Stretched to the breaking point

[RunningWithScissors]

Our staffing level last fall was decreased to where when we are full (30 beds) we can only staff with 5 nurses and 2 nursing assistants. Since then, we have had several instances of elderly people falling because the staff members are spread so thin, and when the out of bed alarms go off you just can't get to them in time. In every instance, the nurse and aide have been thrown under the bus for improper care. There is no longer a ward clerk to answer phone, so they ring incessantly. Does any of this sound familiar to anyone else, or is this a regional thing? This is an acute care hospital, medical telemetry/pulmonary floor.

[steelcityrn, RN]

That situation does sound common. Shame they will not consider rehiring a ward clerk back to answer the phone.

[Caffeine_IV]

It's like that in my area. We have been without a nursing assistant on many a night shift while having a heavy load.

Couple that with no secretary during the night. We have call lights that go unanswered for minutes and phone calls that get missed.

I don't mind working hard and being steadily busy but it's unreal what they expect sometimes. And then they wonder why you don't want to stay an extra 30 for a staff meeting about patient satisfaction scores and other randomness.

[canesdukegirl, BSN, RN]

:redpinkhe Old folks need and deserve more respect than this.

What can we do to demand better care for them? A union? The general population demanding better elderly care? More media coverage? They're always looking for a story. Is elderly care not excitng enough to demand any media attention at all? It's just sad the plight of old folks in this country.

I agree with you. What I don't understand in my little pea brain is why unions are such a bad word here in the South. Any thoughts?

[Sugarcoma, RN]

yep quite familiar with this. Managements solution was to increase our staffing levels and it does look so pretty on paper. We should get 4 pts. per person on days on a 24 bed unit if going by the staffing model. The only problem is that they routinely only schedule 3 or 4 and we don't have enough RN's to cover the model. Our average load is 6 and sometimes 7. On nights its anywhere from 6-9. Techs get 12 and if we need a sitter one gets the whole floor and one sits.

Our managers response to an increase in falls and pressure ulcers was to complain about us to other unit managers. Now we get to spend 10 minutes EVERY morning listening to the best way to prevent falls, whos at risk for falls, on and on ad nauseam.

I am so burnt out. We usually have at least half the unit on bed alarms, DTers, Traumatic brain pts, A&O x 0. Its great. The best part is they post the survey replies (In our staff room so everyone can read them) with all the complaints about how noisy our unit is. Then we get reprimanded for that. Cannot win. Praying for a new job to come around soon!!

[lindarn]

I agree with you. What I don't understand in my little pea brain is why unions are such a bad word here in the South. Any thoughts?

Unions ARE NOT A BAD IDEA! Management in the South wants to continue the control over employees like they had over slaves.

Americans have the Constitutional right to unionize, and it is ILLEGAL FOR MANAGEMENT to prevent you from doing so.

Contact a union, the NNU is your best bet. Others in Florida and Texas have unionized, and you can too.

You also need to go to the public with the staffing and increased falls due to deliberate short staffing. All of the negative outcomes that happen due to short staffing.

Keep track of incidents, so you can have some solid evidence to present. Change is hard, but doing the same thinng over and over and expecting a different outcome is insanity!

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[Mulan]

Problem is, only one person (if any) is going to have balls enough to ask the NNU to come in, and then that person is going to get fired.

[General E. Speaking, RN, RN]

That sounds like my floor. We have a staffing matrix that they choose to ignore because we are "great nurses that can handle it."

I don't mind working my tail off in a pinch. I mean, things happen at last minute with call-ins and floor coverage. I understand that. But that comment "great nurses can handle it" (from management, I assume) makes my blood boil! Great nurses are human and soon wear out and mistakes will happen. Unfortunately, the nurse will be thrown under the bus. What really is at fault is the entire system that sets the nurse up for failure.

Do you have some sort of Patient Safety Committee? Some kind of Ethics line? A Risk Management Dept? Last resort: Do the doctors complain about the phone not being answered? If so, get them to help out and complain about the need for a secretary. Let the doctors know about the numbers of patients each nurse has and how difficult is to do post op teaching or staying on top of pain management. Sometimes management will listen when they complain.

I agree with Lindarn about involving the media or AARP. The nurses need to keep track of the ratios/falls/med errors/bedsores/ignoring the matrix, etc... Stand together with the evidence and present your concerns. Please make someone know that this is not acceptable.

