Nurses Testify on Short-Staffing
›› Read testimony from Maria Sanchez, RN
Unit: Med Surg
On a given night at a hospital during a travel assignment 3-4 years ago, it was not out of the norm for one nurse to be assigned to as many as 11-15 pts. It was said that if one had 11 or less it was a "good night" to which I replied "No, it's a good night if no one dies." The staffing at this hospital was so poor that there were more travel nurses than regular staff in the ER, some of whom backed out of their contract early rather than risk a malpractice suit.
"...We noticed the first patient was no longer breathing."
Unit: ER
As a travel nurse for over 4 years, our profession is frequently called to staff hospitals that are short. One position I encountered last year was very unsafe. We were frequently short, usually taking very high patient loads. The acuity of this older population was high, most were admitted. I came in on the evening shift and was given the hallway bed assignment which could be up to 7 patients. It usually was. Many nursing home patients were left in hallway gurneys, many incontinent and needing to be changed for many hours.
We changed many patients in the hallways, as this was all that was available as these patients waited to be admitted to a room. Monitored patients were frequently in the hall without centralized monitoring. One particular night we bumped a GI Bleed patient out of a monitored room to care for an incoming MI patient. Shortly after we stabilized the MI patient, we noticed the first patient was no longer breathing. We pulled the MI patient out of the room to code the first patient. He did not survive. While this hospital had many issues including limited space and supplies, it was the staffing that made it most unsafe.
"None of this is fiction"
Unit: ER
How do I describe how it feels to want to take good care of ones patients, yet always have such a load of critical people in the assigned rooms that all one can do is to hope that no one dies before even the minimal care can be done?
My assignment was 4 rooms. Only 4 rooms you say? Let me describe the just one 2 hour period regarding those 4 rooms.
Room 1: Evolving inferior wall MI, life-threatening, excruciatingly painful, requiring the skills of a fast moving and knowledgeable nurse on a one to one basis.
Room 2: Overdose of valium on a ventilator who required gastric lavage, respiratory support, life support drugs, and a one to one nurse.
Room 3: Spinal cord injury result of suicide attempt, fearful, crying, under the influence of alcohol and pre-injury drug use. Now wrestling against protective restraints, pulling on cervical collar, thrashing, screaming, cursing and potentially adding to his already life threatening injuries. Also a one to one patient.
Room 4: Allergic reaction to medication with worsening respiratory distress, wheezing, bright red rash, itching all over. Impending anaphyllaxis, also life threatening, also one to one nurse required.
None of this is fiction, ask any ER nurse. The acuity and the shear numbers of seriously ill patients is overwhelming every day, and it is all I can do sometimes to smile let alone create a situation worthy of kudos on a patient satisfaction survey!!
"...Our jobs were threatened."
Unit: med surg
I was a former charge nurse and it was almost certain that an RN and an LPN would have 10 to 12 beds a day. And it was a high volume unit with a lot of admissions and discharges each day, so it was common that at the end of the day you could have cared for 20 or more patients. So if you had a couple of sick patients that needed your time, the patients that were not so sick were not seen enough.
Many days hospital staffing would pull our nurses to another floor because they were short-staffed—which in turn made our unit short-staffed, causing our level of care to decrease even more. If we ever said anything about being short-staffed, we were told we were being insubordinate and our jobs were threatened.
Our Patient satisfaction was almost always low and it was always blamed on the nurses not on the poor staffing.
"This story happens everywhere, every day."
Unit: Neuro
I worked in this hospital several years ago, but have since quit and am working as an RN in a different capacity. We were ALWAYS short staffed! If we had enough to safely staff the ward, someone was sent home.
I had a man who went bad one night. I spent the whole night with (mostly) him, even though I had been assigned 10 patients, plus was in charge. They assume because it is night time, that everyone is just sleeping peacefully. Wrong! The next evening when I returned to work, he was still on the ward and virtually nothing had been done. I immediately demanded he be put in the neuro intensive care unit. Soon after, the man died.
The nurses are spread so thin, they just have to let other patients go when something like this happens. I left not too long after this incident. I doubt things have improved. They have to "budget" nursing staff, but somehow have the money to remodel and build new additions. This story happens everywhere, every day.
"A nurse with 10 patients is unlikely to be friendly."
Unit: Med Surg
I can share what I have seen happen in the last 30 years. Perhaps "friendly" is a good parameter for quality, because a nurse with the responsibility for 10 patients is unlikely to be "friendly". Establishing a therapeutic partnership with a patient, which research has proved lowers the hospital mortality rate, has become an impossibility. There is no time to sit down with a patient anymore and ask them if they know how they are going to alter their lifestyle to avoid another hospitalization. There is no time to sit with a patient and their family and ask whether they know how to care for themselves upon getting home, or whether or not they have transportation for subsequent outpatient care, or even if they have anyone to help them with activities of daily living (like shopping, cooking, paying bills, bathing) when they go home. Or even, do they have a home?