The Ship Is Sinking

[beachtomountainsRN]

Hello out there! This is my first time posting and I will try to be as concise and objective as possible :-)

The Backstory

I work for a corporate hospital in rural Wyoming. In 2014 our hospital merged with its "sister" hospital that is 30 miles away. Many departments have gone to a Market Director approach to management which means that there is one director per department for BOTH hospitals. Inevitably doubling the work load for the director and leaving the department staff short changed when needing immediate unit director intervention- be it with inner staffing issues, floor concerns, etc. I work nights on the Med/Surg floor and strive to be very proactive with direct and objective communication and leadership. My hope for posting this thread is to gain guidance, insight, or words of wisdom about how to continue on with my job when it feels like "all of the rats are leaving the sinking ship".

In the last 90 days...

We have lost our fifth DNO in three years time.

The Med/Surg floor has had eight nurses quit in one month.

The Rehab and PACU/OR unit directors were invited to resign do to poor ethical violations.

On the M/S floor we are required to take up to six patients per nurse and in the evenings it is almost guaranteed that we will NOT have a CNA or assistance to help attend to patient needs- often resulting in a negative patient experience.

Things are feeling pretty dismal.

All of these issues (plus a few personal ones) leave me feeling pretty crappy. I try to tell myself that it gets worse before it gets better... It's always darkest before the light... But it KEEPS getting worse.

If anyone out there has seen their hospital suffer through some growing pains I'm open to recommendations of how to be an effector of change. Or stories to let me know that I am NOT alone.

What I have done...

I have spoken with one of my directors... who may not be my director now... about my goals for employment- wanting to precept and work with the college students. I used to have open communication with one of our directors but I hardly see her anymore because of schedules. I have spoken with seasoned nurses on this floor and they all tell me that I need to keep marching on and ride the tide.

When I first started working on this floor, I knew things were going to be tough. Staffing, pay, nursing ratio, the lack of leadership or teamwork, the threat of an inner circle between nurses and directors. But I was exhilarated to be doing something powerful for my community. Now I just feel blah. I continue to work hard for my patients because that is part of my moral fiber but... damn.

I'll stop here. I know I/we can go on and on about the thankless job we have signed up for but my biggest issue is that it feels like the ship is sinking and there is nowhere else to work.

Thank you for reading and thank you for any advice :-)

[emmy27]

I understand your need for advice in this situation but you mention one person already being let go due to negative social media posts and I suspect that this post will be extremely transparent to anyone who actually knows you/works in your hospital. I understand your frustration but I doubt this would go over well with your management, either. I'd edit it to remove identifying information if I were you.

[beachtomountainsRN]

Thank you emmy27 for your advice. I have attempted to edit any major identifiers in this post. If this post does make it to the hands of managers I hope they see that my intent is not to speak poorly of the hospital itself, as in "personal griping", but more that I am at a loss of its current state of dysfunction. And after reading through information from the National Labor Relations Board (NLRB) regarding social media postings, I feel that I am protected under "concerted activity" although I am not directly communicating with other employees of this hospital.

[icuRNmaggie, BSN, RN]

Agree with removing your location from your profile and asking the admin desk to remove the name of your employer.

It is very hard when you really care about your place of employment and you see a rapid decline in the quality of care due

to unsafe staffing. What you have is the new normal ratio.

Don't hold on and hope that staffing will improve, it won't.

It is time to seriously consider taking a break from this hospital and trying some other avenues such as PACU or IR Cath lab or PICC line. training,an outpatient

service or home health.

Losing 5 CNOs in three years time says it all. This is what happens to nurse executives who advocate for patient safety and safe working conditions.

The other option is to call the NNOC and do not tell anyone that you called. If you have the inner strength and family support I feel it might be the best course of action for your community hospital.

Management's biggest fear is nurses unions. There is a subforum on activism that will be helpful if you choose to fight back. Good luck to you.

