Sick of working short

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I went to work this weekend. I work weekend doubles. On 7-3 we had 23 patients on a medsurg floor. 1RN and 2LPN 1CNA and 1US. We had 8 patients a piece to take care of. Am I just a wus or is this a bunch of crap. We have been told we cannot refuse patients. Can we get fired for rufusing to take report when we know we cannot give the care these patients need? I remeber in nursing school my instructor said we have the right to refuse is this s*** or is the nursing supervisor that said this full of crap? Can we be held responsible for patients not getting their meds on time if I document we have to take care of to many patients per nurse? The staff is sick of this tx and more and more people are quitting every day. I dont know what to do or say. I dont know if I should tell my patients they didnt get their meds on time because I have to take care of my 7 other patients and the ones that are the worst get my care first. The bosses are trying know that so many people have quit. Lpn's are getting 50cent raise and RN get 75cent raise they are trying to bring in traveling nurses but it is hard to even get them to stay. The first worked 2 days and quit she said it was the hardest patient/nurse care hospital and the worst hospital she has ever worked at. People are starting to talk about Unions. I would like to look into one but I dont know where to begin we have to do something or there is not going to be any nurses left. No RN's have put their applications in for more than 6 months so we have been told a bunch of crap because a friend of mine says many of her friends that are RN's have put in their applications and they have never been called. what the h***. I am fed up. I cannot simply find another job b/c of the shift I am working I need to stay on weekends. I work 32 and get paid for 40. I have been looking around but have found nothing yet. I am an LPN have been at this facility for 6 years I dont want to quit but am getting to the point of not caring what happens. I am doing the best that I can. Please give me some advice someone on what to do. If we can get a union to make things better or is it like this everywhere? Every shift we work at least 2-4 people short and this is getting worse every time I go to work. Thanks for listening I had to get this out. By the way I work in a hospital and we have around 120 beds. It is not just my floor working short it is everywhere in the hospital. What should we do?:crying2:

Specializes in Cardiovascular/Radiologic imaging.

It is a real dilema. When you try to use the tools provided by your BON ; ie safe habor, you are ridiculed for opening up your institution to investigation. Some of your own coworkers encourage this. I see a trend toward unsafe practices being accepted as the norm. The idea of nurses working and protecting their license is being discouraged by management. To do so is not considered in keeping with "corparate compliance". We are being socialized as a profession to not think indepently but as corperate employees. The catch of course is we are still indepently licensed and have a responsibility to that. We are caught in a catch 22. As an older nurse it is becoming more attractive to just leave.

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This is BS - my only advice is to get thyself to an area where staffing is good & ratio is 1:4 /1:5 . The hosp. I work at does not use LVN's and very few aids - they hire more RN's & gives us less pt.'s overall.

IMO - this is more cost effective & better for patient care. YES - the RN does TOTAL care; but only has 3-44 pt's at a time (depending on acuity) and at night sometimes 5.

This kind of care is less stressfull because there are not 3-4 people trying to take care of the patient on different levels. the RN does it all - therefore the RN *knows* the I's and O's, the VS, and what's up with the skin assessment (usually done during bath time) AND knows the status of lines&meds as well as all the other more detailed assessment issues & complex procedures including the social issues. I have time to really sit and talk with my patients, assess their issues and attend to their more complex medical procedures and any underlying causes. This is why I am nurse. Having less patients/total care is better for everyone all around and if I were you I would look for a state & hospital you can do this in.

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Wait a second. I need a clarification here. You're saying that 1 RN and 2 LPN's had 8 patients each? Did the lone RN take responsibility for assessing all the patients? If this is a hospital, I must be missing something. LPN's can't assess, at least under Washington state law, and I would assume it's pretty similar elsewhere. If I did what I think you're saying is happening, I'd be operating WAAAY outside of scope. Someone please tell me I've misread.