I know the market is bad in some locations and jobs are scarce. I just hate it when I read posts like this. I fear for the patients safety and the nurses hard-earned license.

[Mulan]

I don't mind working my tail off in a pinch. I mean, things happen at last minute with call-ins and floor coverage. I understand that. But that comment "great nurses can handle it" (from management, I assume) makes my blood boil! Great nurses are human and soon wear out and mistakes will happen. Unfortunately, the nurse will be thrown under the bus. What really is at fault is the entire system that sets the nurse up for failure.

Do you have some sort of Patient Safety Committee? Some kind of Ethics line? A Risk Management Dept? Last resort: Do the doctors complain about the phone not being answered? If so, get them to help out and complain about the need for a secretary. Let the doctors know about the numbers of patients each nurse has and how difficult is to do post op teaching or staying on top of pain management. Sometimes management will listen when they complain.

I agree with Lindarn about involving the media or AARP. The nurses need to keep track of the ratios/falls/med errors/bedsores/ignoring the matrix, etc... Stand together with the evidence and present your concerns. Please make someone know that this is not acceptable.

I know the market is bad in some locations and jobs are scarce. I just hate it when I read posts like this. I fear for the patients safety and the nurses hard-earned license.

So, are you contacting the AARP or the media?

[General E. Speaking, RN, RN]

So, are you contacting the AARP or the media?

Are you being sarcastic?

[Mulan]

The AARP is useless, in my opinion.

I got absolutely no benefit from it in the 5 years that I belonged.

Now I save my money by not paying the dues.

[cinnia]

First--let me explain my background. I am a Respiratory Therapist, presently in school full time finishing pre-requistes for degree. Considering nursing....although when I read the postings I really wonder if I'm nuts to do so... 20 years experience as RT in ICU, including 10yrs in management.

Here are my 2 cents worth:

If repeated falls are occuring: Call the complaint line for Medicare/Medicaid. Call OSHA--tell them that the conditions are not only unsafe for patients but unsafe for the health of the workers (over-working & short staffing increases the risk of serious back injuries when there aren't enough people to help lift pts). You can do this anoymously OR you can actually have a friend do it for you... this does work as I did it once. You need the dates, shifts, number of times falls happened, etc. (as advised by someone in a previous post).

Secondly, If you choose to do this you CAN NOT tell anyone. There are no secrets if 2 people know... This will prevent management from being able to identify how they suddenly have OSHA & HICFA doing an onsite active unannounced survey... Obviously you don't want to be verbalizing all your dissatisfaction to other staff members if you choose to do this...

Lastly--regarding unions & the South... I live in Texas and despite what is said about it being "illegal" to fire people desiring to start a union or be a member...I have seen it happen at hospitals. Why? Because Texas and many other states in the South are call "employee at will". This means that the laws governing buisness regard employees as free will agents. Although seldom done due to discriminations laws...you literally can be terminated immediately without notice as to cause (i.e. why). This is usually with 2 weeks pay and a promise to give you a decent recommendation... Obviously, unions would interfere with this, increase the cost of labor and diminish the control administration has over staff/labor. Why is this attractive? It is to buisness. No union rules or disputes to hassel with, power over labor, keeps hiring cost down and is very attractive when you want to attract buisnesses to your state... there is a good reason that Dallas & Houston have a large number of home offices for mulit-billion $ corporations. Interesting note: the Medical Center in Houston is the largest (in one place) of it's kind in the world. It employees over 50,000 workers...and there are NO unions present in the hospitals. Technologically we're in the 21st centuary, healthcare workers are slightly above open slavery.

I can say that in most of the large hospitals in the Medical Center that Nurses have banded together and actually have some (compared to the past) pull regarding over-work. Nurses in Texas are still in demand... and the hospitals finally realized it was cheaper to do a few things to try to keep people at least minimally tolerant of the working conditions versus paying for agency nurses and/or being totally unable to recruit because of they (the hospital) have a bad rep. for their tx of nurses.

[linearthinker, DNP, RN]

Here the med/ surg/tele floor had 25 beds w/ 3 RNs and 2 CNAs, no ward clerk. Par for the course. I worked in the CCU, 3-4 pts by myself, no other nurse, no CNA, no ward clerk. Everywhere we are expected to do more with less.