Unsafe Staffing

[**LaurelRN, MSN]

i posted this in icu nursing too....i will apologize now for the lengthy post- i want everyone to have a very clear picture of the situation. i guess this is really just a vent or maybe profound disappointment on my part. i know what i need to do but i have such an overwhelming sense of guilt and disloyalty, that i feel i just can't leave.

i have been a nurse for 3 years and an icu nurse for 2 years. i worked in every aspect of nursing cna, huc, mt, and icu tech prior to becoming a nurse. i saw alot, kept my mouth shut and listened to many great nurses- so when i became a nurse, i wanted to be the best nurse i could be. i signed up for every nursing magazine, joined organizations, and of course found an. i believe i am a very good nurse. i just passed ccrn on july 27th and truly do think i have good critical thinking skills and am an asset to our little icu.

i have worked at this hospital for 6 years ( and across town at our competitor for 7 years prior to that as an icu tech)- we are a small community hospital with a larger sister hospital about 12 miles away. we were owned and mismanaged by a "board of trustees" that had a very conservative and somewhat inept view of nursing. though we were constantly understaffed and many times didn't have the things we needed- we were mostly happy with our jobs and the people that work at this hospital- right down to the housekeepers and dietary workers- all are great people and are the main reason why many of us stayed.

last october a large national "health management company" bought our little hospital out. it has been nothing but hell since that day. now don't get me wrong- maybe not all- but most of the employees saw this as a positive possibility for us to now get what we truly need staff and supplies and md's for coverage (many times we have to divert due to not having cardio, neuro..etc or the patient sits there over the weekend and waits until monday to be seen). however, this did not happen...for 2 months nothing happened- all jobs were frozen due to a changeover to their human resources division. now- 6 months later- though there are jobs posted- there are few applicants (qualified at least).

so now on to me and the point of this whole post. though many of us stay due to one another- numerous changes including termination of the entire management throughout the hospital have taken a few of our core staff out of the equation by first promoting them to management- then firing them - so it's been rough but i have tried to hang in because of multiple reasons. i am per diem- but work full time hours. it is close to my house (about 10 minutes) and since i have a teenager- i like to be closer if something comes up.

this past monday i came into work- i'm in charge with 3 other nurses who are not so strong - 1 a traveler, 1 new hire- who thinks she knows everything, knows little and does little and an older nurse who knows a lot but is so disorganized, it boggles the mind that she can manage to get much done. it's ok for the first hour- i mean i'm busy- we have no ancillary staff- no huc scheduled- no tech just 4 rn with 8 pts. there are 4 vents and i have an unstable stemi that infarcted his anterolateral plus septal wall- is continuing to have active chest pain ( a stent was placed to a 100% stenosed lad ) pressure is in the toilet and is going into cardiogenic shock. i won't bore you with the details but over the next 3 hours we get 3 more admissions with no additional help. i transfer my other patient out in order to get a post op- with my stemi still unstable. so last straw was house sup calls and says there's a respiratory distress on the floor needs to tx to icu- i am the only one with 2 pt's that could absorb another (so i'm told by house sup- however, older rn has 2 vented pt's) - my stemi has gone into rv failure- he is truly in resp distress- so i tell house sup- i will not take the patient that it is unsafe. i am told i cannot refuse a patient and must take it. i told sup- i'm not taking it- they can assign- i will not take report.fire me if you want-but i'm not taking it. my stemi ends up on a vent and getting a balloon pump...house sup talks older rn into taking 3 rd pt from the floor- here's the kicker-- this resp distress pt that was in such bad shape that they would endanger the life of my stemi and post op pts- she came in talking on her phone, no o2, and asking to get up to go the bathroom!!!it's not the point that ,ok- well she would have been a no brainer and you could have absorbed her without problem- the problem is-then she takes valuable time and care away from my patient that truly need my care. and this is ok with them! someone is going to die!!!

so my dilemma is...4 or 5 of us still work here that are loyal to one another and if we leave then the problem of short staffing is only exacerbated, they run shorter and shorter- days are worse and worse- and patients are the ones that end up getting horrible care.

