a place to vent

Erbn Girl · Apr 2, 1999

I have worked less than 1 year as a Telemetry

nurse and my complaints are the same as others with the staffing problems. To be brief, yes I have contacted 20/20 and am in the process of contacting my legislators. When others say "document" the dangers, etc of staffing, would this be to keep a journal with dates, times, management I spoke to etc?

I just want to do this properly and professionally. Thank you for any input!

barton · Apr 2, 1999

To Becca and Erbn Girl,

I will attempt to give both of you and anyone else who is new, an abbreviated version of what is going on here---and please everyone, if I leave out something important or accidentally give misinformation--someone jump in and say so, OK?

On the Forum before this, it seemed that many nurses had similar concerns: understaffing, the apparent lack of concern from administration, and most of all, fear for their patients' safety due to understaffing.

After naming our concerns repeatedly and noticing that they were very similar from state to state (and from travelling nurses), some of us decided that we should do more than just complain to each other----we decided that writing to the ANA, state nursing associations, legislators, AARP, etc. might make our concerns better known. Then one of our "posters", Canrckid, found out that Sylvia Johnson, from ABC'S 20/20 was interested in staffing issues!

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Confidentiality of patients and facilities are to be maintained AT ALL TIMES!!

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When that forum became "too long" to be easily read by visitors and all, the moderator and owner of this site, Brian Short, who was impressed with our discussion and professionalism, decided to move the entire subject to a new forum (this one), to make our discussion more focused. He also featured our conversations in "Nurse-zine."

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Here is the info from Canrckid to reach Sylvia Johnson @ ABC's 20/20:

"Barton...........

Yea! Here it is! Sending you her response. Make the best of it!

Go ahead and post my name, email, and phone. I am interested in staffing

issues involving nurses and techs, and am willing to hear from anyone who

has a specific concern. I am most interested in hearing about situations

that are ongoing, where patient care is being affected. Anyone may leave

their number and a description of their concern and I will call them back as

soon as I can.

Sylvia Johnson

ABC News 20/20

212-456-1421

[email protected]

I will email her my thanks, and let her know about this bulletin board where she can read some of the issues for herself......in case there are those of us who are too "shy" to respond. And by all means, all of you pass this info out at your places of employment (discreetly of course!), so we can give input from places other than this BB.

Canrckid"

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Here is the info to reach legislators:

Go to Policy.com---Click "Reach your Rep." under "Interact", enter your zip code, and you will see info telling you how to email, fax, write, call, etc..

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To reach your state nursing associations and the ANA, go to the opening page of this site, wwnurse.com, and click on "Boards of Nursing".

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I could not possibly rewrite ALL of the good info and some of the replies received by everyone here, but if I had to sum up the REPLIES RECEIVED by posters here, I would describe them as a mix of good and vague.

From what I've heard and read, it seems that the ANA and certain state nursing associations have been researching the subject of nurse/patient ratios and patient outcomes.

What I have been UNABLE to find however, is ONE definitive power to whom we can turn--- and that is why I wrote, on the previous forum, the proposed "Mission Statement" below:

"I also suggest that we ALL brainstorm and form a "Mission Statement".

Perhaps something like this:

We nurses, acting in our roles as patient advocates, and finding no ONE definitive power to represent us, are prepared to perform the following acts to ensure the safe care of our patients and ourselves:

1) We will communicate with any and all parties who are charged with the responsibility of legislating and/or mandating the practices of nurses.

2) Since we believe that nursing administrators and other nurses not currently involved in direct patient care do not have first-hand knowledge of the rapid and dramatic changes in bedside nursing, we will ask our legislators to form a body of nurses, comprised ONLY of currently practicing BEDSIDE nurses.

3) We will charge this body of nurses with the solemn responsibility of formulating a patient acuity system that reflects the true nature of today's more seriously ill hospital patient. Based on this and the additional time that nurses require in using Universal Precautions, they will formulate a safer and more realistic nurse/patient ratio.

4) We will ask our legislators to support these findings as law and to impose a fine on hospitals that do not comply. We will ask them also to withdraw federal dollars, if applicable, from hospitals that repeatedly ignore this law.

Just a start..........and a thought.....my brain is tired! (Ha!)

AS I SAID EARLIER, LET'S ALL BRAINSTORM!!

PLEASE ADD TO, DELETE FROM, REWRITE---(WHATEVER) TO WHAT I'VE JUST WRITTEN, OK?

Hugs to ALL!!!

barton"

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Erbn Girl ---as for documentation----I believe that a lot of nurses are documenting their concerns on sheets that they turn in to administration and some are copying (and keeping for their own records), the assignment sheets for each shift---anything that proves unsafe conditions. Just remember what they taught us in school: Document and be OBJECTIVE!

