Many of the readers of my blog will know that I had a passion for nursing, it overwhelmed me, it suffocated me, it thrilled me, it was my life, I lived, breathed and would have died for nursing. I spent years and years researching best practice. I have spent years educating students and new grads sharing my passion and showing what a great profession they are working in. I defined myself by being a nurse first and everything else second.
Now 22yrs later I have just woken up in a shocked frenzy and I realize that I don't have the passion anymore I am tired, worn out, I ache in every bone in my body, I am sick of the moaning and complaining of my fellow workers and I no longer try to enthuse them.
Patients who were once the love of my life now seem harder to manage, they argue more, they want more, they threaten that if you don't do what they want they will either sue, report you, get you fired and most of the requests are so unreasonable.
Every patient, their relative, their meaningful other and their dog has read something on the internet that contradicts everything you are doing! Every pt, their relative, their meaningful other and the dog has watched lawyers on the tv, the cinema, on the internet and on huge billboards tell people about how you can sue the hospital and staff, just phone the 1-800 number and you can be rich.
As a nurse for 22yrs i can count on one hand (well maybe two) the amount of times i have worked anywhere which has been adequately staffed.
Just when staffing levels reach a 'perfect' number several things happen
- somebody calls off
- somebody leaves for a new and more exciting opportunity and they normally leave in 2's or 3's
- somewhere else is poorly staffed so somebody will go and help out there
- somebody injures themselves on duty and is sent to er
- somebody gets pregnant or goes on maternity leave oh yeah 2 weeks paternity leave
So what happens now...
- the somebody who called off, stays off or is replaced by the next call off
- the somebody who left for a new and exciting career opportunity is never replaced
- the somebody who floats is always floating
- the somebody who was injured is now on workers comp so still a number but cant work
So now we are extremely short of staff and we only had one week of the perfect number!
In today's nursing economy what we find is number crunching and hours per treatment reports, all designed by business men/women to make health care more affordable.
Now in the business world for a business to be 'viable' they have a magic number for the sake of an argument lets make the number 2.85, each month health care managers have to achieve this number or come in lower for the efficiency to be reached!
God help you if your hpt (hours per treatment) comes in higher, this means you are not reaching the efficiency that higher management have decided is the right number for your department, and all departments are not the same.
So what dictates how low or high your monthly efficiency number is calculated?
In a health care environment it is calculated by staffing levels, so if you want to be efficient then you stretch your staffing levels thin!
Yes by working your staff short, not replacing staff who have left and not taking into consideration the variables you can stream line your magic number and appear to be a wonderful manager.
If you are in my opinion if you are adequately staffed or over staffed you will not achieve your hpt, you will go over, indicating you are not efficient. What happens now is a huge spotlight comes over your department and everything you do is scrutinized and the very first place the business managers look is at the staff.
They say 'the first cut is the deepest' so in my place of work staffing is where you have to make the cuts, hours of the social worker and the dietitian are looked at first and they trim a few hours here and a few hours there. Then the secretary's are cut to one. Of course then the clinical staff are looked at!
Rn's are encouraged to drop hours, maybe a day a week this is done on a voluntary basis at first.
If nobody comes up to the plate to offer to drop hours you look at several things
- Performance
- Call off's
- Time served
- Discipline
Normally at this time, staff are always aware so they start looking around for another job because they are scared and feel unsettled.
The point I am trying to make is we need these staff but somebody in an ivory tower has decided we can manage with less staff so they have got to go to make the bottom line more acceptable.
So now we achieve the desired rn staffing level (remember we are expensive) and the ivory tower people are happy.
The amount of work is still the same, nothing changed with the amount of patients but now we have less rns working harder to look after more patients. Oh yeah now you also have to do secretarial work, social work and dietitian work because their hours have already been cut, but pts still need 24 hour care and advice, and the rn can multitask.
The rns who are left are happy to have a job, they have always worked hard so they soon adapt to the increased patient load and if they don't like it they can leave but there are no jobs because every department is facing the same problem. So they shut up and put up and management is happy again, until...........well you have increased your efficiency of 2.85 hpt lets now aim for 2.75 hpt and the cycle happens again.
The spotlight, the job cuts
Always remember the powers that be want you to know there is no nursing shortage just a shortage of jobs, this is a means to keep us under control, now they can number crunch and make 1 rn do the job of 2 rn's.
In reality there is and always will be a nursing shortage.
Rn's are now a part of a huge cult, we are being hypnotized into believing there is no nursing shortage.
Wikipedia says
Quote
This article gives a general cultural account of "cult". For its usage in the original sense of "veneration" or "religious practice", see cult (religious practice). For its use in a scientific, sociological context see new religious movement. For other uses, see cult (disambiguation).
The word cult pejoratively refers to a group whose beliefs or practices are considered abnormal or bizarre.[1] The word originally denoted a system of ritual practices. the narrower, derogatory sense of the word is a product of the 20th century, especially since the 1980s, and is considered subjective. It is also a result of the anti-cult movement which uses the word in reference to groups seen as authoritarian, exploitative and that are believed to use dangerous rituals or mind control. the word implies a group which is a minority in a given society. The word was first used in the early 17th century denoting homage paid to a divinity and derived from french culte or latin cultus 'worship,' from cult- 'inhabited, cultivated, worshiped,' from the verb colere 'care, cultivation'
