Sick of working short

[kristi-lpn2]

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?

[kstockdaleRN]

Same thing happened to me this weekend. I had worked 7 days straight, then one day off, and five more days. FINALLY had my weekend off. Sure enough, Saturday I get a call at noon that 3 night nurses had called in - this left a 9-month pregnant nurse and a brand new grad on night shift. I am assistant nurse manager on evenings, so I go on in. Called in another LPN who agreed to work. However, I didn't feel comfortable leaving my unit with one pregnant nurse, one new grad, and an LPN (fairly new grad). We have 30 cardiac patients to take care of. Where are your nurse managers? I LOVE my family time and off time also, but I knew when I took this job that I am essentially on-call 24/7. I will call and call and call people to come in on short shifts, offer bonuses, overtime, whatever - but if that fails, then its ME. It makes my staff work better together also - they know I'm not asking them to do anything that I won't do myself. I ask this question when I interview nurses - how willing are you to come in when the floor is short? We all have to pull together to provide safe care. I am not going to leave a new grad hanging out there with no one to help her. I WILL answer my phone anytime and answer questions if need be. If the facility is that bad and unconcerned about patient care, then GET THE HECK OUT OF DODGE! However, if you can encourage teamwork and pull together to provide care, then do it. I have had to do some creative staffing sometimes - Trade a floor that's short a CNA for an RN, Call other floors and offer bonus and overtime if anyone wants to work an extra half-shift. Sometimes I get an 8 hour evening person to stay and work a 12, then an 8 hour day person to come in early and work a 12, just so I can cover night shift. But I can and do refuse patients. I don't abuse it, though. We take as many as 14 admits on a 3-11 shift when we are staffed. But I have used the words "We cannot safely admit any more patients for at least 2 hours" or something to that effect. Lo and behold, the supervisor magically pulled a nurse out of SICU to work for us. Just have to stick to your guns! Anyway, this is my experience.

[cares2much]

I could be wrong, however the wrong people are being allowed to run hospitals. It seems to me that there is a need for number crunchers, but nurses are and can be the best money savers ever.While nurses do all of the work, the CEO does his/her 40 hours a week and walks away with a big fat bonus for decreasing staff. They are not bothered by you or the patient being placed at risk as long as the job gets done. And after all, all hospitals have a battery of lawyers handy to protect the hospital.(Not the nurse.)

Just a thought.

[flashpoint]

Yes you do have the right to refuse an unsafe assignment, however, this does not mean you are protect from disciplinary action from you employer. You absolutely can be held accountable when you accept an unsafe assignment. When an assignment is refused, it is done to protect the NURSE'S LICENSE with the SBON. Protecting your license as a nurse can and does conflict with protecting your job.

If you refuse the assignment, who is going to take it? If every nurse who is not on the schedule can't come in and the managers have already worked a double shift, what can you do? It happened all the time at the hospital I used to work at...the manager would come in at 0100, work until 1900 and then have three nurses call in sick. The manger already did 18 hours...not really safe to do any more. In eight years I never saw the hospital stop taking admits, we never diverted to other facilities (the closest is 75 miles away), we never sent rehab patients or swingbeds to the nursing homes...we just piled patients up, put beds and privacy screens in the halls, and held people for days in the ER. Sometimes we could talk the doctors into doing outpatient antibiotics and things like that, but more often than not, we would just squeeze another bed her and another bed there...

Who will take care of the patients if we don't???

[nialloh, RN]

If you refuse the assignment, who is going to take it? If every nurse who is not on the schedule can't come in and the managers have already worked a double shift, what can you do? It happened all the time at the hospital I used to work at...the manager would come in at 0100, work until 1900 and then have three nurses call in sick. The manger already did 18 hours...not really safe to do any more. In eight years I never saw the hospital stop taking admits, we never diverted to other facilities (the closest is 75 miles away), we never sent rehab patients or swingbeds to the nursing homes...we just piled patients up, put beds and privacy screens in the halls, and held people for days in the ER. Sometimes we could talk the doctors into doing outpatient antibiotics and things like that, but more often than not, we would just squeeze another bed her and another bed there...

Who will take care of the patients if we don't???

I'm sorry, but that's a horror story all by it's self. If the public were told the truth about most hospitals, they wouldn't believe it. "It just couldn't happen" would be what you'd hear. :devil: :devil:

[travelinghart]

i completely understand the working short syndrome, it's happening everywhere, even where i work in a small town, i work in the ER and we have traumas everyday bad stuff and are expected to deal with it without help.... i have no clue to fix the problem but just be rested when i go to work and deal with it the best i can. it seems management really doesn't care if your license is placed in jepordy.... everyone i talk to is feeling the same crunch. all i can say is document document document! :angryfire

[nativenurse]

I empathize totally. However, what I don't hear (or see) being offered are solutions. The patients that are hopitalized are not there by choice, but because they are sick. I applaud your desire to stay within a system that is abusing you - I am sure it is not only the hours. So, Here's some advice. WRITE!! I realize that time is an issue, but this is critical for your self, your coworkers and your patients. Each time you get an assignment that is not "safe", contact the house supervisor and/or the administrator. If there is a chain of command, give the letter detailing why the patient load is unsafe, the violations of JCAHO standards and other National Standards. (National Patient Safety Goals) Contact your State Board of Nursing for clarification of high acuity patients and only 1 R.N. State your concerns, be logical and write without emotion. State the facts. Write on behalf of the patient. It is the R.N. who is ultimately responsible for the NA's, LPNs and ancillary personnel. As an LPN, there are limits to your practice. Are you exceeding them? It is not the patient's fault the floor is understaffed, but it is their problem. When patients complain, advise them to call Administration (provide phone number) and the patient advocate. This is a risk, but there is an even larger risk if Administration is A) unaware because information is not given, and the "numbers" look good or B) they are able to turn a "Blind Eye" since there is little documentation to prove staff complaints.

