Brain Drain

Brain Drain

By Juli Uzlik, RN

Juli Uzlik

MNA Member

It’s amazing how just the smallest change can have the biggest effects on registered nurses and their patients.  At my hospital, Fairview Southdale in Edina, a temporary nursing consultant came in and decreased the staffing in the Heart Center by one nurse per shift. The hospital has taken away one charge nurse where there have been two since the inception of the unit.

Not a big deal, right?  Still have a charge nurse.  Not really.  The Heart Center is laid out in two separate sections with literally a wall and a hallway between the two sections.  One charge nurse can’t see both sides at the same time.  One section is the CSC (Cardiac Special Care) with less acute patients and the other is CCU (Cardiac Care Unit) with more acute patients.  In addition, the 35 cardiac monitors are now being “watched” by the health unit coordinators (HUCs) who have no medical training. We were told that there was no money in the budget for cardiac monitor techs.  Most of the experienced charge nurses have refused to be in charge of such an unsafe situation and many have stepped down from the role.  As a result, the hospital is now choosing to break our contract and employ “traveling nurses” as charge nurses.  These nurses were given a one-day orientation to the unit, and were apprised of general topics like common side effects of Cymbalta, heart disease, etc, and a one-day orientation to the charge nurse role.

This is an unsafe situation and one of the hospital’s own making.  Many of our experienced cardiac nurses have left the Heart Center due to the lack of management’s response to detailed reports of unsafe situations.  These are also the nurses who respond to “Code Blues” or cardiac/respiratory arrests throughout the hospital.

The nurses who are still working in the Heart Center are making the maximum effort to ensure that patients and their families don’t notice the staffing shortages.  That’s what we do, but how long can we go on?

The sad part is that the patient care we give is changing due to the decrease in registered nurses.  The decrease of just one nurse is all it takes to create an unsafe situation in a unit where all patients are on cardiac monitors.  Due to the lack of a qualified RN watching these monitors, a subtle changed may not be noticed until the situation becomes much more urgent.

If you or a loved one has been in the hospital recently, you know it is the nurses who are on duty 24/7 and it is the nurses who are expected to pick up subtle changes in their patients and notify the MD.  Nurses save patients lives!

17 Comments

  1. Good article Julie! Your words & situation mimics ours at Unity.

  2. Report manager to MN BON because the HUCs did not receive training and BON’s role is to protect public. Does the unit have any accreditation status that has criteria on staffing and education for the employees in that unit that is not now being met? What does the safety officer at TJC say about the safety of the unit?

  3. Nicely written Juli. As one of the last remaining charge nurses left, I feel the added stress and frustration of the role every time I am in charge. My last stretch was five twelve hour charge shifts which left me numb and wondering, “What am I doing to myself” when no one in upper management seems to care! The heart center has always been a busy unit, but the lack of that extra charge is really pushing the envelope. I used to take pride in me quality of work as a charge nurse but sadly that has gone by the wayside. There is no regard for the prime reason we all do what we do, and that is the patients! It is heartbreaking to say the least.

  4. My friend just returned from working in California for 3 years where staffing is a non-sequitur. The staff are legislated and there isn’t any argument about it, it just is. I know MN is big on the doctors and a few of them have created the biggest insurance co. such as United Health Group. Also ICSI Institute for Clinical Systems Improvement which is ran by doctors (including Methodist, Health Partners, & Mayo). To change we need staffing legislated. To do this we need to get powerful people on our side–and inform the public and the attorney general of MN who keeps the public trust. Thanks for your input and thoughtful comment.

  5. If it were me, I would have a group meeting off property to brainstorm some actions. Wear red ribbons every shift. When patients or others ask about them, say they are a reminder of patient safety. Mgmt. will become aware very quickly. Fill out concern for safe staffing reports EVERY SINGLE SHIFT. The BON report suggestion about HUCs being responsible for cardiac monitoring is a good one. March on the boss. Enlist the help of some of your docs. Sometimes they can influence situations.

  6. Register for MNA Governor Candidate Member Screenings 9/9/17 to see which candidate has an actual plan to support and pass nurse/patient ratio bill.

  7. Julie,
    thanks for being brave enough to share this with all of us. Many of us have thought this many, many times but are fearful to say anything as publicly as this due to the fear of retaliation from the hospital or management. I’ve seen nurses who have stepped up and said but than are retaliated against and eventually chased out of their job.
    Thanks

  8. Get involved in MNA’s Practice Commission.

  9. When I participated in MNA education session, Refusing an Unsafe Assignment, the presenter was excellent and I often refer to that information:
    Step One: Recognize an Unsafe Situation (great Julie!)
    Step Two: Refuse an Unsafe Assignment
    Step Three: Stand in Solidarity for Safe Staffing
    Step Four: Concern for Safe Staffing Form (each nurse)
    Step Five: Union Solidarity (actions)
    Step Six: Legislative Advocacy

  10. Very good job Julie bringing this to everyones attention and documentation of this situation is vital. Instruct all the nurses to keep a journal that will demonstrate the unsafe practices of the units. FSH has created a situation that will only result in a terrible outcome and of course that usually means a fatality will occur and maybe just maybe that will get their attention with a huge lawsuit and media coverage. Then bring our your documentation and prove the negligence and that you all tried to stop a bad outcome but management wouldn’t listen. Where did all the good Nurses go? Folks this is why we don’t have experienced critical care nurses – management doesn’t care – its all about the money now. Sad to say. Keep documenting. And follow those 6 steps of MNA. Marie Wendle – Legal Nurse Consultant

  11. Thank you Julie for bringing this to the forefront and having the courage to speak about the unfortunate trend now happening in a unit so many of us loved working in. Perhaps you’ll provide an awareness by sharing this.

  12. Jeapordizing patients’ lives and losing nurses so hospitals can keep more money makes me even less likely to go in to see a Dr. This kind of cost cutting is just is so wrong. And 1 day of training?

  13. I was a HUC (also a former LPN) that worked on a cardiac unit for years. We had to have the same cardiac monitoring coarse that the nurses took and had to pass the same test. HUC’s that are well trained can do the monitoring very effectively but not if they are doing a lot of other duties. If you are busy with other tasks you can not do justice to the monitors. You are not looking at them as often or that well. You have to rely on the alarms to alert you of changes, which could be to late. 35 heart monitors is a lot for one person to watch that has a duel job role.

  14. I pray I never need to be hospitalized on a unit where they can not afford to pay for cardiac monitor techs!
    This is appalling what they have done to these two units.

  15. Hats off to Juli for bringing this forward for all to see! As a longtime employee of the Heart Center I have seen many cutbacks over the years but the most recent cut of the charge nurse has brought the unit to it’s knees. It’s concerning the newer nurses are not getting the guidance and support needed and without that support they will not stay on for years to come. Historically the unit has had great retension of it’s nurses and we were proud to consistently have the highest patient satisfaction rates. With the loss of so many of our skilled nurses the scores have declined. Also concerning is the HUC’s watching the monitors and that is to say we even have a HUC on duty! These are all valid concerns for the safety of our patients and the sanity of our remaining nurses!

  16. Julie. Haven’t seen you for a looong time. Still advocating for nurses and patients. Your article was right on!

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