Why does Nursing put up with short staffing?

[elfinM]

I am wanting to get a little feedback as to why Nursing (in general) allows short staffing to be an issue? I am on our research committee at work and would like to get an idea of where to take my project. I would like to find an answer to the problem and not just more complaints. Thanks in advance for any insight.

[piper_for_hire]

Why does nursing put up with staff shortages? I don't get the question. Nursing has nothing to do with staff shortages. It is simply poor hiring practice. Like in *any* profession, better pay and to a lesser extent better benefits will attract more employees. There is nothing more to it than that. It is the hospital that is in charge of hiring all employees, not nursing. If hospitals cite budget constraints as a reason for not hiring staff all that really means is that they are satisfied with the current situation. If hiring more nurses meant a fatter bottom line, they would.

-S

[CNSgradstudent]

I am currently a nurse in a recovery room at a surgery center. We have experienced a large turnover due to the PRN pool they have established. The PRN nurses make several more dollars an hour, do not have the added assignments of keeping the center running and can work if and when they want. When they are working PRN in other centers around town, we resort to using the Agency nurses, which is even more money and the same issues of not having the added wrokload of daily assignments. How are we as nurses who are employeed by hospitals and corporations going to encourage them to have retention strategies and how do we make management understand our perils. They think if we have a "warm body" everything should be OK with the work load. I am in graduate school and I am doing my research on the use of agency(prn) staff and the retention of RNS. Any feedback is greatly appreciated.

[Rnandsoccermom]

Because people are more afraid of losing their job than they are of losing their license. If there was a national walkout day it would turn the the industry upsidedown. For whatever reasons, it has never happened. We can only blame ouselves.

[CNSgradstudent]

I don't think we will ever have a national organized nursing alliance and you are right it is our own fault. But we would never jeopardize the health of the patients and hospitals, managemnt and physicians know that. We are the largest lobbying group of any medical profession if we could all get organized and make a stand. I think that since we are a predominately female career choice, we have so many other responsibilites in our lives that the majority looks as nursing as their job and not their career. I have been a nurse for 21 years and I am not sure it will ever change. This is a cyclic profession, 21 years ago I came out of a BSN program and went to work for a hospital who was entering Primary care by RNS ( similar to the Magnet status of today). It was a great hospital with virtually no errors, well staffed etc... As the money was taken by the RN staff they started resorting back to the team approach of nursing. This was followed by the 12 hour shift and lack of continuity of care and now we are where we are today- BIG BURNOUT, experienced nursing staffs ready to retire, younger nurses becoming disillusioned at a much faster rate than when we were first nurses. Not sure where I was going with this-just rhetoric :) Sorry, I think we just have to become more proactive and vocal and continually strive to become more educated and autonomous!!

[Sheri257]

If there was one thing, and only one thing, I could get nurses to do, collectively and without reserve, it would be to make them stay home when they're sick.

Nothing bothers me more than hearing these stories of going in sick because of this or that or some other guilt-ridden justification.

For god sakes, stay home when you're sick! If there is no staff to take your place, it's not your fault, nor is it your problem.

STOP PERPETUATING THE NURSE-AS-MARTYR SYNDROME!!!!!!!!!

and maybe, just maybe, they'll get the message and staff properly.

But please stop this throw-myself-on-a-sharp-stick behavior!

If you're referring to my post, I agree ... it was wrong to work sick. I did it because it was my first hospital job, I was new, and they were writing up people for calling out sick. But, in hindsight, it was totally stupid on my part.

However, I am not trying to encourage the nurse as martyr syndrome. I won't ever work sick again.

:typing

[bjlyst]

i'm not sure where you get your information. but, here's a reality for you. if you go to work and clock on, then turn around and leave, it is considered abandioning your patients. which is against the law. which means that you loose your job and probably your license, which in turn makes staffing even shorter.

i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.

[wooh, BSN, RN]

You're not abandoning until you've TAKEN REPORT. Until then, you haven't accepted responsibility. I'll take report on the number I'm supposed to have, then I refuse to take report on any more.

