I started to reply to a comment on my post about after vacation blues. ERmurse responded that only by strict adherence to the nursing ratio's can we force administration to change.
I'm all for nursing ratio's, I have been a nurse when things were downright dangerous, however: The ER doesn't get to shut it's doors when the floors are full. People continue to be sick and try to die and need our help. There are times when an influx of sick patients require us to pull up our grown up socks and do a little extra. Patients can't be made to suffer and perhaps die in the ER waiting room. The first plan needs to be REQUIRING hospital administration to staff someone on call to come in to meet surge capacity. If they can't do that then the unit directors need to be responsible for coming in and staffing their unit. That is how it was done in the old days when we were 'head nurses' instead of 'directors'. If all else fails then the floor nurses need to step up, the burden cannot always be on the emergency room. Plenty of times when we are holding patients due to staffing there are nurses on the floors with all their work done sitting around the nurses station.
The last hospital I worked at would go on 'internal disaster' when the ER was overwhelmed. When that happened, all of admin and the directors had to come in, day or night. You'd be surprised at how fast things got done when that happened.
If you think I complain too much then I invite you to walk a mile in my shoes. And remember, someday it may be you, your wife, husband, mother, father, child, brother, grandparent or other beloved relative who is sitting in our waiting room, sick, suffering and in pain because there is no bed.
Wednesday, July 11, 2007
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11 comments:
Good points.
JCAHO should make an accreditation standard to address THIS issue, instead of which words can or cannot be abbreviated.
We were having staffing issues a couple of weeks ago and working extremely short, until one of the charge nurses started calling our nurse manager at 2 am and giving him play-by-play. He had to come in a couple nights in a row, and then miraculously, he managed to solve all the problems. Go figure.
Your preaching to the choir. I to work in an ED that holds patients and transferes patients when beds are available upstairs but no staff. I am a firm believer in the trickle up theroy. If you just suck it up and accomidate working short and taking patients out of ratio nothing will change. If you bring the issue up to the level of your manager then administratior and CEO putting it in their lap telling them them and documenting it through your incident report system and your Union making sure they know that your blocking off beds to non-urgent patients and that your transfering patients for staffing reasons upstairs ect ect then you get their attention. If you just pull up your socks and make the situation work no mater how understaffed you are then what incentive is there to fix it. None.
I think every nurse has gone over and above their duties at one point or another. I don't think staffing ratios are failing the patient. But I absolutely agree that the nurse manager has twenty-four hour responsibility for their unit and if there is no one to come in, they are responsible for doing so! That is how it used to happen in the "old days". My manager pulled night shifts all the time. If they had to deal with the problems themselves, thing would get done a lot quicker.
There has to be some way of dealing with the unexpected surges. We work in a field with no guarantees, no control over our work loads and yet administrations act like the only way to flex nursing hours is down! It's been that way all my career, no one wants to pay "on call" pay just in case, but they will send a nurse home mid-shift. Drives me nuts.
Personally, I think staffing ratios are the best thing that has happened to California. Unfortunately in the ER, we can go "out of ratio" easily. Why not have extra nurses "on call" to handle this? I has got to be cheaper than paying a ton of overtime and extra shift pay, IF you can get regular staff to come in!
Sorry, I'm rambling. In summation, while there are times when nurses just have to adapt to the unexpected, if we keep adapting so well that the "unexpected" is not addressed, administration will sit on their hands. Sometimes I think they take advantage of the nursing professions ability to "make do".
same old, same old in AZ. I have been told that we need to "flex down" when census is low so that we can "flex up" when needed. The problem is that "flexing down" is SO easily accomplished (send someone home)! But is there an actual PLAN for "flexing up"? NO,No and NO! If we need help, we need it NOW. There is no PLAN, no staff available for this imaginary "flexing up". We have decided that nothing will be done about this until someone dies. Management needs to have MANDATORY weekly shifts in the ER. Maybe that will get their heads back out of their a***&es.
