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Short Staffed: An Epidemic

Published

Specializes in Pediatrics and Healthcare Content Marketing. Has 2 years experience.

I have only been a nurse for a couple years and in that time I have found one issue that unites all nurses: a deep loathing for an under-staffed unit. We’ve all experienced it, we all hate it. So how does it keep happening? To understand the how, we must start with the what. Furthermore, to find effective solutions, we must start with the driving causes. You are reading page 2 of Short Staffed: An Epidemic. If you want to start from the beginning Go to First Page.

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

14 hours ago, Numenor said:

1.Another factor is that nursing is female dominated. I can't tell you how many times we have had new nurses come in and work 2-3 years, start to have kids then go per diem. Per diem nurses are essentially useless as many work the bare minimum which varies by hospital. 

I am just stating my observation but this does play some sort of a role, not saying its good or bad.

2. The other factor is work force drain 2/2 higher education. I am an acute care NP and have had dozens and dozens of nurse techs, barely 21, ask me questions and tell me that as soon as they finish RN school they are headed for their NP. Terrible idea.

I am curious: How long have you been a nurse and are you male or female? I guess you don't have to answer but I would like to know if you choose to.

On 6/5/2021 at 4:27 PM, CommunityRNBSN said:

But what is the same is being given an un-doable amount of work, and told that every item is supposed to be your top priority. Administrators will come and say “Why aren’t you (for example) screening every patient for depression, tobacco use, diabetic symptoms, street drug use, alcohol abuse, asthma control, up-to-date colonoscopy and mammography, and anxiety? You should be filling out all of these forms on every patient who walks in the door.”  They do not want to hear that tobacco screening is less important than depression screening, so the list of items to complete just grows and grows. 
 

When I worked as a teacher, someone would propose new material to add to the curriculum.  And our department chair would say, "Great choice! What are we getting rid of?"  That was the deal.  Our curriculum was stuffed full, and there was no way to add anything without doing a disservice to the material we already stretched to cover.  So anything added must have a corresponding deletion.

In nursing, all I see is administration adding.  When have you heard the powers that be say, "well, we want you to do this new thing, so now you're no longer responsible for that thing"?  Nope, it's always adding, but then expecting everything else to be still be done with the same staff and in the same timeframe.

Iluvnightshift

Specializes in Med Surg. Has 19 years experience.


Come on,are we really going to not notice that hospitals would not have this problem if they hired ADN's and LPN'S?

That is the real and only solution. 

verene, MSN

Specializes in mental health / psychiatic nursing.

COVID policies led to decimated staffing at my hospital. Prior to COVID we had 100% of our positions filled. Yes - we still had sometimes with high call outs, but we even had our float-pool mostly filled so it was manageable. Over a year later we are in dire straights. Nurse staffing is down by  more than 50%.  Those who are left are burning out from the mix of emergency staffing, voluntary overtime, mandates etc. and injuries are WAY up which in turn contributes to even more staff out on leave or quitting.  I don't know how we are going to turn it around because at this point new staff brought on see a hot-fire and thus quit or established staff leave and we are barely filling positions fast enough to keep up with attrition. It's bad. Really, really bad. Management all the way up to DNS and above is working the floor. (even our CMO is working the floor at least shift per week right now.).  And we can't be shut down because we are 100% full on beds and have a wait list to take more patients. Hopefully we will get hiring ahead of attrition and get the place back together again. Apparently it's bad everywhere though - other local hospitals are also struggling and even my PCP said that the out patient clinic I go to is running at about 60% of usual staff due to # of call outs and people out on leave and not being able to find staff to back fill positions.  

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

It will not get any better. Our older population is higher versus the healthcare providers. Don't know if I'm talking out of my anal cavity. Please correct me if I'm wrong. 

Read this article: Nursing and Pandemic 19. It's really interesting. Some nurses I know have been decreasing their work hours because they'd rather be with their families. They no longer feel the need to work extra hours. 