Lee

i guess it is really different everywhere, i am an lpn, i do everything that a basic rn does at my work except for deep suctioning. i am supposed to call in an emergency but most of the time the rn is too busy to help or is unaware of pt or policy (casual staff). i talk to dr.'s take phone orders, process orders, give insulin, narcotics all medic ations including prns, we are supervisors and we can pronounce death and intiatiate iv's with training.....we are cheap rn's...it makes me so mad, if i wanted to be an rn i would've went to school to be one.:angryfire

back to short staffing, i think the pay that would've gone to the rest of the team should be divided amongst the members present. why not. if they only pay 3 to do the work of 5 it is a good deal for them right?

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Wow, I guess I am really fortunate to work at a hospital that can refuse to take pts. I have been working in the ER for 5 years, and have now just started to work asw a nursing supervisor. We are non union, however, we follow union standards because admin know if they did not, we would either leave and go to a union hospital, or ask the union to come to us. The union rules do benefit us. Here there was a union contract renewal in the metro area about 4 years ago where the big nursing push was safe staffing. A couple hospitals went on strike for a time, and the result was that nurses can close units to admits if they feel it is unsafe. The downfall is these pts end up waiting for ever in the ER and the ER gets backed up and wait times increase to outrageous numbers. We do not like to transfer out pts, but we will if we don't have room/staff at our facility. The problem comes that when we are full and can't admit pts, other area hospitals are usually in the same boat, and finding another hospital that will accept can be a problem. Now that I am a supervisor I see it in a whole new light. On the flip side, because our units can close, they seem to cry wolf way too often. As a sup, I am more then happy to help out on the floors. I can do meds, assessments, vitals, help to bathrooms etc, but I can not take a pt assignment, as someone earlier suggested.

One thing that surprises me where I work, is that we do try to call in extra help. But it seems like so many people are unwilling to come in on a day off. Maybe it is just were I work. It seems like they are leaving their peers hanging.

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One thing that surprises me where I work, is that we do try to call in extra help. But it seems like so many people are unwilling to come in on a day off. Maybe it is just were I work. It seems like they are leaving their peers hanging.

i agree sometimes it seems that way( that we leave each other hanging) but non of us our any good when we are overworked and also Home-time is important.

casual/relief are key, ones that actually come in and willing to pick up and work hard. not casuals who just pick up when they are saving for a trip or have 3 jobs and aren't available. causals that want to move up should agree to certain availability (2 out of 4 weekends and selected holidays etc) also if they don;t pick up they should be bumped donw or off the list...if they don't like to pick up cuz they don't like the job..go find another one!!!!!!!!!!!!!!!!:angryfire

it also a catch 22 with shifting staff from unit to unit to cover shortages...help is needed but staff often choose where the work for a reason. they try to shift staff all the time where i work, it's causing us to loose even more staff.

i think float pools rock!

i work in ltc, i have a position 3/4 time, i could have had full time but i didn't want it, i'd have taken it if i did. i used to come in when i was called and it made me tired and stressed out at work and at home, also i was more sick there fore missing more of my regular shifts....i ended up having to take a 2 week leave..dr's orders. i've resorted to coming for short shifts to help cover busy periods (med passes etc) on days off but only once or twice a

pay period. :idea:

if the problem is systemic is important not to enable the system to continue to abuse us and not fix the problem...my management used to say when they predicted a shortage, don't worry somone will come in or stay extra cuz they feel bad. (we have new management now and the administrator workd on the when we are short.) overtime is still cheaper than the mising person's wage would have been. as i mentioned before there should be monetary compensation for working short!!!!!

