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Should Hospitals Set Workloads for Nurses?

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by Melissa Mills Melissa Mills, BSN (Member) Writer Innovator Verified

Melissa Mills has 20 years experience as a BSN and works as a Freelance Writer, Nurse Case Manager, Professor.

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Who should decide how many patients each nurse is assigned during a shift? Some states are taking this power out of the hands of nurses and administrators and creating laws to follow. Discover one nurse's thoughts about Illinois HB 2604. You are reading page 3 of Should Hospitals Set Workloads for Nurses?. If you want to start from the beginning Go to First Page.

SmilingBluEyes has 20 years experience.

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Should the fox guard the henhouse?

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NursesTakeDC works as a Be a part of the movement!.

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On 5/5/2019 at 1:30 AM, SmilingBluEyes said:

Should the fox guard the henhouse?

No they most certainly should not!!!

 

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Hospitals have had all the time in the world to get this right. They are the ones making the choices now, and they choose WRONG. We (SNMF) are huge believers in setting maximum patient ratio limits, not just because I, personally, have felt the terror that comes with realizing a patient is going to die because we’re understaffed (to date, that’s still the worst shift I have ever had in my entire life), but also because the risk factors for violence toward us include short staffing, and problems resulting from short staffing (long wait times, etc.). Since hospitals can’t do what’s right, legislation is something we support. In fact, we typically endorse proposed legislation with ratios matching those recommended by NNU. 

So to answer the question, “who should determine this?” I think clinical bedside staff should be creating the staffing matrix. Only the floor staff knows the workload they are being given through patient care, documentation, and typical orders for their specialty. Bedside staff should set this ratio. Unfortunately, nothing like that is happening, so the maximum allowable number of patients per nurse per specialty should be limited by legislation in the interests of protecting those patients who might otherwise fall victim to a medical mistake or injury, and the staff who are at higher risk of assault because of lack of staff. 

E1252251-C339-444C-88DB-F87963D648F3.jpeg

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On 4/30/2019 at 8:46 PM, beekee said:

I’ve told my charge nurse twice in three years that I felt it was unsafe for me to accept another patient due to the acuity level of my current patients. In both instances, I was told I had no choice; my next admission was on their way. 

Twice. I don’t cry wolf. 

I was ignored.

This makes me so angry I could scream. My old hospital decided to take a med surg CN with no ICU experience and float her to ICU. She refused. They actually fired her. I couldn’t believe it! From then on out, we all knew we weren’t allowed to say no, regardless of safety. It’s hard to ensure your first duty is to the patient and your license when your employer is the ONLY employer for quite a number of miles. I’m so sorry this happened to you.

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OUxPhys has 4 years experience as a BSN, RN and works as a cardiac stepdown/progressive care.

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18 hours ago, Silent No More Foundation said:

Hospitals have had all the time in the world to get this right. They are the ones making the choices now, and they choose WRONG. We (SNMF) are huge believers in setting maximum patient ratio limits, not just because I, personally, have felt the terror that comes with realizing a patient is going to die because we’re understaffed (to date, that’s still the worst shift I have ever had in my entire life), but also because the risk factors for violence toward us include short staffing, and problems resulting from short staffing (long wait times, etc.). Since hospitals can’t do what’s right, legislation is something we support. In fact, we typically endorse proposed legislation with ratios matching those recommended by NNU. 

So to answer the question, “who should determine this?” I think clinical bedside staff should be creating the staffing matrix. Only the floor staff knows the workload they are being given through patient care, documentation, and typical orders for their specialty. Bedside staff should set this ratio. Unfortunately, nothing like that is happening, so the maximum allowable number of patients per nurse per specialty should be limited by legislation in the interests of protecting those patients who might otherwise fall victim to a medical mistake or injury, and the staff who are at higher risk of assault because of lack of staff. 

E1252251-C339-444C-88DB-F87963D648F3.jpeg

This would be amazing if congress actually adopted this but the hospital lobby is too strong. 

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sarolarn is a BSN, RN and works as a Telemetry RN.

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Staffing needs to be determined by people who work with patients. Bedside nurses should be able to speak with their managers and charge nurses about the acuity of their assignments to determine safe staffing ratios, and it should be implemented accordingly. Because of budgetary restraints, this is not occurring. Hospital administration does not allocate adequate funds for this to happen, and it is in the name of profit margins. It is in the name of upper and exec management salaries. Hospital CEOs making millions per year plus bonuses is at the expense of bedside nurses and patients. Unfortunately, greed is at the center of this; and the nursing shortage is perpetuated by hospitals that do not hire ADNs, and there are not enough BSN programs to support hospital demands. Positions are left open because it's cheaper to do so. Hospitals will not act in the best interest of patients or nurses without their hands being forced, and in order to do this, we must become political. It's not easy or safe for us to unionize, and many of us are not so lucky to have union representation. Most of us are at-will. 

By becoming politically involved and having more nurses in office, we can work towards changing the way "health" care is run in this country. Reimbursements would be changed from being based on patient satisfaction and on acuity and clinical outcomes instead. Errors and missed documentation would not be fireable offenses, but rather root cause analyses would be performed to find out why errors or misses occurred in the first place- if clinical staff feel safe in documenting with integrity, we can find honest answers to the causes of the problems that are being faced. Nurses are fleeing from the bedside in pursuit of work that is possible for a human to do with less risk of litigation and less moral injury. What we are enduring now is not sustainable. 

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On 5/18/2019 at 11:56 AM, OUxPhys said:

This would be amazing if congress actually adopted this but the hospital lobby is too strong. 

I think that we should remember that some of these units, need aides as well, and if you have one nurse to 5 patients and no aide, then that nurse is responsible for bathing, dressing, toileting, feeding them because they can't get a spoon to their mouths, meds, treatments, and everything else that the pt. demands, some of these people are 100% total care and can't even wipe themselves, much less sit up on their own, and if you have someone who is 400 plus pounds, well just saying one person can't do all that work. For every nurse there should be an aide to help.  NOW we can take care of people.

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