dry walls
just when i thought it can’t get worse, it did.
i’m talking about our staffing condition.
the change that was implemented last week caught us by surprise, but we are flexible, so yeah, we are still alive. now, if our patient census is 17 and below, we do not have a resource RN, no PCA (patient care assistant), no unit secretary. “what doesn’t kill you only makes you stronger”, right?
i won’t bore you with the details of how i find this new staffing guideline extremely revolting and unbelievably inconsiderate (both to the staff and the patients) but when i say this sucks BIG TIME, you better take my word for it and just believe me.
the other night, i was going to take my patient off the bedpan when i saw G, the other patient in bed 1, naked. she was calling out different names of people who i assume are important people in her life. confused and incontinent of urine, her soaked diaper was left open, a new set of linen, diaper and gown were at her feet. lying in bed diagonally, she was trying to get out, but was too weak to succeed. it looked like somebody started cleaning her up, but was unable to finish the task.
like a real pro in staffing shortage issues, i did the smartest thing to do in situations like these: i looked the other way. ”i have MY own patients, and i need to take care of MY patients first”, i rationalized. you know, to sugar coat the guilt. i went straight to the restroom to wet the washcloths…and what did i see?
an awkward, uncomfortable sight.
G’s nurse, (let’s call her Anna) was standing on the corner of the shower area, crying her lungs out. she covered her face with the washcloths, not much out of an attempt to conceal her identity, but to save her face from the implied humiliation.
i didn’t have to ask her what was wrong, because i already knew. i only asked because i didn’t know what else to say. since my supposed concern made her more tearful, it made me feel bad. i tapped her shoulder a couple of times and told her to wait till i’m done, and i will help her. now, helping another nurse is not in the “how to survive stupid staffing rules handbook”, but there is something about a fellow wounded soldier that strikes a chord.
while we were cleaning G, Anna was fighting back tears. “please don’t tell anyone that i cried, or i mean, that i’m crying… it’s just that…and i don’t want others to make a big deal out of it…”
i nodded. i know, it was not a big deal. G being over 200 pounds, Anna being under 100 pounds. honestly, cleaning a patient twice your weight is not a big deal. the real big deal is: you need help and there was NO ONE who can help! taking care of four total care patients is no big deal. the real big deal is: there are no extra hands and feet when you can’t lift and run in four places all at once. “promise me you’re not telling anyone…”
i told her i’m pretty sure no one will notice it. everybody was just selfishly concerned about their OWN patients. anyway, “it wouldn’t hurt if you wash your face with cold water” i said. while she was drying her eyes, i assured her she was not alone, that like her, everybody else was overwhelmed. images of myself and nurses on the verge of breaking down, and some eventually crying in the middle of countless responsibilities, flashed in front of me. all of a sudden i realized how this whole thing doesn’t make any sense.
this whole situation doesn’t make a lot of sense. it probably doesn’t make sense to others, and it certainly doesn’t make sense to me. it doesn’t make sense to me that a lot of good and caring nurses feel inadequate and drained. it doesn’t make sense to me that many genuinely helpful nurses do not feel rewarded and fulfilled in helping the sick anymore.
it doesn’t make sense to me that a number of usually composed and confident nurses who think straight even under tremendous amount of pressures are found crying inside patients’ restrooms, frustrated and overwhelmed, helpless and embarassed.
it doesn’t make sense.
but it doesn’t mean it’s not happening.
I don’t think I can manage to work like you guys like that. I’m easily fed up and may end up having a breakdown earlier. I don’t know what changes in staffinf was did, but I do hope the management sees the situation isn’t better and try to change it.
Comment by Ferdz — March 30, 2007 @ 8:00 am
I just got the bill for my recent hospital stay. Even with what Blue Cross lops off the top, it’s a whopping number — SOMEONE’S making money… and still corners are cut.
But I have sympathy for you and “Anna.”
Comment by The Curmudgeon — March 30, 2007 @ 8:39 am
Hi have just found your site, very thought provoking I work on 36 bed surgical unit in the U.K. with max of 6 staff am shift, 5 late and 4 night.Seems like staffing and low morale are universal.
