The following stories were shared today (May 5) by members of MNA RN’s from the Allina Bargaining team:
My name is Dawn Yetter and I am an RN on 3 West at Unity hospital. I am here to describe some of the staffing issues on 3W that cause concerns for the RNs who work on our unit. We are a surgical and orthopedic unit where we primarily care for post-op patients. On the average day shift, the RN cares for 4 patients at one time; on a PM shift, 4-5; on the night shift 5, sometimes 6. We have 44 beds total , down 3 different hallways. One hallway is usually closed due to low census leaving 31 used beds.
On the day shift, we are usually staffed for a max of 31 beds even if we already have 31 patients, a list of new surgical patients, whether or not we anticipate discharges. We can also expect new admissions from ED and transfers from other units. So basically, although we are expecting to have a much higher census than 31, we are only staffed for 31 patients. In these situations, as the RN discharges a patient, he/she is expected to quickly take on a new post-op patient. Sometimes this is manageable – sometimes it is very unsafe. An RN can spend all morning, working on discharge arrangements for one patient, figuring he/she will catch up on the other 3 patients once that patient is discharged. Then the phone rings, and the RN is expected to immediately take a new admission or new post-op. If the patient is a new post-op, the RN is expected to drop everything and report to the new patient for settling, assessment, connecting the numerous pieces of equipment that have been ordered, and continuing to monitor the patient. Acuity is never factored into this equation.
When figuring out staffing for the day shift, we are not allowed to count any new post-op who is not expected to have surgery completed before 1100 AM, even if we know that we can expect many surgicals to return between 1200 and 330. One Wednesday, we were expecting 5 new TJR patients and a lumbar fusion patient who were all scheduled for 0900 surgery. None of these patients was counted when determining staffing for the shift. 5 of these 6 patients came back on our shift. None of them was assigned to a nurse at the beginning of the shift. The charge nurse had to figure out who would be able to take these patients. These are big cases, very time consuming, and with the potential to run into trouble post-op due to typically large blood losses.
When we are staffed this way, we usually have to call in an additional RN in the middle of the shift. This RN is expected to take an assignment of all new post-ops, admissions, and transfers. We have had shifts where we were asked to each trade a patient so this RN did not have all new post-ops. This is very disruptive to the patients who are expected to acclimate to a new nurse every 4 hours through the day. It is also very disruptive to the nurse who has spent 4 hours monitoring, coordinating, assessing and building a relationship with the patient.
We occasionally have BTK patients who are not assigned a nurse at the beginning of the shift, even though we know they will come back on the shift. These are extremely challenging patients, with high potential for post-op complications, who benefit from specialized nursing care. I have spent my entire afternoon in a room with a new post-op BTK patient, completing auto-reinfusion, giving blood, watching precarious BPs, and basically ignoring my other 3 patients. How would any of us feel if this patient was our mom, or dad, or husband, or wife? How would we feel if our family member was being cared for by a hectic RN, who hasn’t had time for a break, and just found out that this new patient is to be absorbed into his/her assignment? This is factory nursing and I really do not believe that this is what we want for our patients at Unity Hospital. We need staffing that considers the acuity and best interests of our patients.
At our staff meeting this week, we had speakers who discussed how we could improve pain management for our patients, how we could improve the way we educate our patients , how we could do a better job of preventing the spread of infection among our patients. These are all issues which could be improved if we were staffed better, allowing RNs to take the time to address these issues. Monday, I had a very complicated shift which resulted in limited time period to review discharge instructions with my 80+ year old patient and her husband. CHF came up as a diagnosis so I needed to discuss the CHF discharge instructions with them. I recently read in the paper that Unity has the highest rate of re-hospitalizations for CHF patients so I really try to make sure that I review this information before discharge. I went into this room with the very thick CHF book and the discharge handouts and I tried to teach them. Although I anticipated that this would just be a review, I figured out that this couple did not know anything about CHF. I did the best I could but I was very discouraged because this couple needed someone who could really sit and take the time to explain everything – probably a 1 hour job and all I had was a few short minutes. I was rushed, my phone was ringing constantly, and I did a rotten job. Then after work, I went to the staff meeting and watched a video of how important it is that we teach our patients in ways that facilitate learning. This is something I want to be able to do – if we were staffed to provide me with the time to do it.
