Sunday, September 25, 2016

Nursing Staffing Levels Threaten Patient Care

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned 6 patients to care for – an absurd patient volume for a step-down unit.  “Why so many patients?” I asked.  She explained that some nurses called off work and the patients had to be spread around among the existing nurses.

This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale?

I suppose it saves a few bucks on payroll, but this strikes me as very short term gain that risks medical and financial consequences.   Providing high quality medical care can’t be a rushed effort.  If a nurse’s job description increases by 30%, do you think the quality of care and patient/family satisfaction won’t decline?   Don’t administrators fear the risk of medical errors from overworked nurses?  Would any of them like to be patients under these circumstances?

Nurses Need Help

Nurses have confided to me for years how demoralized they are that no one speaks for them.  Instead of watching their backs, they often feel that they are stabbed in the back.

I do not have warm feelings for labor unions and I support right to work initiatives.  But, when I see what nurses endure and the lack of support that they receive, I would support them if they moved to organize.

If a 3rd grade teacher is ill, we expect a substitute teacher to be called in.  The third graders are not simply herded into another classroom expecting one teacher to handle a double load. 
Many of us today are asked to do more with less.  Teachers, law enforcement, businessmen and government program administrators know this well.  At some point, you aren’t cutting fat anymore, but are slicing into bone. We are not taking proper care of those who have dedicated their lives to care for us.  Who will heal the healers?


Anonymous said...

In California there is a nursing Union, and I believe a strong one. Not sure about your state. I work in an ER, and if there is a nursing shortage then patients who would normally be moved into a room continue to wait in the waiting room. Also obviously not ideal. But from my understanding the nursing Union in CA has clout.

Anonymous said...

Aadministrators do not seem to be worried about nurse making errors due to overloading. The institution is the primary client in case of a law suit and the nurse is punished. When nurses stand against unsafe practises they can face diciplinaries at work.
You are more often thrown under the bus instead of being supported.

Michael Kirsch, M.D. said...

Appreciate comment. I wonder how administrators would feel they or their family members were in their own hospital? Would they demand special treatment for themselves?

Anonymous said...

I work at a level one ED in Orlando. The Director is driven by her paycheck and spot on the peg board. Nurses are expected to go far beyond what is safe for the patient's as well as nursing staff. If there are excess patients they are put on cots in the halls and the staff has to take on those patients along with their existing patient load. However if an administrator or their family member shows patients are moved out of private rooms and the administrator or their family or even friends are given that room. If the nurse says something they are more than made aware of how "replaceable" they are. I know this happens throughout the hospital as well. Many nurses were either fired or bullied into finding new jobs a couple of years ago because of this tactic that is becoming the norm in most hospitals it seems.

Michele Coomer said...

My specific unit manager gives the nurse who is taking care of a "family member or employee" less patients so more attention can be given to that "SPECIAL" patient! It's actually quite sickening.

Anonymous said...

Yes it does. I wish Arizona was unionized. There's powerful forces against it here.
Nancy. ICU RN for 30 years.

Anonymous said...

Yes they do get extraordinary treatment as do wealthy donors (and their families) when they are hospitalized. And, they are VERY if a nurse should ignore all her other pts.
Nancy. ICU RN of 30 years

Anonymous said...

YES,YES,YES...all the time for about 20 years in my facility ( inner city hospital). It's a shame.

amykizzle said...

Thank you for posting this story. I started nursing as a second career in my late 30s and have been an ICU nurse my entire career. At my institution we have not yet been overloaded with patient:nurse ratio, but they have taken away almost all our ancillary support. There is no unit secretary so the phones just ring and ring - all the nurses are in patient rooms and not coming out to answer a phone. Most days there is no patient care assistant either for a 24 bed unit, so that extra pair of hands to get patients out of bed safely and turn when indicated, transfer to the med-surg floors, etc is often not available. All the while there is more and more data entry to be done. I've been a nurse now for 11 years and I'm done. I don't think it is any better at any other institution, so I am in a Master's program for family nurse practitioner - I feel that the only solution in the limited time I have left in my career is to leave the hospital setting.

Anonymous said...

I am not a RN yet, but I have worked as a CNA for 8 years and see this happen all the time. When I worked at Maine Medical Center we did have a float pool which helped us out when nurses or assistants were sick but since I have lived in Oregon it has been a nightmare sometimes. Not only for the nurses but the CNA's as well. When you have more then 12 people to take care of with there ADL's it can get too much to handle. I have even been asked to stay at work or come into work really sick and just wear a mask. Which still puts our clients or patients at risk. I am going to school to get my RN but I may be changing my field because over the complete disregard to nurses and there health and just plain well being. Finally someone has noticed! Thank you to all the healthcare professionals out there!!!

BayBrn said...

Bless your heart. I have been a NICU nurse for 35 years. For several years I worked registry and as a traveler. In fact, I worked registry at the hospital where I am on staff now. We have not used registry for about 15 years. When our census goes up we are simply expected to care for more patients unless staff is willing to work extra or we can get floats from the nursery. In addition, we have just started a new computer charting system that is not very "user friendly". Our clientele is extremely demanding and it is nearly impossible to chart while trying to meet the demands of our families. If we stay late to finish up charting we are "disciplined" for using overtime (we work 12 hour shifts). We are often asked to work 16 hour shifts. The kicker is that we are not even allowed to have water in our unit - something about a health department rule (but our breastfeeding mothers can have their lattes at the bedside if they want). Sorry to rant but I am coming to the end of my career and won't even get a discount on health insurance. It's just nice to see an MD notices what we endure!

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