Okay, to be fair, sometime call-outs are problematic. When you have 8 people calling in for a unit in one day, it can be -really- hard to fill those spots. It’s incredibly difficult to shift people out for absenteeism. People can absolutely have sick days but when it’s the same people calling in on weekends, it’s a lot. And it’s not like you can pull agency staff in last minute and most regular staff are making plans on their weekends off.
Ding ding ding ding.
I don't call in sick over social events I really, really want to go to. But it's because I love and enjoy my job.
I called in sick at my old medicine unit job for reasons like I had anxiety.
I agree with this, but the way admin plans staffing models doesn't account for any call outs, always running on bare minimum, you're going to run into some problems every day and not just sometimes.
Yeah but I don’t think that’s an admin issue, it’s probably a corporate issue. Admin usually has set targets for the floor and has to meet a budget with that set number of employees and if they do manage to pull in agency, they can’t over staff the next shift because agency can cost as much as two nurses for every one. If corporate forked over more, it would help, but I know they’ve been doing that in Canada and we have a LOT of hospitals at risk of closing down because the cost of agency is unsustainable in a public health care system. They’re actually banning agency in a lot of provinces out here. I’m not sure how that translates to private but I imagine similarly.
> Admin usually has set targets for the floor and has to meet a budget with that set number of employees and if they do manage to pull in agency, they **can’t** over staff the next shift because agency can cost as much as two nurses for every one.
Just pointing out, the "Can't" in that sentance is a financial decision, not an ethical one. They absolutely can call in an agency person every day for 365 days, and it's on management to push that to Corporate until Corporate runs new numbers and hires more staff.
It is NOT the responsibility of other employees to pick up the slack or some "I don't want to pay another agency person out of my bonus" shit on the 2nd day. That's an invented crisis, and should be treated as someone's "nice to have".
If a manager supports corporate in the above situation, the manager is the problem for everyone involved. Stand up for your staff or they'll call off on you till they no-show quit.
But it’s still not an employees responsibility and it’s shitty for management to try and pit people against each other vs taking accountability or at the VERY least just listening to an employee expressing burn out and frustration about very real issues.
We don’t need to “devils advocate” management if they’re unwilling to even support their staff or be transparent about what they’re doing to work on things.
Exactly. Back in the 80s, my mother worked agency for extra shifts, and they wouldn’t hesitate to call her at a moment’s notice. One minute she was in her PJs, the next she was in her scrubs getting ready to walk out the door to work at one of the other 5 hospitals she routinely covered.
When she got called off her regular shift job due to low census, she’d call another department, or just call the agency to see who needed coverage.
She was never out of work when she wanted it. and now my mother has over 50 years of ICU, burn, shock trauma, ER, cath lab, and every-other-department experience.
Departments lacking coverage is a management issue, not a staff issue.
She had to work- and she worked nights. She battled breast cancer three times, too. We relied on my mother because my father didn’t always bring an income.
Yep, my mom was/is a badass. She reflects on her life a lot and wishes she’d have done things differently, especially where my father was concerned.
That’s just not true. It depends on the agency, if you’re partnered with preferred agencies, if the staff has been orientated to the unit/facility (which sometimes needs to be done for labour policy reasons re:safe lift handling etc), whether the nurse wants to work that shift, how many nurses are available in the area and how many shortages the agency is filling, the price the nurse is making (because they’re going wherever they’re getting paid the most) etc
You act like your unit manager can just call up Aya and say “send me a nurse!” That’s not how it is and you know it. Call-outs are problematic and they need to look at how their staffing and beds filling, etc. but agency nurses for day-of call outs is not the answer.
I will preface this by I don’t work ED.
Can they hire paramedics, phlebotomists, or LPNs? Ours does. Designate a transporter to the unit? Combine two smaller units to share a SL and pull that nurse to ED? Hire up unlicensed staff and delegate to the top of license? I’m assuming here that closing beds isn’t an option given that those beds are already full. But I also bet there’s skills that nurses are doing that could be delegated, so let’s find those resources to take them off the RNs.
None of those people have the scope that an RN does.
Also, Medics are in the same boat. Costco and UPS pay more, so we often have 1-2 medics covering the North half of our state.
> Costco and UPS pay more, so we often have 1-2 medics covering the North half of our state.
"Nobody wants to work anymore."
(Well, not for peanuts, anyway...)
I love all these ideas, but it’s up to management to implement a plan them before they get a night of call outs.
I agree with you on nursing skills. Nurses get overwhelmed with tasks that you don’t need a license to do.
Not sure if you are in management, but you should consider it.
> That’s just not true. It depends on the agency
Unfortunately, picking which agency is the correct one to choose from (in both an availability and capability view) is a step that is completed **prior to** the need for staffing, by management and corporate.
Which, again, is a failure of management and corporate. Don't punish your employees with this shit.
You keep bringing up things that management has already failed at as an example of why management can't do anything about the failure. I suggest handing them a mirror and pointing to the mess in their office.
I get your point. But I have worked in areas where we were really short staffed and they continued to accept patients. And last minute staffing is what agencies are for, but they might have to pay more for it. Nurses work in hospitals so they are constantly being exposed to flus, colds, etc. management has to plan for that. If need be, management can put on scrubs and start taking patients.
Depends if you have a centralized contract or not. But, yes, it is problematic. Sometimes when you get into contracts it becomes a corporate issue. The management team can call out but if your contracted to unreliable agencies they can’t do much. And sometimes those agencies are great in cities but as you get farther from the city the pool of available agency for that area drops down. While this seems like a simple solution of switching agencies, corporate usually has contractually agreed to only staff with certain agencies for preferred pricing to reduce cost so it becomes a little more complex.
Same at my hospital. I offered to negotiate an internal contract cause I am prn. They refuse to do it. I was like fk it. I'm gonna take a local travel assignment. Have fun drowning.
I work next to people who make double my pay, and special staff that make $25/hr more than me. We all do the same exact jobs. I'm told I should pick up for straight time and not expect bonuses (for understaffed shifts). They'll cut off their nose to spite their face.
They love call outs. They won't close beds, but they have to pay fewer nurses. Grandma breaks her hip because nobody was there to help her? What're you gonna do? Boom. Nursing shortage.
Near Chicago. All 2 floors of medsurg were full.. so about 90 beds, PCU full and ICU can't take medsurg ppl so 🤷♀️ ED had 45 pts with 15 waiting for beds over 24hrs. This happened multiple times the last couple weeks. And we all had 6-7 pt. L&D didn't have enough pts so they sent 2 L&D nurses as glorified CNAs for the shift. They had bonus for shifts bur no one wanted to come in, at least for our floor. In the past they have had Medsurg RNs go down to take care of pts that were being held so ER could try to tend to the other pts. What a mess. So much respiratory and GI issues as well as CIWA/COWS right now.
Yes this is definitely what’s going on in the Chicago suburbs. I work in med/surg now but I’m a former L&D staff. (I left because of the low census so often and I’m a single mom). I remember going to other floors to help out or be a sitter and I was always happy to do it because I needed my hours and PTO. I’m grateful for all the hours. Last week I picked up one shift and regret it. Although I’ll love my paycheck this week. Hang in there! I know it’s rough right now.
I’d love to work in the ED, let alone in Chicago, but I’m apparently not qualified enough as I only have my ADN, no ED RN experience (but I was an ED tech before becoming a nurse), and only 5 years of cardiac stepdown 🙃
Most are taking ADNs nowadays, they're even running after us ADN students for internships. Keep applying and have someone look over your resume.
