Preparing to present grievances to heads of hospital

Published

What I'm looking for is info re: other tele floor RN's and PCT's work load/description for comparison.

I am a telemetry RN. Our floor is transitioning to tele/med surg floor for past year. Our grid has changed from 4 pts with one admission, 1-2 discharges to now: 5 patients with 2 admissions and up to 3 discharges per shift. We went from being an excellent floor clinically to being average and many times, less than adequate. We are burnt out! We've lost 12 RN's (total from all shifts) in last year and 6 PCTs. Our management says that according to their info, we are comparable to other hospitals, even overstaffed. We are MISERABLE and dropping like flies! We can't ever find coverage, we are always short PCTS and RN's, everybody hates to float to our floor, and agency and contract RNs never return.

Are we crazy? Are we pansies? HELLLLLP!

A typical day for our RN:

5 patients

2 to 3 isolation (MRSA, pneumo, flu, TB);

80% are 75-90+ years old;

3-4 are unable to roll/sit up independently,

1-3 iv abx per patient;

3-4 are incontinent of b/b;

all have approx 10-15 pills at 9am, 5-6 pills before 7pm;

3-5 are ACHS diabetics;

3-5 have dementia;

1+ with open wounds and wound care;

2-4 are 250+ pounds, many 300+ (this requires mult RN's and PCT's bedside for one patients care be it boosting, bathing wound care etc); occasionally (1 pt per week) wrist/posey restraints.

Other common duties:

tube feeds

heparin drip,

cardizem drip,

insulin drip

pre/post cath

pre/post pacemaker,

mult tests which require transfer to cart by 2-3 staff

Rn's have to take patients down in WC at discharge to their rides;

hang blood products and of course

dealing with the abusive, high maintenance families (people seem to get worse all the time.)

We don't have an IV team.

Both managers are mostly at meetings. We really don't see the unit manager at all and the asst manager early in am then she is mostly in her office.

Our charting is Meditech.

Our Charge RN is absolutely unavailable to us, only to quickly answer a question. She doesn't have time to assist physically with pt's do to her schedule (bed meetings, covering tele clerks for breaks 3xday etc). She is actually more stressed than us many times.

PCT's: take temps and pulses. They have 10-12 pts/day. Isolations, obesity, incontinent, baths, and many complete patients keep them so busy that we assist them.

I've been invited by VP of nursing to present my concerns to CEOs/Drs/Heads of hospital. I think it's payback to speaking up at that last staff meeting.

I need numbers/facts so I can make an intelligent argument.

THANKS FOR RESPONSES IN ADVANCE.

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I don't work med/surg so can't help you, but.... I'm exhausted just reading what all you're doing! Good Luck!

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Specializes in ICU/ER.

I work in an ICU so my ratios are not as high as yours and we do not have CNA's or ward clerks. Our max ratio is 3:1. But we also enter all of our own orders/labs/referrals. We do the complete admission and dismissal. We also monitor and document/analyze all the teles on the M/S floor. We do complete care and are called out to MS to help with tricky IV starts or if someone is going down hill we also are called out to assist. We are also the "code team".

Our Med Surge nurses sometimes have as many as 8 patients. During the day each nurse gets a CNA. At 5am 1 CNA comes in to do ice water and I&Os for the entire floor. Then at 7am the other CNAs arrive. 2 CNAs leave at 11pm and one will remain till 1am to assist with call lights etc etc.

There is a ward clerk on the floor from 6am until 11pm.

They have just recently hired an "admit" nurse who works 9am to 9pm. She will do all the admission and dismissals. Then once the pt is settled in, she will report off to the assisgned nurse. This has greatly helped the nurses. Greatly. If she is not busy admitting or dismissing she helps where needed. May start an IV, may pass some meds, may talk to the familys, just helps where she needs to help.

So yes their ratio may be high, up to 8, but they have a large support staff.

Best of luck. We all need to stand up and demand better ratios and more help. Changes must take place, and it must begin with staffing.

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You probably will not be able to obtain the statistics you would like to have ready to shoot at them during your meeting. I have worked on this very same floor for a year, i feel your pain. I think all the info you gave is a good detailed description enough. Believe in me when I tell you they have many of their own statistics that show the decline in patient care. Of course its due to them burning out the staff.They probably have numerous complaints from patients, their families and others. Im sure their risk assessments and costs have risen due to the negative effects of their poor planning. Do you have any idea how much it costs to orient one fulltime rn, then to have so many quit in a year. I would just prepare a detailed description of your day, and it would be better if you had support from other nurses in writing. Best of luck!

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I wonder if we used to work together?? J/K, but I used to work tele under those, if not worse conditions, and I left...I went to another hospital, and I went to their med/surg because their tele floor gave the nurses 8 pts!!!!!

