OK. Everyone has read a complaint about short staffing and what not on here. Unless this is your first time on the site and this is the very first thread you have ever opened, you've seen it.
I too balk at the staffing levels admin. expects us to function under. Don't preach to me that you want to see "5s" on the surveys when you barely staff well enough for "3s".
With that said, I'd like to take a look at the staffing problem from a different, more introspective angel. I recently finished doing a boat load of OT this pay period. Too much to be honest. Problem was, every time I went in to do a four hour evening shift, it turned into a twelve hour overnight shift. That plus one daylight shift in which there was no aid (hence the need for nurses) but we still had our usual ratios and.........well, I did my part to "take one for the team" these past two weeks. My life outside of work is in the ditches and no paycheck is going to make me happy about it.
So, I'm talking to a night nurse one of the times I stayed and she is boobing her head back and forth telling me "He he, I can't believe you stayed but I'm so glad you did. We would have had to take (X) patients if you didn't stay. I can't function with that many patients. I don't know how you do it though, I don't do OT, its too tiring. I NEVER DO OT."
OK. Thanks for the info. legally blonde wanna be. You basically just got done telling me that if the roles were reversed you'd be out the door letting me function with (X) pt load. Nice, I'll remember that next time.
As I look around my unit, I do notice her approach to "helping" when things get tight is the norm. Very few people do OT or come in on a day off to help their coworkers from having to deal with excess stress. Everyone walks around with this idea of what it is they want to do and wont stray from it one way or the other. Ask them about changing their schedule because one day is overstaffed and another is short.........forget it. Ask them to work a weekend thats not "their weekend"......boo hiss.....they'd rather see their coworkers drown. And holidays............forget it, everyone thinks they are the only one's with a family and plans.
So, with regards to running short staffed, how much of it is us (nurses) doing it to ourselves? How much of it is us not answering the phone, saying "its not my problem" while we know our coworkers are at work drowning.
Heck, there was even a thread in here of someone calling off because they found out they'd be floated. Ummmm, next time your unit is short and the M/S nurse refuses to help out, I hope they remember that day.
Me, I do more than my share of taking some of the "pain" in the helter schelter schedule. I work my off weekend from time to time. I stay to help other avoid bad days. I often come in on off days. Holidays..........just give me T-day and I work Christmas Eve, Christmas day, New Years Eve and day. Granted, I am flexible to the extreme but my gosh........a little bit of flexibility would do wonders for the work environment.
I just don't understand the people who think they are ever going to have a "steady" schedule. Nursing never has nor will offer that unless your are in an office or something. Did they not know that when they got into it?
Well, here is another view...your shift may be filled by someone-travelers and agency nurses.
One hospital replaced all nurses on certain floors with all agency and travelers every shift.
This meant that each day patients would have different nurses from agency/traveler group
including the charge nurses. This saved the hospital lots of money in benefits etc.
And the hospital is a well known teaching hospital in a major city. The original nurses employed were in a union, but the hospital reorganized (bought by another group).
So when members say it is not my problem, be aware in some cases management will fix it..
I'm curious, could you elaborate more on how staffing with outside agency is cheaper than hiring your own staff? One of the hospitals I worked at years ago was shelling out $60/hr for agency nurses when new staff was starting at $20. They ended up redesigning and beefing up their float pool and abandoned using agency all together because it was more expensive, as per the hospital's nurse recruiter. I thought that benefits generally accounted for 1/3 or less of your salary, which makes agency convenient but still more expensive. Unless the employer has horrendous staff retention, I'm not seeing how agency is a more cost-effective solution.
Maybe its just that my experiences have been very different from yours. I have always worked in large hospitals with float pool, PRN staff, and a staff member routinely on call. We don't really have the issues of routine last minute phone calls for staff to come in, but if we did, I'd be doing some deep inquiry as to why we couldn't prevent that problem from happening in the first place. The complaints about staffing that I've seen on this board mainly relate to nurse : patient ratios being high, not that staff is calling out or not agreeing to OT.
Are you in a small hospital? I hadn't thought of this before, but for small community hospitals I can see how the last-minute-phone-call issue may legitimately be there, though, I'd still wonder why there wasn't a heavier on-call system in place, or a back-up use of agency/PRN nurses.