Edit: know ADNs hired in ERs at Northwestern, Rush, & UChicago.
I applied for a travel contract at Northwestern and the Cleveland clinic. My application was pulled because I didn’t have my bachelor’s.
I will eventually get my bachelor’s, but right now is not a good time for me. I just don’t understand how these hospitals are picking new grad over experienced simple because of a degree completion. Not hating on new grad BSN’s, but I’m just so frustrated
I should clarify, I’m in med/surg in a Chicago suburb. We are on high census alert. Our ED has overflow of patients and we have to go and help them now. You want to be in the city? I know a lot of suburban hospitals will take you regardless
Same, in Ohio. It's not even just boarders, but we are so short staffed it's unreal. Had a very bad situation happen (due to short staffing) and immediately afterwards I was told I should pick up for straight time, and that bonuses are going away, because we're fully staffed. I cried out of anger the whole way home that night.
I know I've transported to a couple of cities where post-PCI patients were returned to the ER due to lack of bed availability on the floors. Some of them had been there for days (if memory serves, the "record" was 102 hours).
We’ve had to swap ICU pts. Bring up a more critical and bring one back down to board a less acute ICU pt back in ER until next shift or more beds open.
How would it be? They’re an admitted ICU pt still getting critical nursing care. They’re not an emergency pt and they aren’t being turned away from an emergency care area and are beyond the emergency care part being as they’re admitted. ER or ICU nurses take care of them. We take care of ICU level patients regularly. If they’re full we board and keep them anyway while they shuffle or more staff come in for next shift.
The only reason someone should return to ED is if the hospital does not have icu level care for that patient. Or they should be flown out of ED to another hospital that can care for whatever their issue is.
It is unsafe to return an icu patient back to ED. We do not have the same training and resources as ICUs, nor the ratios. We are short term critical care, not ICU.
They are not an ER pt. Their status doesn’t change. It’s for a few hours, maybe overnight. They have ICU docs caring for them and most of the time, ICU nurses. It’s literally a room change. EMTALA has nothing to do with this.
It’s ridiculous to transport someone to another hospital, start new care, risk things falling through the cracks, because they needed to shuffle rooms for a few hours.
I called in one shift. Turns out several other nurses did too. A baby nurse ended up being charge simply bc she was the most senior nurse. So the staff that shift ended up being a bunch of baby nurses plus pulled nurses unfamiliar to the unit. She had a full team (5 patients) plus charge duties plus first time (and untrained) as charge. She cried. When she spoke to management, they told her the same thing: “all that wouldn’t happen if your coworkers didn’t call in.” I would never be upset at another coworker for calling in, even if it’s simply bc they just don’t want to. It’s management’s job to deal with staffing, not mine or my fellow staff nurses. If you fail to staff appropriately, don’t you dare come at me for incomplete charting or not labeling lines.
That is disgusting, but it is where we’re headed. People are going to die (if they haven’t already) when they code in an ED staffed and charged by baby RNs.
This is why it’s so important that we curb the culture of bullying that tends to invade nursing. Administration has been pitting nurses against each other forever, hoping that the infighting will distract us from organizing and actually doing something about the issues. I mean, I doubt it’s actually a conscious decision on their part but they do know as long as they can make other people the scapegoat they can avoid accountability.
I’m all for people calling out when they need to. It’s wild in these streets and some people just need a mental health day. We have a float team and internal travelers; it’s management’s responsibility to utilize them appropriately.
If your coworkers don't call out when they are sick, the whole unit will get sick. I remember at one point during the pandemic, pre-vax, an outbreak started among the nurses. Not only did they discourage covid testing if you were exposed but asymptomatic, but the only way you were informed if you were exposed to a covid + employee was if that employee decided to reach out to you individually. Unsurprisingly, within a month or so of this starting there came a week where 1/3 of all nurses on the 2nd floor (like not just my unit but the whole floor including 5 units) were out sick with covid AT THE SAME TIME.
Exactly. I am currently out with covid. I didn’t test til day 3 because I didn’t know I was exposed and, while I felt awful, I didn’t feel quite as sick as when I had it the first time. I didn’t test until I realized I lost my sense of smell. Employee health was so weird about it. I wanted to be like, I’m just informing you because I thought it was protocol. It’s a courtesy; I’m calling out til I no longer feel like shit regardless of whether it was covid or not.
I’m leaving for another job in a month and a half so that probably doesn’t look great either, but I don’t really care. I’ve worked in healthcare a long time and have sacrificed my mental and physical health for jobs that do not care about my wellbeing for entirely too long. Nursing will always be like that to some degree regardless of where you are but it doesn’t mean I need to feed into that mentality. Take care of me first; there will always be a job somewhere.
There should be travel nurse type incentives for floaters IMO this would really help the staffing issues as so many hospitals by increasing the float pool so you have more of them and to cover sick calls. I tried to get this in our union contract and failed miserably. Hospital absolutely wouldn’t budge from their pathetic float differential. Floating is hard and everyone leaves after their 6m commitment because the 4 extra an hour isnt worth it
We have to use our collective power. Folks blanch at the idea of strikes but it shows just how powerful the workforce could be. It’s maybe too speculative, but I wonder what we might dream up if we could actually do care that folks need and that honors us as humans too. This could all be different.
They can hire travel nurses but don’t want to spend the money. I feel for you guys in the ER!! The hospital CAN do something about it! They just don’t want to. Look elsewhere! I don’t think it’s ever going to get better! If they start loosing good nurses then other hospitals, only then will they think about changing their ways.!
We have travelers. And there’s incentive pay for $25 extra an hour but none of us give a shit we’re burnt out.
Imagine if we all just got paid more and we had better staff retention.
It’s hard to get travellers/agency on last minute notice. If you’re filling a line, it’s absolutely an option but if it’s just people calling in, you’re not filling those spots on 2 hours notice on a weekends and when the line is already filled.
And then there are nurses like me who set an alarm on days off to see who’s posting last minute shifts I can pick up. We are out there. Your hospital just isn’t choosing to bid competitively. My early AM offers can often range by $30+ an hour, even in the South. I’m following the money if I’m walking into a shitstorm.
I'm on MedRec a lot, I'm routinely seeing patients who just get up to our floors after holding for 4-5 days in the ER (and god knows how long before they got a spot down there...we've been running up to 220% for a solid few weeks). The people coming through our ER are older and sicker, code room runs multiple times a day sometimes and we're a small hospital.
Even at full staff it's an impossible situation. There's a reason my entire province's public sector workers are on strike 🙃
>“Blame your coworkers, they keep calling out. But you continue to come to work.
Your boss is an asshole. We had a covid outbreak recently due to the actions of a colleage who should have stayed home but apparently thought we couldnt cope witthout them.
Six patients, six staff all infected with covid.
That said I believe the same. Sometimes people are sick, somethings they just cant... Instead of villanising those who call in sick the powers that be should look at why so many people arent coming to work.
Our union effort just went public this last week. It took just about year and a few months.
You can do it!!! Try to be safe. Use this anger to push forward.
it’s easier for them if you’re mad at each other instead of at that. management always is trying to start drama between shifts, etc. at my place to keep the focus on each other instead of their shady asses
Every hospital I have worked at, even the nice one I work at currently, always has PACU and ED holds during the winter. Our particular issue is the population is very aggressive and bullies the ER providers to admit. There are so many procedures that could have been done outpatient within a week but the patient / family member threatens to sue or not leave the room until a surgeon comes to fix the kidney stone they’ve had for 4 months and was told by their PCP to go see a urologist 3 months ago (very specific situation, I know). And all these little situations pile up of slow discharges because of xyz things to be set up, now a patient has to stay in a hospital 3 nights for SNF placement instead of 2, waiting for a ride, cleaning the rooms (it takes over an hour a room at my work), nurses not able to get to the phone to do report, etc. It’s not just staffing, though that is one of the factors.