Management is asking us as RNs for flexibility in some tough economic times. We have been more than flexible over and over and over and over. In my 30+ years, the care we give our patients has changed tremendously. RNs have developed pathways which have resulted in specialty care which moves patients through the system in an efficient manner. RNs have worked hard to decrease the LOS of our patients. RNs have adapted to a complex computerized system which changed our daily workflow. RNs have learned to use all sorts of complicated technological equipment to monitor and improve the care of our patients. We are constantly changing to adapt to a complex hospital environment. But there are some areas where we cannot be flexible about and one of these areas is patient safety.
Hello, my name is Georgine Malone, I have been a critical care nurse for 33 years and have a great love for bedside patient care. I believe that each patient deserves the very best care we can provide for them and the idea of becoming more “Flexible” while working means we would have to sacrifice that care. Recently we had a patient, who is a quadriplegic and on a ventilator. He required frequent suctioning of his endotracheal tube and frequent medication as well as bedside comfort to help alleviate his anxiety. The nurse caring for this patient was open to admit another patient. The other nurses on staff had a full assignment already along with no PCA, all while the charge nurse was busy assisting the other nurses with certain tasks like, getting certain medications the nurses’ needed, helping the other nurses with turns, taking temperatures and answering the phones.
The supervisor wanted to admit another patient to the unit. The charge nurse determined, along with the admitting nurse thought that this would not be safe nor in the best interest of patient care. The supervisor said we were not able refuse and suggested we take the PCA from the other busy ICU so the PCA could sit in with the anxiety ridden quadriplegic. However, since the PCA is not qualified to suction or give medication and therefore not adequately take care of the patient it was not in the best interest of the hospital, patient, or nurses on staff to allow such treatment. Given the dangerous and hazardous situation we did not admit the patient on to our under-staffed floor in the best interest of the patient, the staff, and the hospital. This charge nurse was disciplined for her stand for safe patient care.
Becoming more flexible, as to the standards you are setting, means that patients with severe illness will receive inadequate service and care. As a neuro ICU nurse I often care for patients with brain hemorrhages. These patients are extremely volatile, going from fully aware and communicating to comatose with a brain stem herniation resulting in death, in a matter of minutes. It is my job to do frequent neurology checks and assess for subtle changes in the patient such as restlessness, new onset weakness, pupillary changes, bradycardia and hypertension, that suggest impending herniation and death. If any of these changes occur the patient requires surgery with minutes to prevent death and devastation. The time and care these patients require is exhaustive and all the while we have our other patients to attend to that are just as serious and that need just as much attention. He may be on a ventilator and be on medicines to affect his blood pressure that requires every 15 minute vitals. We can only hope during the time of crisis of my other patient that he is okay. I don’t hear any alarms so I hope his blood pressure is okay and that he does not need suctioning. Most often there is not an extra nurse to take over care of this patient while we care for the crisis happening with the other patient.
Becoming more flexible while allowing for additional admits greatly reduces the amount of individual care given to patients and reduces the overall quality of our great hospital. The previous situations are demonstration enough that the acquisition of your new policy and standard will be detrimental to society and to the health care industry. Everyone admitted to any hospital should have the trust and the faith required to leave their loved ones in the hands of others, all while knowing that we are doing the best we can and using the best available resources allowed to care for their loved one.
Would a police captain send the same number of police officers to a gathering of 10,000 people for the Race for the Cure as an anti-war demonstration? Would a fire captain send the same number of firefighters to a one building fire be it a single family dwelling versus an multiunit apartment building?
Being able to budget our units to 115% would allow for patient acuity and nursing intensity … As nurses we see patients as people. They have families like you and I, loved ones like you and I, and a life like you and I. We value that life as if it were our family and would hope that the administration regulating our care would allow us to treat society accordingly. In the event that you or a loved one is put into our care, we would want to be given the opportunity, appropriate staff, and ample time to devote to their care and your love, putting safe patient care above “flexibility.”