Comment by Cathie — March 30, 2007 @ 8:56 am
I cannot even begin to imagine your frustration levels. I had trouble caring for a man who was only 40 pounds heavier than me and just a few inches taller. I can’t imagine what it must have been like for Anna. To have to choose between caring for your patient or helping another who is obviously in need of assistance is a nightmare.
Take care of yourself.
Comment by Student Nurse Nancy — March 30, 2007 @ 12:21 pm
Like Cathie’s observations above, your situation there across the pond is just oh, so familiar. The NHS have frozen the hiring of new staff here as a cost cutting measure and is affecting not only the staff but patients as well. What a nightmare! Makes me wonder though, how is that possible in privately funded US health care?
Comment by howling — March 30, 2007 @ 12:21 pm
I hear you. In the position I am employed in, i have to look at staffing from 3 different perspectives. 1)The Front Line- making sure there is enough help for my staff to do the best possible job without hurting themselves or the patients. 2) The Bottom Line- I work for a nonprofit organization, but we still have a budget that needs to be maintained or the bills/paychecks won’t get paid and the staff and patients will suffer anyway 3)The Fishing Line- this is wher I have to “go fishing” to find enough staff to cover the shifts at the last minute due to call offs. Trust me when I say the fishing line is the hardest to handle. Often times I will fill the shift by staying myself - sometimes without pay - because I am a salaried employee.
To answer “howling’s” question about the privately funded healthcare in the US - it’s not as privately funded as you may think. The patients get the care no matter what, but frequently the private insurance companies will find a loop hole in the system and avoid paying for part or all of the patients bill. The government funded insurances such as medicaid and medicare operate on what is called a “base year.” Each facility is assigned a “base year” when they are authorized by the government to provide services and bill medicare/medicaid. The payments the facility recieves for each procedure are regulated by what the procedure would have cost in that base year. In theory this “base year” is supposed to be updated periodically to account for inflation etc. but I can tell you first hand that many facilities are getting reimbursed at a rate that is over 20 years old. My facility is currently entered in a lawsuit with over 30 other agencies against the state government where we are located to bring our reimbursement rate up where it belongs. We are still operating on a 1983 budget. The only reason we are surviving at that rate is because it is a nonprofit organization and we have received donations from generous benefactors allowing us to stay in business.
Comment by Joe — March 30, 2007 @ 1:46 pm
May, I don’t know what to say, but I know I could never do what they expect from you. My sister was a nurse for many years. She is retired now, but in her days, they had LPNs and also nursing assistants to help with alot of this. Is it like this in all the hospitals there? If not, then I think I would be hunting a new job.
Comment by cathy — March 31, 2007 @ 6:52 am
And the suits wonder why there is a nursing shortage.
Comment by Janet — March 31, 2007 @ 12:17 pm
Been there, done that, and I will do it again tomorrow.
Comment by shrimplate — March 31, 2007 @ 7:17 pm
I have a question for you: Are you unionized? If not, why not? If you are, why isn’t your union doing something about the obscene staffing situation? Rather than cry, you need to band together and fight this crap. Nurses have a tremendous amount of power, ESPECIALLY in the current staff-shortage. Use it.
Comment by cre — April 1, 2007 @ 2:51 am
I’m so sorry for Anna and for you, and I have been there, too….
Comment by RN — April 1, 2007 @ 11:23 am
Hi, I was trying to find web sites regarding nursing . . . someplace to post the letter I wrote to my hospital chaplain March 20th..the day I was supposed to go into work and I didn’t. I have been off since. I can SOOOO realize the nurses frustration and pain described in this story(reality) of Anna. Please read the following that was submitted to my hospital located in Alton, Illinois.
The Caregiver Needs Caregiving—A Nurse’s Cry
By Miriam Susong, R.N.
I have worked in the field of nursing for over twenty years. I am an R.N. (a real nurse). I never heard that phrase until I began working in the hospital setting. An L.P.N. (Licensed Practical Nurse) referred to R.N.’s as the “real nurses.” Well, if my memory serves me correctly, when I was a graduate nurse working at Shore Memorial Hospital in Somers Point, New Jersey back in 1984, it was the L.P.N.’s who showed me the ropes of how to be a “real nurse.” But that was years ago, over twenty to be exact. I am certainly no longer a graduate nurse, but I have graduated to the growing number of nurses suffering from burnout. Too many days of not enough nurses. Too many demands for turkey sandwiches and ice water . . . when you haven’t even medicated a post op patient. I have learned that the turkey sandwich and ice water mean ever bit as much to an incapacitated patient than the pain medication that has to be administered. So, you take a good look around to find “someone” to help you. There is no one. YOU are it.
