safe assignment

Get a Union.

It's pretty much like this at my job, too. The more we function this way, it's like it proves to management that it can be done. When I complain about our staffing ratios, they don't seem to understand the position we are put in when they don't provide safe staffing based on patient acuity.

there are supposed to be changes coming at my job. More in middle management that floor nurses, but it's producing a little anxiety.

This pretty much says it all. What are your plans?

I just don't know

Pretty sure everywhere is like that. The grass isn't always greener on the other side …and if it is THATS because its **** covered. :) good luck

Rules about staffing vary from state to state. Some states mandate that hospitals have staffing committees responsible for formulating staffing plans. Does your hospital have one?

Are nurses missing breaks? Staying late to chart off the clock? These are issues that can be raised with your state's labor board.

Do you have staff meetings? Perhaps have conversation with your manager and find out if there are plans to increase staff due to acuity issues. A thought would be to have per diem sitters who help with the delirious high risk fall patients. Another thought is to pilot a team nursing concept. Or that 3 nurses take the LTC patients and the rest of you take the acutes (switch off so no one gets burned out) The LTC patients have team nursing--one does x, another y, and then a z. The acute care has a primary nurse, however, there's one "floating" nurse who assists with meds and the like. The CNA's stay as a team. They literally go down the line and work together to get what needs to be done, done.

The Joint Commission has guidelines as well on staffing numbers. That would also be a good reference.

I would think about a union. Any number of union contracts do not address patient load. And they should. Just because it is not done often, doesn't mean it can't. Anything can be negotiated. And what that gives you is another reference to record unsafe staffing levels. This is the information that is then brought forth to management to attempt to make changes.

The trend really is to do more with less. It is a bottom line business. Which is so contradictory to what a nurse feels their goal is, but it is a reality. And it is everywhere.

Completely agree - conversation with your manager is the place to start. Has there been a change in the staffing plan for your department? If so, you and your co-workers should have been informed. Be sure to do your homework. Does you state have any regulations about nurse staffing? What is the daily staffing plan for your unit? How are staffing variances managed? Are there insufficient PRN nurses to fill the gaps? What is the overall strategy for staffing when you have a call-in? How is vacation time covered?

Discussion of issues at a staff meeting is very appropriate, but I would suggest taking steps to prevent it from turning into a gripe session. For instance, ask for suggestions to improve efficiency and prevent re-work or duplication of effort. If you only have 2 techs, I am sure that they would appreciate some sort of advanced task schedule so they can plan their day a bit better.

BTW, the JC does not actually recommend any staffing numbers. They have standards related to 'staffing effectiveness' that require an organization to allocate, track and measure staffing, but no actual ratios or numbers.

We are in the same boat, and it's dreadful. They are offering incentive pay, but no one wants to come in to work extra because it's just such a cluster. I have never ever dreaded work, but lately I have. I am not even sure what the answer is, although I do hope with the warm weather coming things will slow down a bit. I love my job, but I spend so much of my time feeling stressed out and worried about working that it's just - UGH. I see where burnout comes from. This has been a horrible winter for us. Management doesn't even want to hear about it because honestly I do not think that there is much that they can do at this point to fix the situation.

1.union's not an option.

2. Like I said ( i think) it's not so much the numbers assigned , its the acuity mixed in with the delirium/geripsych/reg.psych/severe alzheimers. Since we are spending so much time chasing these people down, and running like maniacs when all the bed alarms are going off, it leaves a BIG window for error especially if we are running tight drips or have a post sheath pull who has had a failed closure device.

3.We cant have additional sitters- well occasionally we get one, but not too often. They count against us in out tech count. so if we have 2 techs and one has to sit, then that leaves one on the floor.for 28 pts, which I'd say are now 70 percent confused/vs AMI's, GIB's etc.

I just don't know. I know it's not greener anywhere else- that's why I have not jumped ship.Yet.If I do, it will be for something NON Medical related! I'll just have to live in a cardboard box in the meantime. well, i guess its not that funny.