Lack of staffing on midnights

Nurses General Nursing



I work afternoons. I work only once a week. Mostly weekends. I always go home...feeling horrible. Our midnight nurses are short staffed. I used to work help them out. But now I have my son. I don't like working doubles. That means I don't sleep over 48 hours...because I'm up with him.

The midnight nurses say they voice they're concerns. And the manager says there's not enough nurses.

Our units a stepdown unit. Usually midnight nurses get 6 patients on midnights (per matrix) Which is a lot. But we haven't had enough nurses to meet matrix. They've been taking 7-8 patients each.

When you bring up concerns. They say everywhere it's short staffed. That there's not enough nurses anywhere.

Is anyone noticing there hospital having difficulty staffing? Due to shortages of nurses.

I'm getting very concerned regarding hospitals. And safety issues with staffing. Hospitals don't have good nurse tongue.gifatient ratios. And now we can't even staff to matrix. Is there anything we can do?

We have the same problem on my unit, and we have all voiced our concerns- I work the night shift and it sure is nice to hear a person from days that understands and backs us up, Thanks!


I'm happy not too many people are responding to me. That probably means people are getting enough staff for matrix.

I can't believe our hospitals not even meeting matrix. I live in the midwest. I though maybe it was a more universal problem.

I agree that there is a nursing shortage, the unit I work in is understaffed when it is full...there just arent enough nurses.

Why are nurses leaving nursing? We dont get paid much for the work we do and hospital administration seems to treat us like rodents, there will be a new crop to fill the slots soon in their opinion. The unit meeting I just attended consisted of how we dont fulfill the needs and expectations of the patients and families.....I think God should be consulted on a lot of these issues, he didnt make humans immortal and that is usually the problem. The patients are sicker and sicker and we cant cure them, we can only prolong the suffering until the body and organs finally give out. Modern medicine has its faults and I feel that in 20 0r 30 years we will look back at ICU nursing as a torture chamber.

Deanna RN

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I work the midnight shift as well on a telemetry/oncology unit. It is not uncommon for us to have 8-9 pts per nurse. The management does not believe that this is a problem. Fortunately we have a great group of nurses that work well together but not a lot of experience. It seems to me that at this hospital the lowest senority work the nightshift with the least support. Doesn't make a lot of sense to me.

[This message has been edited by shortnrse (edited February 10, 2000).]

I completely understand about working in a facility without enough staff to care for the patients. I recently left my last facility for this problem. Before I left I was working the 11-7 shift in a 94 bed facility. On many occasions 2 CNAs and 2 LPNs were responcible for the total care of all 94 residents within that facility. Management was aware of the shortage but refused to hire any more help telling us to "handle it the best way we could". These working condition are unreasonable and unsafe!!!

I work nights on a tele floor. We usually take 7 patients. It can be too many pts depending on who they are. All it takes is one to go bad and everyones night is chaotic. I agree its the people with the least senority that are generally relagated to nights. These people learn how to organize and prioritize at the hands of a night nurse, then they go to days. It is the way it is.

I personally love nights, I wont give up the autonomy that i have, no one looking over my shoulder and the ability to make the decisions myself.

I also work on a Telemetry/IMCU unit and the most patients I have ever gotten was 7. But...they were all stable at that time and no one had an enormous amount of IV piggybacks etc. But as you stated, it only takes one patient to go bad and it happened to an agency nurse as I was Charge having the 7 patients. Her patient coded and chaos was the norm for the remaining 7 hours! In comparison to the other area hospitals (I live in the midwest also) our unit is understaffed because we are a combo unit (tele/intermediate care-stepdown). All of the other hospitals have a 1:4 max on days and pms and 1:5 on nocs. We can go up to 7 for one nurse and the rest 6! I hardly ever get out of work on time and its draining. But there is a light at the end of the tunnel, at least for me at this stage. I am moving to Missouri because my husband is retiring (I am from Indiana) and have secured a position in an ICU stepdown where the nurse tongue.gifatient ratio is 1:2 or 1:3 on 7a-7p (8 bed ICU stepdown) and 1:4 max on nocs (there is always 2 nurses on the unit on nights). It is primary nursing and after checking out the facility and others, it sounds a lot better than where I am now. Less pay, but cost of living is less too. All of the previous posts are what I am hearing from nurses in the midwest also. Personally, I agree with Night Owl-I love nights and the autonomy and definitely do not like someone hanging over me either!!!