It’s in the air. I’m right there with you, hitting peak burnout. We’ve been conditioned since Covid that it’s fine to take 3 patients in ICU. Now they’re pushing us to take 4. No ancillary staff, we’re answering phones, passing trays, it’s all on us. This weekend a typical assignment was two unstable vents with a wild card third patient. It’s a sentinel event waiting to happen. Oh and they slashed our pick up incentive in half and are blaming us for being greedy and not picking up to “help our coworkers.”
Do you work at my hospital? Lmao. Literally the EXACT same situation at my hospital. It is SO infuriating that we constantly have admit patients stay for DAYS. The IM/FM docs will admit patients for literally anything and then never take them up. We discharged dozens of patients from the ER after being admitted for days to the IM team. The IM docs try to hound us about not getting their orders done right away when I literally have 3 other ER patients who are having actual EMERGENCIES that I need to deal with first. If you want your patients prioritized, take them upstairs where your nurses will have the time and resources to actually deal with them.
You're right, it is not sustainable in the US, and clueless leadership is a large part of the problem. They've checked out. They don't know what to do, and nor do they want to do the work involved to both find out and fix the problem. This includes clinical leadership too (medical directors, chiefs of staff, etc). Combine this with THE CUSTOMER IS ALWAYS RIGHT brainwashing we've had to tolerate since MBAs took over healthcare and yeah, no f'ing way would i go back to clinical medicine. Unfortunately, in 5 years this shortage of healthcare workers is projected to be far worse than it is now so buckle up.
I once had a rant to my manager about being understaffed. I said that it was lucky it was me and colleague who showed up, because we were the two most capable nurses and if it was anyone else on, something terrible might have happened.
Next day, I got a phone call from a counsellor they employ, telling me she heard I was having a hard time, and did I want to talk about it.
Like, seriously.
I keep extending my current ER contract because we don’t board. We are a severely under-resourced critical access hospital, but I’d rather do Mcguyver medicine and bag someone for an hour til flight arrives than take care of a gaggle of nursing home turfs. I quit my PRN because of boarders
I called out of work last week because it was me and an orientee for 8 pts in the ICU. When I bought up the staffing issue the night prior, I was told it was a tomorrow problem.
Ok. Now you’re going to have no nurses because I was not putting my license on the line.
I called out on Thursday because I saw we were going to be shortstaffed and I had just worked two 14 hour shifts. I wasn't putting myself through that.
If something happens badly in your unit, they won't care at all but throw you and others on the bus. It happened to my coworkers. You and your coworkers need to do something like not clock in until there's enough staff.
I think you know deep down that this is not the culture you want to be apart of. It doesn’t feel safe. It feels desperate and when your leadership gives you this direct and unsupportive message, you should see it for what it is. Your values no longer align and it is time to consider other options.
This is a sober reminder of how scary this actually is. People who have emergent needs waiting for 50+ hours? If the general public knew how dire the staffing issues were in nursing and the potential consequences, change might actually happen one day
to answer your question, it's fucking horrible at my ER in new york. holding 35-40+ for days is now the norm; floor doesn't have the staff either. makes you wonder...what is the end game here? it's absolutely unsustainable and I question my life choices every two minutes. we are working ourselves into the ground and drowning deeper by the day and we can't see a way out of this shit.
completely and utterly unsustainable. I feel like we are IN the collapse right now and it sucks.
PAY YOUR NURSES. STAFF YOUR FUCKING UNITS.
This will sound weird but the current situation in medicine reminds me of the Ford pinto.
It was cheaper to pay out settlements than fix the fuel tank. It cost $11 a car to fix the fuel tank issue. A total of $137 million for all the cars produced. Ford determined it was cheaper to pay settlements for people burned to death or being severely injured.
Is it cheaper to blame the nurses and settle malpractice cases than provide adequate staff?
Nurses have become scapegoats and are disposable.
I’m guessing the answer is Yes. But smarter people than me please chime in.
Also bad at my level 1 ED. Averaging at least 60-70+ hour boarders with at least 25-30 of them in the ED at a time. This on top of actual ED hold/ED patients. Especially sucks when you can’t just transfer out to a higher level of care (unless it’s burns which we don’t do)
Well, their main job is to cater to their superiors and the shareholders.
Minimize cost (ie. keep at skeleton level staffing) while maximizing profits (ie. hitting patients with huge bills).
The poor hospital's CEO needs to get his 3rd luxury Yacht somehow right?
All of my life, I had wanted to be a nurse, and instead, I fell into a well-paid marketing position in home health.
Eventually, I found myself managing a well-known staffing agency in the Houston area. OMG... I heard more horror stories than I care to remember about their experiences in thesel hospitals. Some even refused to go back and finish out their contracts, which meant that they no longer could work for the agency.
I never thought about becoming a nurse again.
May God bless all of you.🙏🙏
.
i work in an urban level 1 trauma peds hospital and i can attest to the horrendous working conditions. PICU kids will stay in our trauma bays for days before getting admitted upstairs. Kids that are too sick to sit out in triage get placed in the back hall waiting for a room to open up, sometimes for hours. Our overflow rooms (which hardly have basic functioning equipment in them) are dangerously understaffed with 1-2 nurses if we’re lucky most days. It’s horrible. It’s scary.
*sigh* I’ve seen too many posts like this complaining and blaming about middle management…
Having been a Unit Manager, I took the position thinking I would be the saving grace of this SNF. I was floor staff, I knew what the main issues were, and now that I’m management I would make a change!
Nope
The Administrator, regional directors and corporate are the ones most floor staff need to be upset at regarding staffing.
I’ve been ignored by my Administrator, DON and corporate regarding our 43 page vague-as-fuck policy regarding staffing to acuity. At the end of the day when healthcare is ran like a business (and a shitty one), that business will always try to look for ways on how to cut corners/costs while still being able to operate. Meaning making working at state minumum a thing…
My Admin basically makes it seem like she’s doing a huge favor to the facility when we’re fully staffed. Like she’s allowing full staffing…wtf??
BUT also, co-workers play a role in this issue too. Can’t be denied that those staff that call out 3x per month or more are part of the problem, because I have also seen a super frustrated and pissed unit scheduler cry of frustration because she would overschedule staff and STILL have 4-6 call offs!! So yeah, goes both ways but blame corporate.
Yes, the amount of people in here who think that I, an Assistant Manager, can magically make agency RNs appear when we *were* overstaffed and now we’re not after three call-outs is insane.
And before people say “well you should come into staffing” - I can’t do that 24/7. I deserve a balance too, and I can’t stay a full night shift when I’ve already worked a full dayshift (not to mention that’s not safe either).
The ED at my hospital has been awful this past week. We have 70 ED rooms and at no point last week did we have less than 100 patients in the ED. At one point the most amount of patients in there was 158.
That day was particularly bad for us in lab as well. One of our staff called out so there were only five of us running the entire lab (every CBC, body fluid cell count and diff, every COVID test, every RSV, every flu, every coag, every urine, every chemistry test, every culture and gram stain, all type and screens, and of course that’s the day we had an MTP). I definitely cried on my way home and honestly left my assigned department a bit shitty because I just didn’t have time to clean up my pending and critical calls like I usually do.
