Understaffed hospitals and unemployed nurses

Greezbhal · Feb 2, 2010

Before you get excited about politicians promising reform....

Ohio passed a nurse staffing law in 2008:

http://www.safestaffingsaveslives.org/NewUpdates/OhioLatestLegislation.aspx

The problem is that it has NO TEETH. There are no "real" requirements regarding staffing aside from "have a plan".

It's pretty much a joke. It's a nice way for politicians and nurse-politicians to say they did something without actually doing anything. Units still work dangerously short... especially on nights and weekends. Staff nurses have no "real" recourse especially with the economy the way it is and no protection in the way of labor laws here in Ohio. If someone makes a stink... they might as well clean out their locker.

lpnflorida · Feb 2, 2010

Hospitals being understaffed and people needing jobs. Seems like an easy fix. However the bottom line is the almighty dollar.

Best laid plans often run into gliches. Schedules may have been set out and on paper it looks like enough staff are scheduled .Someone calls in, no one is available to come in or perhaps it would mean overtime and the budget it being closely watched. Or enough people were scheduled and then admits start coming in. We are told they can only staff for the patients on the unit not potential admits that may or may not arrive.

Sadly the budget will win out. Without remaining within budget no one will have to worry about staffing as the hospitals would be in financial ruin. Hate realty somedays.

fungez · Feb 2, 2010

It's my opinion that hospitals underhire so they can routinely throw their hands up and say "sorry! no one will come in!" as an excuse for understaffing.

I read a comment thread once started by a former hosp. administrator bemoaning the fact that "most of the budget went to overpaid nurses." Yep, and that's where most of the budget should go. Hospitals exist for nursing care. We should be the most supported unit in the facility; instead, we are the least.

Awhile ago I watched five people in the administrative level gather around our unit board. For over fifteen minutes they discussed if it should be replaced and if so, what with? Various opinions were offered, considered and rejected. Consensus must have been to keep the board as is because six months later it's still there.

I'd have more respect for admin. and their budgets if they ever watch their own. If nursing is not sweating blood we are not being productive enough, but they still get their breakfast/lunch meetings.

pennyaline · Feb 2, 2010

Awhile ago I watched five people in the administrative level gather around our unit board. For over fifteen minutes they discussed if it should be replaced and if so, what with? Various opinions were offered, considered and rejected. Consensus must have been to keep the board as is because six months later it's still there.

LOLOL!!! I watched a coterie of corporate representatives do the same thing on my unit about a year and a half ago. There was a huge powwow about what to do about a crumbling corkboard on the wall behind our chart stand. Discussion about this board went on and on, and they were back to do it all over again the next day, and then the next. Today, that same old cruddy board is still on the wall. I guess the consolidated brains of the organization hit an insurmountable snag on that one

classicdame, MSN, EdD · Feb 2, 2010

our hospital, like many in US, look to Medicare & Medicaid as biggest payor. We get about 25 cents for every dollar we bill them.

I guess hospitals are not hiring for the same reason I cannot hire a maid. No $

HOWEVER, if the healthcare plan goes thru we will have MANY more patients. Will that result in more dollars and more jobs? Who knows? Could mean simply more work.

Tankweti · May 23, 2012

I must admit that am puzzled that so many able and willing nurses are out there actively looking for jobs and are routinely turned away yet many hospitals care having trouble meeting their minimum staffing levels. This coming election nurse patient ratios will be a major factor in whom i chose to vote for, just wondering how many of you feel the same? I have to give california nurses credit for ensuring that staffing levels were passed as state law. My hope is that many if not all states will do the same now that we have the super union. I hate to see the seasoned nurses burnt out and our young left hopeless after all the hard work.

I am an RN BSN grad from 2010, 3.5 GPA, dept honors. To date, I have never even been called for an interview for a hospital and I have sent resumes within a 60 mile radius from where I live. I cannot afford to move. I have given up looking for a nursing job and have gone back to medical transcription which I did for many years. Comically, the hospital I now work for did not respond to my nursing resumes but they did respond to my transcription resumes and hired me. However, I only have 20 scheduled hours per week but it is better than nothing. And, yes, I applied to nursing homes and home care (home care was what I really wanted) but where I live home care wants a minimum of 5 years experience.

Point of my answer to this post is that I have concluded that the reason hospitals and others all want experience is that they are overloading the nurses they have and they have convinced themselves that this unsafe practice might be made safer by using only experienced nurses.

I heard from someone who is an insider the other day that one of our local hospitals (not the one I work for, which is quite far away from where I live) had a recent nurse:patient ratio of 1:12! Of course, when something does go wrong as it inevitably will, the nurse will be blamed (and fired) and management will proclaim that the problem has been solved by getting rid of this one person when, in fact, the problem is sytemic in nature. The nurse, on the other hand, may lose her license which she worked so hard to get as a result of brinksmanship by hospital admin. Hospitals roll the dice and take chances every single day with understaffing, hoping that nothing bad will happen.

My husband is currently dying of end stage liver disease, which has recently been complicated by acute on chronic pancreatitis. I am, of course, his advocate and you would not believe some of the things I have seen being by his side in hospitals. For one thing, no one compares the printed out discharge summary with the actual handwritten scripts that the discharging provider gives. I once caught an error wherein Aldactone was prescribed at one dose on the discharge summary (which was the correct one) and on the actual script the dose was double what it should have been. No one caught this error and we all know what the end result could have been.

Relying on the computer, and being too busy, no one bothered to cross reference the two. I got in touch with the Director for Patient Advocacy at the hospital and she later told me that I had no idea what I had done...in that an incident report had to be generated and it turned out to be a major computer problem that no one was aware of ... i.e. that the computer was supposed to recognize certain discrepancies and was not. God only knows how many other patients were given incorrect scripts, with horrific results.