in the 6 years that i have worked at this hospital- no matter how bad the day was- i never let it get to me so bad that i allowed myself to lose control and cry. last monday, i did....i cried and cried and hated myself for allowing them to push me to the point that i was at. i just felt so overwhelmed...i felt i couldn't give my patient the care that they deserve....this 50 year old stemi is the same age as my husband..what if it were my husband- would i want the nurse taking care of him to have 3 or more patients...this guy should have been a 1:1....i left charting until after the night shift came in...i was there until 11:00 pm charting....i love being a nurse....i am so proud to be a nurse....but not this way....

i could have a job at one of the large hospitals in orlando that is 45 minutes away...i just don't know what to do

[nrsang97, BSN, RN]

Flat out you should leave. Your license is in danger there. I know making that kind of decision sucks, but you should do what you have to do for your sanity.

I think you would be an asset to another ICU anywhere.

[nursemichelle80, BSN, RN]

You absolutely should leave. Like the previous poster said, you have a license to protect. When it comes down to it in court--that house supervisor won't back you up. Nobody will but yourself. Your co-workers will manage without you or they will join you :) You have to take care of YOU! The 45 minute commute might just be worth your happiness. Good luck!

[jbluehorseh]

You were right for refusing that patient. If management wants to do everything on the cheap it will be more costly in every way in the end. You also have to protect your license because they sure are not thinking of your wellbeing.

[Risgirl]

Kudos to you for doing the RIGHT thing for your patient - you're there to advocate for your patients and give them the best care you can. You did the right thing by refusing the additional patient and by standing up for your patient and YOURSELF! I agree with the other posters that it may be time for a change. Sometimes we need something like that to make us realize that it's time to go...you know the "handwriting on the wall".

GOOD LUCK with whatever you choose :)

[CrunchRN, ADN, RN]

Insane - you have to take a stand. You all should. If you all resign for whatever reason you want to put they will be forced to beg you all to stay and you can demand appropriate staffing levels. If not, you need to save yourselves! The drive will suck, but this kind of stress is worse.

It would be cool if you all turned in your 2 week notice on the same day. That should get some attention!

[Simply Complicated]

While it's admirable that you do not want to leave your co workers who matter to you in a bind, you need to protect yourself and your license first and foremost. They are in the same position as you, and it is their personal choice if they stay and take the chance.

You sound like you already know what it is you need to do. Good luck to you!

[deemalt, BSN, RN]

You should leave. By staying, you are all saying everything is fine, keep pushing us and we will stay because we are loyal to each other. Management will only learn when they have to pay through the nose for registry.

Sorry that you work at a place like this. Sorry that places like this exist.

[GoddessLilithLPN]

I knew before the first sentence of your posting was finished that you work in Central Florida! I work around 45 minutes away from Orlando, so I know that there are only a few hospital options that you could be talking about. I think we have worked at the same facility! Mine was a small community hospital with a sister hospital exactly 12 miles down the road!

[Anna Flaxis, BSN, RN]

House sup needs his/her head examined. That patient clearly did not belong in the ICU. Perhaps this was *really* about short staffing on the floor. Sounds like things are pretty bad there. No advice, just empathy. Good luck, whatever you decide. You sound like a great nurse!

[nola1202]

What's ironic, if you complain to the DON, she will whip out a staffing matrix and prove to you that you were fully staffed (and safely staffed, so suck it up and deal!)

Sounds like the House sup and everyone else is afraid of losing their jobs. I can't tell you what to do. I can relate to the buy out and sudden changes. I had a wonderful job, it was really busy but then there'd be a little decrease in census so we'd have time to catch our breath and regroup, when it was bought out and combined with another hospital, there was only busy...and then to the point of stretched thin, then thinner, then dangerous...but according to the staffing matrix, everything was just peachy!

[netglow, ASN, RN]

Get out.

Negotiate at least a week off for yourself before starting your new job. You can't keep this up and not lose part of yourself in it.