Martinette

Yeah lots of people are quitting but there is a nationwide recruitment freeze and no where for them to go and work as nurses. Management know this and want to see them go. Quitting doesn't stop the patients from suffering unfortunately.

Oh and these same managers deny that we are short staffed and deny that there is a problem.

Just imagine that you could have a few minutes or hours or however long you need inside a room with hospital administrators/managers. Imagine that you could say anything you wanted to them and educate them about Nurse/Patient ratios and the reality of life as a bedside nurse without any consequences to yourself and career. What would you say? What would you say to managers that allow a 35 bed medical/surgical ward to be staffed with only 2 RN's and 2 health care assistants during the day. Keep in mind that these guys have been refusing to hire staff, have tried to get rid of nurses and are defending these horrendous ratios by saying that if the care is bad than the nurses are at fault. They accuse the nurses of having a bad attitude. Multiple staff nurses have written letter after letter to these same managers and are told that there are no staffing problems. The staff nurses have told the managers and head nurses that the staff are working their tails off and the patient care is horrendous. When patients complain to management about the care they are told that the staff nurses will discuss the complaint at a meeting. They will not admit that they are staffing the ward dangerously because they will not admit liability. Patients on this ward are suffering all kinds of bed sores and necrotic heals, the staff are exhausted and in constant pain. The managers are still refusing to allow anything more than one or two more new hire members of staff and are refusing to meet with the staff and answering their letters. What would you say to these guys if you could talk to them? Keep in mind that even though this ward is over 35 beds and acute med /surg many many of the patients are total care of the elderly/palliative care and stroke patients. The suffering is horrendous. They are often left with 2 or 3 nurses and 1 or 2 assistants in the day time on this ward. There have been times when there was only 1 RN and no assistant to 24 patients (multiple fresh post ops). They still get slammed with acute and chronic admits at these times. Fire Away and don't hold back.

Mine shut of at 110 and I passed. I was so sure I failed.

Thank you for the great advice Forenurse. We will try anything at this point.

Our managers have refused to come to the ward and speak with us. We have been making frequent requests for months. The only message that has come down from them is this "tough" "deal with it" and "any nurse who tries to refuse admissions because she claims she is overwhelmed will be disciplined" and "you must take your lunch breaks". Breaks are not possible without hurting patients. One of our nurses was the only RN to nearly 40 patients and she refused admits and she was punished. While she was in the office getting yelled at by bed logistics they put the new admits in the bed and left them there for her to find at some point. Our sisters have written letters to them and the newspapers and a group of doctors (the ones who are not abusive) have done the same. This is been going on for 8 months. Then all of the senior nurses at the hospital wrote another letter.

I was supposed to be out of there months ago but our house buyers pulled out of the sale so I am stuck until we get another buyer. I have been looking at waitressing in the meantime but if it takes time to sell the house we are screwed. At least I can rant away on the net. Does anyone else think that doctors are totally on another planet?

It's not a bad mistake at all considering some of the stuff that is happening on our ward. I'm not losing sleep over it really. I am just so sick of the doctors and their attitudes. It's like they live in a cave or something and just crawl out to abuse nurses. Everyone knows the wards are like this yet it is open season on the nurses. They have no idea of the battles we have to fight in an impossible situation in order to carry out their orders and take care of the patients. They get so angry when a screw up occurs yet never address the multiple systems errors...they just crap on the few nurses left.