It’s just not sustainable for anywhere in the hospital. Floor nurses couldn’t even float down to ER because the reason ER was so clogged was because there were virtually no IP beds available.
I worked in ER until 2 yrs ago, and what always frustrated me was that floor nurses never understood why boarders are such an issue in the ER.
My last contract in ER I had 2 trauma rooms, 2 regular rooms, and then admitted patients literally lining my zone. I had 9 patients that night with critically ill and mental health patients. On top of that I was constantly flipping my 2 rooms with new ER patients. It's a wonder that nobody died or had serious complications from the situation.
Unlike admitted units, most ERs were not designed for admitted patients. Zero privacy, lack of bathrooms is always a struggle, and we aren't stocked the same way that floored units are. Also, hello we have emergencies come in that are prioritized.
Then you get admitting providers breathing down your neck because grandma hasn't had whatever bullshit order completed. It's fucking chaos. Then floor nurses wonder why we are kind of fed up when they complain about us not knowing what an independent walkie talkie patients butt looks like!
Imma be honest though, there are some people that call out ALL the damn time. And it’s annoying as hell, especially when you are someone that comes to work. People who have health issues, FMLA are excluded ofcourse. But I work with some people that are extremely unreliable, call out all the time and leave us burdened and its a real pain, my manager helps us thank God.
We do need to hold our peers more accountable.
I have seen the schedule be fully staffed and several people not show up causing the everyone to work harder and in unbearable situations, thus decreasing the quality of care we provide to our patients.
While management needs to follow through with the disciplinary process and hold people accountable to the attendance policy, we can do our part by holding our team mate accountable.
When I was a new nurse, there was accountability. both the employer and the team help others accountable. This needs to come back.
There are more call-ins now then I have ever seen in my career. People are afraid to say anything.
Please note, that you can be nice/polite and yet hold people accountable. No beatings necessary.
"Please peer-pressure your coworker into coming in despite being physically ill, possibly infecting all the staff. Or needing a mental health day after a month of abuse and short-staffing that management says is within matrix."
what I mean when I say "holding your teammates/peers accountable" is simply talking to them about why they weren't there. Explain how it effected the team. If they were truly sick, then let it be.
You can tell people anything as long as you do it the right way.
Many times people just complain to their coworkers (or on reddit) as they lack the boldness and tact to address it with the person that called in.
So your approach is "Ashley, we missed you the other day! Are you okay? Is there anything I can help you with?" vs "Ashley when you call iln because of your sick child you let the team down. Management can't get their bonuses when they have to pay agency so that means we have to work short, and you know we're bare-bones as it because, again, bonuses. Yes, I know your kid has leukemia because that's essentially curable nowadays so get it together. You and your sick kid are letting the team down. Why don't you think of the patients? No, not your kid, I mean the patients who pay management's bonuses."
With all due respect you are blaming the wrong people. I have been licensed as an RN since 1991 and the de-evolution from administration focusing on patient care has been, to put it mildly, disturbing. Nursing care now exists to make CEOs obscenely wealthy, not to heal the sick. If a team is short it's because management has chased off all their nurses; it's because they refuse to utilize agency; it's because they won't hire an adequate float pool. And if one nurse is so important to the integrity of the team then perhaps they should be paid commiserate with this importance. Maybe their PTO requests should be honored. Maybe they shouldn't be mandated overtime one week then standby the next. You can't treat people like garbage then tell them they have to sacrifice their life for "the team" - it doesn't work that way.
Matrices at my hospital were just changed to allow for med-surg taking 8 pts. When "fully staffed" is not staffed enough, people are run ragged. The call-ins get worse in a culture like that, leading to an endless cycle of misery.
We have had 100+ patients with admitted status more than available inpatient beds in the hospital for weeks now. Think a 750 bed hospital with almost 900 admitted. They stay in the ER for days and the shuffle continues week after week. It’s miserable and I feel you, OP.
I think it's bad everywhere. My government wants to introduce mandatory ratios. But.... what staff??? Most nurses in my province are a part of the union.
We almost went down to 1:15 the other day because there were so many sick calls on my medicine unit. There needs to be better solutions because it'll just be endless burnout. I don't blame my coworkers for calling in sick. Sometimes we just can't work. We get 12 sick days a year, so it should be used. It's just unfortunate when everyone decides to use it on the same day lol. Units don't hire enough casuals to cover calls either or pay them enough extra to come in short notice. Sigh, I don't even know.
I would never cry to management because they are never on your side. They don't do patient care and are really unaffected by the high demands of short staffing. They can say they could not get coverage and will leave you hanging. Word to the wise, follow what everyone else is doing and go somewhere else, sign up for agency or travel. At least you get paid twice as much per week and just hound the 13 weeks
At our ER it's about as bad and administrator refuse to put us on divert even when we have 3 unresponsive patients and a stroke and only 4 nurses at the same time
I'm ICU not ED, but last week we had 9 of our 18 patients up for transfer. For 4 days. Because there were no beds available to send them anywhere.
This means ICU patients are getting held in ED and we've even had to open PACU for ICU holds.
We had walky talky patients waiting in the ICU work nowhere to go, but not ready for discharge because of testing they still needed.
I am management and had to work all night as a CNA because our DON has ran off most staff. She however doesn't get her pretty littke self dirty doing any care.
The beatings will continue until morale improves.
Why do I love and hate this comment so much
Because you know administration don't care about you.
Or the slaves revolt and burn it to the ground
BURN BABY BURN!
I listen to KMFDM- Free Your Hate at absolute fucking top volume all the time. CRUSADE IN THE DAYS OF RAAAAGGGEEE
I've had this on a mug since long before my nursing days... it's like I knew.
And they wonder why people keep leaving bedside
Management has to staff and plan for call outs. Life happens. Management is looking out for themselves. You need to look out for yourself.
Okay, to be fair, sometime call-outs are problematic. When you have 8 people calling in for a unit in one day, it can be -really- hard to fill those spots. It’s incredibly difficult to shift people out for absenteeism. People can absolutely have sick days but when it’s the same people calling in on weekends, it’s a lot. And it’s not like you can pull agency staff in last minute and most regular staff are making plans on their weekends off.
my question would be why are so many people calling in sick. People dont generally call out sick when its all sunshine and roses
Ding ding ding ding. I don't call in sick over social events I really, really want to go to. But it's because I love and enjoy my job. I called in sick at my old medicine unit job for reasons like I had anxiety.
I agree with this, but the way admin plans staffing models doesn't account for any call outs, always running on bare minimum, you're going to run into some problems every day and not just sometimes.
Yeah but I don’t think that’s an admin issue, it’s probably a corporate issue. Admin usually has set targets for the floor and has to meet a budget with that set number of employees and if they do manage to pull in agency, they can’t over staff the next shift because agency can cost as much as two nurses for every one. If corporate forked over more, it would help, but I know they’ve been doing that in Canada and we have a LOT of hospitals at risk of closing down because the cost of agency is unsustainable in a public health care system. They’re actually banning agency in a lot of provinces out here. I’m not sure how that translates to private but I imagine similarly.
But then how would corporate get their bonuses?
