DavisaRN9

I can relate. I too, have 20 years experience in various nursing specialties. And I have had some difficulty in getting hired, BUT staying employed is bigger problem. I get hired and during the probationary period I get saddled with 1-2 nurses (newly graduated) to show them the ropes. Well, after 88 days I get called in to speak with management. I get told I'm "not a good fit" and let go citing "probation period failure". Funny, all my "new nurses", the ones I trained to the floor remain with the hospital. Note: I am over 50 years old; all the new nurses I trained were under 32. This situation has happened verbatim 4 times in 3 years. And every hospital I was hired at had NO education orientation for 'new grads'. I did consult an attorney regarding this practice (as I was never late, never missed a day, and have a clean nursing record) and was told that there was nothing I could do as I was 'let go' during a probationary period. Plus, I was unable to garner any help from unemployment services; they cite I was never really employed. Between jobs I looked for 3-11 months to get hired. In the mean time I had exhausted all savings (liquidated IRAs, retirement funds) and am soon to be evicted to live on the street. BTW: My BSN nursing license is current and clean. I am now so depressed I no longer care.

I'd like to hear more about nurse-patient ratios. What is considered safe for each denomination and nursing specialty? (ER, OR, MED/Surg, L&D, ect.,). How many patients can be assigned to a floor (bedside) RN simultaneously and still be considered safe? To my knowledge, only 1 state in the United States is legally bond to limit nurse-patient ratios. That state is California. BUT what I have seen there is the hospitals, facilities, methods of circumventing this: namely, "ON-CALL.". Many RNs are placed ON-CALL very severely (500 hours per month) to circumvent them being 'assigned' a massive patient case loads but must remain available for ANY amount, meaning they can work 12 hour shifts then afterward are given ON CALL status where they can be given many more patients to care for, or very rarely, just a few. Plus, I want to know what is LEGALLY REQUIRED for the employer to divulge to a prospective employee. Example: A nurse is hired to work 3 12-hour shifts per week to be deemed full-time, AND is told she/he will be assigned a patient load of a maximum 6 patients. BUT, when he/she is working that job, he/she is assigned MORE than 6 patients (7---25 patients), plus the ON-CALL status of "one week-end per month" is EVERY week-end per month, because the hospital sites "nursing shortage". IF a nurse (RN) cannot or refuses unknown about or unplanned for ON-CALL assignments--he/she will be fired. Meaning NO unemployment benefits, NO reference, and YES to "no rehire" status which prospective HR employer reps. automatically view as "undesirable". What are the LEGAL perimeters of Hospitals towards RN employment?

Yes, I believe there is a 'nursing shortage'. Why? Not because there are not enough nurses, but because Hospitals (and other patient facilities) purposely understaff floor RNs to save on salary costs, thus blame delayed, frantic, poor patient service on the nurse stating, "we're understaffed due to the nursing shortage". Hospitals (I'll use them as an example) have been purposely doing this FOR YEARS. And they will continue to do so. Why? Because they can. Remember one state out of 50 in the United States has mandatory nurse to patient ratio limits. One. All the others can (and often do) assign monstrous loads on floor RNs with NO LIMITS, yet expect perfect patient care--which is impossible. Plus, hospitals are much more concerned with their stock holders, profit margins, and doctor retention than they are of nurses. It takes an RN approximately 7-10 years to be considered a nurse--(not including impacted programs which commonly have a waiting list of 1 1/2 years): (2 years pre-nursing college classes, followed by 2 years clinical AND nursing classes, 2 years bachelors upper division nursing classes, plus 6 months to 1 year floor orientation, then 1-2 years independent floor work; for specialty nursing such as ER, L&D, Neuro, Psych, OR=add 1-2 more years). Yep, to become an RN takes a lot of training and a lot of work (and a lot of money). So show some respect.

About nursing ratios. Let me say this: It is NOT about whether a nurse 'can handle' a certain patient load, it is what the patient, all of the patients in that 'load' are in need of, due by way of nursing attention. It is about what the patient truly needs--and is NOT about the nurse. Too many times, especially with 'older' more experienced nurses when orienting/precepting on-coming, usually new graduate nurses, they convey an attitude of competition, and failure---in order to impress the 'newbies' with their expertise, while simultaneously informing them (the newbies) of how difficult, how hard, how impossible it is to address ALL patients needs---yet they are still here. The over-whelmed, over-worked, RN has learned to account for their failures, their imperfections, to being assigned huge patient loads, saying, "I'll just do the best I can. See if YOU can do as well." This is NOT patient oriented! The culture of bedside RN nursing is, unfortunately, more focused on what that nurse is expected to accomplish in the time span allotted (which usually extends beyond 12 hours) and how difficult it is to succeed in accomplishing all in that time frame, rather than what that nurse has actually done. Failure to adequately address, treat all of the needs of the amount of patients they have been assigned, is seen as an endurance of stature of that nurse--and serves as an excuse because of it. The number of patients assigned to an RN and their un-identified, uncommented acute care status is both an excuse for the RN to fail to meet their patient's needs, and a reason for the efforts that RN attempting to accommodate the tasks they were given. Its called heroism---sacrifice in the efforts to accomplish. And this is a habit, a culture, a way of proceeding that most bedside nurses do to get through their shift. All may have tried at one time to perform their best--but all have learned they cannot because of hospital demands, patient loads...so they do the best they can initially, then accommodate to just doing enough to get through the shift. And to justify failure---blame scheduling and blame patient acuity. Neither of these has been adequately acknowledged or dealt with in most U.S. states. Why? Answer: Money. Hospital health care is a BUSINESS!!! Nurses comprise the bulk of company expenditures in the way of salaries. So, keep the salaries while adding to the nurse's work load. Why not? More patients equal more money. Its BUSINESS!!! And returning patients, those who were discharged too soon, inadequately educated upon discharge, incur post operative infections because of both----are admitted, yet again, and are cash-cows for the hospital's business. So it is no wonder hospitals ignore, are deaf to, any and all complaints or concerns coming from the nurses. In "AT WILL" states any complaint/concern coming from a registered nurse is seen as reason for termination--and is stated as "Not a Good Fit". And so it goes... Keep silent to management. Do just enough to thwart killing a patient. ***** about it all to a preceptee, play victim, then come back the next day...............