Edited by ThursdayNight

On 6/10/2021 at 2:04 AM, Iluvnightshift said:

Come on,are we really going to not notice that hospitals would not have this problem if they hired ADN's and LPN'S?

That is the real and only solution. 

Hospitals wouldn't have this problem if they hired. Period. We just hired a bunch of new CNA and Student Nurses (who work as CNAs, but can do a few extra things, too).  Can I tell you how much better it is already now that I'm (mostly) able to delegate patient care, vitals, etc.?  When the CNAs had like 16 patients each, it was almost like not having an aide (even though they were running their tails off).  

Lots of hospitals hire ADNs.  We've even got some diploma nurses at mine, and not just the veterans who were grandfathered.  I think there's like one diploma RN program left in my state, and I know at least one diploma RN who was hired about six months before I was with my shiny BSN.

As for LPNs, I personally see no reason that LPNs couldn't take an assignment in a hospital.  But I also don't think we're short staffed because we're not hiring them. There are enough RNs out there to staff hospitals, if they were supported enough to want to stay in bedside positions. If you hired LPNs, that would be a temporary infusion of labor, but then management would cut back, and I can't see LPNs wanting to hang out in the same short-staffed high-pressure environment that RNs are leaving.

The real problem is that hospitals intentionally go for lean staffing to save money.  If they proactively hired as soon as they got wind of a resignation, we'd be better off.  If they hired a few nurses more than they really needed, they'd be covered when someone left.  Instead, people leave, and HR or the Powers That Be wait around for a while while a little flame turns into a dumpster fire as more and more people leave.  As @verene says, once you hit a tipping point, it's really hard to get ahead of the attrition.  At that point, you can't hire fast enough, and newbies leave before they finish orientation, either because they're noping out of there or because they can't keep up with the insane demands and are let go.

 

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

The above post is true except hiring more staff is not the only answer. Making those who work there want to stay is even more important because we always need experience. Having a charge nurse 3 months out of orientation is.  not.  safe. Take care of your employees; they will take care of everything else if you do.

25 minutes ago, SmilingBluEyes said:

The above post is true except hiring more staff is not the only answer. Making those who work there want to stay is even more important because we always need experience. Having a charge nurse 3 months out of orientation is.  not.  safe. Take care of your employees; they will take care of everything else if you do.

True, but all the listening and morale-boosters in the world won't have the impact safe staffing does. Bonuses and shift incentives only work temporarily until people burn out.  More money is nice, but higher pay won't keep me in a job that makes me cry from stress and exhaustion. 

I think if you hire more staff, you have a better chance to retain the staff that's already there.  I've seen so many excellent, experienced nurses leave bedside positions in the past year.  For all of them, it was just the sense that they couldn't keep doing this anymore. I really think that if the staffing hadn't been stretched so thin for so long that they would have stayed.  

As much as I like donuts and socks and water bottles, all I really want for nurses week is safe staffing.  I feel like the floor managers and ANMs get this, but their hands are tied by upper management. I love being a nurse. I love my colleagues and my managers and my patients, but unless staffing improves, the day is going to come when I can't do it anymore either.

Edited by turtlesRcool
elaboration

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

1 minute ago, turtlesRcool said:

True, but I think if you hire more staff, you have a better chance to retain the staff that's already there.  I've seen so many excellent, experienced nurses leave bedside positions in the past year.  For all of them, it was just the sense that they couldn't keep doing this anymore. I really think that if the staffing hadn't been stretched so thin for so long that they would have stayed.  

As much as I like donuts and socks and water bottles, all I really want for nurses week is safe staffing.  I feel like the floor managers and ANMs get this, but their hands are tied by upper management. I love being a nurse. I love my colleagues and my managers and my patients, but unless staffing improves, the day is going to come when I can't do it anymore either.

Agreed! I want it for the whole year round. The stupid kitschy gifts they can keep.  For those of us who got nothing, I would settle for safe staffing and fair compensation for the risks I take being a nurse.

verene, MSN

Specializes in mental health / psychiatic nursing.

