OK, OK, I know why. It's because it makes them feel unsafe, that they won't get good enough care, that they won't hit the callbell when they need to bc they don't want to be a "bother" because we're "already so busy."
But mgmt is SO ADAMANT about us never speaking to pts about staffing, it makes me feel as if they're protecting themselves from something. A bad reputation in the community, perhaps?
I don't normally say this. But if I'm late with something simple, like a ginger ale, I may say, "sorry, I had to grab it, we're short techs tonight." Sometimes a short, truthful explanation goes a long way toward pt satisfaction, as opposed to them just thinking I was lazy or Facebooking.
Other times someone else has said something to the pt before me, and they say to me, "I hear you're short staffed."
True, our hospital is a business and we shouldn't discuss business with clients. But a little nagging voice in the back of my head says to me that this may be one of the ways to effect change, if the community starts to hear about what goes on here instead of us just complaining to each other. (We are in a notoriously union-unfriendly state.)
No, I'm not going to start discussing staffing with pts or their families. Often a pt will say to me, "You must have a lot of pts," like a backdoor way to test staffing levels (these old people are savvy), and I will simply say, "I do have other pts, but you are my focus right now."
I was just speaking from my perspective as an ICU nurse. My comment was not directed at anyone or meant to sound like an insult.
I agree with toomuchbaloney, in fact I am sure that the lack of staff at my current job is directly related to the drop in scores since January. It is a perfect opportunity for the staff nurses to say "that is when you cut our staff and increased our ratios, we have all we can do making sure that they are safe and receive their medications."
The management aren't very astute about the day to day operations so spell it out for them so they know it's affected the all important bottom line.
Every single lawsuit I know of was settled out of court. Nothing changed, in fact years later, things are even worse as far as the quality of care in those facilities.
I'm not saying we should go in rooms and say, "Sorry, but we're short staffed, so I'll likely end up letting you die tonight." But I have made it clear to patient families that because we're short, I'm not going to be able to do much fluffing and buffing. It will be keep the patient safe, not necessarily happy. Doing peds, I've had to tell parents that they can leave, and the baby will be cared for, but won't necessarily be happy. I'll make sure to get meds, we'll feed and change the baby. But baby won't likely get cuddles. Toddler will get the same, and likely stuck in front of a video. You'll get meds on time, but juice will likely wait. I would love to do more. (Especially cuddle some babies.) But unfortunately, circumstances won't allow. There comes a point where having parents come back from their smoke break and giving me that look of horror that I'd dare be doing anything else when their baby is crying... It gets old. I'm not taking the blame for things beyond my control anymore. Management wants to screw me and our patients? THEY can get the look.
Customer Service 101. Although there are many more complex issues at work in healthcare, it is NEVER acceptable (to the customer) for an employee to use an organizational issue/problem as an excuse for bad service. An alternative to the "we're short staffed" statement is "we are dealing with some very urgent situations right now, but I will make absolutely certain that you have everything that you need".
This brings your patient(s) into a collaborative mode ... most will 'pitch in' by decreasing their demands so that you can take care of the sicker patient's needs. The unspoken commitment? If they have any unexpected problems, they will also receive greater attention from you.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Customer Service 101. Although there are many more complex issues at work in healthcare, it is NEVER acceptable (to the customer) for an employee to use an organizational issue/problem as an excuse for bad service. An alternative to the "we're short staffed" statement is "we are dealing with some very urgent situations right now, but I will make absolutely certain that you have everything that you need".
This brings your patient(s) into a collaborative mode ... most will 'pitch in' by decreasing their demands so that you can take care of the sicker patient's needs. The unspoken commitment? If they have any unexpected problems, they will also receive greater attention from you.
Much to the dismay of my employer, I am not a marketing professional. I am required to be honest with my patients particularly on matters that may well adversely affect their health outcomes. Some very reputable studies have directly linked hours of RN contact in the hospital setting to improved health outcomes. The patients have a RIGHT to know what things are happening with THEIR care that may adversely affect their outcomes. If I tell the patient that the department is short an RN or tech, etc; I am simply giving them information which is important to their care and well being...NOT MAKING EXCUSES.
It should never the be the intention of the RN to attempt to cause harm to the relationship between the employer and the patient, it should also never be the intent to mislead the patient about some aspect of their care when in the acute care or long term care setting either. IMHO.
The hospitals have market and risk management people who can provide some "nuanced" information to patients in an effort to preserve and protect market share or community ratings, etc. Nursing is charged with caring for the patient's health needs while on that nursing unit.
Problem is, the people in charge of customer service in hospitals also aren't marketing professionals. They usually have no concept of managing expectations. Instead it is, tell the patient we will do this and that! When this or that gets missed once, we have failed. If you worked I retail or food service for a few months before nursing, you'll know more about customer service than the people in charge of most hospitals. We're set up to fail and then blamed for failing. Beatings continue because morale hasn't improved.
