TreceRN

It doesn't seem to be a problem in my hospital. Our facility DOES discipline chronic tardiness. We keep track of those that come in late on our database, but the biggest problem with that is that the charge nurse has to call our staffing office and tell them that "so and so was late" and they often don't want to do that 'cause they feel like they're tattling. If someone has more than three "tardies" in 6 months, they start up the employee counseling road and can be terminated. I don't know of anyone that has actually been terminated. If they start down the formal discipline road, they either get it together or they quit. We HAVE to treat everyone the same as managers; not only is that the fair and honest thing to do, but if you don't the person being disciplined can "grieve" the counseling and have it overturned by HR. It is also considered a "terminatable" offense to falsify your timecard, and we have fired people who've come in 1/2 late and wrote on their timecard that they were on time.

It's called St. John Medical Center in Longview Washington. It's a non-for-profit, Catholic affiliated, community hospital that is part of a larger, 5-hospital system known as PeaceHealth. I'd say the rate of pay is very good compared to cost of living. We make about as much as nurses in Seattle, and the cost of living is less. Our sister hospital in Bellingham, which is north of Seattle, has lower wages than we do. Our last contract negotiations went very well (only took 8 sessions to reach an agreement, and three years ago it took 6 months!), and our nurses got a three year contract with a 21% salary increase spread over those three years.

'dreamon' had a wonderful list for you. The hospital I work at is great. We have good wages with step-increases and great bennies. Starting wage for a new grad is 20.04 and top wage is 30.84 plus shift differential, double-time after two hours of OT after your regular shift, and time and one half for any extra days worked about your regular FTE and for call back. Our turnover rate is about 5%. We're located in southern Washington state. We do a "care-pair team model" of nursing that pairs one RN with one CNA for a max of 6 patients. If you look at HCAB (Health Care Advisory Board) web site they have an entire 50 page study of staffing levels throughout the nation that is interesting. We have an admit nurse who floats and completes admissions during our peak admit times, but we don't have an IV team. We also have an Employee Wellness program that offers free help with smoking cessation, exercise programs, weight loss, massage, etc. We are a "closed shop" union environment, and we also promote shared governance in all of our nursing departments. Remember when you look for a job, are you really searching for a rewarding career or just a paycheck? Sometimes the highest paying hospitals with the biggest bonus' are also the ones with the highest attrition and lowest employee satisfaction. Good Luck in your search

Don't hate me because I'm "management", but I've read these posts with great interest and would like to present the other side of this dilema. I manage a 33 bed telemetry unit in a small, 150 bed community non-profit hospital. I've worked both sides of this issue, as a cardiology and critical care nurse for 7 years, and now as a manager for 2 years. I've received three "assignment despite objections", all of them within the first 6 months on the job. I took them very seriously and investigated the circumstances of each. We did adjust our staffing guidlines based on increased acuity and increased documentation demands that are placed on our nurses, and on a daily basis I'm involved with staff and other nurse managers desperately trying to decrease the workload of nurses while still meeting documentation standards. All the while we are walking the tightrope between our "mission and margin", coping with government reimbursement cuts in Medicare and Medicaid (which is 70% of our income), staggering increases in malpractice insurance, and the ever increasing government regulations that force us to hire non-nursing support to help us stay in compliance. Like it or not, gang, if we can't make enough money to pay our bills, our doors close and we are all out of jobs! I can't speak for all nurse managers, but I can say that I spend a great deal of my time on the unit helping with admits, discharges, and transfers. No "meeting" takes precedence over my unit's needs. I work 10-12 hours a day, 5 days a week (and I'm exempt, folks, no overtime pay for me). Unfortunately, I can't always be there and I know there are still shifts when all heck breaks loose and staff want to call it quits. Believe it or not, I bet your managers are just as frustrated as you are. And contrary to the beliefs of some, we cannot pull nurses out of thin air. There really ARE times when we simply can't find one more nurse of aide! Why not cut your managers some slack, stop in and ask them how their day is going for a change. It's very easy to critize and blame managers for our current crisis in healthcare. Take it from me, this is a VERY TOUGH JOB. Walk a mile in my nurse-shoes for a day and you'll agree.

Our 33 bed cardiology unit switched from a taped report (which took 1/2 hour to 45 minutes) to "walking rounds" over a year ago and we've cut our report time down to 20 minutes max. Our process is the charge nurses come in 15 min before shift and the off-going charge gives a brief report to the oncoming charge on every pt (just the essentials to make appropriate assignments based on acuity/skill mix). Then everyone for the oncoming shift meets in the report room for 5 minutes to get their pt assignments and a report sheet with all the pt's names, MD, & diagnosis. Then the nurse meets with the off-going shift and they exchange verbal report. We've found that this not only decreases time spent in report, but it has increased inter-shift communication and improved staff relationships and peer accountability.