War is coming, the lines have been drawn!

  1. War is coming and the lines have been drawn. Management says we need to cut payroll. Flex people off. We are being looked at by "Corporate" for low numbers and high payroll. I work in a hospital in a very very depressed area. Most patients are medicare and medicaid if any ins. at all. I work in outpt surgery area and Endoscopy area. 5 yrs ago a nurse had 3 pts to check in for surgery and take back postop. Some went to recovery if general anesthesia used and others returned to out patient surgery if IVM anesthesia. This week they want 5 patients per nurse. Nurses are angry, upset and saying that is not safe and they dont feel safe! Trying to check in two pts due at 615 to get ready for surgery at 715. Taking your postop pts back while trying to check in more preop pts. Its horrible. Supervisor for area ready to quit and so are the others. But it was made VERY clear in the staff meeting (first in months) that $$$ is the deciding factor. Too much payroll for the "numbers". Bottom line, cut payroll.

    CAN THE NURSES REFUSE THE ASSIGNMENT? Would they be fired, written up because they dont feel safe, because they are not giving pts (preop and postop) the attention both types of pts need??
    Example: be checking in a 10am pt and have a ivm postop pt come back directly to you with nausea, pain of 8 then have a postop pt come within 20 min of last postop doing fine - already have had a postop pt waiting to be discharged--and another preop patient expected to arrive within 45min.

    Whispers of a walkout or going around. Whispers of people looking for another job but very few can do that since the next closest hospital is 40 min away and owned by same company. Next closest is 1 hr away in different state or 1 1/2 hr same state.

    This post condensed down so not to take up so much of your reading time. Thanks for the forum.
  2. Visit outptsurgeryrn profile page

    About outptsurgeryrn

    Joined: Jul '11; Posts: 5; Likes: 3


  3. by   roser13
    Here is a solution that has been very successful in my outpatient surgical area. Nurses only do pre-op OR post-op. Admit OR discharge. This allows the nurse to focus on one process (and streamline it) without interruption from the other.

    Admittedly, this suggestion can't be implemented in time to help the immediate situation, but it could be a potential solution for your unit's issues.
  4. by   AgentBeast
  5. by   inshallamiami
  6. by   ktliz
    ScottE... brilliant. I watched the whole thing.
  7. by   outptsurgeryrn
    roser13, how many pts per nurse? this sounds good to me. I would be for it. We were told to "come up with a better solution".....

    inshallamiami....there is no hope of union, too small and most have given up and just want out
  8. by   kcmylorn
    Go to your state's health dept website and get the ambulatory care guidelines, if any, get the guidelines for moderate sedation and post sedation recovery guidelines. If you can't find them on the website call the dept of health for a copy and tell them why you want them.( you could play dumb andcall them anyway just as an excuse to report what's going on to them) Start documenting violations of guidelines and calling your state's health dept each and every time there is a violation or unsafe condition. The state, any state dept of health is obligated to investigate each and every complaint. They have 24/7 reporting hotlines and the complaints can be anonomous. Make administration's life miserable. and don't let up. Give the administration the same dumb look they give you.(DUH, who me, us??) Call TV, radio stations, and newspapers. The outpatient surgery and proceedures units are the money making units of the hospital.That is war.

    A better solution: Have the CEO cut his salary to a more resonable amount, in tune with today's norm, not yesterday's bing. Tell him to look to thy self/ in hisor her own mirror. and stop looking to nursing first.
  9. by   silentRN
    That's when you begin to slow down the pace a little bit, allow surgeries to not start on time, show that you guys are overworked and there's no way these new ratios will work...
  10. by   Zookeeper3
    AH, no union, unfortunately you are well aware with medicaid/medicare cuts. It has now unfortunately slapped you in the face as a area. Management needs to calculate how future cases will be delayed with recovery times.

    I'm sure you have a policy on the detail of monitoring each case. If your staff is cut, starting a new case will be delayed. This costs $$. you may consider hitting that from that aspect as you're now short and need to monitor them?
  11. by   Old and New
    I understand that situation completely. Someone said slow down a little, show that it's not working very well, and I agree with that, although not only for that reason. The bottom line is still doing the job right, and since your "product" is people you only get one chance.
  12. by   dthfytr
    So how much more work will the CEO and the rest of management be doing to help cut costs. Hospitals are for patient care. Patient care is the last place that should be overloaded. A few less management people wouldn't be noticed at all by the patients. Just saying......
  13. by   wtbcrna
    Facts are usually your best defense. Here is the best place to start. http://www.aspan.org/ClinicalPractic...lt.aspx#acuity
  14. by   dudette10
    Quote from outptsurgeryrn
    We were told to "come up with a better solution"
    This irks me. You know why? Management is responsible for identifying problems, recommending solutions, getting buy-in from staff and higher-ups, piloting a chosen solution, tweaking it based on pilot data, and implementing an improved version on a permanent basis with continued reevaluation. Management 101, regardless of industry.

    While good leadership always engages front-line employees in solving problems, what you were told reeks of throwing the sole responsibility for solutions on the front line. Ridiculous.