staffers.  What is getting to be annoying is regular staff getting called off or sent home due to low acuity at the moment (seasonal, I'm in Florida) and travelers (per contract) get the priority for shifts.  I personally don't mind it as I have more PTO than I could possibly spend, but many very much want to keep their PTO for other reasons.  I feel less and less valued by my employer from this and thinks maybe the future should just make us all 1099s.  But back to your original question about asking questions for the job hunt, keep in mind....the problems are everywhere, you just have to pick your suck as most of it does in the hospital setting.

[SunDazed, BSN, RN]

3 hours ago, MountainGoatRN said:

  But back to your original question about asking questions for the job hunt, keep in mind....the problems are everywhere, you just have to pick your suck as most of it does in the hospital setting.

I agree that every job has the potential to have burrs that continually nag at the position being really great or near perfect. One thing I am curious about is what the crazy is elsewhere. Travelers come to our hospital and leave before 2 weeks are up. It sucks for them so hard that it is not worth it to fulfill a 6 week contract. But I don't have the opportunity to do exit interviews... so what was unusual? What made you draw the line in the sand?

One of the worst things to me about nursing is just when you think you have the best set of pros and cons, suddenly things outside of your control turn your job upside down. You finally get a boss you really like and respect... bloop... they are gone, and moving up or out to better things. You have a patient mix that is professionally rewarding to care for... blahp.... CMS changes how they reimburse hospitals so the unit is in flux and the regular kind of patient is gone and suddenly it looks like a swing bed unit instead of a cardiac unit. 

We had some ICU travelers a while back who got everything but ICU assignments. They were on telemetry step-down and med-surg. I get why they did not renew their contracts. ICU nurses are in demand and want ICU assignments where they have ICU patients. 

One of those travelers told me she though California ratios would be great, but then there were no NAs. The NAs have mostly been sitting with behavioral holds for months. There can be as many behavioral holds as Covid patients. Our staffing grids calls for NAs but the sitters were all let go. And their must be sitters on behavioral patients, so NAs and even nurses are sitters. 

We were getting a lot of emails about getting out Epic training done prior to the 'flipping of the switch'. Now it is crickets. An occasional email about something that needs to be done in Epic but not much else. I did not even get the caregiver health flu shot schedule. It was forwarded to me by a friend in the staffing office. 

It feels like we are on a ghost ship and about to hit the rocky shore... oh is that a lifeboat full of administrators? Where are they going with those big bags of money? Is there anywhere to go? 

So what is the one thing happening where you work... that you cannot believe has come to be? What would you warn an experienced new hire to ask? 

 

[JBMmom, MSN, NP]

I guess everywhere is awful, just different. In my hospital nurses are mandated to stay for up to 16 hours if we are short staffed. This used to be used only in the case of last minute call outs and was a moderately infrequent occurrence. My hospital is just under 200 beds with five inpatient floors, a six bed step down unit and a 12 bed ICU. In the past three weeks more than 80 nurses have been mandated to stay past their scheduled shift to cover shortages. It's no longer mainly for call outs, now we're covering spots where there was just no one assigned. We don't have enough nurses and apparently our hospital isn't even competitive enough with traveler wages to attract many travelers to the middle of nowhere.

However, I know that it's not unique to our hospital. I have a friend who works in the transfer center and he said that at another hospital in our system, the ICU is so short staffed that nurses are getting FOUR patient assignments, often including a fresh post-op cardiac patient. Patients on ECMO are not 1:1, they are up to 3:1. Our night shifts nurses the other night had 13 and 14 patients on one med surg unit. 

The part that kills me is in our morning huddle the other day, our manager pointed out a "concerning increase in falls" recently. Their solution? We have to fill out five Quality Cards per shift where we audit whether a patient has the appropriate fall prevention interventions in place. So two PCTs on the floor for 27 patients isn't the problem, it's the fact that the patient didn't have their yellow fall risk bracelet?! It's total BS. The people in the offices are so far removed from the reality of what impacts the care of patients they roll out stupid time wasting interventions and then blame staff when things happen like falls. 

I feel so badly for new nurses coming out into this crap show of a work environment. We have had many nurses taken off their orientation early so they can take full assignments. And it's not their fault because they don't know what they don't know and the managers are all telling them they'll be fine. The other night I was on the floor with a nurse on her first night alone and she had never seen a heparin drip. I had the time to walk her through the highlights, but with my own six patient assignment I may have missed something and even if I didn't she only heard it once, after her orientation was done. Unacceptable that they didn't get the proper training to be successful. 

[LibraSunCNM, BSN, MSN, CNM]

I haven't worked as a floor nurse in a long time, but I honestly don't think it's THAT bad everywhere.  I know COVID has caused some seriously painful staffing and supply issues, staff is totally burned out, and that poor management is rampant a lot of places, but I've never worked in a facility like you're describing.  That being said, I've only worked in quite large institutions, so perhaps that is one difference.  I think nurses are treated better in the Northeast, where I started my career, than in TN, where I am now, but it's still not like that---travelers not able to make it more than 2 weeks?  That's pretty extreme.  And it's so hard to say, just move!  Because not everyone can, obviously.  I hope you find something better though ❤️

[LibraNurse27, BSN, RN]

7 hours ago, JBMmom said:

the ICU is so short staffed that nurses are getting FOUR patient assignments, often including a fresh post-op cardiac patient. Patients on ECMO are not 1:1, they are up to 3:1. Our night shifts nurses the other night had 13 and 14 patients on one med surg unit.