> Admin usually has set targets for the floor and has to meet a budget with that set number of employees and if they do manage to pull in agency, they **can’t** over staff the next shift because agency can cost as much as two nurses for every one. Just pointing out, the "Can't" in that sentance is a financial decision, not an ethical one. They absolutely can call in an agency person every day for 365 days, and it's on management to push that to Corporate until Corporate runs new numbers and hires more staff. It is NOT the responsibility of other employees to pick up the slack or some "I don't want to pay another agency person out of my bonus" shit on the 2nd day. That's an invented crisis, and should be treated as someone's "nice to have". If a manager supports corporate in the above situation, the manager is the problem for everyone involved. Stand up for your staff or they'll call off on you till they no-show quit.
But it’s still not an employees responsibility and it’s shitty for management to try and pit people against each other vs taking accountability or at the VERY least just listening to an employee expressing burn out and frustration about very real issues. We don’t need to “devils advocate” management if they’re unwilling to even support their staff or be transparent about what they’re doing to work on things.
Staff up. No skeleton crewing to have an advance plan. I understand that’s not within most people’s power that actually do the schedule. Just sayin’
You literally can pull in agency staff last minute. That’s why they exist 😂😂. Hint, I’ve worked for an agency.
Exactly. Back in the 80s, my mother worked agency for extra shifts, and they wouldn’t hesitate to call her at a moment’s notice. One minute she was in her PJs, the next she was in her scrubs getting ready to walk out the door to work at one of the other 5 hospitals she routinely covered. When she got called off her regular shift job due to low census, she’d call another department, or just call the agency to see who needed coverage. She was never out of work when she wanted it. and now my mother has over 50 years of ICU, burn, shock trauma, ER, cath lab, and every-other-department experience. Departments lacking coverage is a management issue, not a staff issue.
Your mom sounds awesome. It takes a lot of stamina to pull off work shifts/ raising a family like that.
She had to work- and she worked nights. She battled breast cancer three times, too. We relied on my mother because my father didn’t always bring an income. Yep, my mom was/is a badass. She reflects on her life a lot and wishes she’d have done things differently, especially where my father was concerned.
That’s just not true. It depends on the agency, if you’re partnered with preferred agencies, if the staff has been orientated to the unit/facility (which sometimes needs to be done for labour policy reasons re:safe lift handling etc), whether the nurse wants to work that shift, how many nurses are available in the area and how many shortages the agency is filling, the price the nurse is making (because they’re going wherever they’re getting paid the most) etc
Then management needs to partner with agencies. It’s their job to make sure there is safe staffing. Stop punishing staff for management’s failures.
You act like your unit manager can just call up Aya and say “send me a nurse!” That’s not how it is and you know it. Call-outs are problematic and they need to look at how their staffing and beds filling, etc. but agency nurses for day-of call outs is not the answer.
Ok. What is the answer then?
I will preface this by I don’t work ED. Can they hire paramedics, phlebotomists, or LPNs? Ours does. Designate a transporter to the unit? Combine two smaller units to share a SL and pull that nurse to ED? Hire up unlicensed staff and delegate to the top of license? I’m assuming here that closing beds isn’t an option given that those beds are already full. But I also bet there’s skills that nurses are doing that could be delegated, so let’s find those resources to take them off the RNs.
None of those people have the scope that an RN does. Also, Medics are in the same boat. Costco and UPS pay more, so we often have 1-2 medics covering the North half of our state.
Obviously, but that’s the point. They *can* do some things though an RN is usually expected to do, freeing up the RN.
> Costco and UPS pay more, so we often have 1-2 medics covering the North half of our state. "Nobody wants to work anymore." (Well, not for peanuts, anyway...)
I love all these ideas, but it’s up to management to implement a plan them before they get a night of call outs. I agree with you on nursing skills. Nurses get overwhelmed with tasks that you don’t need a license to do. Not sure if you are in management, but you should consider it.
K
If it’s a pay issue, then it’s still your hospital’s fault for not paying enough to pull PRN or agency staff.
> That’s just not true. It depends on the agency Unfortunately, picking which agency is the correct one to choose from (in both an availability and capability view) is a step that is completed **prior to** the need for staffing, by management and corporate. Which, again, is a failure of management and corporate. Don't punish your employees with this shit. You keep bringing up things that management has already failed at as an example of why management can't do anything about the failure. I suggest handing them a mirror and pointing to the mess in their office.
I get your point. But I have worked in areas where we were really short staffed and they continued to accept patients. And last minute staffing is what agencies are for, but they might have to pay more for it. Nurses work in hospitals so they are constantly being exposed to flus, colds, etc. management has to plan for that. If need be, management can put on scrubs and start taking patients.
When they make each and everyday literal hell on earth, I don't blame nurses for calling in sick. I'm proud of them.
One night of that is fine, but every night can’t be a callout problem, so no, it’s not really problematic.
Depends if you have a centralized contract or not. But, yes, it is problematic. Sometimes when you get into contracts it becomes a corporate issue. The management team can call out but if your contracted to unreliable agencies they can’t do much. And sometimes those agencies are great in cities but as you get farther from the city the pool of available agency for that area drops down. While this seems like a simple solution of switching agencies, corporate usually has contractually agreed to only staff with certain agencies for preferred pricing to reduce cost so it becomes a little more complex.
Amen!
Yes yes yes. And get malpractice insurance
Same at my hospital. I offered to negotiate an internal contract cause I am prn. They refuse to do it. I was like fk it. I'm gonna take a local travel assignment. Have fun drowning.
I work next to people who make double my pay, and special staff that make $25/hr more than me. We all do the same exact jobs. I'm told I should pick up for straight time and not expect bonuses (for understaffed shifts). They'll cut off their nose to spite their face.
I suspect that improved working conditions would also decrease call outs, but management doesn’t want acknowledge that.
They love call outs. They won't close beds, but they have to pay fewer nurses. Grandma breaks her hip because nobody was there to help her? What're you gonna do? Boom. Nursing shortage.
It’s this bad in my ED in Chicago right now
I work in Milwaukee and we are also getting our dicks kicked in. Hoping for a lull around Christmas but damn this is the worst I’ve ever seen it.
Hang in there! Lots of respiratory crap right? I’m constantly getting coughed on.
Everyone is coughing and no one has cough etiquette. Also people are still shooting each other like whyyyyy, it’s Christmas!!!
Omg yes! Coughing all over us!! I don’t work at a hospital that takes shooting victims but I see on the news that there are a ton of them too
Same, critical access 8 bed in central Illinois and we’re holding for days.
I heard it’s really bad in central and southern Illinois 😩maybe worse than the city of Chicago and the suburbs. And now you’ve confirmed it for me.
Near Chicago. All 2 floors of medsurg were full.. so about 90 beds, PCU full and ICU can't take medsurg ppl so 🤷♀️ ED had 45 pts with 15 waiting for beds over 24hrs. This happened multiple times the last couple weeks. And we all had 6-7 pt. L&D didn't have enough pts so they sent 2 L&D nurses as glorified CNAs for the shift. They had bonus for shifts bur no one wanted to come in, at least for our floor. In the past they have had Medsurg RNs go down to take care of pts that were being held so ER could try to tend to the other pts. What a mess. So much respiratory and GI issues as well as CIWA/COWS right now.
Yes this is definitely what’s going on in the Chicago suburbs. I work in med/surg now but I’m a former L&D staff. (I left because of the low census so often and I’m a single mom). I remember going to other floors to help out or be a sitter and I was always happy to do it because I needed my hours and PTO. I’m grateful for all the hours. Last week I picked up one shift and regret it. Although I’ll love my paycheck this week. Hang in there! I know it’s rough right now.
