Why Do Nurses Allow Understaffing?

[RNfaster]

I am preparing to begin nursing school. It boggles my mind that people work in places that understaff.

I am definitely going to go for an advanced degree. I think it can't help but get better with a masters. But if nurses banded together, couldn't something change for the better? (Consider nursing ratios in California --CA is a great state for employees overall as I see it.)

When she heard I was planning on studying nursing, a former cardiac critical care nurse told me NOT to work at a hospital. I thought she must have gotten tired of it and things surely have improved. But now, I am wondering, and thinking I will consider doctors' offices (as a NP), pharmaceuticals, etc. Maybe it's just working med-surg that is so nutty. Maybe it gets better on other units.

--I love to work hard. But not simply running my butt off. I'd like to use my mind more...to be able to care and listen to patients a little more.

When I worked in "corporate America." we had time to bond with our coworkers, to advance our skills and teamwork, to work pet projects, to really delve into things. It wasn't a crazy race just to provide the bare minimum.

Any thoughts? Sorry I was so long-winded. It was a hard night.

[tntrn, ASN, RN]

only if you tolerate it, will it continue to happen...

I am a house sup, and make daily staffing decisions...I would NEVER do this to my floor nurses...the charge would get an assignment, I would take an assignment. I would call in the director...

Can you come and work in our hospital? Our CNO, when called, says to call our Nurse Manager, even when she's on vacation. The CNO we have now is the ultimate "high heels and clip board" type. I've got it on good authority that she has a little table with tablecloth in her office for meals. Rarely sets foot outside her own little world. And as a result, hasn't a clue what the world outside her little office has in it.

Thank you for your support of the nurses in your facility.

[llg, PhD, RN]

There are 2 types of understanding and I see some people treating them both the same.

Type 1 is when the management has PLANNED to staff the unit at a level you disagree with. The number of available positions they have budgeted is filled ... there are no vacancies ... people are NOT asked to work overtime because there are no holes in the schedule. My recommendation to "say NO to overtime you don't want" won't help that type because the staff is not being asked to work overtime regularly.

Type 2 is when the planned staffing matrix includes an adequate number of numbers, but the actual nurses are not there either because the positions are vacant -- or because the mangement is counting on nurses picking up extra hours to fill holes in the schedule. That's the more common situation -- and that's the situation that nurses "enable" by allowing continuing to pick up the hours. As long as the nurses pick up the hours, the administration has no need to hire more people (which costs them recruitment, orientation, benefit, etc. expenses). There are sufficient numbers of nurses working any given shift (or almost enough) -- but the nurses are burning themselves out. As the nurses burn out, they are miserable and many leave the profession. It's a major factor in retention problems and lowers the quality of life for the nurses involved.

While the staff nurses are NOT to blame for the situation (type 2), some DO contribute to the problem by being enablers. They burn themselves out by taking all the burden for staffing on their own shoulders instead of putting most of that burden back onto the shoulders of the administration and society in general -- where it belongs.

[hogan4736, BSN, RN]

...some DO contribute to the problem by being enablers. They burn themselves out by taking all the burden for staffing on their own shoulders instead of putting most of that burden back onto the shoulders of the administration and society in general -- where it belongs.

good post...

my philosophy has always been, the unit's staffing problem is NOT my problem (as a staff nurse)...that's not to say that I won't pitch in and help, but i won't sacrifice my life over and over to support the staffing of the unit...

I will not beg people, or guilt them into working...I simply ask once, and that's it. I always thank them for considering.

Asking a nurse to work above ratio is unacceptable. I routinely "closed" ED beds at my last job (ED sup) d/t staffing issues. Triage knew not to fill the 3 beds I closed. End of story

We don't mandate people to work, as that is a deplorable staffing technique, and those who tolerate it are lemmings...

[MIA-RN1, RN]

Dread, as in not wanting to do so? Or dread, as in knowing what the answer most likely will be?

both!