[emmy27]

Thank you emmy27 for your advice. I have attempted to edit any major identifiers in this post. If this post does make it to the hands of managers I hope they see that my intent is not to speak poorly of the hospital itself, as in "personal griping", but more that I am at a loss of its current state of dysfunction. And after reading through information from the National Labor Relations Board (NLRB) regarding social media postings, I feel that I am protected under "concerted activity" although I am not directly communicating with other employees of this hospital.

It's an unfortunate truth of most employers that if they dislike your legally protected activity they can and will find a way to discipline you for unprotected activity (ever clocked in a minute early or late, failed to chart anything, been late with a med? ... you get the idea). And complaining publicly about the global dysfunctionality of a hospital system is not likely to be taken better by management than personal griping- possibly even worse.

It's your job to risk, though. I hope you get some helpful advice. My experience of profoundly dysfunctional work environments is that they don't get better and that low-ranking employees have very little hope of effecting change, but I hope you find a way.

[icuRNmaggie, BSN, RN]

Never discuss anything related to organized labor or job actions at your place of employment on any website of any kind.

[jadelpn, LPN, EMT-B]

I agree with the above, in that you really need to be mindful about what you post and where.

Bottom line, the people who run your facility don't care about how many nurses are staffing it, who is in charge of it, the morale of the staff.

They want to turn a profit. And with nurses and middle managers leaving, it puts them in a place to hire more of the same, at lower and lower wages.

And with nurses with little to no experience looking for jobs, there is an abundance of nurses who would work regardless--at per diem of course as to not have to pay benefits out.

In the same vein as one person working both facilities, you will find it will be the same thing with nursing. They will want your ideas and energy to implement "changes", however, won't be willing to pay you extra or promote you with a pay raise.

Patients are just a product. The real meat and bones is the business itself. Which is a complete contraindication on what any number of nurses are used to, are in this for--but it is fact.

So in other words, don't kill anyone, document as to the highest chargeable amount, stick to the script to give illusion of exceptional care, and stop with the emotional tug of war.

Corporate is not your friend. Corporate are not nurses, therefore, have not an IDEA in the WORLD why the heck ya'll don't get a grip and just take care of the patients (you have 6 of them, what's the big deal?! Just deal...) They think in a completely different realm than nursing theory.

More than likely, the facilities were combined due to poor profit. So sharing is a natural course of action to get profits up. Soon you may find that even nurses can be scheduled for either facility--and made to feel grateful that they have a job at all.

Very sad state of affairs. And I would stop offering them free advice. They either don't want to hear it, or will make you responsible for even more at your current salary.

[beachtomountainsRN]

Never discuss anything related to organized labor or job actions at your place of employment on any website of any kind.

I'm sorry- I'm a little confused by the tone and message of your response. In your first post you directed me to NNOC which helps to organize nurses unions or at least be a resource for the latest in nurses rights. Now, if I understand correctly- are you advising that IF I should want to organize a "union" that this not be discussed in the place of employment? Or, am I being dogged for posting and expressing? Just a little clarification.

[klone, MSN, RN]

My experience of profoundly dysfunctional work environments is that they don't get better and that low-ranking employees have very little hope of effecting change, but I hope you find a way.

This. Your wishes to change the culture are admirable, but you are fighting a losing battle, my friend. In order to effect facility-wide culture change, it HAS to come from the top, and not just one person, but at least 20% of upper leadership has to be aligned in solidarity with a shared vision. Even then, it takes about 3-5 YEARS of continued effort to effect facility-wide change. Until that solidarity and shared vision happens from a good percentage of upper leadership, the ship will continue to sink.

[klone, MSN, RN]

Now, if I understand correctly- are you advising that IF I should want to organize a "union" that this not be discussed in the place of employment?

Yes, that's exactly what she's saying.

[Been there,done that, ASN, RN]

The ship is sinking, and you will go down with it. Do you really want to go so far as to organize a union?

Nurses are expendable, easily fired and black- balled. Agree with icuRN maggie. It's time to do something, anything out of the hospital.

Come on over to the other side ( insurance work).. it's nice here.

[Jules A, MSN]

My rule of thumb is to be gone well before the rats even start scrambling. I have no interest in attempting to stop a sinking ship with a wad of bubble gum. If things are going south I'm outta there and on to the next adventure.