Charge nurses are a valuable source to speak to for day to day issues, however for permanent change I'd recommend that you do "write letters to admin". If there are that many issues on your unit that one person not agreeing to OT can routinely (sorry but the way you put it, it sounds routine to me) cause dangerous staffing levels, then at least try to fix the situation for the future.
I went to my manager because we would routinely have 9 total patients during the day and do our own admits/discharges, which was difficult to keep up with and patient care was suffering. I wrote out a list of suggestions to help lift nursing's burden by changing a couple of policies/slightly changing equipment. I was told that the omnicell system was too expensive to implement(running out of equipment took up a lot of our time), and of my policy changes (with research studies backing it up), was told that the hospital was "slow to implement changes" and not to expect much, but that it was forwarded on. A few minor time-saving changes such as a redesign of our medroom were approved and implemented in the end. It wasn't much but was a start.
Absolutely people should be helping each other out when it works for them, and I'm surprised why anyone would have issues with pre-planned swapping/schedule changes - maybe the staff just aren't good together. A balance does need to be looked at for last minute phone calls though.
When census was low a year ago we had a group of people who volunteered to be called off more. Sure, of course, there were those who were living paycheck to paycheck who had concerns when it was their turn to be called off. We also implemented a heavier on-call system, so when census did spike we didn't have those issues of last minute phone calls to people who already made plans. There are a myriad of options out there to pre-plan for many potential staffing issues before they get out of control.
If you are in a smaller hospital, well, that will require some more creativity. But I'd love to brainstorm with people on this thread as to how to help solve your department's issues if you are in a smaller hospital. :)
Doh. Really? You can tell that? IDK how.
Yeah, I'm at a strange hospital. Its either a really big "small hospital" or a really small "mid sized hospital".
And who's on third?
Yeah, I'd consider my hospital small. They had a float pool before the economy went really bad. As we went through our little period of "low census" awhile back, a lot of them were told to seek work elsewhere, no hours were available. Only the best and...........ahem, I'm not being an arsh here but it's true...........the best AND THE MOST FLEXIBLE float pool nurses were kept. The bank of float pool nurses remains very small now still, with only a few of them wanting any night shift at all.
Trust me, I'm not saying admin./management are not without their faults and part in this. But, like I said before, they don't feel the sting from the really bad nights the way we do. There is a complete lack of urgency on their part because, well........we and our patients are the ones who suffer soooooo...............
I think making coming in on off days can be made more rewarding without spending money, or at least not a lot of it. A small meal ticket for the kitchen would go a long way. Sounds trite but, hey, one of my biggest complaints when I go in is not having time to eat and having to spend money on some Wendy's to take to work. Gimme a meal ticket, let me eat healthier and call it a day. Little things such as this could go a long way to keeping people on my side of the fence motivated.
As far as avoiding having to make emergency calls in the first place goes, I'd have to brainstorm that a bit.
I'm curious, could you elaborate more on how staffing with outside agency is cheaper than hiring your own staff? One of the hospitals I worked at years ago was shelling out $60/hr for agency nurses when new staff was starting at $20. They ended up redesigning and beefing up their float pool and abandoned using agency all together because it was more expensive, as per the hospital's nurse recruiter. I thought that benefits generally accounted for 1/3 or less of your salary, which makes agency convenient but still more expensive. Unless the employer has horrendous staff retention, I'm not seeing how agency is a more cost-effective solution.
IDK if there are even any ways to look it up, things like that are not routinely posted as public knowledge, but:
I used to travel nurse, and the few travel nurses I still talk to have all told me compensation has gone way down. I'd imagine it'd be the same for agency nurses.
Okay....Eriksoln I read your post and the first thing that came to my mind was this was written by a man (and I am sure I will get flamed for saying that!). Here it goes........I have two children for which I must arrange child care, cook all meals and make lunches, do laundry, take to sporting activities and help with all homework. I volunteer at the school when I can and clean the house, maintain the lawn and pay the bills, arrange doctors appointments and any other thing that needs to be done.
I could go on for days about the things that I am responsible for OUTSIDE of work. I don't know your situation but I committed to work three days a week and that is what I can give. Back in the day, before kids, I loved over-time......not so much anymore!