[lindarn]

I'll tell you one thing you can do but unless you want to get fired like I did, you better get most of the nurses on your unit to do the same thing. After I explained what would work to the other nurses, I was let go the next day I came back to work. This is it: Say you are shortstaffed and you're in charge; or you aren't in charge but you have a number of very sick patients or too many patients so that you can DOCUMENT THE REASONS CLEARLY WHY IT IS UNSAFE. You type it up, name the date, shift, and the supervisor(s) you notified about the problem and why it could result in poor patient outcomes or even a sentinel event. DO NOT USE PATIEN T NAMES IN YOUR REPORT SINCE THAT WOULD BE A BREACH OF THE HIPPA LAWS. USE EITHER ROOM AND BED NUMBERS OR MEDICAL RECORD NUMBERS TO IDENTIFY THE PATIENTS WHO ARE AT RISK. Explain how you presented your case to your immediate supervisor, then called your unit Manager and tell her that as a courtesy you are notifying her that you will be filing a report documenting the circumstances surrounding the events that have transpired thus far and any untoward events that may result possibly due to the understaffing issue. Explain that you will have a copy sent to the hospital administrator, the Director of Nursing or Executive Nursing Officer and keep a copy for yourself. Tell her this is the only way you can see that you will not be held ULTIMATELY LIABLE SHOULD A SENTINEL EVENT OCCUR, since without any evidence stating any different it might be construed that you never notified any of your superiors of the conditions on the unit during that shift.

Believe me, documentation is the last thing administration wants because they have no or very little defense when faced with the cold hard facts that they each blatantly ignored. If you are in Charge, you may need to call the Executive Nursing Officer if your manager will not step up to the plate and find a solution like closing the unit to further admissions or coming in herself to work. If you are a staff nurse you can document only what your personal situation is with the patient load you have and explain in great detail why it is unsafe and that you do not want to risk not only a person's life but your professional license as well should things go south. You may also want to notify some of the physicians of your patients who you know would be sympathetic and concerned about your plight and their patient's welfare.

I was the charge nurse in an ICU in a small community hospital and I was forced to type up such a report. I also explained to my nurses what I was going to be doing and allowed them to read it. I told them that uncontrovertible documentation is their only defense when faced with Shift Supervisors who refuse to get permission to close a unit to further admissions or worse with Nurse Executives and CEO's who won't back up their nurses because of the bottom line. Not one nurse would relate that they believed that they were understaffed and their patients at risk (even tho' they all complained about it to me) and they did not lose their jobs. I did lose mine but when I filed a wrongful termination claim with the Arizona Dept. of Economic Security, the Hospital was found in the wrong and I received 3 months of unemployment pay. Unfortunately, I have learned in 30 yrs of nursing that most nurses talk the talk, but are ultimately afraid to walk the walk and take that chance by fighting the good fight. Maybe if more would do it, hospitals would become more afraid of that tactic and might try a little harder to get staffing.

I will once again bring up the fact, the classes that nurses need to learn about, and survive being a nurse are not being taught in nursing school. Nurses need to take classes like Employment Law, Administrative Law, Insurance Law, INdependant Contracting, starting a business, etc. These are "survival classes, so nurses now how to proactively deal with situations like the one above, and keep their job. Along with placing the blame and ramifications on the guilty parties.

These classes can be taken on line with Kaplan's Legal Nurse Program, or their online Paralegal Program. You will not regret educating youself on these topics.

I have toyed with the idea of offering seminars on these topics, along with concrete ideas on dealing with abusive management and administration.

Nurses also need to learn to not be afraid to speak up. I know excactly what you mean, that everyone complains, but no one will hold their ground, and stand up for what is right. I feel your pain. I have been there!

Lindarn, RN, BSN, CCRN

Spokane, Washington

[llg, PhD, RN]

I

I have toyed with the idea of offering seminars on these topics, along with concrete ideas on dealing with abusive management and administration.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Sounds like a decent busisness idea to me -- though you would have to account for the fact that there are some differences in the laws from state to state.

It also sounds like an idea that would make for a good series of articles or regular column in a major journal.

[lindarn]

Sounds like a decent busisness idea to me -- though you would have to account for the fact that there are some differences in the laws from state to state.

It also sounds like an idea that would make for a good series of articles or regular column in a major journal.

I should have added that nurses allow understaffing and abuse by EVERYONE, because nursing school brainwash nurses into being "martyr marys". We graduate from nursing school believing that we have no control over our profession, and it becomes a self fulling prophecy. The presant day nurses in this country have no control over anything, but the ways that we abuse each other, and refuse to support those of us who do have backbone and speak up.

