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January 18, 2016

Safe Staffing Barriers from real life Nurse Managers and Executives

By | Nursing | 4 Comments

I am one of those people who wants to hear the real stories from the trenches. It’s all fine to say that “This number of patients experienced suboptimal care related to staffing, but let’s hear ALL of the stories.  Some of them are not what you would expect.  And some are absolutely terrifying. Here are a few I received when I asked the question.

Question: Nurse Managers and directors only, please.
Send me a PM – real life scenario of your struggle with the higher-ups and staffing. For now: Have you had to tell your boss that your facility/floor was dangerously understaffed? What happened?

  • So do house supervisors count in your question? In my previous life and and facility ((for 10 years) sometimes we had incentive to offer, sometimes agency contracts. the very last time I had a staffing crisis nothing was done and I quit. Was expected to be supervisor, ICU with a LPN and 4 patients, and backup in ER on a weekend
  • Yes I have told my previous Administrative chief that we were dangerously understaffed, and she told me too bad. You are not hiring anyone. Then she left, so I was able to hire a couple of people under the new administration.
  • The manager position I just resigned from…. We had a large amount of resignations in October and November (because we are so short staffed). I suggested we close a unit because the staffing was critically short. We had several new grads in orientation, or just out of orientation, and not enough experienced staff to have one on every unit with new nurses. I was told that closing a unit would upset the physicians. My response was “the doctors will be really upset when patients die because we don’t have safe staffing”. I was ignored. One (the biggest) of the reasons I left!I-think-ones-feelings-waste-themselves-in-words-Florence-Nightingale-quotes
  • To answer your staffing Question, yes I have asked for safe staffing and nothing IS done. I’m told that we can only staff to our budget PPD. I am a unit mgr for a 60 bed rehab/LTC unit. We have about 40% of our unit 2 person transfer with a lift and my cna’s routinely work w 10pts. Its horrible
  • I believe your staffing question was focused entirely on acute care; but as a Director of Clinical Services for a Hospice company thought I’d share a different side of staffing shortages. In many states, Hospice case managers (RNs) are paid salary not hourly wages. As a case manager I had caseloads as high as 23. Worked 60 plus hour weeks, with no support from management. I called myself an Indentured Servant. I am now fortunate to be employed by a regional company. After this past years employee satisfaction surveys were “tallied up” Changes were made, caseloads no higher than 15. Money released for increased staff and training. Took the collective voices of case managers from Georgia to Colorado to achieve the change. BUT I have many friends who work HH and Hospice who continue to work 60 plus hour weeks. Staffing shortage? Corporate greed? Due to government cuts in reimbursement the only way for a company to stay afloat and make a profit? Another side of health care shortages
  • I was a DON for 6 years. Now I’m in a regional position. Our staffing is not good, but because there just weren’t enough applicants to fill the positions. We always were a few nurses and MANY aides short. The staff were allowed to work overtime but they get tired and burnt out. The push back we got from “corporate ” was to have less overtime hours, but there was no one else to work the shifts. We had to sit on useless conference calls related to hiring, giving us suggestions on where to find staff – all things we were already doing. I know I’ll get crucified to say this on the post but staff these days cones in with demands. “I won’t work weekends, or nights, I need more money, half shifts, etc”, and they rotate from facility to facility looking for the greener grass.
  • I was NM of a “progressive ICU” (long-term ICU, stepdown & over-flow unit); This situation is partially attributable to physical layout, but… Pt disconnected from ventilator, there was no one not involved with other patients so no one heard the vent alarm. We did hear cardiac monitor when bradied down – thank God full recovery with reconnect. I was told that upper administrative staff felt “we almost killed pt” and they were right. Eventually I got removed from that position. My immediate director would come help when I told her we were unsafe – she was let go also. An additional example (same unit), we suffered a power failure, and emergency generator failure, with more pt’s on vents than staff avail to bag them – I taught the two housekeepers present how to bag in less than 10 secs each.
  • I left my last Job as a house manager because of staffing. They had me working as the charge nurse in the ICU and the house officer on night shift. There was no one with greater than 8 months experience other than myself scheduled in the ICU the night I made my decision. The ICU was full. The house was full. The ER was busting at the seams. There was a fall in the rehab due to them being dangerously staffed in their unit and I had to transport that patient to another facility which took me out of the ICU and away from the young nurses who kept calling me while I was tending to the fall victim. I had never felt so helpless! I had been calling upper management begging for agency relief and been denied due to budget and been told we were “fine and I was a good leader who could manage.” I called that night to update them on the fall and ask again for help and was denied. A few days later I found out one of the new nurses in the ICU made a very devastating error with a medication and I got blamed for not being there for a resource!!! It solidified my decision to leave. I pray for the nurses who have to split themselves and try to make decisions they should not have to make because of unsafe staffing.


Perhaps you should share this with the lay people you know.  We need support in the safe staffing arena. They need to know what is happening behind the scenes.  It is time to make healthcare transparent.

Also, a page I found on Facebook about this very thing. Who knows?



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