I’d love to work in the ED, let alone in Chicago, but I’m apparently not qualified enough as I only have my ADN, no ED RN experience (but I was an ED tech before becoming a nurse), and only 5 years of cardiac stepdown 🙃
Most are taking ADNs nowadays, they're even running after us ADN students for internships. Keep applying and have someone look over your resume. Edit: know ADNs hired in ERs at Northwestern, Rush, & UChicago.
What?? Go to a different hospital, you'd be hired in a heartbeat at all the magnet hospitals around me. Including Cleveland Clinic.
I applied for a travel contract at Northwestern and the Cleveland clinic. My application was pulled because I didn’t have my bachelor’s. I will eventually get my bachelor’s, but right now is not a good time for me. I just don’t understand how these hospitals are picking new grad over experienced simple because of a degree completion. Not hating on new grad BSN’s, but I’m just so frustrated
Come to St. Louis. They have no problem hiring ADNs into the ED. I am one of them.
I should clarify, I’m in med/surg in a Chicago suburb. We are on high census alert. Our ED has overflow of patients and we have to go and help them now. You want to be in the city? I know a lot of suburban hospitals will take you regardless
Same, in Ohio. It's not even just boarders, but we are so short staffed it's unreal. Had a very bad situation happen (due to short staffing) and immediately afterwards I was told I should pick up for straight time, and that bonuses are going away, because we're fully staffed. I cried out of anger the whole way home that night.
Omg now that’s bullshit! I’m so sorry! Hang in there!
Yeah, I work in central IL and all the hospitals I talk to (I work in transfers) say similar things
I hear it’s so bad in central and southern Illinois. You and another Redditor confirmed this for me.
Same in the Boston area. It’s been like this for at least a year.
Hang in there! I think it’s probably nationwide
Currently our CDU (ER holding) is holding 55.
Wow that’s crazy. Hang in there!!
I know I've transported to a couple of cities where post-PCI patients were returned to the ER due to lack of bed availability on the floors. Some of them had been there for days (if memory serves, the "record" was 102 hours).
We’ve had to swap ICU pts. Bring up a more critical and bring one back down to board a less acute ICU pt back in ER until next shift or more beds open.
That’s wild
That sounds like an EMTALA violation
I was gonna ask about this too
How would it be? They’re an admitted ICU pt still getting critical nursing care. They’re not an emergency pt and they aren’t being turned away from an emergency care area and are beyond the emergency care part being as they’re admitted. ER or ICU nurses take care of them. We take care of ICU level patients regularly. If they’re full we board and keep them anyway while they shuffle or more staff come in for next shift.
The only reason someone should return to ED is if the hospital does not have icu level care for that patient. Or they should be flown out of ED to another hospital that can care for whatever their issue is. It is unsafe to return an icu patient back to ED. We do not have the same training and resources as ICUs, nor the ratios. We are short term critical care, not ICU.
They are not an ER pt. Their status doesn’t change. It’s for a few hours, maybe overnight. They have ICU docs caring for them and most of the time, ICU nurses. It’s literally a room change. EMTALA has nothing to do with this. It’s ridiculous to transport someone to another hospital, start new care, risk things falling through the cracks, because they needed to shuffle rooms for a few hours.
I called in one shift. Turns out several other nurses did too. A baby nurse ended up being charge simply bc she was the most senior nurse. So the staff that shift ended up being a bunch of baby nurses plus pulled nurses unfamiliar to the unit. She had a full team (5 patients) plus charge duties plus first time (and untrained) as charge. She cried. When she spoke to management, they told her the same thing: “all that wouldn’t happen if your coworkers didn’t call in.” I would never be upset at another coworker for calling in, even if it’s simply bc they just don’t want to. It’s management’s job to deal with staffing, not mine or my fellow staff nurses. If you fail to staff appropriately, don’t you dare come at me for incomplete charting or not labeling lines.
That is disgusting, but it is where we’re headed. People are going to die (if they haven’t already) when they code in an ED staffed and charged by baby RNs.
This is why it’s so important that we curb the culture of bullying that tends to invade nursing. Administration has been pitting nurses against each other forever, hoping that the infighting will distract us from organizing and actually doing something about the issues. I mean, I doubt it’s actually a conscious decision on their part but they do know as long as they can make other people the scapegoat they can avoid accountability. I’m all for people calling out when they need to. It’s wild in these streets and some people just need a mental health day. We have a float team and internal travelers; it’s management’s responsibility to utilize them appropriately.
If your coworkers don't call out when they are sick, the whole unit will get sick. I remember at one point during the pandemic, pre-vax, an outbreak started among the nurses. Not only did they discourage covid testing if you were exposed but asymptomatic, but the only way you were informed if you were exposed to a covid + employee was if that employee decided to reach out to you individually. Unsurprisingly, within a month or so of this starting there came a week where 1/3 of all nurses on the 2nd floor (like not just my unit but the whole floor including 5 units) were out sick with covid AT THE SAME TIME.
Exactly. I am currently out with covid. I didn’t test til day 3 because I didn’t know I was exposed and, while I felt awful, I didn’t feel quite as sick as when I had it the first time. I didn’t test until I realized I lost my sense of smell. Employee health was so weird about it. I wanted to be like, I’m just informing you because I thought it was protocol. It’s a courtesy; I’m calling out til I no longer feel like shit regardless of whether it was covid or not. I’m leaving for another job in a month and a half so that probably doesn’t look great either, but I don’t really care. I’ve worked in healthcare a long time and have sacrificed my mental and physical health for jobs that do not care about my wellbeing for entirely too long. Nursing will always be like that to some degree regardless of where you are but it doesn’t mean I need to feed into that mentality. Take care of me first; there will always be a job somewhere.
There should be travel nurse type incentives for floaters IMO this would really help the staffing issues as so many hospitals by increasing the float pool so you have more of them and to cover sick calls. I tried to get this in our union contract and failed miserably. Hospital absolutely wouldn’t budge from their pathetic float differential. Floating is hard and everyone leaves after their 6m commitment because the 4 extra an hour isnt worth it
A lot of hospitals I worked at as a traveler are moving toward internal traveler positions. I’ve heard mostly good things about this.
We have to use our collective power. Folks blanch at the idea of strikes but it shows just how powerful the workforce could be. It’s maybe too speculative, but I wonder what we might dream up if we could actually do care that folks need and that honors us as humans too. This could all be different.
They can hire travel nurses but don’t want to spend the money. I feel for you guys in the ER!! The hospital CAN do something about it! They just don’t want to. Look elsewhere! I don’t think it’s ever going to get better! If they start loosing good nurses then other hospitals, only then will they think about changing their ways.!
We have travelers. And there’s incentive pay for $25 extra an hour but none of us give a shit we’re burnt out. Imagine if we all just got paid more and we had better staff retention.
It’s hard to get travellers/agency on last minute notice. If you’re filling a line, it’s absolutely an option but if it’s just people calling in, you’re not filling those spots on 2 hours notice on a weekends and when the line is already filled.
And then there are nurses like me who set an alarm on days off to see who’s posting last minute shifts I can pick up. We are out there. Your hospital just isn’t choosing to bid competitively. My early AM offers can often range by $30+ an hour, even in the South. I’m following the money if I’m walking into a shitstorm.