I never lie if asked, but I don't necessarily volunteer the information. If we were very far behind in a physician's office, we would often give a general reason: emergency at the hospital, etc., and if challenged about that, the reply was always, Well, the doctor would be over there for YOU......" and let the patient figure it out from there. Never, ever had another comment!
I think we all feel this pain. My state does not have legal safe nurse-patient ratios (based on acuity). Each facility determines liability vs payroll for staffing needs. They then staff floors based on lowest payroll cost for the associated legal fees/ judgments. This increases my personal liability, which they will not back if I am named in a lawsuit. With full awareness of this, I am gladly no longer working on a medical unit that wanted to understaff and under support its nurses. The facility that I currently work in is slightly easier (workload), but is also slowly increasing our acuity levels and cutting staffing to boot. Since I work per diem, I can certainly cut my hours to cope with the additional stress and hope to get through each shift. However, I am TIRED of making excuses for my employers. Instead of directly telling a patient that we are understaffed, I INFER it (in non-emergent cases). "I am right in the middle of something right now; my aids are helping other patients. Please turn on the call light and when someone is available, we will be with you." I will NOT apologize for this any longer. The CEO of my organization is the highest paid healthcare CEO in the state. I have not had a raise in 2 years, despite "outstanding" reviews. I don't owe them a thing. I CAN find other work.
I don't know I was told one time the reason for the empty beds were not enough nurses while I had to wait quite a while to be transferred to a floor from the ER. Also, just recently I was told the reason why they didn't feed my brother his breakfast was due to short staffing. I just asked the nurse if she would help reposition him and we did and I fed him. It worked out good as she had to give him his medicine. It helped that I was a nurse and understood
It is all about illusion. You can not say you are "short-staffed" as according to managment, you are not. If you would only manage your time better, stick to the scripting, and just check the boxes. All of the "little extras" are what is keeping a nurse from taking on larger and larger patient loads. But be careful, you need to stick to the script lest you give the slightest hint that ya'll aren't a well oiled machine.
All of which is quite amusing, since we "have the time" and "endevour to give excellent care!!" Cause we don't have the time. And excellent care is subjective.
And be careful about "informing about delays" as THAT could come back and bite your butt too.
If they can't force compliance with an unreasonable demand that a nurse be everywhere at once with multiple patients with multiple needs, they could hire customer service reps as opposed to nurses.....
Old school nursing practice doesn't compute well in today's acute care. So never say you are understaffed, you just need to lower your expectations in practice.
OH, and be sure that if you even hint at the fact that you are busy with an emergency or answer a call bell within 20 seconds instead of 10, be sure that no visitor or patient sees you discussing anything with another coworker (ie: can you waste a med with me) or coming out of the restroom....as THAT will be the focus "Nurse Jade was having conversation with a coworker when I was needing my water glass refilled!! She said that she had the time, and clearly the priority on the floor with EMPTY beds was socializing about weekend plans....." (Uhm I said WASTE not WEEKEND.....) Sigh.
I agree with Wooh---setting up to fail is never a good thing, but it makes way for the customer service reps who will be an integral part of healthcare one day.
Specializes in NICU, PICU, Transport, L&D, Hospice.
In my view, patients are admitted to acute care hospitals because they require nursing care that cannot be provided at that level in another setting.
There are reputable studies which directly link health outcomes to direct contact with an RN in the acute care setting. There are specific nursing functions in the hospital that cannot and should not be completed by non-nurses and those functions should take priority over other functions, duties, or tasks that could be delegated to another discipline or staff member (we are taught to prioritize and delegate in school).
The hospital may not think that the unit is short staffed. However the nurse is not obligated to pretend to have time to pass water AND resusitate patients at the same time and should be free to tell patients important details about the care environment they are experiencing.
It is an important detail that the tech called in, the unit is full, and the facility determined to NOT replace that staff member expecting that the RN will assume responsibility for that additional care without assistance. If you (employer) reduce the number of hours that RNs interact with your acute care patients you are actively and adversely affecting their care and their outcomes. Patients have a right to know.
If we are short staffed and a patient is mad about something taking too long, I absolutely let them know what's going on.
Someone should point out to management, that not allowing us to admit when we're short makes it look like they have an incompetent, lazy staff. Which to me, is much worse.
Acutally, management would prefer it if the patients thought it was a lazy nurse. Then they just say,
"Oh her? Yes, we addressed that problem. Thank you for letting us know." That way, they can pin the lack of customer service on YOU instead of THEM and make you look like the bad guy.
icuRNmaggie, BSN, RN
1,970 Posts
I was just speaking from my perspective as an ICU nurse. My comment was not directed at anyone or meant to sound like an insult.
I agree with toomuchbaloney, in fact I am sure that the lack of staff at my current job is directly related to the drop in scores since January. It is a perfect opportunity for the staff nurses to say "that is when you cut our staff and increased our ratios, we have all we can do making sure that they are safe and receive their medications."
The management aren't very astute about the day to day operations so spell it out for them so they know it's affected the all important bottom line.
Every single lawsuit I know of was settled out of court. Nothing changed, in fact years later, things are even worse as far as the quality of care in those facilities.