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.
Talk to any nurse and they will have something to say about the staffing at their hospital or facility. More often than not, that something will be an unflattering depiction best summed up with three words: stretched too thin. Additionally, the COVID 19 pandemic, like a flare up of a chronic disease, has only exacerbated the issue. While the problems addressed here can be frustrating, the goal is to rationally examine the causes of under-staffed hospital units in order to then identify potential solutions.
The Problem: Defining Short Staffing
What is short staffing? That depends primarily on the defined nurse-to-patient ratios in each hospital and on each unit. Ask any hospital administrator and any nurse at the same hospital to describe the safe, ideal nurse-to-patient ratio on a given unit and they will be give completely different answers. Why is this? One likely reason is the perspective and roles of each side varies greatly. An administrator considers a completely different set of criteria than a nurse would for the same problem.
The Fix
If nurse-to-patient ratios are the foundation for safe, effective patient care then coming to an agreement on what those ratios should be is paramount. This requires open, honest communication between clinicians and administrators alike. Clearly defined and agreed upon criteria for what adequate staffing on each unit looks like gives everyone a solid foundation with which to start. Nurses are critical to helping define these standards in order to ensure that expectations are realistic.
The Problem: Accounting for Census Changes
There is no question that patient censuses can fluctuate dramatically in short periods of time. We've all left a shift with adequate staffing only to come back 12 hours later to twice the patients and half the staff. These variabilities are difficult to predict, although not impossible to prepare for.
While floating nurses to other units is a commonly used solution, it is a temporary fix and not always seen favorably with floor nurses. Why is floating such a dreaded event? There are many perspectives and reasons although most of these boil down to one common element- the unknown.
On any given shift, there is a lot a nurse can know ahead of time and a lot they cannot. We can know our units- where the supply room or code cart is or the policy for various unit specific procedures and processes, on the other hand we can't know our patients, their conditions, or what may happen over the course of a shift until we are there. Floating to new units takes away the piece of the shift we can know.
The Fix
One option is to give nurses to chance to choose two separate units to work on and then provide full orientations to both units. Allowing nurses the choice of an extra unit gives them some element of control, additionally the orientation gives them the chance to be more comfortable and therefore safe on the unit. Furthermore, this would have the added benefit of reducing potential burn out from being in are place too long.
Another option is to hire nurses specifically as float/pool nurses. Setting the expectation at the time of hire for their role and work expectations will allow the hospital and nurse alike to find and fill roles that fit both parties.
The Problem: Nursing Burn Out and Turn Over
It's a true "chicken or the egg" type question: does short staffing cause nurse burn out or does nurse burn out cause short staffing? There are good arguments for either side, however ultimately addressing both issues is crucial.
The Fix
Hospital administrators have many parameters they use to measure their hospital's success. There are internal considerations such as patient satisfaction surveys and even employee surveys as well as external influences such as various accreditations that can elevate a hospital's standing. Including safe nurse-to-patient staffing ratios as a unit of measurement for success and then getting "dinged" every time a unit operates without appropriate staffing aligns nursing priorities with administration priorities.
This alignment of goals puts everyone on the same page. Which, in turn, helps nurses feel protected by their hospitals leading to a reduction in nurse turn over. All in all, it is mutually beneficial to ensure safe nurse-to-patient ratios.
The Best Chance for Change?
While short nurse staffing can be difficult problem to address, it is not impossible manage. Ultimately, the best chance for change has everyone working towards the same goals: safe, effective, compassionate care for our patients.
What are some of the issues you've found that contribute to under-staffing at your hospital?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
2 hours ago, Wuzzie said:
So at a recent “town meeting” a nurse stood up to verbalize to our CNO our desire to provide good patient care which cannot happen with the bare bones staffing we have. His response to her…”Amazon is hiring”.
I have no words.
If only the public knew.
If its at all possible I suggest you RUN from that place.
If its at all possible I suggest you RUN from that place.
I would but it will just be the same at the next place. I believe our union got wind of this and will be making it public. I believe a ?storm is about to happen.
Here in New England they are woefully aware. There has been a pop up of concierge medicine service just due to the fact that hospitals and offices are so backed up. It may be location dependent it is just so painfully aware of the presentation of patient safety and the reality of the opposite in this part of the county
It's going on a bit of everywhere. Maybe, just maybe, it'll wake some admins up
So at a recent “town meeting” a nurse stood up to verbalize to our CNO our desire to provide good patient care which cannot happen with the bare bones staffing we have. His response to her…”Amazon is hiring”.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Here in the Bay Area the concierge medicine thing is super popular. If you're wealthy enough you can have all your appointments at home and not have to go to the lab because a phlebotomist will come to your house.
If no one with power is ever affected by staffing issues things won't change. If not for HIPAA it would be cool if someone filmed a behind the scenes of being a nurse to show people how it really is when a hospital is short staffed and how much nurses have to juggle. I think you have to experience it or witness it firsthand to really understand, and people would be alarmed and demand change. No one wants to be a Med/Surg nurse's 8th patient, but people don't know! If there are any nurse filmmakers out there, I support you in letting people know the truth!
I think one of the hardest things about being short staffed is that in addition to just trying to keep my head above water, get things done sort-of on-time-ish, and not miss anything major, I also have to deal with irate patients and their families. So now in addition to my job, I get to expend time on customer service to patients and their families who believe (not without reason) that we are not attentive enough to their needs. And that's a huge time-suck that puts me further behind and keeps me from doing my damn job.
Seriously, last week I spent over half an hour with a patient and her husband who were upset that when she rang to use the bathroom, the aide told her she was with another patient, and didn't make it to the room for 20 minutes. I apologized, and explained that sometimes we really can't get away. She was insistent that if you can't make it, you send someone else. Dear reader, there literally was no one else to send because we are ALL running from one patient to another. My aide that day had 17 patients. She wanted me to call the doctor in her presence to tell him how dissatisfied she was and she wanted to leave, and she insisted I do it in the room so she could make sure I didn't lie. I called the doctor in her room (though she wasn't really satisfied because my phone doesn't have a speakerphone option for her to hear his side), and finally got out of there with the promise that I'd get my nurse manager to talk to her. But there was honestly nothing I could have done or said to appease her other than go back in time and toilet her faster. That half hour was not just unpleasant, but it put me behind on my 1400 med pass.
Yesterday we needed 23 nurses to run the clinic properly. We had ten. We take care of very sick oncology patients. Let that sink in.
Meanwhile they are falling all over themselves providing hybrid schedules to clerical staff who would rather work at home (gee, I wonder why) because they are afraid of losing them. They are banking on the nursing staff continuing to take it in the rear out of service to our patients who deserve so much more than they are getting now.
One time, I was upset that I resulted telling a person, "We don't have a vending machine where I can get a nurse urgently. I don't like it that you aren't getting the best care. I have to spread my time. I am sorry that you're in this mess." We were short staff in nurses and CNAs.
At the end of my shift, the patient apologized to me for being impatient. I reiterated that she didn't have any fault.
PMFB-RN, RN
5,351 Posts
If its at all possible I suggest you RUN from that place.