Published Feb 18, 1999
I work in a cardiac recovery area which is relatively new. We are suffering from a severe understaffing problem. It's a very long story but I'll try to be brief. The hospital allows as many cardiac surgeries a day as are requested. We are staffed for approx. 6-7 cardiac surgeries a day but the surgeons are allowed as many as they want. Lately we have been doing about 13 surgeries with the majority of them being open hearts. This has caused our overtime to skyrocket. We have voiced our concerns to doctors and management alike and the response from management is to deal with it!! Due to the overtime I felt is was best to drop the class I was taking at the college (SO much for continuing my education). My daughter has become very upset with me and has threatened to write to the adminstration. Yesterday I approached my supervisor with the concerns of the staff and the safety of the patients. Her reply to me was to not work any overtime. I said I didn't think it was fair to my co-workers or the patients. Her reply----if you don't like it find a job somewhere else!! I am to assume that they, the management, do not care about its staff or its patients. Today I tried to take a personal day to take my daughter to the doctor,(she's been sick for 5 days). I was informed it was not a good day and that I would have to come in so try to take her to the doctor in the morning so I could be at the hospital by 11A. Like a fool I did it. When it was time to leave they were at least 3 nurses short but believe me ---I went home. Nurses have to stick together and not work the overtime. They have played on my sympathy long enough. After 19+ years of employment at this hospital I am going to look for a new job. I apologize to my patients. I have always had their best interest at heart and I am sorry that my supervisor doesn't understand our concerns. Her response was "all you nurses do is bitch"!!!
WOW! We'er all in the same boat, the one with the big leak!! I can sympatize with you Joellen. My institution doesn't do the high amount of cardiac surgeries, but the same problems exist. We are just getting by though with our number of nurses that do take hearts. We are so short staffed that maybe a heart pt. will get a nurse that has barely started taking them, and it's sink or swim ( or at least dog-paddle). Our administration has gotten to the point of saying the same things " If you don't like working here, well then..." We had a mock inspection a few weeks ago and the inspectors concern was with the sheets that were touching the floor, I wonder if they took a look at the staffing book and saw that the shift was 2 nurses short! Their focus is way out of perspective too. When will the idiots wake up about this shortage, lack of compensation, and do what it takes to get the nurses and to keep them. It's so sad that the public has to pay the price with their health and comfort for the administrations lack of concern for anything except cutting costs at whatever consequence.
Sophie, I hear you because I bailed from the ship we were on together. It's not perfect here, but our manager has it set up that we almost always have 2 admit spots in 2 of our 3 units with the nurses to take the admits, we also always have on call nurses. We have 16 hrs mandatory on call hrs every 4 week schedule. As for JCAHO, any of the nurses that are inspectors have to have been away from bedside nursing for at least 10 years. In other words, >10 yrs. in administration. They purposefully don't use bedside nurses because we would cut out the majority of their bs rules and the streamlining would be done by someone not of their own heirarchy. Only administration knows what needs to be done. Done to make more $ so they make more $. You know, cut the nurses pay while you send doctors and their wives to Hawaii at the hospitals expense. And the used car salesman running your hospital said,"these aren't patients, they're marketshare."
This is a response to all of you nurses who put in the extra patient care. I totally and completely respect anyone who is in the RN field. Because the job you have is a demanding one. I've been to local hospitals and to hospitals far away and the nurses that I have met (usually) have a great attitude. I'm not a RN yet but looking forward to going into the field. I agree with alot of the responses I've read that's it's not just the title but, it's the attitude.
nurse 1, congratulations on your working toward your RN. I've been one for 15+ years with 14+ in critical care. Although I may not always like what administration does to make the work harder, I love what I do. When a patient & family hug you and say thanks for being so nice and taking such good care of them, no money can buy the feeling you will get.
Wow...this situation sounds terrible! As a recruiter, what questions should I ask hospitals about their open-heart unit to make sure I'm not sending people in to the same sort of mess?
I am fortunate to say that our nurse managers are just as frustrated as the staff regarding working conditions. We do have managements support to close beds when we don't have enough staff. Unfortunately the hospital administrators don't have a clue. Our organization has so many projects going on right now including merging, building a heart hospital, and building another hospital, that they can't see whats going on in the existing institution. I don't understand why nursing is not lobbying more regarding our unsafe working conditions. Why aren't we getting the word out to the public more especially the AARP which has one of the strongest lobbying forces for consumers. My other concern is why nursing schools are not helping with this problem. For instance, in my area one of the community colleges had 300 applicants for the nursing program and only 50 slots. At this rate, we will never catch up with the need so that us "elderly" nurses can mentor those that are going to take care of us in our old age.
