Night Shift Rn's Revolt (long, venting)

[Mofe'ny]

Just a little background about my unit first! I work in a Level 2 NICU. Our normal staffing is 4 RN's and 1 LPN per night shift. This is to cover our level 2, level 1, and well baby nursery as well as transport services to pick up NB's at other community hospitals. Between December and May of this year we have lost 5 RN's on night shift, right now we have 2 RN new grad orientees on the unit for nights. We have been covering our unit, with overtime, float pool, and PRN---- as well as working short staffed and having to call our NM to help cover the unit at times.

Well, in the last 2 weeks our census has dropped in the nursery. The rest of the hospital's census has picked up now. Sooooo, someone made the bright idea to reopen a wing of the hospital and staff it with nurses from other units. the patients are fresh admits from ER and post-ops. Guess who they start trying to pull:devil: The other day thay had a nursery RN and LPN and an ICU stepdown RN to staff this 'unit'. To make a long story short, the RN's on night shift requested in writing to be removed from the schedules for ALL overtime, because we cannot safely provide care to adults (especially in a unit that was closed because there is no staff to work it!!!), and we refuse to work Overtime to provide Rn's for the hospital to use whereever they feel like pulling us to! The supervisors were letting the Overtime people come in to work the nursery (minimum staff of 3 RN's) and pulling the regularly scheduled staff to work this 'overflow unit'.

Our NM was on vacation so this letter was given to the NM covering for her, and our staff coordinator. We were removed from the master schedule but have agreed to come in and work if our unit needs it on the overtime days---"However, we are not willing to work any overtime for any other unit in this hospital." This letter was passed along in nursing admin. and we got a letter back that day. The letter is almost threatening--- 'this works both ways', you will want your hours and a full paycheck, but the census may not support it'--- if you continue with a low census we all may be scrambling to get our hours, etc.

I am furious that they missed the entire point of our requests, and are trying to threaten us. At this point I would love to have a conference with those in admin who wrote this letter. Oh, and copies were sent to the CEO and DON. I can't wait to see our NM. I kinda feel sorry that she is gonna get caught in the middle of this-- she is the best NM that we have had and is supportive of us.

Sorry this is so long, but I am mad now. I have spent a lot of time reading the posts on this board, but don't normally reply. I feel that y'all listen and understand though! :blushkiss

[hoolahan, ASN, RN]

So sorry for you! That stinks. I agree that your OT should not be utilized to staff the rest of the hospital. But, what is the policy on your regular hours? Do you have to be pulled on your regular hours of census is low? Also, do nurses in ER and surgical units "work both ways" and get pulled to your unit? ON regular hours or OT? My guess is they don't. I would suggest they keep you in peds or OB areas only, it is just as unsafe for you guys to float to care for adults, as it is to give an adult nurse a premie on a vent w an umbilical line!

[ceecel.dee, MSN, RN]

I don't understand how they can think all RN's can be everything to everyone! You work in a highly specialized area! I would not be able to cover for you without some extra training, and the same goes for you or anyone else working out of their element!

Stick to the principles you introduced in your letter about patient safety in a unit you aren't comfortable in/prepared to cover.

You may have to accept being put on call or cancelled due to low census, or spend some time being trained to work with the adults, so speak with your coworkers about what is acceptable to the majority so you can show a united front. Good luck!

[Youda]

A few years back when I worked L&D, they tried to do the same thing to us, floating us out of the L&D unit when we didn't have any (or many) in labor, and they needed us for census in the rest of the hospital. One of their more stupid tricks was floating us out, then half-way through the shift when L&D got busy, pulling us back to the unit!!!!

We finally got their policy reversed by screaming loudly about infection control issues. The idea being that it really isn't cool for a nurse one day to be messing with MRSA and the next day handling a premie or scrubbing for a C-section. It was a long fight, though. Good luck to you. Stick to your guns, but research out some basis and "rationale" for your refusal to float, including no cross-training, infection control, sudden full-moon mass deliveries, etc. What you've got on your side is that experienced specialty area nurses aren't very easy to find. They can't fire you all, so stick together. The suits have to wise-up that you just can't plug any nurse into your area and have them suddenly knowledgeable about reading early d-cells, fetal distress, on strips, and suddenly know what doctors use what size of gloves, etc., etc.

Speaking of the docs, tell the OB docs what is happening. They may have a few words for the suits, too! :)

[plumrn, BSN, RN]

There are nurses who are skilled in several areas and work different areas enough so that they can handle being pulled. They are usually (not always) prn staff. I have always thought it was not in the best interest of patients or staff to pull nurses to unfamiliar areas. ICU, ER, MED-SURG, OB nurses -etc, are all skilled to their area, and are familiar with the routines and important tasks that have to be completed, but might be near clueless in another area. Our hospital routinely pulls staff to OB/Gyn/Nursery dept, even if they haven't seen this dept since nursing school 10 yrs ago! Managers don't listen to their pleas, they just want to satisfy their need to fill a slot. It would be like pulling an Orthopedic surgeon in to perform a hysterectomy, and the Urologist in to do a Total Hip Replacement!

[Mofe'ny]

Hoolahan, the policy is that you can be pulled during regularly scheduled shifts. So they would pull the "regular people" and have the overtime people come in to staff the nursery. We sometimes pull from other units, normally peds, but we put that RN or LPN in wellbaby nursery with another RN. We don't let them assess and chart on the babies really, we try to just let them do PO feeds, diaper changes, and VS.

Thanks for your support! I'll see what happens when I go into work tonight. I really love my job and the unit functions really well together as a team, it is just that administration doesn't get it.

Youda, you're right that they can't fire us. Then they would only have 3 RN's on staff for nights!!!! I'm sure our census will pick back up really soon. September was our busiest month this year, and according to L&D we will stay at least this busy for the next month or two. As always in OB, it's feast or famine.

[miniaussie]

Wow. It certainly does seem like the administration just doesn't get it.

I certainly hope everything works out well for you.