I posted this in the UK forum because many of you know the situation with targets, short staffing, recruitment freezes etc. The Americans might not realise that medicine and surgery are so divided here. They have a lot of "med-surg" there it seems. My hospital is doing some really bad things. They have combined a medical ward and a surgical ward onto a very large ward that has many beds. They are getting rid of nurses and we are working very very short. This restructuring has resulted in nurses taking dangerously high patients loads in a specialty they are unfamiliar with and lots of bad things have happened. The management of the floor is a joke. None of us have had any cross training. Fo example..they only had surgical nurses on duty one day and they were overwhelmed and something happened with a medical patient and they didn't pick it up...the medical nurses may have. This resulted in them getting abuse by the medical docs. They once had one nurse to 24 medical and surgical patients on a weekday. When she asked (begged in tears) for additional help she was told "tough" and "deal with it" We had a medical nurse left alone with surgical patients with epidurals and she had never nursed patients with epidurals before. She had a total of 13 patients which is dangerous anyway. She asked for help. She filled an incident form in. A screw up happened and she took the heat. Letters have been written to management begging for help over the last few months and they have been ignored. Daily incident forms are ignored. The situation is getting worse. We usually have 2 or 3 nurses and one HCA to nearly 40 patients. It is a fast paced unit with lots of admits and discharges and many many EMI patients to boot. I'd say 2/3 of our patients are total care with dementia. There are no jobs anywhere else and the powers that be know that we are trapped. Sometimes all the beds are full and they are so desperate to get acute admits and surgical cases in (thanks to government targets) that they send them up to the ward to be admitted and we are told to get other patients "out". They tried to send one of my medical patients home without her being officially discharged. They tried to do this behind my back while I was busy with a poorly patient. They (bed logistics) had her packed up and in a chair. I refused to dishcharge her so they did. She was readmitted a few days later. This is always happening. The nurses are always taking the heat. I was put onto the specialty I was unfamiliar with and had 13 very unwell patients..most of them total care as well as 2 complicated discharges. There were 4 admits due to come in so they were sent to me and I was told to "make room and admit them" They were for theatre that day...list to start in an hour. At this point I was drowning with my other patients. I told them that I couldn't do this and I needed help...was blown off....did fill in an incident report. The other nurse I was working with was drowning on her side. I managed to take care of my patients and get the new ones admitted and ready and did find beds for them. I was so proud of myself. Then i get a phone call. One of the patients I sent to theatre (specialty I am not familiar with) was supposed to have a piece of equipment ordered by the nurse and sent with the patient to theatre so that they could use it there. This thing was supposed to be ordered from pharmacy by myself and sent with the patient to theatre. Getting it from pharmacy would have meant legging it down there myself. A. I was run off my feet B.I was not orientated to this specialty despite begging for it because I knew I would have to take these kinds of patients. c. The bloody surgeons had NOT even prescribed the damn thing or written orders for it anywhere BUT I would not have realized that I needed to physically get the thing and send it with her to theatre anyway even if they had. D. I had 20 minutes from the minute until she got into a bed until the minute she had to go to theatre and had many othe patients and admits. I am totally grateful that nothing worse happened. :w00t: Guess what. The surgeons went ballistic at me. Absolutely ballistic. I have been reported to everyone and there brother over it because their precious list was held up for 20 minutes over it. Apparantly I should have called them and reminded them to order it and then retrieved it from pharmacy. Our pharmacy is so at the minute they take hours to dispense anything. I can take responsibility for my actions but this is like some kind of joke. We have made multiple courageous attempts at trying to get someone to listen and help us but it falls on deaf ears. We have no option to leave unless I want to take a lower paying job and get my house foreclosed on. I am so ****** off. Then the next day at work these surgeons from this specialty were all glaring at me. The other nurses I work with backed me up big time and tried to tell them where to go. Couldn't get a word in edgewise and just looked like we were deflecting blame. :angryfire I am off now but I am still angry. I have been off for awhile now and I am not going back. This was the straw. I am sick of feeling guilty all the time. Usually I get over it after a few days but I am just still so mad!! Everyone is so beat down. No matter where we turn to report this no one cares. If anyone is going to suggest the unions, the NMC, and the health commision and the RCN all I can say is bought the t-shirt already months ago.

sorry double posted.

Oh for god's sake and if she had told him to stop he would have probably started berating her and screaming saying "i'm the doctor blah blah blah".

I totally agree. Nursing has more bad points than good IMHO. It's a shame too because it doesn't need to be that way. If nurses had decent management, support, a safe number of patients, authority and respect it would not be so bad. I would really enjoy the job if I had a small number of patients and some back up. I am sick of having 20 patients at one time who demand one to one care and get nasty when they don't get it. Meanwhile management is cutting the numbers of nurses etc etc. They should have to take the abuse from the patients. It could be a very rewarding job in the right environment. I am looking at getting out. More money won't get me back in but guaranteed small nurse patient ratios would.

It is not LESS education. It is a different kind of education. My 3 year diploma program was a lot tougher than your average Bachelors degree in other fields. I was attending nursing school while my twin was doing a degree in education. I was at a 3 year diploma hospital nursing program that was affiliated with a top university for all of our sciences etc. My twin was at a 4 year school doing a degree in education at the same time. Guess who spent more time in class.... had more material to study that was much more complex...etc etc? I did more work and covered more material in 3 years than she did in 4. It is a different kind of education.