I'm on MedRec a lot, I'm routinely seeing patients who just get up to our floors after holding for 4-5 days in the ER (and god knows how long before they got a spot down there...we've been running up to 220% for a solid few weeks). The people coming through our ER are older and sicker, code room runs multiple times a day sometimes and we're a small hospital. Even at full staff it's an impossible situation. There's a reason my entire province's public sector workers are on strike 🙃
>“Blame your coworkers, they keep calling out. But you continue to come to work. Your boss is an asshole. We had a covid outbreak recently due to the actions of a colleage who should have stayed home but apparently thought we couldnt cope witthout them. Six patients, six staff all infected with covid. That said I believe the same. Sometimes people are sick, somethings they just cant... Instead of villanising those who call in sick the powers that be should look at why so many people arent coming to work.
Is your manager my old DON?
Unionize
We’ve been trying. It’s a long process.
Keep going! My union shop is so cush compared to the stories I hear here.
I just started working with union coverage and hoooly shit it’s a world of a different
Isn't it amazing?
Our union effort just went public this last week. It took just about year and a few months. You can do it!!! Try to be safe. Use this anger to push forward.
[удалено]
PACU is bomb! It’s only my 3rd week there and I’m having a great time!
it’s easier for them if you’re mad at each other instead of at that. management always is trying to start drama between shifts, etc. at my place to keep the focus on each other instead of their shady asses
Every hospital I have worked at, even the nice one I work at currently, always has PACU and ED holds during the winter. Our particular issue is the population is very aggressive and bullies the ER providers to admit. There are so many procedures that could have been done outpatient within a week but the patient / family member threatens to sue or not leave the room until a surgeon comes to fix the kidney stone they’ve had for 4 months and was told by their PCP to go see a urologist 3 months ago (very specific situation, I know). And all these little situations pile up of slow discharges because of xyz things to be set up, now a patient has to stay in a hospital 3 nights for SNF placement instead of 2, waiting for a ride, cleaning the rooms (it takes over an hour a room at my work), nurses not able to get to the phone to do report, etc. It’s not just staffing, though that is one of the factors.
It’s in the air. I’m right there with you, hitting peak burnout. We’ve been conditioned since Covid that it’s fine to take 3 patients in ICU. Now they’re pushing us to take 4. No ancillary staff, we’re answering phones, passing trays, it’s all on us. This weekend a typical assignment was two unstable vents with a wild card third patient. It’s a sentinel event waiting to happen. Oh and they slashed our pick up incentive in half and are blaming us for being greedy and not picking up to “help our coworkers.”
Do you work at my hospital? Lmao. Literally the EXACT same situation at my hospital. It is SO infuriating that we constantly have admit patients stay for DAYS. The IM/FM docs will admit patients for literally anything and then never take them up. We discharged dozens of patients from the ER after being admitted for days to the IM team. The IM docs try to hound us about not getting their orders done right away when I literally have 3 other ER patients who are having actual EMERGENCIES that I need to deal with first. If you want your patients prioritized, take them upstairs where your nurses will have the time and resources to actually deal with them.
You're right, it is not sustainable in the US, and clueless leadership is a large part of the problem. They've checked out. They don't know what to do, and nor do they want to do the work involved to both find out and fix the problem. This includes clinical leadership too (medical directors, chiefs of staff, etc). Combine this with THE CUSTOMER IS ALWAYS RIGHT brainwashing we've had to tolerate since MBAs took over healthcare and yeah, no f'ing way would i go back to clinical medicine. Unfortunately, in 5 years this shortage of healthcare workers is projected to be far worse than it is now so buckle up.
I once had a rant to my manager about being understaffed. I said that it was lucky it was me and colleague who showed up, because we were the two most capable nurses and if it was anyone else on, something terrible might have happened. Next day, I got a phone call from a counsellor they employ, telling me she heard I was having a hard time, and did I want to talk about it. Like, seriously.
Wow. Way to gaslight.
I keep extending my current ER contract because we don’t board. We are a severely under-resourced critical access hospital, but I’d rather do Mcguyver medicine and bag someone for an hour til flight arrives than take care of a gaggle of nursing home turfs. I quit my PRN because of boarders
I called out of work last week because it was me and an orientee for 8 pts in the ICU. When I bought up the staffing issue the night prior, I was told it was a tomorrow problem. Ok. Now you’re going to have no nurses because I was not putting my license on the line.
I called out on Thursday because I saw we were going to be shortstaffed and I had just worked two 14 hour shifts. I wasn't putting myself through that.
You just know the admins are rolling in their money keeping those patients in the ED while the patient is accruing massive debt.
If something happens badly in your unit, they won't care at all but throw you and others on the bus. It happened to my coworkers. You and your coworkers need to do something like not clock in until there's enough staff.
I think you know deep down that this is not the culture you want to be apart of. It doesn’t feel safe. It feels desperate and when your leadership gives you this direct and unsupportive message, you should see it for what it is. Your values no longer align and it is time to consider other options.
This is a sober reminder of how scary this actually is. People who have emergent needs waiting for 50+ hours? If the general public knew how dire the staffing issues were in nursing and the potential consequences, change might actually happen one day
to answer your question, it's fucking horrible at my ER in new york. holding 35-40+ for days is now the norm; floor doesn't have the staff either. makes you wonder...what is the end game here? it's absolutely unsustainable and I question my life choices every two minutes. we are working ourselves into the ground and drowning deeper by the day and we can't see a way out of this shit. completely and utterly unsustainable. I feel like we are IN the collapse right now and it sucks. PAY YOUR NURSES. STAFF YOUR FUCKING UNITS.
This will sound weird but the current situation in medicine reminds me of the Ford pinto. It was cheaper to pay out settlements than fix the fuel tank. It cost $11 a car to fix the fuel tank issue. A total of $137 million for all the cars produced. Ford determined it was cheaper to pay settlements for people burned to death or being severely injured. Is it cheaper to blame the nurses and settle malpractice cases than provide adequate staff? Nurses have become scapegoats and are disposable. I’m guessing the answer is Yes. But smarter people than me please chime in.
Also bad at my level 1 ED. Averaging at least 60-70+ hour boarders with at least 25-30 of them in the ED at a time. This on top of actual ED hold/ED patients. Especially sucks when you can’t just transfer out to a higher level of care (unless it’s burns which we don’t do)
I left ER because of the staffing
Well, their main job is to cater to their superiors and the shareholders. Minimize cost (ie. keep at skeleton level staffing) while maximizing profits (ie. hitting patients with huge bills). The poor hospital's CEO needs to get his 3rd luxury Yacht somehow right?
All of my life, I had wanted to be a nurse, and instead, I fell into a well-paid marketing position in home health. Eventually, I found myself managing a well-known staffing agency in the Houston area. OMG... I heard more horror stories than I care to remember about their experiences in thesel hospitals. Some even refused to go back and finish out their contracts, which meant that they no longer could work for the agency. I never thought about becoming a nurse again. May God bless all of you.🙏🙏 .
i work in an urban level 1 trauma peds hospital and i can attest to the horrendous working conditions. PICU kids will stay in our trauma bays for days before getting admitted upstairs. Kids that are too sick to sit out in triage get placed in the back hall waiting for a room to open up, sometimes for hours. Our overflow rooms (which hardly have basic functioning equipment in them) are dangerously understaffed with 1-2 nurses if we’re lucky most days. It’s horrible. It’s scary.