Careful if you leave and be sure you are not going to end up at a hospital with worse staffing issues.

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Specializes in Maternal - Child Health.

Do you have access to software, or could you calculate by hand, the number of hours of patient care per day per patient in a typical assignment? I'm certain that you could demonstrate objectively that these patients require more hours of patient care than you have to give, based on your staffing numbers.

Also, point out the rate of nosocomial infections, fall related injuries and other "hospital acquired" complications that Medicare will no longer pay for, and demonstrate the amount of revenue that could be lost due to inadequate staffing.

If these administrators understand nothing else, they understand money.

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Specializes in Utilization Management.

We have ratios similar to yours, and our patient population's age is probably 90% geriatric, but:

  • Techs do vitals, accuchecks and most of the hands-on.
  • Each nurse usually has a tech. Rarely a nurse has 4 patients without a tech.
  • We have an IV team till 5pm.
  • We have transporters till 11p.m.
  • We have an admissions nurse on the weekdays.
  • If a patient is very labor-intensive, (like an insulin gtt with accuchecks q1h) we can sometimes get the doc to transfer the patient to ICU/CCU because we simply don't have the time available to keep up with it.

Obviously, acuity is a huge factor.

I think our unit is pretty well staffed, most of the time. It sure beats the 8-9 patients I'd start out with on day shift with Med-Surg.

Is it possible that you could get a copy of the CA ratio/staffing laws for comparison?

Here's a link to a booklet from the CNA regarding how safe staffing has improved care as well as brought nurses back to the bedside. http://www.calnurses.org/assets/pdf/ratios/ratios_booklet.pdf

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Map it out in minutes for each required task and add walking time from room to room and other supply areas. You will find that on paper these assignments are impossible. You need to promote that most family issues taking more than 1 to 2 minutes to resolve need to be referred to the social worker. All home care, discharge, payment, etc issues are referred immediately to the Case Manager who will work with the social worker.

The first med pass should not be closer than 2 hours from shift change as the nurse needs to get report, review the charts and assess the patients first for safety reasons.

An effective way of nurses sharing family requests for information sharing from physicians needs to be in place.

Nurses need to be notified of STAT anythings on any of their patients.

Nurses require a 'seperate from patients and familys' area to take their uncompensated breaks.

A charge nurse who does not have a patient assignment and has the experience and skills to assist the unit in functioning smoothly. If you dont have them, train them.

Ask the staff who work there what they really want to change, one suggestion per staff member. Then work up ways to make them work. Quick suggestions from other staff members helps a lot once you have your list.

Hope this helps,

good luck!!!!!!!!

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Specializes in ICU, MICU, SICU.

I have no advice...but I swear that we work on the same unit. I constantly hear "oh yeah, we have all full time and part time positions full", yet I get a call every SINGLE day I'm off begging me to cover a shift. I just don't get it.

I work at night and I'm so tired of 2 discharges and 4 admissions (yes, we freaking discharge and 11pm at night, what the HECK?)

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

They have just recently hired an "admit" nurse who works 9am to 9pm. She will do all the admission and dismissals. Then once the pt is settled in, she will report off to the assisgned nurse. This has greatly helped the nurses. Greatly. If she is not busy admitting or dismissing she helps where needed. May start an IV, may pass some meds, may talk to the familys, just helps where she needs to help.

I think this is a wonderfully innovative idea! The position could be configured to the needs of a particular unit: full time, part time, full shift, short shift, etc. It helps the nurses, it allows the patient to be admitted by someone who can give their undivided attention and isn't being paged every few minutes, and might be a position for a nurse who can't or won't do full-time bedside nursing any more.

To the OP: good luck! I hate those kinds of comparisons, in part because it implies that you're just a bunch of whiny malcontents; after all, if we're comparable to the hospital down the street, and the nurses there go to work with smiles on their faces and don't complain, then you must be the problem!!

I think management should regularly put on a pair of scrubs and get out there and follow someone around for a day and see what you actually deal with! I would surely issue that invitation!

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Specializes in med-surg, radiology, OR.

You have pretty much all the information you need form your post. Also, get copies of assignments from nurse managers and head nurses since they have sheets that they fill out on number of patients on 1 to 1 for safety, etc, total cares, etc. Someone is keeping a record of this, find out who and makes copies.

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I'm also on tele. We get 5 pts and PCT's have anywhere from 12-16 normally. Although our delusional manager says they only have 8-9. We have been preparing a letter (for awhile) to send to CEO, but have yet to finish. Amazing how difficult it is to actually do.

Here is a link to a previous thread I had started with some of our concerns. I hope it helps and good luck.

https://allnurses.com/forums/f8/does-sound-familiar-very-long-257572.html

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