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Sickandtired_RN · Jul 28, 2021

Hi,

I work on a PCU unit at a major hospital system, we are currently at “code red” status due to a surge in COVID admissions. According to the CEO >95% of admissions are non-vaccinated. Overtime contracts, burnout, and sick nurses have resulted in frequent call outs. Yesterday four of my unit’s nurses were floated, three were sent to a unit that has ten permanently staffed nurses due to terrible conditions (40 bed neuromedical pcu). This resulted in my unit being staffed 5:1 with one tech. The hospital is so desperate, they are offering $1000 for a single shift and $600 for a half shift (however our taxes increased to 30%).
Picking up is not mandated but the money has incentivized nurses to come in on their off days. However, it’s doubtful that it will be sustained for long as the toll on bedside nurses mental and physical health increases. Management continues to give us talks about how our HCAPS scores are going down due to patients not responding with “always” to survey questions like “the nurse came to my room every hour.” Patients are referred to as “customers” and we are not allowed to be honest with them about the staffing crises, therefore expectations are unrealistically high and nurses are always the ones to get the blame.

allnurses Guide · Jul 28, 2021

10 minutes ago, Sickandtired_RN said:

Patients are referred to as “customers” and we are not allowed to be honest with them about the staffing crises, therefore expectations are unrealistically high and nurses are always the ones to get the blame.

Well, healthcare is a customer service business. If patients had the option to go anywhere they wished and received what they think is poor service at one facility they would go to another facility. It is not unrealistic for people to get a service they pay for after-all.

Hppy

Jedrnurse, BSN, RN · Jul 28, 2021

5 minutes ago, hppygr8ful said:

Well, healthcare is a customer service business. If patients had the option to go anywhere they wished and received what they think is poor service at one facility they would go to another facility. It is not unrealistic for people to get a service they pay for after-all.

Hppy

It sounds like a set up though. If one of the criteria on the satisfaction survey is "nurse came into the room every hour" but the unit's staffing and/or acuity didn't allow that, well, getting dinged for it is inevitable but unfair.

It's like having increasingly heavy weights being put on your ankles and at the same time being told to "jump higher".

Additionally, hotel "perks" are often at odds with reality when you're sick and need necessarily intrusive care.

allnurses Guide · Jul 28, 2021

1 minute ago, Jedrnurse said:

Additionally, hotel "perks" are often at odds with reality when you're sick and need necessarily intrusive care.

I have been a patient more times that I care to recall. Always limited to the hospital's contracted by my insurance so no choice about where I receive care. While I have always received good care I would never say that I got any "Hotel Perks". Hospital Admins don't enact policies to please a captive customer base.

Hppy

Sickandtired_RN · Jul 28, 2021

They do have the option to go anywhere, but they will continue to be disappointed as the ratio of nurse to patient continues to increase. I treat my patients with empathy and respect all while working 13+ hours of mentally and physically exhausting shifts. This week I worked 5 shifts in a row. The capitalistic model of healthcare is a failing system.. as profit is valued more than patient outcomes by management. The hospital/corporation I work for is the best/biggest in my area, for example we offer a procedure for NPH trials (CSF is drained through a lumbar drain in the hopes that it improves the patients symptoms such as incontinence, ataxia, memory, etc) that no other hospital in Florida provides. People wait for months to receive this procedure.

Jedrnurse, BSN, RN · Jul 28, 2021

1 minute ago, hppygr8ful said:

I have been a patient more times that I care to recall. Always limited to the hospital's contracted by my insurance so no choice about where I receive care. While I have always received good care I would never say that I got any "Hotel Perks". Hospital Admins don't enact policies to please a captive customer base.

Hppy

By that I mean patients focusing more on the fact that they got cranberry juice on their tray instead of orange juice (but they did have that new onset DVT diagnosed and treated successfully.) If the points are weighed more heavily on the important things on surveys, okay. (I'm not sure.) If "juice issues" have the same survey influence as medical care then I think that's a huge problem.

Sickandtired_RN · Jul 28, 2021

7 minutes ago, Jedrnurse said:

It sounds like a set up though. If one of the criteria on the satisfaction survey is "nurse came into the room every hour" but the unit's staffing and/or acuity didn't allow that, well, getting dinged for it is inevitable but unfair.

