Why does Nursing put up with short staffing?

RN4NICU, LPN, LVN · Jan 23, 2007

Thank you everyone for your input. It seems everyone knows the problem, but what do we have to do as a whole to make the change. Granted an individual nurse trying to take on management is a sitting duck. Doctors have managed to united themselves, without unions, as a profession to gain respect from the hospitals. How can we take that model and apply it to our own profession, and are more nurses ready to do that than not?

Doctors are not hospital employees. In order to apply their model to our profession without unions, we would need to separate from the hospitals and work as consultants/independent contractors rather than employees.

tencat · Jan 23, 2007

Doctors are not hospital employees. In order to apply their model to our profession without unions, we would need to separate from the hospitals and work as consultants/independent contractors rather than employees.

So why don't we do that? It seems that everyone in the realm of direct medical care IS an independent contractor except nurses and CNAs. How come we can't all become independent and bill for our services the way others do? Just wondering. I guess that's a topic for another thread.

burn out · Jan 23, 2007

Doctors are not hospital employees. In order to apply their model to our profession without unions, we would need to separate from the hospitals and work as consultants/independent contractors rather than employees.

That is when nursing can and would make a change both for nursing and healthcare. It would depend on good leadership and to some extent forming some kind of nursing organization (not a union). We could be incontrol of our own profession and charge for our services just like the docs. Where are our leaders, where is our BON at on this? We would need help and guidance.

Roy Fokker, BSN, RN · Jan 23, 2007

All I get is a blank stare. Why can't these nurses help out in a crunch? Are they too good to do bedside care?

Bedside care?

Listen - at our facility, we need another nurse to double check out insulin dosage before administration. We use the Innolet system - dial the unit dose, press the button and presto! Insulin delivered!

So, it's a little busy and I can't find another nurse for my double-check sign. I spot the case manager (name tag with bog bold, RN/BSN on it). I approach her, show her the accu-check glucose results, the sliding scale, point out that I need to give two units, hold up the innolet thingie and show that the dial is set to "2"... now can I please have her login ID so I can use for my double check?

She made some kind of excuse as to "I'm not familiar with it" and refused to help! :eek: I thought that was kinda silly - I'm not asking you to administer it ... merely to verify if I have the right dose for the right condition. I mean really - if you can't read a simple sliding scale and verify if "2 units" is "2 units" - what good is that big, fat title on your name badge?

somewhat frustrated,

Roy

oramar · Jan 23, 2007

Another thing is that managment through Hospital Ass. have a lot of influence over legislation. The frequently use that influence to have laws, rules and regulations passed aimed at keeping nurses in line. Right now unlimited immigration of nurses is allowed. This will give them more leeway to deal with uppity nurses that speak their minds.

oramar · Jan 23, 2007

Bedside care?
She made some kind of excuse as to "I'm not familiar with it" and refused to help! I thought that was kinda silly - I'm not asking you to administer it ... merely to verify if I have the right dose for the right condition. I mean really - if you can't read a simple sliding scale and verify if "2 units" is "2 units" - what good is that big, fat title on your name badge?
somewhat frustrated,
Roy

There was a time when most people in managment were experienced staff nurses that could fill in here and there for whatever came up. Nowdays they are professional desk sitters and there would be dead bodies everywhere if one of them set foot on the floor. You would expect that this would increase their respect for the people they managment but their contempt has never been greater.

leslie :-D · Jan 23, 2007

Another thing is that managment through Hospital Ass. have a lot of influence over legislation. The frequently use that influence to have laws, rules and regulations passed aimed at keeping nurses in line. Right now unlimited immigration of nurses is allowed. This will give them more leeway to deal with uppity nurses that speak their minds.

i know that mha (mass hosp assoc) is going nuts at the thought of passing mandatory staffing ratios here in massachusetts.

one of the reputedly best hospitals here in boston, almost went on a huge strike because of the unsafe staffing/pt ratios....and they're the highest paying hospital around. they advertise new grad programs for all the different icu's, and obviously prey upon nurses that are fresh out of school.

i've been offered a job there a couple of times...won't go near it,even if i could make $50/hr. my license is priceless.

leslie

jjjoy, LPN · Jan 23, 2007

I think part of what contributes to short staffing is trying to apply assembly-line efficiencies to acute care health services. It is considered "a waste" if it is discovered that the nurses have any down time so they figure to the minute how much time it "should" take to complete one's nursing duties (eg 4 minutes to administer an oral med) leaving no room for the uncertainties, human psychological needs and competing demands in providing acute health care. The tell-tale sign of short-staffing being due to reasons beyond the nursing shortage is that in many facilities when the census goes down, nurses are called off and the remaining staff feels just as stretched as when the census was up.

Another related question to ask is why hospitals are using so many agency nurses. It makes sense to use agency for periodic peaks and to fill in if a flu bug is making the rounds of your nursing staff. But instead, you'll find agency staff being used routinely at many hospitals. If they can find and afford agency nurses, why can't they lure more nurses on full-time? It may be because they are systematically understaffing in a misguided effort to save costs. Such understaffing makes finding and keeping nurses more difficult. Thus, they have to use agency to meet even their relatively low staffing needs.