In my last postition we had a handful of guys working in the unit...they were all second career nurses. One had been a landscaper, one had been a carpenter and so on and so forth. They all talked about how easy three shifts a week is compared to their previous jobs. They always joked about the female nurses saying "they complain about everything, they don't know how easy this job is." One day an older nurse I work with said......."I think you might find this job easy because when you go home your job is done, when most of these women go home their job is just beginning." Of course she put a few choice words in there as well.
Don't worry about what others are doing......if you want to do OT, do it......you can't know what other peoples situations are.
Maybe I misread but I think what the OP was saying is, if someone is good enough to stay over and help, they ought to get a little help, or maybe the easiest assignment. I used to be the ADON at a LTC and when a CNA or nurse had to stay over, they got to pick which assignment they wanted. Afterall, they had already worked a whole shift.
I just read two threads about new nurses not being able to find jobs after 1-2 years. This is so sad when obviously there are places in dire need of help!
I just read two threads about new nurses not being able to find jobs after 1-2 years. This is so sad when obviously there are places in dire need of help!
My hospital is hiring. It has its pros/cons but I think you can do a heck of a lot worse. I wonder how it is more people don't find us.
Although the overtime is not officially mandatory where I work, it can be creative. If say no to staying, especially on a Friday night, I can't tell you how many times my relief just doesn't show up, the nursing office boards are wrong or an agency is a "no show". Then I find out it is the nursing office's **** poor planning that is the real problem, meanwhile, I can't abandon my patients. Or you find out at the last minute that your relief is on another floor with a huge assignment that they are expected to give up. I have stopped making any plans after work, dental appt. etc. cause it is too stressful not knowing if I am going to be held hostage.
I'm reading these posts after a call minutes ago by our staffing office, "can I pick up anything extra"?, thank God I screened the call, and not a day of work goes by, it seems, that they don't want me to stay. I will admit I am quite burned out and have to agree with many of the posts that to bail them out of their self made staffing crises is a form of enabling.
Although the overtime is not officially mandatory where I work, it can be creative. If say no to staying, especially on a Friday night, I can't tell you how many times my relief just doesn't show up, the nursing office boards are wrong or an agency is a "no show". Then I find out it is the nursing office's **** poor planning that is the real problem, meanwhile, I can't abandon my patients. Or you find out at the last minute that your relief is on another floor with a huge assignment that they are expected to give up. I have stopped making any plans after work, dental appt. etc. cause it is too stressful not knowing if I am going to be held hostage.
I'm reading these posts after a call minutes ago by our staffing office, "can I pick up anything extra"?, thank God I screened the call, and not a day of work goes by, it seems, that they don't want me to stay. I will admit I am quite burned out and have to agree with many of the posts that to bail them out of their self made staffing crises is a form of enabling.
Thats just sad. I often get annoyed by how perfection is expected by us, the nurses, yet everyone around is just so.......amateur/generic about their work. Hard to soar when you are tied down by a bunch of turkeys.
I think too a big part of the gap between opinions on the matter tends to be from differing situations. I've been at places like the one you describe, especially as a travel nurse. When staffing was short and they knew an "agency" nurse was coming in or someone was going to be late..................guess which assignment that person was assigned to. Yeah, mine or another traveler's......every time. There was a group of daylight nurses who were simply expected late, they never showed up on time. Again, guess which assignment they were assigned to.
When considering places such as this, no, I would not think simple "teamwork" would help much of anything. I will repeat my mantra "You can't soar when you are tied down by turkeys." But, for me and for a lot of people, this is not the case. The manager and staffing office where I work are doing just fine. The "real emergencies" are rare enough that just a little flexibility from us the nurses would go a long way. What I am talking about in this thread is the situation where everything that can be done is and there are only a few bridges that need crossed with regards to staffing.
My hospital continues to use a per diem/float pool to cover gaps. Supervisors often hold onto a nurse or two when units are close enough to whatever magical "census" number that is needed to keep them, that way when admits arrive, the unit is still fully staffed. There are very few days on the schedule with existing shortages showing, and most of them are filled quickly by people (like me) who wish to earn some extra cash.