It's like having increasingly heavy weights being put on your ankles and at the same time being told to "jump higher".

Additionally, hotel "perks" are often at odds with reality when you're sick and need necessarily intrusive care.

Literally, the worst part is that my unit has the most percentage of surveys completed and is therefore ruining the whole hospital’s scores. This is because we are the number one unit for discharges, most of our patients are there for an elective procedure and leave the hospital oriented enough to complete the survey. Recently we had 8 patients in PACU at 6pm waiting to be transferred to our unit with no nurses/beds to go to. My team consists of some of the most dedicated and amazing nurses who are specialized in the care of these patients. The ratio pre COVID was 3:1 with no techs. Today we have 5:1 teams that can include multiple confused, incontinent trach, peg, and total care patients. It’s a 39 bed unit, sometimes we have two techs but they are overwhelmed as well. It’s an impossible standard.

Sickandtired_RN · Jul 28, 2021

13 minutes ago, hppygr8ful said:

I have been a patient more times that I care to recall. Always limited to the hospital's contracted by my insurance so no choice about where I receive care. While I have always received good care I would never say that I got any "Hotel Perks". Hospital Admins don't enact policies to please a captive customer base.

Hppy

They actually do, we have service standards that we are continually trained on. This includes a mandatory three day customer service orientation based on practices such as how to apologize to the patient when their expectations are not met. Which is great and all, yet unrealistic many times. For example, a nurse can be yelled at/verbally abused by a patient or family member for inconsistency in expectations, whether it be their meal order was wrong, they had to wait _____ amount of time for crackers or for a question to be answered. While the nurse is coordinating care for multiple patients, some of which may be deteriorating or who’s clinical condition doesn’t allow them to even press a call button. Many times I have been late on bolus feeds for trach/peg patients because I am so distracted by the unending call lights of patients asking me to fix their pillow or demanding pain meds before they are due, etc. people do not understand that I’m not ignoring them, I literally just don’t have the time to attend every call light in a timely manner. Yet I am not allowed to be honest with the patient as to why I couldn’t see them. I’m sorry but sometimes my priority is making sure my patient isn’t laying in their feces/urine instead of providing “hotel services”

allnurses Guide · Jul 28, 2021

5 hours ago, Sickandtired_RN said:

They actually do, we have service standards that we are continually trained on. This includes a mandatory three day customer service orientation based on practices such as how to apologize to the patient when their expectations are not met. Which is great and all, yet unrealistic many times. For example, a nurse can be yelled at/verbally abused by a patient or family member for inconsistency in expectations, whether it be their meal order was wrong, they had to wait _____ amount of time for crackers or for a question to be answered. While the nurse is coordinating care for multiple patients, some of which may be deteriorating or who’s clinical condition doesn’t allow them to even press a call button. Many times I have been late on bolus feeds for trach/peg patients because I am so distracted by the unending call lights of patients asking me to fix their pillow or demanding pain meds before they are due, etc. people do not understand that I’m not ignoring them, I literally just don’t have the time to attend every call light in a timely manner. Yet I am not allowed to be honest with the patient as to why I couldn’t see them. I’m sorry but sometimes my priority is making sure my patient isn’t laying in their feces/urine instead of providing “hotel services”

Perhaps I would agree to disagree because I don’t see having my water filled or pillow fluffed when I am unable to do it myself a perk. Often times a simple pillow fluff or reposition helps to alleviate discomfort as well as prevent pressure injuries which is a win win for patients and nurses. Granted my specialty (psych) is a bit different but I often find myself caring for upwards of 10 patients at a time. When I did bedside I could set boundaries and limits without apologizing for staffing issues. In my routine care I could let a patient know that I would be caring for another patient and might not be able to respond immediately to a request made while I am with another patient.

often I could say something to the effect that I would check back with patient when next medication was due. Thus letting the patient know I am anticipating their needs. When patients are aware of what you do as well as what you can’t do they are more likely to be satisfied.

on one occasion I had an infiltrated I’ve and had called several times due to the pain with no nurses in evidence. It took over an hour to be checked on and by then my arm was swollen and very painful. It would have taken just a minute to pop into the room and assess the trouble. As a nurse I understand the limitations of care but the above incident did not have to occur.