I'll come in from a different angle here because I have a strong stomach. I cannot handle anything sad involving young mums and their babies /children. We have a very young single mother with young babies dying of ovarian ca at the moment on our floor. She has metz. everywhere. Her ex-husband is AWOL and she has no family so the kids are in foster care now and she is going to hospice. Merry freaking christmas. Seeing this kind of stuff makes me want to throw in the towel and sit in a corner and weep.

It seems to be the same all over. Most of my friends colleagues are nurses from the Phillipines, India, and Singapore. In India it is 1 nurse to 60 patients yet their hospitals are really modern and high tech. In Singapore it is 1 nurse to 20 and if there is any kind of screw up or complaint from a patient they demote you to nursing assistant. Nothing but disrespect all over. The role of nursing has changed so much due to changes in the way health care is delivered and technology. People's attitudes are not changing. I had someone tell me that they thought that a childcare worker had the same level of education as a nurse.

This is not only a US problem it is global. I work in a country that has national health taxpayer funded government run hospitals. There is a nurse I work with who is the best nurse I ever saw. She is smart, hardworking, caring, she thinks fast..the patients all get the best care when she is around. It's like she is supernurse. I can't say enough nice things about her. She is leaving because of the high ratios and abuse and management cannot wait to see her go. They have had a recruitment freeze in place for years. They want to make 500 nurses redundant but the community had a fit so they are hoping that people get fed up and quit. This is all because Blair's government (I am in the UK) targets have left the hospital with extreme debt. They are increasing beds and driving nurses away. We are 2 hours away from another hospital. The people in charge of our hospitals have no clinical nursing or medical experience. If I were a chief executive I would fight to keep nurses like her around. I am also going but I am probably too burned out to be any good anyway. Just waiting for my husband's visa and we are off abroad. Not too long now!!! I also work with another RN who is fantastic. She was dealing with an IV med and had a major reaction (allergy) and coded. She ended up in a vent in ICU and when she came off that vent our matron was telling her to get herself discharged so she can get her ass back to work. I couldn't make this stuff up. She is leaving as well. This community cannot lose any more nurses. I think that the problems we are all seeing are NOT down to the type of system (private vs socialist model) that we have in place. The bottom line is that nurses are disrespected and treated like crap and will always be the last consideration of hospitals/governments. Hospitals centre around nursing care and yet no one wants to make nursing a priority. This directly hurts patients and ruins nurses but no one seems to be making the connection. Things will only change when nurses are understood. But no one wants to listen to "a nurse". I am afraid that it will never happen and nursing will continue to deteriorate. Nurses will continue to get a bad reputation and people will listen to us less. It doesn't matter what system is in place.

My hospital has really really bad ratios. We are talking one nurse to 24 patients on a good day. These are acute med surg patients. The managers have no interest in changing or hearing about nurse/patient ratio studies and they feel that the bad nursing care is due to the nurses being "lazy" and crap". It has been my experience that the public shares the same attitude. They are refusing to hire and it is the same story throughout the country so we are stuck where we are. I don't think any of this will be fixed until we educate the public. If they had any idea of what nurses do and how much responsibility nurses have they would never put up with this kind of short staffing. Something needs to be done.

My belief is that yes...it is a result of the way our health service is run and meddling by politicians. The people who make the decisions have no clinical knowledge. It is bad but there are no jobs anywhere else and we have mortgages and they know it.

By the way most of the nurses I work with were nursing back in the "good ole days" and they are hardworking, caring but also distraught regarding the terrible nursing care.