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I am an RN and have been a DON. The staffing issues is what drove me away from the position. It is very difficult to know what is right. If staff are not mandated, there is not enough help. If staff do stay and work doubles, they are tired and often working unsafely. Solutions are not always there. Overlapping short shifts, sometimes work. Incentives for not calling in, might work. Sick calls cannot be avoided, but rewarding those that do not call in, can work. Unions are not all bad because both sides have to follow the rules. Staffing issues hurt everyone. Working out assignments together, may help divide up the work load. I know that I had difficulty assigning staff to work extra hours, when I myself, did not like to do it either. Get together and brainstorm what can be done when staffing is short. Good luck! KRHoffman

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Rachel, RN (RaeRae)- I want to comment on your post about how can an RN refuse an assignment before accepting report. Well, I know that it sounds rediculous, because often you only find out how high the acuity is after you GET report/accept an assignment. However, once you accept an assignment in my home state of CA, if you leave it is considered patient abandonment (You can lose both your license and job). That's why you have to refuse before you get report. However, let's say you do arrive to work and you have 15 patients and two nurses on, no unit secretary...and one aid for 4 hours (acute care). You could refuse to work BEFORE getting report simply based on nurse patient ratios. But, of course, you could lose your job (not your license necessarily). That's how it works.

This brings me to another plug for unionizing nurses...because if I do accept an assignment and find out later it is unsafe, and management ignores my requests for help, then I can fill out a UAP (assignment under protest) at ANY time during my shift. The hospital management is obligated to have a follow up meeting with the union when these are filled out. The management is held accountable for it's failure to provide adequate safe staffing.The key term being- is it SAFE. We are also in process of implementing acuity measuring tools that are supposed to provide additional staffing for higher acuity. Sometimes, we all know, you need extra nurses aids or an extar nurse or whatever, because there are too many total care patients on your unit.

We do have nurse patient ratios in my state (CA) which was brought about by guess who...fed up nurses ;-) (the Calif. Nursing Assoc. union was a major supporter of this legislation). And, again, I now work for a union hospital. I want to say that one of the good things our union got changed in our last contract negotiation, was that it made it so that Lead Nurses/Charge Nurses do not get a patient assigment (they are not counted for nurse patient ratio staffing in any unit). However, this sometimes means we don't get a unit secretary (on pm shift), so the Charge nurse is busy with that too. I HATED being lead when I had 5 patients of my own. How can you effectively help the other nurses who need help when you have a full load and are putting in orders and answering the phone? I guess I wasn't the only one bothered by this, as our union addressed it. Now the Lead nurse can help with an admission, start a drip, or put in an IV...for another nurse. They can cover meal breaks. It's great! And the Lead can actually Lead.

I'm very pleased with what the union has done at my workplace. Each time we have new contract negotiations, we are able to put anything on the table for conversation...that WE the NURSES think needs to change. It is far from perfect where I work, but it is a lot better than it was a few years back, and WAY better than the nonunion hospital that I started out in.

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Specializes in Med-Surg.

I can totally relate to all that has been said at this post. I have been wanting to open such a post for a while. The hospital I work at is very shot staffed. I work 12 hour nights and we usually have 2 RN's and 1CNA down each hall. 10 patients a piece and 20 for the CNA. Even when we have five RN's we end up with 7 each. These patients don't sleep, are elderly, and have restraint belts on if they are confused. Sometimes they manage to get out of the belts and all heck breaks loose.

And talk about centinal events. One weekend three patients fell. One broke a hip and went into respiratory distress and had to be transferred to the unit. Very Very Sad. THe supervisors we furious. But we keep telling them we need more help and the nurse/patient ratio is ridicules.

My co-worker says I should stay on, but I told her after I have done a year there I am gone. I have been there 6 months and it feels as if i have been there 6 years, I am totally burnt out already so sad. Medication errors are very easy to make and patients have been falling. But since that weekend no one will admit to the falls because no one wants to get in trouble. None of my patients have fallen THANK GOD FOR HIS EVER LOVING GRACE AND PROTECTION with this matter. But I am very fearful for my license that I worked so hard for. I ahev been a nurse for 3 years now and my previous palce of employment is in another state. I worked there for two years prior to relocating here.

I attempt to give the best care to my patients that I can each and everyday. I love being a nurse but can no longer place myself or my patients in harms way. What does the code of nurses state, "FIRST DO NO HARM" Well when you give a nurse 10 -13 patients to care for I do not see that not happening.

Just had to vent!

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Specializes in neuro, m/s, renal, ortho, home health.