I've never been an ER nurse (presently a CRNA) but I can tell you that similar problems happen in PACU also, with surges of post-op patients and nowhere to send them. And some of these patients are SCHEDULED, so the "managers" already knew about their existence.
Even though as nurses we always end up doing whatever is best for the patient, it isn't always what is best for nursing. Because of this, this is an almost universal problem we have enabled. Without having personnel ON THE PREMISES 24/7 to oversee the BIG PICTURE and be a mover and a shaker, it seems to me that these problems will never end, and nurses will continue to complain and be unhappy and some will burn out.
When our daughter, Hannah, is hospitalized, Janette and I remain the in-room (lay) nurse. One of us stays in the room, and we rotate our coverage: one in hospital, one at home resting (or at work, as needed).
As parents, that's our job as part of Hannah's team. Pragmatically, it's also the only way to insure that Hannah's complex health needs will be met. The standard 1-to-4 nurse/patient ratio on the Pediatric Floor isn't adequate for a child using a ventilator, g-tube, etc..
Most of the nurses and RTs know us now, and I think they appreciate the team effort we all contribute for Hannah. I know that this isn't the answer to poor nursing ratios, but I would like to see more parents and families involved where possible.
Please review the use of the apostrophe. Other than that, I'm sorry for your beat in ER, but that's the path you chose, so suck it up. I work on the floor and have my own problems. When my work is done I don't feel like taking on another department's extras. Work is done in this life for payment. If it's free it's charity and that's not why I go to work. More often than not the hospital offers ridiculous incentives for taking on extra work: we get a "thank you" paper signed by our boss. Solutions? Start by actually using that triage and refuse the mothers bringing in their kids for "checkups." Free "checkups" that is...
"The last hospital I worked at would go on 'internal disaster' when the ER was overwhelmed. When that happened, all of admin and the directors had to come in, day or night."
That is brilliant!
As an RN who got her feet wet on tele,icu and med/surg before "choosing my Path" I would like to comment to the november posting from a tele nurse.
I believe that it is "our" responsiblity to ensure that the patients we see receive the appropriate care they deserve and need. It is attitudes "it's not my table" that drive me nuts.
We in the er do not have the luxury to cry "staffing" issures, we can't refuse to answer the phone, not take report because we changing shift, say the room isn't clean and not call back when it is. All of us would love to control the pace at which we see patients. None of us want to go to a new patient when we are not finished with the first, however that is the path ED nurses have chosen.
I am truely disappointed in the way we have segregated ourselves into little units without regard to our fellow nurses. Despite the frustration I feel when floor nurses won't take report or let the phone ring 30 times without answering when they see it is from the ED, if asked I will hold a patient 30 minutes longer so a floor nurse can "catch her breath" between my three patients that are ready to go up. In the mean time the ED is still getting ambulances, walk ins with chest pain, trauma alterts and many other little emergencies.
"I work on the floor and have my own problems. When my work is done I don't feel like taking on another department's extras."
Tele nurse, if the patients down in the ED are admitted under your unit and have not been moved up simply because of ratios, then you're not "picking up another department's extras", they're your patients!
I worked in ED for 3 years and had to cop hallway patients and 3-day waits for an in-patiet bed, and now work up on a ward. Tell you what though, I'd accept one or two patients over my quota any day if I knew that I was helping to relieve the congestion in the ED. I reckon it is far better for the wards to accept one or two patients over their limit than have all of those patients stay down in the ED and just accumulate...
Apologies to any offence that may occur here, but if you're a ward nurse and you've never worked in the ED, then you need to go and do a shift in their shoes. That is the only way you're going to develop an appreciation for just how hard ED nurses are worked, every single day.
*Note, I'm an Australian nurse, so I'm sure there are some differences in our systems. The ED overcrowding and ward nurse ratios seem to be simiar though.*
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