OMG. That sounds soooo unsafe. I really feel for you guys. I wonder how many patients will die because of short staffing. How can even the best nurse keep track of 4 ICU patients or 14 Med/Surg patients??

[JKL33]

18 hours ago, JBMmom said:

The part that kills me is in our morning huddle the other day, our manager pointed out a "concerning increase in falls" recently. Their solution? We have to fill out five Quality Cards per shift where we audit whether a patient has the appropriate fall prevention interventions in place. So two PCTs on the floor for 27 patients isn't the problem, it's the fact that the patient didn't have their yellow fall risk bracelet?! It's total BS.

What kills me and is absolutely mind-boggling is that an entity like CMS won't touch this issue except with vague/philosophical wording (e.g. nursing personnel must be "adequate"). They were able to quickly update their CoPs to include staff covid-19 vaccination but (still) won't touch staffing. I know HCW vaccination is important and I'm not in any way trying to say it isn't. But...come on...poor staffing is pretty much the root of myriad other long-standing safety issues. And it's untouchable??

Still, if I were working in some of the situations described in this thread and elsewhere I would consider reporting it to CMS anyway. The more complaints they get, the better. Tell all patients and family members, too. People need to start raising hell.

[OUxPhys, BSN, RN]

A friend works in the SICU where I work. They are getting 8 travel nurses (because this hospital system is notoriously slow in getting people hired, even in 2021). She basically said there will be a riot if the agency nurses staff the SICU while the actual hospital employees float throughout the hospital. 

You ask how administration can tolerate this.....they don't care. They got their big salary. They get their bonuses. They forget where they came from. So for them its just simply saying "not my problem" anymore. 

[Guest 1152923]

6 hours ago, JKL33 said:

What kills me and is absolutely mind-boggling is that an entity like CMS won't touch this issue except with vague/philosophical wording (e.g. nursing personnel must be "adequate"). They were able to quickly update their CoPs to include staff covid-19 vaccination but (still) won't touch staffing. I know HCW vaccination is important and I'm not in any way trying to say it isn't. But...come on...poor staffing is pretty much the root of myriad other long-standing safety issues. And it's untouchable??

Still, if I were working in some of the situations described in this thread and elsewhere I would consider reporting it to CMS anyway. The more complaints they get, the better. Tell all patients and family members, too. People need to start raising hell.

     I wouldn't hold much hope in CMS or JCAHO improving staffing ratios or any working conditions for bedside nurses.  Both are total sham agencies in bed with the hospital systems and the last thing they want to do is rankle these powerful (and wealthy) entities.  Their 'surveys'-wink, wink, nudge-are bought and paid for.  Hence, their M.O. is to zero in on BS, non consequential issues like refrigerator temperatures, restraint documentation, tape residue..... I could go on but I digress.

[JKL33]

That's true of JCH/JCAHO/TJC/Joint. They are check-listers who don't make any laws or originate regulations.

CMS is an entity of the government, which is to say US citizens. I understand it isn't likely that they would finally address the issue, and it is even less likely that it would happen in a timely manner. But they are by no means in the same category as JCAHO with regard to their duty to US citizens.

[2BS Nurse, BSN]

"We were getting a lot of emails about getting out Epic training done prior to the 'flipping of the switch'. Now it is crickets".

Before Covid, we would have our Epic updates on weekends with ONE support person stationed in the hospital (I worked in outpatient UC). I had to make multiple calls to support while simultaneously trying to care for patients. At least during the week we had in person support.

After Covid, all Epic support was made remote (while nurses and MAs were crammed together with masks on). We are lucky to get an answer from them.

By not hiring Epic support, these companies are saving money. That's all that matters to them.

 

[SunDazed, BSN, RN]

On 10/10/2021 at 11:57 AM, LibraSunCNM said:

I know COVID has caused some seriously painful staffing and supply issues

Anyone else out of catheter kits? We use BARD indwelling catheter/foley kits. Word from one supervisor is that BARD will not be able to supply more until after the new year, Jan 2022? 

So we piece together foley insertion kits with all the bits, except we have only had latex coude catheters for a few weeks now. Everyone gets a coude tip... man or woman. Everyone is getting latex. It is the dark ages again. 

@JBMmom "The part that kills me is in our morning huddle the other day, our manager pointed out a "concerning increase in falls" recently. "

Similar to the falls issue when staffed well below matrix, when CAUTI infections go up... will it all be the nurses fault? What resources are going into  figuring out how to get us the supplies we need?

Is all this stuff sitting in the ships parked off the coast that can't get in to unload? Or is there something else? Or is it just too expensive? IDK. Does anybody?