I sincerely hope and pray that a sentinel event does not occur. Unfortunately, severe events shine the light on negatives.

[AtlantaRN, RN]

protect your license...I worked at a tenet facility in middle georgia and they said "we are never unsafe," except we were taking up to 7 patients on day shift on a med/surg floor...I'm sorry, but I think 7 is too darned much, I work at a piedmont facility south of atlanta and we max out at 6 on the floor, 4 in the stepdown unit, and 2 in the unit...much better, also we have a charge nurse on each 18 bed hall and they don't have any patients so they help alot...

linda

[No_White_Hat_4_Me]

after 5 yrs i recently left case management and a 50k salary for a more hands on nursing job in a rehab unit here in florida. the reason i did this was because i wanted to hone my skills and get back onboard with the changes in technology as i am studying for my rn. after only 6 days of working there on my own @ $16.00 an hour, i quit. the patient to nurse ration was generally 1:7 and on a bad day 8. twelve hour shifts were really thirteen and essentially no breaks. my opinion, if you are given 7 or 8 patients it says a lot about the facility. with these ratios, patient care is compromised; there is no way to get around that. one's license is in jeopardy. it will be you they pull into court, not the facility. it will be your loss not the hospital.

i will be again starting a case management position in a large hospital with my previous salary. needless to say, i don't understand why nurses take this. it's mindless. i will never look to work on the floor again. as shakespeare said: this above all: to thine own self be true

[wooh, BSN, RN]

In the state of GA, LPNs can do shift assessements, but cannot do initial (admission) assessments. So, I guess it depends on the state in which you are practicing.

LPNs can do shift assessments until JCAHO comes, then make sure you tell them you aren't doing an "assessment," instead you're doing "data collection." I work very occasional PRN at a hospital that's running off their experienced RNs and only hiring in new grad LPNs. Can you imagine the payroll they're saving? As long as they can scrounge up an RN on the floor (or in the building), they can stay legal with it.

[traveltrash]

document, document, document. and REPORT IT TO JACHO. Unfortunately I see this kind of situation every where I go - and I'm a travel nurse. It's a situation that seems to be prevalant on med-surg floors. You are working in unsafe conditions. When you take report, you are accepting your assignment, therefore if you walk off the unit, it is considered abandament. What can you do? - all of you have got to get some balls and stand up to administration - everybody - together - get a strong, loud, responsible, organized, but not obnoxious smart-mouth, leader. What are they going to do? fire everybody - and then who's going to work the unit - the manager, CEO, Administration? And if they're not willing to pay for necessary staff, do you think they're going to pay for a whole unit of travelers? But if all of you keep up with the numbers, statistics of how long it takes you to give meds, number of complaints the pts make per shift - then you have some ammo to go the State Board, Osha, JACHO. But no, you really should not say a whole lot to the pts - it's "unethical" according to administration - but really it's just saving face for them. You have to be as suttle as possible when answering the complaint of the pt. They can tell when you're running your butt off - apologize for the wait - explain you were attending to one of your other pts, and now you are there to meet their needs. If you have those little response cards that some hospitals have to give out to pts - give it to them with an explanation of exactly how to fill it out, just be careful that they don't want to wage a tyrant on a particular nurse - remember all of you are in this together - day and night shift. Union? - Yea I think it's a great idea - there are pros and cons - but when it comes to protecting the nurse - it's a great tool. How do you get one started? Well, as a matter of fact, I've had many nurses tell me because I seem to speak my mind, that I should look into organizing one back home - but that was pre-Katrina, and right now, we don't have but 2 hospitals fully up and running and 2 others who are trying to get there. We don't have enough nurses left on the Coast to organize (by the way, the Coast is Mississippi, NOT NEW ORLEANS) DO SOMETHING!! DON'T KEEP PUTTING YOUR LICENSE ON THE LINE - SOMEBODY'S GOING TO END UP IN A BAD AND SAD SITUATION - THE PATIENT AND YOU. Oh, think of it this way also, if all of you nurses are feeling like you're not giving the best care, what do you think the doctors are thinking of you. It might be you can find an ally in one or more of the doctors - Adequate Staff = Better Care for "Their" Patients = Happier, Satisfied Doctors = Less Dissed Nurses

[melpn]

Somebody please help me out with "safe harbor"; I've no clue what it is. Does it involve the BON or JCAHO? How does one claim it and how does it benefit you? My other question is this; I have heard of accepting an assignment but doing so under protest. You fill out a "protest assignment form" or something similar. I have the same questions about that; what is it, what protection does it afford you, etc. If anyone can come up with a sample form or give me an idea of how it is worded, I'd be very grateful. On occasion I just don't know what to do; I've already gotten report and realize I'm in over my head (the last time, the other nurse didn't show and we were alredy short-staffed; we usually work with three!). I'm obviously not going to walk out the door but I do want it on record somehow that I believe I am working under unsafe conditions . Any help anybody can give me will be deeply appreciated- melissa

[ZootRN]

I kind of feel that filling in the gaps, doing more with less, accepting bad ratios - quietly accepting and adjusting instead of speaking up and fighting, we just continue to feed the system.

The work itself is so hard, I can barely sleep before the shift, and can't sleep after, still worrying about everything that could go wrong with my patients. I plan to move on with my career after completing BSN, and if some kind of fortune teller would predict that I'll do the same bedside nursing in 20 years from now, I would be absolutely terrified.