[BBFRN, BSN, PhD]

i'm not sure where you get your information. but, here's a reality for you. if you go to work and clock on, then turn around and leave, it is considered abandioning your patients. which is against the law. which means that you loose your job and probably your license, which in turn makes staffing even shorter.

i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.

not true- at least according to the ana, and most nurse practice acts.

http://www.ana.org/readroom/position/workplac/revmot2.htm

"patient abandonment is . . .

a unilateral severance of the established nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for continuation of nursing care by others. refusal to accept an assignment (or a nurse-patient relationship) does not constitute patient abandonment."

in other words, you have to get report on these patients first. it has been established that the nurse is not accepting the assignment by merely clocking in. this may, however constitute "job abandonment," which is quite different. don't let your superiors fool you into thinking the 2 are the same.

[BBFRN, BSN, PhD]

i don't know about anyone else, but when my bosses know they are short for my shift, they let me clock in, then they tell me that i'll be working the full 126 patients alone.

And I were you, I would refute this as well. Why is it abandonment for YOU to turn around and clock out, but not if THEY clock out and go home, leaving you with that patient load? I believe in some states (and this is true in my state) that nursing management can be held accountable if something happens to one of your patients if they leave the facility to be staffed like that. I would speak to your state BON about this.

[mystcnurse, MSN, APRN, NP]

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.

That's what an agency nurse does. What if we were ALL agency nurses

[Indy, LPN, LVN]

For me the question is becoming less "why do I put up with short staffing" and more "how do I respond to this deliberate short staffing and still keep my job?"

Basically my facility now says it's got budget problems. We were adequately staffed during the JCAHO thing. A couple of times we might have been said to be overstaffed. Hmph! I was one of the "extras" one night - just there to help out and I'll be danged if I didn't work my tootie off. There was a code and a ICU transfer, two separate highly acute cases, within the first hour. It took having an extra nurse there to recognize the very sick lady who was in respiratory failure, d/t the code having prettymuch scrambled the beginning of the shift.

I know it's anecdotal... and maybe I'm just weird in that I can't go to work and not work, if not really hard, then at least steady through the shift. It's hard for me to sit still! I've charted standing up some nights.

So after the JCAHO thing the flu season hit next. And we had nurses out left and right with cold, flu or that horrible GI bug. Yuck. So we were barely adequate, with higher acuity. No problem, we know why, so we worked hard and thought whew! sometime in january. Hah!

Next up ... now we have the "budget cuts" deal going on. Can we catch a break and just have adequate staffing? WTH. I still haven't been able to calm down long enough to have a word with our DON or ADON yet; don't wanna barge in and issue ultimatums and show my orifice. So for the last week I wasn't in the dungheap end of staffing and we had a good week. But I had to watch people I care about (fellow nurses) go in there and deal with ridiculous acuity, understaffed, and feel bad that I haven't spoken up on their behalf. On nights they have enough to cover, they are now low censusing someone to make it not quite enough.

I don't mind taking a larger load when the hospital's full, everybody's sick, the ER has a 4 hour wait and people are vomiting all over the waiting room, etc. I'm not allergic to hard work, and I'll do what it takes to get a crisis under control. But for the love of pete, expecting people to work like that all the time is just plain heartless. And when you hire enough new grads, and train them, for night shift, and get 'em to the phase where they are comfortable enough to work it, then start calling off your experienced nurses so your new grads can come this close to a nervous breakdown, well that's not excusable.

So my answer for right now, is I'm bitching but I'm not talking to management yet. And the facility is gonna wind up paying me overtime for 13+ hour shifts when I wind up being dumped on, and I think I'm due soon. I'm also thinking I'll keep a track of what's not safe that can be written up, such as meds more than an hour late, etc. and while I'm charting, at 8 am, I'll merrily sit there and write up all the variances too. You have to put a "recommendation to prevent it from happening" at the bottom: safe staffing levels.

The rub though, is that after the flu season hit, our dayshift managed to keep their staffing at a level that is close to ICU levels. 5 nurses for 14 patients... God if I had that at night, the place would be spic n span in the morning! You might not need a housekeeper! Secretary? Nah, we're good thanks! We could have patients bathed before breakfast, backrubs done at night, etc. instead of passing on dirty, restrained, confused, lonely ole folks like we do sometimes. Anyhow. /rant off.

[LeahJet, ASN, RN]

Because people are more afraid of losing their job than they are of losing their license.

Wow.

You just said a mouthfull.