Nurses who are brave enough to speak up and break the mold, are selectively "bred out of nursing. We leave, and never come back. Those who are left, are left to complain to each other, and to a deaf management and administration. And the abuse, and understafffing goes on. From generation to generation, just like child abuse.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[hogan4736, BSN, RN]

... because nursing school brainwash nurses into being "martyr marys". We graduate from nursing school believing that we have no control over our profession, and it becomes a self fulling prophecy. The presant day nurses in this country have no control over anything, but the ways that we abuse each other, and refuse to support those of us who do have backbone and speak up.

huh?

I learned how to be a nurse...

I never learned to give up my seat to a doc

I learned to question orders that don't seem right

I learned to take control

I learned to respect my peers

Nurses who are brave enough to speak up and break the mold, are selectively "bred out of nursing. We leave, and never come back. Those who are left, are left to complain to each other, and to a deaf management and administration. And the abuse, and understafffing goes on. From generation to generation, just like child abuse.

Lindarn, RN, BSN, CCRN

Spokane, Washington

I've spoken up since graduation day, and am still here...

Shame on any nurse for allowing her/himself to be "bred out of nursing"

I am administration, and I listen, and have my nurses' backs every day...

I don't buy all of the nonsense... you claim we learned it in school...i claim they were already like that...

[reesern63, RN]

I will once again bring up the fact, the classes that nurses need to learn about, and survive being a nurse are not being taught in nursing school. Nurses need to take classes like Employment Law, Administrative Law, Insurance Law, INdependant Contracting, starting a business, etc. These are "survival classes, so nurses now how to proactively deal with situations like the one above, and keep their job. Along with placing the blame and ramifications on the guilty parties.

These classes can be taken on line with Kaplan's Legal Nurse Program, or their online Paralegal Program. You will not regret educating youself on these topics.

I have toyed with the idea of offering seminars on these topics, along with concrete ideas on dealing with abusive management and administration.

Nurses also need to learn to not be afraid to speak up. I know excactly what you mean, that everyone complains, but no one will hold their ground, and stand up for what is right. I feel your pain. I have been there!

Lindarn, RN, BSN, CCRN

Spokane, Washington

I would take those courses if you offered them, linda. I would like to hear them coming from a nurse who has been there, done that.

[reesern63, RN]

huh?

I learned how to be a nurse...

I never learned to give up my seat to a doc

I learned to question orders that don't seem right

I learned to take control

I learned to respect my peers

I've spoken up since graduation day, and am still here...

Shame on any nurse for allowing her/himself to be "bred out of nursing"

I am administration, and I listen, and have my nurses' backs every day...

I don't buy all of the nonsense... you claim we learned it in school...i claim they were already like that...

You are an administrator. I admire your resolve to back your nurses, but you must know that you are only one person, and there are

many other people who can influence a nurse's decision to leave.

Not shame on the nurses...shame on facilities that allow management and abusive physicians to run amok.

It's a much larger issue than giving up a chair or being afraid to question orders.

[BBFRN, BSN, PhD]

Not shame on the nurses...shame on facilities that allow management and abusive physicians to run amok.

It's a much larger issue than giving up a chair or being afraid to question orders.

True. It's a multi-faceted problem.

[fleur-de-lis, BSN, RN]

I should have added that nurses allow understaffing and abuse by EVERYONE, because nursing school brainwash nurses into being "martyr marys". We graduate from nursing school believing that we have no control over our profession, and it becomes a self fulling prophecy.

Not true for all schools. My school empowers us and teaches us that we DO have control over our profession. We have assignments such as writing letters to legislators or editors of newspapers over nursing issues, and we have frequent online discussion on the politics of healthcare and the state of the profession, with a focus on what WE can do about it.

That said, I am being hired on to the unit where I am doing my residency. I will be on nights, which has been recently somewhat understaffed, although not at unsafe ratios. I plan to work as many extra shifts as they ask for (that I can safely manage) to pay off my debt, and I have let management know I am willing to do so. But, I will not become their doormat and will have no problems saying no when the time comes. This unit is the acception to the rule, with manageable ratios even with unplanned absences. Perhaps the knowledge about healtcare given by my school has inflcuenced me to choose a unit such as this one!?!