SmilingBluEyes · Jul 28, 2021

4 minutes ago, hppygr8ful said:

Perhaps I would agree to disagree because I don’t see having my water filled or pillow fluffed when I am unable to do it myself a perk. Often times a simple pillow fluff or reposition helps to alleviate discomfort as well as prevent pressure injuries which is a win win for patients and nurses. Granted my specialty (psych) is a bit different but I often find myself caring for upwards of 10 patients at a time. When I did bedside I could set boundaries and limits without apologizing for staffing issues. In my routine care I could let a patient know that I would be caring for another patient and might not be able to respond immediately to a request made while I am with another patient.

often I could say something to the effect that I would check back with patient when next medication was due. Thus letting the patient know I am anticipating their needs. When patients are aware of what you do as well as what you can’t do they are more likely to be satisfied.

on one occasion I had an infiltrated I’ve and had called several times due to the pain with no nurses in evidence. It took over an hour to be checked on and by then my arm was swollen and very painful. It would have taken just a minute to pop into the room and assess the trouble. As a nurse I understand the limitations of care but the above incident did not have to occur.

No it did not and should not have. But if they are in another room fluffing pillows and running for ice in yet another, it takes time. And lots of things get in the way, minimal staffing being one.

You should not have had that happen to you and I am sorry. I see this getting worse as staffing becomes a bigger issue in the future, not better, sadly. Surely an infiltrated IV takes priority of fluffing a pillow or refilling water. Only so many hours in a nurse's day. So those things do become "perks" in a way in the face of more serious issues going.

Sickandtired_RN · Jul 28, 2021

1 hour ago, SmilingBluEyes said:

No it did not and should not have. But if they are in another room fluffing pillows and running for ice in yet another, it takes time. And lots of things get in the way, minimal staffing being one.

You should not have had that happen to you and I am sorry. I see this getting worse as staffing becomes a bigger issue in the future, not better, sadly. Surely an infiltrated IV takes priority of fluffing a pillow or refilling water. Only so many hours in a nurse's day. So those things do become "perks" in a way in the face of more serious issues going.

100%

@hppygr8fulAlthough I do agree that sometimes nurses forget to be empathetic of the patient’s struggles/condition, there are simply too many tasks and not enough time for a nurse to properly care for every patient when the ratio is too high. In nursing school we were taught prioritization. Often, I can’t get through one task without getting one or more phone calls creating new tasks or problems to solve. Also, patients frequently do not properly communicate when they use the call bell.. they will simply ask for their nurse, regardless of the HUC asking them what they need. I may be in another room cleaning my incontinent, bed bound patient, who came from a SNF with a sacral wound… I could be in the middle of a rapid response or with a declining patient.. I could be putting in orders for important medication/diagnostics the doctor refused to put in himself… the list is endless. When we have techs, I tell my patients to say what they actually need because I may be busy and their PCT may be able to get to them before me.
We are supposed to round on our patients every hour. However, sometimes you will be with one patient for 40 minutes. I always try to ask before I leave or enter a room if there’s anything else they need. Yet will be called 10 mins later by the same patient for chocolate pudding. Sometimes, a patient’s healthy/able family member call me to refill water (we have several accessible water refill stations) or literally to change the temperature of the thermostat.
I always feel terrible when I miss something like an IV gone bad or if I haven’t seen one of my patients in hours because I am constantly busy with the others who can actually use their call bell or even talk.. however, when We used to have a 3:1 ratio, there was a much better chance that I could give excellent care to all of my patients. We are now running at 5:1 on a pcu unit with many total/neuro/psych/surgical/accucheck/incontinent/IVDA/trach/peg/dobhoff patients. Despite it all, I am so grateful to have a team of amazing nurses, techs, HUCs, PTs, and ANMs on my floor. Sometimes I am surprised by the praise I get by a lot of patients/families when I had been struggling all day.
I do my best to treat my patients with empathy they deserve. However, at the end of the day the nurse is only a human as well, who makes mistakes and may sometimes wrongfully project their anger/frustrations to their patient. It’s time that more people started having empathy for their nurse as a human as well.

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