YOU are it day after day, shift after shift. Your eight hour shift turns into a nine or ten hour shift. Your twelve hour shift . . . well we won’t even go there. On second thought, I will go there. A twelve hour turns into a fourteen hour day or night. I must ask, “Who works like this?” I mean steady working. No breaks. That is, unless you are a smoker (no offense smokers). Somehow smokers find the time that non- smokers can’t seem to find. They leave the floor for fifteen minutes or so every hour and a half. I used to get upset but I don’t anymore. After all, it is how they cope. I seriously thought about taking up the nasty habit just so I could escape like the smokers, but I value my lungs far too much. So, I don’t pay attention any longer when nurses leave, dragging on their Winston’s (if they still make them . . . I wouldn’t know as a non-smoker).
A great friend of mine, who I had met while working as a home health nurse in Florida, got to the point where she didn’t want to go to work any longer. She dreaded work. I used to think, “Poor thing.” Well, at the time, I didn’t know I was next in line to becoming the “poor thing.”
Burnout happens slowly but when the final stage of it appears, it smacks you in the face and knocks you down flat. You become like a child who screams, “I don’t want to go to school!” (but in your case it is work) Unlike the child, you have responsibilities and many of them. You can’t just shut down. But, there is something greater than responsibility that hollers out, “If you don’t stop, you are going to really lose it, and I mean lose it.” Before the end of burnout comes around, you begin to get the dreads. You literally dread going to work. Look it up in Websters: “a profound and deep-seated spiritual condition of insecurity and despair in the free human being..”
Let one or ten more things compound this feeling of dreading your job and you are like a sinking ship. That is, unless you throw up your hands and say, “I need help.” “I really can’t do this any longer.” So, you call your work. You take a deep breath. “I can’t come in.” The “caregiver” needs care–desperately. They write your name as a no show for the next shift. The guilt sets in. At 5:15 a.m., the hospital staffing secretary calls to see if you are coming in that day. I learn about the 5:15 call when the next call comes at 7:15 a.m. I listen to both voice messages. “Are you coming in?” “The floor (the unit where I would have been assigned for that day) is looking for you.” There has definitely been a lapse in communication. The pit in my stomach has intensified.
I was awakened by their call for help. It was obvious that my plea was totally disregarded. I call again later in the morning. This time, I speak to a nurse who I think may understand. I explain to her that today is my anniversary, my husband is 1000 miles away asking for a divorce, I have a fourteen year old who every word out of her mouth is, “Can you?”, I have a home in Florida that I left to the tenant, I have a daughter who is working on her Master’s Degree and who works full time in Child Protective Services who had recently called to tell me she is pregnant, and THEN, there is the hospital calling me at the but crack of dawn after I have already explained to them that the candle is no longer burning. Nobody knows the effort it has been taking for me to do simple things like go grocery shopping, take my daughter to school after she has missed the bus, or just sitting down to pay the bills.
I decide to take control of this situation before it does any further damage to me. I have to make myself more important that my job at this point because if I don’t take care of myself, I can see that no one else will. I tell the nurse that I won’t be coming in today, or tonight (I had scheduled myself 7 a.m.- 3:30 p.m., take an 8 hour break then come back 11 p.m. - 7:30 a.m. (all so I can get the hours in so I have more time off)). I tell them I probably won’t be coming in for a twelve hour shift on Thursday either. I schedule an appointment with an Employee Assistance Counselor . . . but I can’t go in until Tuesday, which is seven days away. I asked the nurse/receptionist, “What am I supposed to do until then?” Her suggestion was this, “Get up in the morning and put your uniform on and just do it.” I stuffed the scream and calmly said to her, “I have been doing that for a few months now. Getting up and doing it all over again and again. I am beyond that. I can no longer get up and put my uniform on. I want to keep my pajamas on and do nothing. I want to sit and watch a comedy on television, maybe eat a bon bon or two. ANYTHING, but put a uniform on and go in to take care of five, six or seven needy patients with no nurses aide or patient care tech to help me.