Coming in here for a 3rd party OH-pinion re: the ER I work in (this will ramble, I apologize in advance):
Staff morale at all time low with:
(1) all time high mandation (we usually work 3-13hr shifts/wk, and for past 4 mos have been easily pulling 3-20hr shifts in 10 day period)---according to Nurse Manager 'will only get worse' and per union 'sure it's against contract but that's too bad';
(2)moving to brandy-new ER in one week with a million brandy-new policies/paperwork/ computer/monitors/you name it, without orientation/guidance/problem solving from Nurse Mgr 'it'll all work itself out' (we/staff have requested and received many many meetings on subject without any guidance/solutions to questions), one policy includes completely revamping triage and registration/insurance info secondary to COBRA violation (MSE by MD/PA/NP before insurance info);
(3) and hospital filled to capacity since last November (we've been holding at least 2-6 ADMITTED ICU/tele/med pt's per day--even had 2-3 ICU pt's rotting in ER for 3 days apiece--without assistance from ICU/tele/med RN's, floaters, or Travelers)--management (DON)refuses to help us out because 'the pt's are in the ER - you ER nurses take care of them' (including everything that comes in--esp when Level I center on diversion, P.S. we are not allowed to go on diversion).
Everyone has their last nerve exposed (if you know what I mean)...tension is VERY high. Many of us have tried humorous E-mail, funny scrub shirts, big red clown noses to get a laugh, even going out to the local bar and having a bi*&h session--not much is working any more. Management's answer to staff's pleading's for help is 'well, then ya'll can just quit, we don't need you THAT bad' (which of course has just PLUMMETED morale to an even lower plane as you can imagine).
I'm not sure what type of answer's I'm looking for...anything that will bring a smile to about 20 VERY tired, VERY overworked, and VERY low spirited RN's.....
I love my work, it's just the job that's causing my pom-poms to sag....
wow...reading your notes makes me glad that I am in a small LTC facility. I am a nurse manager, and I beleive that MOST of us recall what it was like onthe floor, particularily in stressful situations. You have to believe that first we are nurses then managers. And as much as it may not seem like it, we do empathize with your situation, but we are being pulled between nursing and, yes, that dam budget.
I was ashamed of the response that you are getting from your managers, the two most important functions of a manager is 1) ensure good patient care and 2) ensure good staff care. Sounds like some just aren't producing. I guess I blame our nursing training, we are taught to be nurses not managers. But the excuses really don't help.
As I have said, I'm in long term care, so I can't fully appreciate your situation, but have you tried "creative" approached. And by that, I'm not really sure what I mean because our situations are so different. My staff sometimes (sometimes??? most of the time) feel overworked. Can you and your co-workers come up with a schedule that allows full coverage in the unit when it is needed and also have ample time off for your recovery? Can you have an SOS plan to spell each other off when you need to be else where (such as with a sick child)? It seems to me that paying for extra nurses would be cheaper then paying for overtime. Is this something that your union can help you with? I don't understand why your manager wouldn't hire more staff. Do you have a professional body that could help your situation, is there legislation that should be passed. Nurses are a huge group and together can effect great changes is we stick together.
As for your daughter...she should be your highest priority. Don't feel badly for having to nurse her. Your patients will have other nurses, your daugther will have only one mom.
I think it's a great idea for her to write to your administrator. Sometimes it's a small voice calling for help that gets the attention. I don't know if a copy of that letter to your local paper would be advisable. You will have to decide how much extra pressure that would put on you with your manager.
And I guess when all is said and done, maybe it is time to look into another area of nursing. I hope I don't sound like your manager, but if your health, sanity and family are being jepordized by you working in the stressful situation, maybe you should look at what is important to you.
Your committment to care and excellence is evident in your letter and I'm sure is also evident to your patients. Maybe moving to another area where that would be appreciated is a possibility.
I wish you luck, please post another note to let us all know how things are going with you.
Truthfully, I would think that the cardiothoracic surgeons would be smart enough to realize that their patients may suffer post op and not recover as quickly with understaffing. But then again, every day they are in the hospital is more $ in the surgeons pocket for spending a couple minutes checking on them! We have run into problems of not having any critical care beds for open hearts and AAA's and then it's kind of pick and chose who is the most stable of what you have to transfer to the floor. We have even recently admitted trauma patients to PACU in the middle of the night when there was nobody triagable!! Again, as I've said in another post, low staffing can lead to deadly errors; unfortunately adminstrators seem to forget or are clueless on this aspect.
[This message has been edited by jmccrn (edited March 02, 1999).]
If I'm living in the past, I hope others will want to jon me, cause it's a great place to be. I can only assume that there is vast difference in our health care systems. And as I said throughout my posting, I can't fully appreciate the difference between critical care and long term care. I might add, I can't fully appreciate the difference in our two countries' systems, but I understand from classmates of mine working in the US, that there are frustrations and challenges in your country that we don't share up here. I do believe that every system has it's advantages and disadvantages. As a nurse, I've got to tell you, that your comment re: patients being "market shares" was almost frightening. I hope that if I have to access the system for my parent or children, that the nurses looking after them don't have the same "bottom line". I still believe that nurses can make a difference in one life (ie: at the bedside) or as a group (ie: with legislation) is they STICK TOGETHER. I hope others share my veiw and would be interested in hearing comments from nurses on both sides of the boarder.
MoonstoneMist All readers:
Please see our ongoing discussion on this site under "General Discussion", "Topic-Hospitals in Trouble". I'd love your input.
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