I understand your problem. I work in Oklahoma, the first night I was off orientation I was assigned 14 patients. It wasn't always like this but having 12 was not uncommon. Needless to say I was in burn out mode after working only 6 months for this hospital. I started traveling. I travel to CA bcx I know exactly what I am going to get. I can make twice the money and only have 5 pts to care for. I usually only travel part of the year and each year the hospital (the hospital that gave me 14 pts right out of orientation) calls me back to work for a couple of months, knowing full well I intended to go out on the road again. This time when I came back I would not take more than 10 pts. The charge nurse kept telling me I had to take the assignment or I would be written up for patient abandonment.(this happened @ 2230) I told her you can't abandon a pt if you have never provided care for them. They were trying to split the floor between me (RN) and an LPN, this would of been 12 pts each + new admits. At this particular hospital the LPN does everything an RN does. They do the assessment and we have to sign off on it. We don't sign off on any other charting. (This is so different from Calif.) She spoke w/ the supervisor and he said there was nothing he could do about it. I politely told him that I felt like staffing should be instructed to call someone in. Then the charge nurse called the unit manager of the floor. She told her about the assignments and that we refused and said we would leave before accepting more pts. This is not what we said. I said "I would rather go home than risk my license by taking this unsafe assignment." The charge nurse had also told us if the manager comes in (this all happened on a weekend) she will relieve us permanently. We said fine, let her take care of 24 pts.It did not come to all of this. The manager had scrubs on ready to come in and help, was not upset w/ us. Staffing found another nurse to come in. That a.m. when I finished my shift the day shift was asking me if I really refused the assignment @ 2300. I told them yes and they will continue to do this to you all until you stand up for yourself. It's not a matter of being mad, or yelling. Everything can be handled in a professional manner. My manager was not upset and if it was unsafe and we were short it was her job to come in if we couldn't get a call in nurse. In Okla. they will give you as many patients as they can. When I was assigned 10 pts I had all 10 pts to care for w/ 1 CNA. What they did to the CNA's and techs was even worse!

I've worked @ 3 different hospitals in OK and they are all the same. So what I have done is join the ANA & the ONA. I was contacted by the ONA to sit on a committee about this problem. Right before I left this last time I saw a nurse reprimanded for an incident. I had tried to calm down the family member of this pt. (because I had cared for him before) and it ended up the pt coded that morning. The family was tired, the pt was difficult and this nurse had a very needy team. The doctor said he thought the pt had coded due to sleep apnea. After I witnessed the manager not standing behind the nurse I decided that I was going to do everything within my power to help make changes and promote patient safety. I really like this manager and was shocked to see how this was handled. So in reality, if you have too many patients, are unable to keep up, mistakes are made .......you are on your own. The manager, hospital and anyone else will not stand behind you. I feel like it is my duty to refuse too many pts rather than jeopardize their health! I'm sure not all hospitals feel this way and I would love to hear from anyone else that might have some ideas.

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Specializes in A myriad of specialties.

"Medication errors are very easy to make and patients have been falling. But since that weekend no one will admit to the falls because no one wants to get in trouble."

Excuse me Addiern--how can someone NOT admit to the falls that happen---especially if there are bruises, etc that result? How are those things explained? There's also the possibility of hairline fx that these folks could have received when they fell. I understand the frustration but don't these nurses have consciences?

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Specializes in Psych.

To op: Vote w/your feet and get the "f" outta there. Let them TRY to find someone that will take this assignment. I'm guessing they will have no luck. You have earned your stripes. If you have been handling this load, you should be able to find a job ANYWHERE.

FIGHT THE POWER!

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Specializes in neuro, m/s, renal, ortho, home health.

kadokin,

Thanks for your kind words, I would love to see things change in OK. That is why I joined the ANA & ONA, I hope to make a difference. I love nursing but hate to nurse in OK. In CA w/ 5 pts. you can do excellent nursing. The committee meets this month so I hope we can make some progress. I know we have a couple of bills before the House but government moves slow. I'm not willing to stand by without a fight.:smiley_ab So wish me luck!

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