Woody, I think that the majority of "bad care" happens when the nurses are overwhelmed rather than incompetent or just plain nasty. I currently work on a 30 bed med surg unit that won't staff anything with more than 1 RN and a few volunteers. A family member may know their loved one well but I don't. I have just come on duty to be responsible for 30 people I have never seen before with nothing but a flimsey rushed handover from the previous shift. The UK hospitals are having money problems and are getting rid of nurses left and right and intentionally short staffing the wards. There is also a nation wide recruitment freeze and they will not hire. How do they get away with this dangerous practice? People like you. These managers know that they can save a few bucks but giving the nurse way more patients than she can handle with no help and folks will blame the nurse. The most caring, most wonderful, most hardworking and competent nurse in the world will flounder big time if he/she has too many patients. The standard of nursing care will be horrendous. This is a well researched and proven fact. I have seen pregnant RN's on my floor work 14 hour shifts without stopping for a glass of water and food working their butts off for all of those 14 hours because they are so dedicated to trying to do an impossible job for too many patients. And they get nothing but abuse from family members who want one to one care and don't understand the dynamics of one nurse caring for 30 acutely ill totally dependent patients. Do these irate family members run screaming to administration regarding the appalling level of staffing? 80% of our new nursing grads in the UK cannot find jobs and yet the hospitals are not hiring and leaving one RN with a dangerously high number of patients. But do they run screaming to admin for staffing the wards like this? Nope. This just allows these managers to keep thinking they can get away with it because the nurse will be the one to take the fall. And remember that plenty of research has proven that the best nurse in the world is completely screwed with too many acute patients. Nurses want to work hard and give good care but it is very unreasonable to expect the nurses to give decent care and have a good handle on all of their patients with these kinds of staffing levels and acuity. A nurse could bail out the atlantic ocean with a teaspoon more easily than provide good care to too many acute patients at one time. It is just not going to happen. If my father was a patient on a ward where the nurse was overwhelmed with too many sick patients I wouldn't expect his care to be good and I would be in a managers office screaming and threatening the manager and wondering why my dad's nurse is being made to work in such overwhelming conditions when there is no need for it. This would be the best way to stop my dad from suffering via poor nursing care. Back to my pregnant colleague who worked for 14 hours non stop with nothing to eat and drink and happens to be one of the most caring and hard working nurses I know. She managed to keep her 10 critical care patients (who should have been in ITU) safe and alive for those 14 hours by running her ass off and not stopping and the daughter of another patient complained and got very abusive with her for not giving dad a back rub and sitting with him all shift. Same nurse had asked the managers to send her another RN or at least a care assistant because patients were suffering and she was ready to collapse and was told to f*ck off. If the public wants good nursing care they need to get off their asses and demand that hospitals are staffed safely and well. I don't believe for a second that they really care for their loved ones if they won't do this. I instead see them as a kid having a tantrum who gets off on abusing a nurse. If they abused those that intentionally short staff instead of abusing the nurses we wouldn't have so many problems with bad nursing care. Admin and the managers sit laughing at the money they are saving by staffing the wards like this knowing full well that the nurses will be the receivers of the wrath of an ignorant and unrealistic public. I know this for a fact. I have seen it with my own eyes. Then they get rewarded by their bossed for doing it. Let's give every nurse safe staffing levels and resources and back up and then we can weed the bad nurses from the good. Hope I have clarified things for you a bit Woody.

I love med surg and consider it my specialty but would like it a lot better if my unit was staffed. I usually have 13 + patients. I get upset because we are too overwhelmed to provide decent care and the patients and their families often come into hospital expecting one to one care and get very abusive towards the nursing staff. They don't understand the how ill the patients are and how difficult it is to be the only nurse for that many patients. They just think that the nurses don't care and cannot be bothered and they are not afraid to let us know that. It's hard to bear the complaints and the abuse for things you cannot control when you are working so hard and so committed to doing a good job. By the way I have 13 patients on a GOOD day. Usually it is 20 or 30 that I am the primary for and we also take high dependency. The ward I work on is also very unorganized. The recruitment freeze in this country means that there is no where else to go. I am going back to the USA as soon as my house is sold. The hospital I am going to there is well known to have great ratios.

So when do we know if it passed or not?

Thanks for all of your replies. This ward I am working on really scares me and I think it is all the "what if's" that are freaking me out. It's not going to get any better there. In a few months I will be overseas in a new job...just have to stick it out a while longer.

I think I am beating myself because when I went back to look at the drug chart the insulin order was obviously prescribed and I don't know how I didn't see it. Yeah live and learn I guess.

I did check the blood with another RN. She had the other assignment of 14 patients on her own at the other side of the ward....and I did the 15 minute check. This was during the drug round, call bells, charge, total care. I know it was my fault and I take responsibility I just want to know why the powers that be get away with this kind of staffing and general BS. Poor staffing is definitely a contributing factor.