I work for a for profit hospital I have kept an open mind over the last five years and worked all units at our hospital to make myself more valuable to the hospital. currently we are under the worst nursing crunch I have seen. Our step down unit is any where from 6-8 to one with the charge taking at least 2 pt's on midnights there is no secretary. we are now using rehab and skilled nursing nurses with no telemetry experience to fill the void. our nurse managers walk around with clipboards making assingments they themselves could never hope to take on

our docs have caught on and know that if their pt is on the fine line of failure they will not down grade from the cicu our cicu is overloaded and we are on diversion most of the time. with the charge nurse taking on her pt's and handling the clerical duties for the 30-40 beds the poor rehab nurse drowns or misses something. the managers made a new 36 dollar an hour contract for temp nurses and the staff nurses still make 16 an hour. this has caused horrible feelings toward administration. some of these nomads have less cardiac nursing skill than our poor rehab nurses. but we kicked ass on our joint commision inspection.

Specializes in Geriatrics, LTC.

Hi, I recently started working at a nursing home. I just obtained my nursing license, and this is my first nursing job. And on my second day of orientation I had to work part of it on my own. What I mean is we were forced to have me pass some meds or be way behind waiting for one of the other nurses to pass all the meds for her group and the "short" group. But do you know what helped? Well it was the fact that we work as a team there. I wasn't afraid to ask questions or to go to the other nurses for help. But I am very concerned with staffing of nursing homes, and anywhere else. It isn't just nurses it is nursing assistants also. Short staffing is due to the fact that staff regulations say that there is a certain ratio of care givers to patients/residents. I don't feel that nurses should count in that ratio, because it is the nursing assistants (as far as in nursing homes) that do the actual hands on care. The nurses do plenty of work, don't get me wrong, but we do NURSING work, we give them their meds and do physical assessments. But for the most part the nursing assistants do the ADL's for these pts/residents. I feel this is such an unsafe position to put everyone in. It is unsafe for the pts. becuase there isn't enough supervision to prevent accidents. And not enough nursing staff to be sure they are doing thorough assessments and to be correctly passing meds. And becuase of staffing ratios, everyone is overworked and underpaid and who wants to become part of that type of team? But anyhow this is my opinion. I would like to hear more about this subject and if anyone has any information about getting this changed. rolleyes.gif

Dear askater,

Oh my, sounds like we work at the same place! I've been in nursing for 6 years and it's never been this bad. Just the other nite I was working evenings on our Med-Surg floor. We get general surgery, vascular (fem-pops, carotids)and many more. I was starting the evening out with 7 patients. 4 were already on the floor, and my 3 post-ops all came at 1600. If that wasn't a mess. I ended up during the evening, walking down the hall crying. I just didn't know what to do next. Don't get me wrong, I am a very strong person, but something just snapped that nite. I just couldn't take it. Families, phone ringing off the wall, demanding patients, confused and restrained patients. It was just too much.

What's even more interesting, before we started listening to report that evening, we beeped our nurse manager. She calls back and we tell her "Do you realize we don't have enough nurses?", accordingly to our hospital guidelines). Her reply was "This is all your getting, so you better get busy!"

I just don't know how much more I can take. Our floor is so demanding anyway, Central lines, PCA's, Fentanyl epidurals, TPN, foleys, NG's, IV's, chemstrips, almost every body is a diabetic theses days, and multiple medications, was about to forget all the pain meds since these are fresh post ops. Then throw in all the charting, care plans, pain med documentation. Something has got to give. There is NO WAY I provided safe, patient care that evening.

Nurses being pulled to our floor, we try not to give any new postops, carotids, Epidurals, or confused patients to them out of kindness. Which means we get all the HARD patients.

What can we nurses do? Our nurses are leaving left and right for other jobs or positions within the hospital. The previous shift nurses will sometimes stay and help get things settled, but gosh they're tired too. The hospitals are working us to death.

Rumor has it that hospitals are not hiring new employees because it's cheaper to pay the overtime than to fork out all the money on a new employee - insurance, benefits, etc. Well, I'm only 43 years old and I leave there feeling like I'm 83! With no brain cells intact. Sometimes I don't know what I've charted and what I forgot. This is not safe. Some of our nurses jokingly say as they leave "Well, at least they're all alive and breathing when I left"

What can we do?

Totally disgusted, frustrated, and mad that my patient's are NOT getting what they pay for. The care that they deserve.


I've been an ICU Nurse since 1977. I have always worked in Florida. Staffing has always been an issue anywhere I worked. What's new is now it is day shift as well.

I don't believe it will ever change until we change the entire concept of Nursing. Hospitals are a business, and we only eat up their available revenues (on paper). For example: We draw all of the labs in the ICU. Each blood test has a phlebotomy charge. This is credited to the phlebotomy dept. (yet they did not do the work). All respiratory treatments ordered generate a charge to the Resp. Dept. even if the nurse does it. This ability to charge for services in a Hospital are endless. We do not generate a single charge for anything we do. The more Nurses we have the more profit we eat up. In order to be able to do what encompasses Nursing, we are going to have to learn the language of "Big Business".

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