I will go back. But, I will get well first. There is an old adage, physician heal thy self. Well, this is nurse heal thyself. I will get the help I need. A Chaplain at the hospital suggested that I check into a local Holiday Inn (by myself, of course), take a bubble bath and meditate on the Lord’s words that He would comfort me and protect me from all harm. He told me that I could rest on the assurance that the Lord knows what I am going through and that He would help me through it.
I will be o.k. I have always been o.k. But burnout sure is scary when it happens. The initial phase is worthy of your attention. When you dread ANYTHING, pay attention. Dread isn’t normal. Dread will kill your spirit and take your physical body along with it. If any of this sounds familiar, whatever your profession or job is, don’t be afraid to ask for help. No amount of money is worth your mind. Your mind is your most valuable asset God has given you. Make arrangements with work. ASK others to help you. People care about you more than you think. If you don’t have the time off and are concerned about finances, ask creditors to work with you. Tell them exactly what is going on. You will be surprised at the response. Everyone needs a nurse at some point in their life– it is to everyone’s benefit to help you so YOU can help them.
Comment by Miriam — April 1, 2007 @ 12:26 pm
i am nursing student and i also see the scenario of staff shortage during my exposure. i feel sorry for those who are subjected to stressful situations like that and sometimes when it kicks in, i feel like crying myself specially when the pressure seems too much.
Comment by mhijz — April 2, 2007 @ 11:22 am
may,
your story makes me kind of sad…and recall my days of work as a GNA and short-staffing and not being able to DO what i wanted and needed to do for my patients and all the bullshit.
but what struck me most, was how grateful i was that is was YOU who found Anna. it was YOU, who didnt make her feel like a jackass on top of her feeling inadequate. YOU who cared enough to help her out and offer her a cold washcloth and let her know she isnt the only one overwhelmed.
i pray when i am a new nurse and the tears come, there will be kind nurses like you.
love,
gypsy, future-RN
Comment by gypsygrrl — April 2, 2007 @ 8:48 pm
Wow, sounds just like my hospital. Lately there is usually at least one nurse crying on the job or thinking about it. And most of us take antidepressants! Very sad, the staffing cut backs make most of us dread coming into work. This past fall and winter we have also lost a high number of nurses because they couldn’t or didn’t want to deal with it anymore.
Comment by Heidi — April 3, 2007 @ 9:56 am
I just read your post about the 3 H’s. I think some of my fear of becoming a nurse went away when I read that. I fear the shortages of nursing and I know it is going to be a very difficult job but it seems perfect for someone like me who can’t sit still for more than 5 minutes. Thanks for boosting my confidence!
Comment by Katie — April 3, 2007 @ 8:14 pm
Great post. I completely understand the frustrations of being short staffed and how helpless it makes us feel. Health care is a business and unfortunately quality of care has been sacrificed in order to reduce financial burdens. I hate the fact that health care has become a business. Where is all of this money going? There aren’t enough nurses to take on the burden of provider care to all of america yet the nurses who are there aren’t been paid well enough. I love what I do. I remember in nursing school hearing the nurses get paid well- I think that was a ploy to keep us going. Again I love what I do and I try to recruit people into nursing all the time but why going into nursing with long, stressful hours and poor pay when the world of business is waiting and you can sit at a desk and twiddle your thumbs for thousands more. We didn’t have a secretary the other night and all kinds of things were missed. Our secretaries are incredibly important and help us in being able to provide better care. We are more concerned with care than secretarial duties and having them allows us more time to do the things that we need to do. Of course to the people who aren’t on the unit… they don’t see that. If your census is under 17 you should have enough time to get your work done.. hey you do it when there are more. What they don’t get is that we are being stretched so thin that when there a census of 17 or less (with a pca and secretary) we are finally able to do the work as it was meant to be done.
Comment by Nurse M — April 4, 2007 @ 2:16 am
I have just spent two days reading all your posts. My husband and I (who are both mid 40’s) are entering the nursing program in January. You make me excited. I love your blog!!
Comment by Kim — April 6, 2007 @ 1:44 pm
May:
Some state have a law that protect nurses who refuse to accept an unsafe unit. Does your state have this law? The working conditions that you describe are unsafe for you and the patients.
MJ
Comment by Mother Jones RN — April 9, 2007 @ 11:45 am
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