I'm just waiting for this type of staffing "efficiency" to make it's way into public safety services. Hey, there were no fires this week and we were paying a full crew of fire fighters to sit around and do nothing?! Why don't we just cut those crew and when a fire arises, we can temporarily hire those very guys we laid off. Firefighters can be free agents, competing for gigs. Pay per hour will rise and city costs go down! Everyone wins, right?

gonzo1, ASN, RN · Jan 23, 2007

Big business downsizing was applied to the hospital model. The one thing they didn't factor in is that nurses are not making widgets and can't make so many widgets an hour. Nurses are working with sick and dying people. You can not make a model of how many minutes it takes for each nursing duty, ie. giving a shot etc because what happens when the shot is to a 15 y/o girl that starts crying as you are trying to do it and has to be calmed down, etc. Management doesn't care about this though. They have everything figured out down to the wire. They have carefully examined how many nurses they need on hand versus what an acceptable mortality rate is. For every pt you have the risk of injury or death to each pt goes up 7%. So imagine how high the mortality risk is if you have 4 versus 6 pts, or even more. But until the public realizes what is going on and there is a public outcry these practices will continue to go on.

Hospitals right now believe that agency (can we say migrant) nurses are cheaper because they have more control over when they work them, do not have any financial committment to them (sick pay, holiday, insurance, vacations) and can let them go if they are too vocal or trouble makers.

The problem is for example on our hospitals med/surg units on the pm shifts they have a revolving door of inexperienced agency and new grads and no experienced nurses to help or mentor. I would not want to be a pt right now on these units as the nurses are so new and green.

The majority of nurses are just plain old moms and housewives and don't have the fight in them to buck management and raise an outcry about what goes on. Maybe as more men come into the field this will change.

Don't flame me because I too am just a plain old housewife and mom and I sure don't have the kahunas to cry outrage.

Simplepleasures · Jan 23, 2007

Please don't try to switch the blame for short staffing from the managment to the staff nurse. Over the years I have witnessed managment use many techniques to deal with nurses who protest short staffing and it is not pleasant. Managment uses threat of firing to actual firings as well as going to BON with trumped up charges. Also more subtle methods are used like appealing to nurses team spirit or making it be known that persons who do not have team spirit will not be considered for promotion or desk jobs. It is nasty out their and nurses need advocates not more people to add to their burdens. By the way it has been pointed out that the great nursing shortage of the last 10 years is nothing more than nurses talking with their feet. I left my last job when I was talked living with a temporary reduction from 6 nurses to 5. When I realized the temporary staff reduction was actually permanant and sometimes we would be working with 4 nurses I protested loudly which resulted in me being asked to resign. THAT IS NOT THE FIRST TIME I GOT IN TROUBLE FOR PROTESTING BAD STAFFING. So don't come around here asking me why nurses put up with bad staffing.

Yes, you , me, and many other nurses.We are at their mercy until we have our own strength in numbers.

CaLLaCoDe, BSN, RN · Jan 23, 2007

I would like to find an answer to the problem and not just more complaints. Thanks in advance for any insight.

The answer to your question is quite simply this....we will not tolerate more than 5 patients in medsurge, no more than two in ICU and no more than 4 in ER...

Do you think budget cuts that involve less staff really work? Increase the CEO's work load and involve a few lives on the line and see how he likes it!

We will complain in numbers to your silly offensive logic! :lol2: :lol2:

lindarn · Jan 23, 2007

I think the real question is why does hospitals put up with nursing shortage?
Nurses have no control over it but if we clock in and then refuse to work short we can charged with abandonment..we get screwed coming and going.the nursing shortage is crammed down our throat. However, we manage to do the job of 5 people with only 3, for the most part our patients are basically happy and the nurses are exhausted only to repeat this again in the morning.
Hospitals on the other hand have created the monster known as the "Nursing Shortage". Who benefits esp. financially when we work short..the hospital. Who writes our job descriptions and sets our policies and staffing matrix..the hospital. Why doesn't the three nurses (and I also mean to include the techs, and cna's and lpn's) get the pay of five people the day they have to work short instead of getting the regular pay?
Hospitals do not have an answer to the problem because they are the problem. A vision I see for nursing is to distance themselves from the hospital. Let nurses as a group funtion as doctors do. Let them first unite enough to determine their own entry into practice, then teach them to negotiate job contracts and set their own worth. Nurses need to take control of their own profession instead of sitting back belly aching about it.

I have said more than once, and it is worth repeating- nurses need to have included into their curriculum, the concept of independant contracting, to remove us from the concept of "daddy hospital", and include Employment Law, and Administive Law, to educate us as to what are RIGHTS ARE IN THE WORKPLACE, and how we can effectively manipulate the employment law, and administrative laws that govern our employement and all types of appeals, for all types of agencies, including the Board of Nursing in disciplinary issues, and licensing issues. Nurses have no clue how to work these laws to their advantage. It would be worth it to all nurses to either take classes at a local community college that has a paralegal program, or take them on line in either Kaplan's Legal Nurse Program, or their Kaplan' s Paralegal Program. You will receive ten fold, what it took you to take these classes.

There was nothing like it, when I told my nurse manager, that if the hospital tried to lay me off, I would get a restraining order to stop it until my attorney had cleared up the matter. You should have seen the look on her face. Knowledge is power, and nurses need to power of this type of knowledge in the worst way. JMHO.

Lindarn, RN, BSN, CCRN

Spokane, Washington