I have also, more than once, caught my husband while an inpatient in a state of sepsis with the nurse being blissfully unaware of what to do to confirm what was going on and just giving him "sips of water" instead and telling me he was fine. (All she had to do was obtain a rectal temp but she continued to get oral temps.) Of course, I have now become the proverbial "thorn in the side" for my local hospitals and they don't like to see me coming. (But I figure they are never going to hire me anywhere, having made that perfectly clear after I graduated.)

Interestingly, in regards to hiring, I was told by a nurse manager in one of these hospitals that I had to have a perfect 4.0 and a BSN to be hired, that a 3.5 was "not good enough" and that maybe I could get a job working in a doctor's office with that GPA. Well, it turned out that I later bumped into 2 of my former colleagues from nursing school, both of whom had failed nursing classes and had to repeat. In fact, one of them I actually tutored to help get her ready to get back into the program. These were the 2 people they hired, because they were known entities as they had been CNA's while in school and I had not. I have had nurses tell me about my husband's "blood pneumonia" levels (meaning blood ammonia levels) and another nurse telling me on the phone that he was in "total liver failure and that his LFT's were through the roof" (a medical diagnosis which she was not allowed to give and which I brought to the attention of management). The list goes on with many other blunders from nurses who are supposed to be "4.0".

I was just looking at a copy of "The Hospitalist" today and it stated that, once Obamacare comes into play, that (while there will be alot of new patients) no hospital is planning to increase its number of beds. The article stated that adding one new hospital bed to a unit costs one million dollars. (How they arrive at this number, I do not know.) The article also stated that hospitals, in general, are not planning to add staff when this tsunami of new patients hits, flying in the face of the nursing shortage myth. Truthfully, knowing this, I am glad that I did not get a much coveted hospital job as, when all this occurs, hospitals will not be fit places for man nor beast. We will probably wind up back with the old "ward" model and that will just be for starters.

OCNRN63, RN · May 23, 2012

i doubt nurse to patient ratios will even come up. there are other more important matters to discuss, like whether romney is really a christian and whether obama has a secret plan to turn the us into a socialist nation.

classicdame, MSN, EdD · May 23, 2012

I would LOVE to have more help. However, we earn approximately 25 cents on the dollar. We do not have the money to pay for more nurses. Unless nurses want to earn less, of course. Any volunteers??

DoGoodThenGo · May 24, 2012

I would LOVE to have more help. However, we earn approximately 25 cents on the dollar. We do not have the money to pay for more nurses. Unless nurses want to earn less, of course. Any volunteers??

You've touched on something that has been roaming around my mind for quite awhile.

Say a hospital offered nurses a chance to practice as "they've always dreamed". Adequate to generous staffing of not just nurses but UAPs (where necessary), ward clerks and other support personnel, the whole nine yards including enough back-up so meal and other breaks could be taken. The trade-off being wages less than the average for local area. So say in NYC instead of around $72K you got between $65K to $69K.

As ClassicDame says: Any takers?

DoGoodThenGo · May 24, 2012

I must admit that am puzzled that so many able and willing nurses are out there actively looking for jobs and are routinely turned away yet many hospitals care having trouble meeting their minimum staffing levels. This coming election nurse patient ratios will be a major factor in whom i chose to vote for, just wondering how many of you feel the same? I have to give california nurses credit for ensuring that staffing levels were passed as state law. My hope is that many if not all states will do the same now that we have the super union. I hate to see the seasoned nurses burnt out and our young left hopeless after all the hard work.

There are so many bits to the puzzle of staffing that it's often hard to hit that moving target.

One of the biggest issues, and one that is only likely to grow larger with the increasing use of UAPs/techs is just what consitutes safe staffing and by whom?

In the old days you could staff a floor with mainly students, probbies, and or new GNs with just one or a handful of RNs who mainly acted as supervisors. Voila! You have warm bodies on the floor but is it safe for patient care? Today we're seeing some of the same thing but it's UAPs being handed bits of care peeled away from licensed nurses. Again you've got warm bodies, but...

While it is tempting and often deserving to take pot shots at administration the real problems boil up from how healthcare is run and paid for in this country. You can mandate all the staffing you want, the question then becomes who is going to pay for those nurses and where are they to come from?

For any business or anyone else in the United States the costs come not just from taking an employee on, but keeping and if necessary getting shot of them.

Back in the day places often staffed by number of beds regardless of how many were occupied. If there wasn't enough patient care to go around per shift, nurses were dispatched to tidy linen closets, med rooms and such. Or, floated around the place as needed on the working theory that a nurse is a nurse is a nurse.

The Sunday New York Times amoung others reported a few weeks ago that for the first time in ages healthcare spending for the USA was flat and or decreased. Trouble is no one from the government to economists to hospital bean counters knows exactly when and or if the trend is likely to continue. What is certain is that the cost curve is being bent and hospitals/facilities are feeling allot of that pain.

Americans are not only delaying non-emergency healthcare, but either putting it off entirely or seeking lower cost alternatives. High deductible health insurance is one of the reasons given for this change. The other is efforts by insurance companines and the federal government to pay for quality of care not quantity.

Whatever the reasons hospitals are looking at what might be the new normal, less demand for in-patient care services and or lower reimbursement for care provided. Labour being the largest cost for any business it is somewhat understandable that would be the first place turned to for cost savings.

Finally the other side of the coin: for much of the history of professional nursing hospitals depended upon a steady supply of *cheap* labour provided by females. Over the years both the profession and women's roles in society have changed. Today's professional RN is a far cry from Miss. Nightingale's "trained" nurses and as such expects more, much more from her (or his) employer.

NicuGal, MSN, RN · May 24, 2012

Money, money, money. Budget, budget, budget. That about says it all.