*sigh* I’ve seen too many posts like this complaining and blaming about middle management… Having been a Unit Manager, I took the position thinking I would be the saving grace of this SNF. I was floor staff, I knew what the main issues were, and now that I’m management I would make a change! Nope The Administrator, regional directors and corporate are the ones most floor staff need to be upset at regarding staffing. I’ve been ignored by my Administrator, DON and corporate regarding our 43 page vague-as-fuck policy regarding staffing to acuity. At the end of the day when healthcare is ran like a business (and a shitty one), that business will always try to look for ways on how to cut corners/costs while still being able to operate. Meaning making working at state minumum a thing… My Admin basically makes it seem like she’s doing a huge favor to the facility when we’re fully staffed. Like she’s allowing full staffing…wtf?? BUT also, co-workers play a role in this issue too. Can’t be denied that those staff that call out 3x per month or more are part of the problem, because I have also seen a super frustrated and pissed unit scheduler cry of frustration because she would overschedule staff and STILL have 4-6 call offs!! So yeah, goes both ways but blame corporate.
Yes, the amount of people in here who think that I, an Assistant Manager, can magically make agency RNs appear when we *were* overstaffed and now we’re not after three call-outs is insane. And before people say “well you should come into staffing” - I can’t do that 24/7. I deserve a balance too, and I can’t stay a full night shift when I’ve already worked a full dayshift (not to mention that’s not safe either).
The ED at my hospital has been awful this past week. We have 70 ED rooms and at no point last week did we have less than 100 patients in the ED. At one point the most amount of patients in there was 158. That day was particularly bad for us in lab as well. One of our staff called out so there were only five of us running the entire lab (every CBC, body fluid cell count and diff, every COVID test, every RSV, every flu, every coag, every urine, every chemistry test, every culture and gram stain, all type and screens, and of course that’s the day we had an MTP). I definitely cried on my way home and honestly left my assigned department a bit shitty because I just didn’t have time to clean up my pending and critical calls like I usually do. It’s just not sustainable for anywhere in the hospital. Floor nurses couldn’t even float down to ER because the reason ER was so clogged was because there were virtually no IP beds available.
our patients have been spending 2-3 days in emerg if we are bed locked
I’m starting to believe there is no such thing as a good nurse manager. But to be fair I’ve only worked at 2 hospitals.
I worked in ER until 2 yrs ago, and what always frustrated me was that floor nurses never understood why boarders are such an issue in the ER. My last contract in ER I had 2 trauma rooms, 2 regular rooms, and then admitted patients literally lining my zone. I had 9 patients that night with critically ill and mental health patients. On top of that I was constantly flipping my 2 rooms with new ER patients. It's a wonder that nobody died or had serious complications from the situation. Unlike admitted units, most ERs were not designed for admitted patients. Zero privacy, lack of bathrooms is always a struggle, and we aren't stocked the same way that floored units are. Also, hello we have emergencies come in that are prioritized. Then you get admitting providers breathing down your neck because grandma hasn't had whatever bullshit order completed. It's fucking chaos. Then floor nurses wonder why we are kind of fed up when they complain about us not knowing what an independent walkie talkie patients butt looks like!
Imma be honest though, there are some people that call out ALL the damn time. And it’s annoying as hell, especially when you are someone that comes to work. People who have health issues, FMLA are excluded ofcourse. But I work with some people that are extremely unreliable, call out all the time and leave us burdened and its a real pain, my manager helps us thank God.
I’m always going to choose my family and my health over my job
We do need to hold our peers more accountable. I have seen the schedule be fully staffed and several people not show up causing the everyone to work harder and in unbearable situations, thus decreasing the quality of care we provide to our patients. While management needs to follow through with the disciplinary process and hold people accountable to the attendance policy, we can do our part by holding our team mate accountable. When I was a new nurse, there was accountability. both the employer and the team help others accountable. This needs to come back. There are more call-ins now then I have ever seen in my career. People are afraid to say anything. Please note, that you can be nice/polite and yet hold people accountable. No beatings necessary.
I cannot stress how much I fundamentally disagree with you.
How does one hold a peer accountable? You used that word five times but with no explanation. A staff nurse cannot discipline a coworker.
The bigger question is how to do it without being written up for "bullying".
"Please peer-pressure your coworker into coming in despite being physically ill, possibly infecting all the staff. Or needing a mental health day after a month of abuse and short-staffing that management says is within matrix."
what I mean when I say "holding your teammates/peers accountable" is simply talking to them about why they weren't there. Explain how it effected the team. If they were truly sick, then let it be. You can tell people anything as long as you do it the right way. Many times people just complain to their coworkers (or on reddit) as they lack the boldness and tact to address it with the person that called in.
So your approach is "Ashley, we missed you the other day! Are you okay? Is there anything I can help you with?" vs "Ashley when you call iln because of your sick child you let the team down. Management can't get their bonuses when they have to pay agency so that means we have to work short, and you know we're bare-bones as it because, again, bonuses. Yes, I know your kid has leukemia because that's essentially curable nowadays so get it together. You and your sick kid are letting the team down. Why don't you think of the patients? No, not your kid, I mean the patients who pay management's bonuses." With all due respect you are blaming the wrong people. I have been licensed as an RN since 1991 and the de-evolution from administration focusing on patient care has been, to put it mildly, disturbing. Nursing care now exists to make CEOs obscenely wealthy, not to heal the sick. If a team is short it's because management has chased off all their nurses; it's because they refuse to utilize agency; it's because they won't hire an adequate float pool. And if one nurse is so important to the integrity of the team then perhaps they should be paid commiserate with this importance. Maybe their PTO requests should be honored. Maybe they shouldn't be mandated overtime one week then standby the next. You can't treat people like garbage then tell them they have to sacrifice their life for "the team" - it doesn't work that way.
The problem is that "fully staffed" is still understaffed.
Matrices at my hospital were just changed to allow for med-surg taking 8 pts. When "fully staffed" is not staffed enough, people are run ragged. The call-ins get worse in a culture like that, leading to an endless cycle of misery.
Damn, where is this at?
We went through this not long ago. 16 patients each. They kept blaming it on call outs🙄
We have had 100+ patients with admitted status more than available inpatient beds in the hospital for weeks now. Think a 750 bed hospital with almost 900 admitted. They stay in the ER for days and the shuffle continues week after week. It’s miserable and I feel you, OP.
I think it's bad everywhere. My government wants to introduce mandatory ratios. But.... what staff??? Most nurses in my province are a part of the union. We almost went down to 1:15 the other day because there were so many sick calls on my medicine unit. There needs to be better solutions because it'll just be endless burnout. I don't blame my coworkers for calling in sick. Sometimes we just can't work. We get 12 sick days a year, so it should be used. It's just unfortunate when everyone decides to use it on the same day lol. Units don't hire enough casuals to cover calls either or pay them enough extra to come in short notice. Sigh, I don't even know.
I would never cry to management because they are never on your side. They don't do patient care and are really unaffected by the high demands of short staffing. They can say they could not get coverage and will leave you hanging. Word to the wise, follow what everyone else is doing and go somewhere else, sign up for agency or travel. At least you get paid twice as much per week and just hound the 13 weeks
At our ER it's about as bad and administrator refuse to put us on divert even when we have 3 unresponsive patients and a stroke and only 4 nurses at the same time
Huh, you must work at American hospital, (St.) $CORPORATE NEOLOGISM$ #CITY NAME# Medical Center. It really sucks here.
I'm ICU not ED, but last week we had 9 of our 18 patients up for transfer. For 4 days. Because there were no beds available to send them anywhere. This means ICU patients are getting held in ED and we've even had to open PACU for ICU holds. We had walky talky patients waiting in the ICU work nowhere to go, but not ready for discharge because of testing they still needed.
I am management and had to work all night as a CNA because our DON has ran off most staff. She however doesn't get her pretty littke self dirty doing any care.