1 hour ago, SmilingBluEyes said:

The above post is true except hiring more staff is not the only answer. Making those who work there want to stay is even more important because we always need experience. Having a charge nurse 3 months out of orientation is.  not.  safe. Take care of your employees; they will take care of everything else if you do.

Oh we are working on morale boosters too and seeing what we can do to get people to stay and to get people who've  been out on leave to come back to work. It's not a single prong approach by any means.  And fortunately while my unit has had it rough - we still have better morale compared to most and people will chose us over other units for voluntary overtime, and more of our regular staff show up to work.  I think having good leadership makes a big difference. You can tell the units/departments that care about their people and the ones that don't right now.  Hopefully the ones that are better off can impart some of their leadership and morale boosting strategies to those who are struggling more.

I'm confident that we'll turn it around eventually. The hospital has been around for well over 100 years and has been through any number of ups and downs in it's history so while it make take time I'm confident that we'll circle back to better days again. (This is no where close to rock bottom the historical perspective).  In my own perspective as much of a dumpster fire as it currently is - it's still one of, if not the best, job I've ever had - so I'm willing to stay to help turn the place around and make sure those new staff coming on are welcomed and given support in hopes they then become well trained and stick around.  My confidence in our hospital leadership has yet to be broken (The fact that our CMO and a lot of our other executive leaders will come work the floor -- even on weekend NOCs and other less desirable shifts -- and do whatever needs to be done to meet patient needs with out ego speaks highly to their willingness to lead by example and to put the safety and needs of their staff and patients first). 

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

Just now, verene said:

Oh we are working on morale boosters too and seeing what we can do to get people to stay and to get people who've  been out on leave to come back to work. It's not a single prong approach by any means.  And fortunately while my unit has had it rough - we still have better morale compared to most and people will chose us over other units for voluntary overtime, and more of our regular staff show up to work.  I think having good leadership makes a big difference. You can tell the units/departments that care about their people and the ones that don't right now.  Hopefully the ones that are better off can impart some of their leadership and morale boosting strategies to those who are struggling more.

I'm confident that we'll turn it around eventually. The hospital has been around for well over 100 years and has been through any number of ups and downs in it's history so while it make take time I'm confident that we'll circle back to better days again. (This is no where close to rock bottom the historical perspective).  In my own perspective as much of a dumpster fire as it currently is - it's still one of, if not the best, job I've ever had - so I'm willing to stay to help turn the place around and make sure those new staff coming on are welcomed and given support in hopes they then become well trained and stick around.  My confidence in our hospital leadership has yet to be broken (The fact that our CMO and a lot of our other executive leaders will come work the floor -- even on weekend NOCs and other less desirable shifts -- and do whatever needs to be done to meet patient needs with out ego speaks highly to their willingness to lead by example and to put the safety and needs of their staff and patients first). 

I appreciate this positive post. Thank you.

AmandaBeaverhausen

Specializes in CMA, CNA.

So is anybody noticing hiring LPNs in hospitals? I'll be one in a year and then bridge to RN, but I would LOVE to try hospital. LTC currently, for 5 years. All the nurses say money is better here but benefits better in hospital. I'd totally do 3 12-hour shifts in a hospital-- sign me up!

6 hours ago, AmandaBeaverhausen said:

So is anybody noticing hiring LPNs in hospitals? I'll be one in a year and then bridge to RN, but I would LOVE to try hospital. LTC currently, for 5 years. All the nurses say money is better here but benefits better in hospital. I'd totally do 3 12-hour shifts in a hospital-- sign me up!

No.  

Honestly, as I said above, there are enough RNs out there.  There just aren't enough RNs willing to work for the current pay and conditions at certain hospitals. And even that's not true. There aren't enough experienced RNs willing to STAY at those hospitals.  