In situations like that, I think a lot of nurses forget/don't know how bad things can get and they start thinking they deserve/are entitled to some Disney Land steady schedule that never changes and allows them to come and go without interruption. Very few industries offer this, much less the medical field. Its almost as if, the nurses in good situations, instead of counting their blessings and returning the favor with a little extra effort on their part...........instead become spoiled and selfish, always wanting that one more inch, one more "schedule accommodation". I don't get that.
Now, the survival manual for working in conditions like the one you are in would read completely different. In situations like yours, I took on more of a "I'll take extra time when I can, but the second I start feeling burnt, I'm resting". Not really all that different from how I do things now, just I don't give them the benefit of the doubt if my phone rings and its them.
I never dealt with low staffing really until I worked in LTC . It is always that way and nothing changes facility to facility . Corporations own LTC facilities not hospitals and I worked for one non profit one ran by a church in Oklahoma best LTC I ever worked in but the whole place only had 36 residents.
When I worked for the state and federal and in acute care hospitals I didnt have these issues . However right now I have a PRN job at the state and they are short staffing all facility personnel to save money as well as doing furlough days ( not being paid you can use PTO but me being PRN I dont accrue much. However management levels are up still though.:zzzzz
Staffing to me is a management issue. I am hired to work X number of hours and its all my body will put up with . I have worked with other nurses who work themselves into illness so its is not worth it to me.
i never dealt with low staffing really until i worked in ltc . it is always that way and nothing changes facility to facility . corporations own ltc facilities not hospitals and i worked for one non profit one ran by a church in oklahoma best ltc i ever worked in but the whole place only had 36 residents.
when i worked for the state and federal and in acute care hospitals i didnt have these issues . however right now i have a prn job at the state and they are short staffing all facility personnel to save money as well as doing furlough days ( not being paid you can use pto but me being prn i dont accrue much. however management levels are up still though.:zzzzz
staffing to me is a management issue. i am hired to work x number of hours and its all my body will put up with . i have worked with other nurses who work themselves into illness so its is not worth it to me.
if you allow staffing to simply be "a management issue" or leave it to them to handle it, you'll get what you asked for, and you won't like it. like i said before, simply dumping the problem in admin.'s lap and saying "eh, not in my job description, i am hired to work x hours and if i do more i'll miss way too much sleep.................." is the road we've been taking, and it has not worked. how many times do we, as nurses, have to walk headfirst into the same wall before we say "oh gee, that hurts, i better go around next time."?
again, listen carefully this time...............................it is your problem. no one else has to go into work and take extended assignments (lol, admin and management leave the exact same time day after day, regardless of your personal ratios). no one else skips their breaks because they are spread too thin, no one else cancels plans cause they have no clue when they will be leaving, no one else deals with any of it except us. the only group the consequences of being short handed fall upon is............us. its a nursing issue, not a management or admin. issue. what is their motivation to change anything?
i'll ask this too. for everyone who takes the (lol, cough) "if i help too much, admin. and management will never learn their lesson and i'll be enabling them." approach.....................has anyone ever, anywhere or anytime...........seen this actually have any effect? not me. raise your hand if you've ever had a manager say to you or announce in a meeting "gee, no one wants to help out and assist their coworkers. i really need to change the way we do things. in fact, i'm going to overhaul how we staff completely so you guys never have to work short again. thank you all for showing me the light and applying such tough love when it was needed. i am a changed person and now i see what i need to do to help you give the quality of care these patients deserve................blah blah".
Ummmm, next time your unit is short and the M/S nurse refuses to help out, I hope they remember that day.
And who's on third?
guest64485
722 Posts
I'm curious, could you elaborate more on how staffing with outside agency is cheaper than hiring your own staff? One of the hospitals I worked at years ago was shelling out $60/hr for agency nurses when new staff was starting at $20. They ended up redesigning and beefing up their float pool and abandoned using agency all together because it was more expensive, as per the hospital's nurse recruiter. I thought that benefits generally accounted for 1/3 or less of your salary, which makes agency convenient but still more expensive. Unless the employer has horrendous staff retention, I'm not seeing how agency is a more cost-effective solution.
edit: reference http://www.bls.gov/news.release/ecec.nr0.htm Table A