Hope I've answered some of your questions and given you a brief :-) (and accurate?!) summary of our purpose/actions here.

Thank you both for your interest, please join our efforts, and continue to post, OK?

barton

P.S.--I believe that a lot of nurses here are also referring their co-workers to this forum and distributing the info on how to contact the organizations, etc. I've already named--GREAT, HUH!!!!

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[This message has been edited by barton (edited April 02, 1999).]

barb o · Apr 9, 1999

I recently attended a seminar on legal issues in nursing and, as this is a hot topic, the question of what to do about staffing problems came up. The lawyer, who is also an RN with over 20 years' experience as a nurse said that the thing to do when you are unsafely staffed is to write up an incident report STATING THE FACTS! Note the number and skill level of personnel that were present and the acuity of the patients. Even if ratios are established, they are GUIDELINES and are not carved in stone. If you have 1:1 patients, for example, and are not able to provide 1:1 staffing, note it! Criteria describing what constitutes a 1:1 patient should be found somewhere in a policy manual. This information would be more useful than the staffing "standards" in a case where inadequate staffing was present. Common sense in staffing patterns is what will prevail in a court of law, therefore, the "staffing standards" won't hold up. So, write up the incident report and address it to your supervisor, but keep a copy for yourself, because these things tend to get "lost." Your record of the events may be crucial in case of a lawsuit. I would guess then, that if trends could be established, it could be shown that the hospital was at fault for not providing staffing. It IS, after all, THE HOSPITAL'S RESPONSIBILITY, not the charge nurse or staff nurse, to provide adequate staffing.

barton · Apr 10, 1999

barb o,

Thanks for the info! It's good to hear what a nurse/lawyer has to say------very interesting!!!

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Mike RN · Jun 11, 1999

Its impotant to realize, that the reason some of you don't see the danger yet or have had a patient hurt by under staffing is because we are nurses and we do whatever is needed to ensure our patients safety. No matter what the cost to us. Beware, it will catch up to you. The time to act is now. We need to "rock the boat", before its to late for me, you and that patient that just died because no one detected the warning signs of a heart attack or stroke in time. Join us.

pdxrn · Jul 3, 1999

great forum and I applaud anyone who is notifying legislator's, board's, 20/20 and ANA (although I don't have much faith in ANA doing too much)

BE aware that a national whistle blower act has not passed in the congress yet so "watch your back" There are many nurses who have been black balled form the profession for being "rabble rousers" and "squeaky wheels" and once black balled you'll never work in nursing again.

Just a warning.

c-rose · Jul 15, 1999

I would like to ask a question. I work in an O.R. where we have a nurse manager who is also the charge nurse. Recently, she handed that position over to the RN's. Each RN has to do a week of charge. It was forced on us so to speak. There are some co-workers that question our authority and I personally have a hard time being put in those situations. Do you think there is anything I can do about this? As a whole, she is giving us more responsibility with no incentive. She still gets the pay for charge even though we have that role now.

MollyJ · Jul 15, 1999

To the last poster, You and your manager are [likely] both being victimized by a system that just uses people. If you work in an OR of any size, you need both a unit manager AND a charge nurse and she is delegating something she doesn't have time to do!!! I would guess that she has asked for separation of her job roles and couldn't get it and is just trying to survive for the good of the unit. However, charge nursing, done well isn't just a "do it today, not tomorrow role" and no one develops authority or crediblity or the full potential of the role doing it intermittently, one week at a time.

If you are a member of your state nurses assoication, you can investigate with them the ramifications of refusing the charge role. It is unlikely that you will get information that you want to immediately act upon; you'll think about it. Also, NEVER forget to do the obvious. If you haven't already, meet with your unit manager and express your concerns. Do it in a group, if you can get some group support. Consider, if that doesn't help, meeting with your unit manager and her immediate supervisor. Do not be personally critical, but be ready to state the real and potential harms that are occuring with this system. Approach this in a problem solving mode and act like you believe the problem can be solved. Use "I statements" and factually represent your real and potential concerns. You can document your contacts with a diary AND with follow-up letters to the person you meet with that summarizes your meeting. DO not assume actions or outcomes. "On this date, we met and discussed these concerns... and came to these conclusions... Since no plans for change were stated, I await your response to our meeting."

Right up front (not having worked the OR) I can see that a temporary charge nurse would always be taking a long time to manage the type of medium fiascos that charge nurses manage, just because there is no continuity of experience. The temporary charge nurse is always reinventing the wheel. This leads to inconsistency and upheaval.

IF you discover that your manager and your administrator have no intention of working to change the situation, then you are faced with the "do I stay or go" situation with the potential of entering in to refusing a job assignment (charge nurse role). If you have read this thread, you've seen that many people are walking this path; be strong.