Hiring LPNs might sound like a great opportunity, until you think about why we're even having this conversation.  RNs are leaving because the conditions are bad, which makes the conditions worse, which makes more RNs leave. The conditions that make RNs leave hospitals aren't magically better when the employees are LPNs.  An organization that doesn't proactively fill positions, and uses lean "just-in-time" staffing models to save money with RNs is not an organization that is going to facilitate robust staffing with LPNs.  

You can say now that you'd totally do 3 12s a week...until you actually experience the reality of those shifts turning to 13s and 14s with barely a pee break and too many patients in unsafe conditions. Until you see patients with poor outcomes because you were stretched too thin. Until you are filled with dread before a shift and exhaustion after. Trust me - you wouldn't "LOVE to try" that. You're not even a nurse yet; you have not gone to work knowing people could literally die because you don't have time to give them the care they deserve. It's not just overwork; it's moral injury (look that up if you're not familiar with the term), and it gnaws people out from the inside. The reality of what we're experiencing in hospitals now does not match the exciting opportunity in your head.

Edited by turtlesRcool

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

I work in SNF. It's guaranteed that at night that we have 30, or 40 people per CNA. Some CNAs think that 12 or 20 is hard. It becomes a good laugh in my circle for being CNAs when they say, "I don't like____; they have 18 or 20 residents per CNA at night." For me, even though it's not funny, it makes me laugh. 😂. I took care of the ventilators before. 2 CNAs for 38 vents and trach with a few trying to pull their trachs.  We made it. Our nurses and RTs were fabulous, so I wasn't nervous that much. My partner was outstanding, too. She is halfway in her pharm to be a pharmacist. 

I feel bad for the nurses when they're short-staffed. It gets chaotic. They should have at least one person passing medications to stable patients. 

Edited by ThursdayNight

ThursdayNight, CNA

Specializes in Wiping tears. Has 3 years experience.

14 hours ago, SmilingBluEyes said:

The above post is true except hiring more staff is not the only answer. Making those who work there want to stay is even more important because we always need experience. Having a charge nurse 3 months out of orientation is.  not.  safe. Take care of your employees; they will take care of everything else if you do.

It also makes our duties as CNAs, a lot easier. Got a newly graduate nurse who administered MOM at night. It's safe for the people who are bed-bound but those who can walk. We already had a few serious injuries as a result of this rushing to get up to use a toilet. 

I don't know really how the MOM is used during the night time, but it has been causing some issues among patients who are capable of walking.

Edited by ThursdayNight

NurseScribe

Specializes in Psyche Nursing, Med/Surg, LTAC.

  There needs to be a hard limit on the amount of patients one nurse is responsible for. I really enjoyed being a nurse for years-until the amount of patients kept getting slowly increased, more and more duties were gradually added, and LPNs and CNAs were quietly phased out. It became a nerve-wracking, undoable job where I was driving home every night scared to death that I missed something critical.  I don't care how good your time-management skills are-there is a limit to how many people you can pay careful attention to while performing multiple tasks and still be aware of changes. I would take a job with less pay if they would guarantee a limit on number of patients and some auxiliary help. 

  A CEO at the hospital once asked in exasperation ,"Nursing is never satisfied. What do they want?" My answer would be-"To do a good job."

If you create the conditions where a nurse can NOT do a good job, no matter how hard they try-they leave. 

 

Nurselexii

Specializes in Non judgmental advisor.

I think there won’t be an incentive to change if nurses do continue to come into work . When they do not the following steps happen 

management will be asked to work as cnas or nurses . 
 

and if not enough policies will be revised to increase the ratio. Maybe 12 to one 

 

if that’s doesn’t work out they’ll float till they have to shut down 

On 6/11/2021 at 10:57 AM, ThursdayNight said:

Read this article: Nursing and Pandemic 19. It's really interesting.

😮  Some journalist actually tried to find out some things! (Although they hold the refrigerator decorations in too high regard and don't seem to understand that's just another dog and pony show). Pretty well done, though!

 

On 6/12/2021 at 3:39 PM, NurseScribe said:

If you create the conditions where a nurse can NOT do a good job, no matter how hard they try-they leave. 

Confirmed.