Thursday, December 21, 2006

Why I want a day off.

I'm frustrated. I'm worn out. I'm a little bit angry. And a little bit country and a little bit rock and roll, but that's a subject for a different post.

I'm learning that, in the absence of competent managers and anybody who gives a damn about staffing, good time management skills can be a bad thing. They'll land you with extra work when other people are drowning, and you'll have to help the drowning folks as well. Not that I mind doing that, generally, but it's a bit of a stretch to expect that one person can carry six or seven high-acuity patients while still starting IVs and putting NG tubes down other people's patients. Something has to suffer, and it's usually the care of the least-acute patients.

Or it's the nurse. As it is in this case.

See, we're having staffing problems. We're having problems with management, in that management simply doesn't give a damn. We're having problems getting supplies. We're having problems getting answers.

And what that means, for us on the ground, is this: there is no guarantee that the person who manages the floor or the poor sod who's been tapped to charge will be around when you need them. More likely one or both of them will be stuck on the phone, trying to put out fires somewhere. That leaves the most experienced nurses, the ones with the best time-management skills and the broadest clinical knowledge, to juggle things like signing off orders and implementing bizarre drips and titrations, all the while trying to take care of their own patients and clean up messes left by people in other departments who are so overworked they can't see straight.

This is why I want a day off.

The last three weeks have been hellish. We've all run our bohunkeses off, trying to keep it together, and nobody seems to notice. Nobody in charge, that is. A group of five of us got called in to the Big Mangler's Office last week to get quizzed on why we haven't earned enough Customer Service Points to get the nifty T-shirts that proclaim us TEAM players.

We all stared at each other for a few seconds, glassy-eyed, before another nurse said, "Um...well, we've been too busy doing our jobs."

And that, my friends, is the root of the problem. If your manglement cares more about the external signs of Good Customer Service than the basics (which translates to "being able to provide good care to your patients"), you'll get screwed...and then dinged for walking bow-legged.

I want a few simple things for Christmas this year:

Enough staff to do a decentish job keeping people from coding.

Support staff that knows what they're doing.

Enough supplies to do my job. We don't need hinty-quintillion thoracentesis kits on a neuro unit; we need enough urinals and suture kits.

Managers that aren't too busy with customer service issues to notice what's going on in patient care.

Ten extra minutes in a day. That's all. Just ten minutes.


Judy said...

Last summer we had staffing problems. Big time staffing problems.

We found a corporate patient safety hotline number. We called it.

Every day until things got better.

I am no longer charge nurse. Coincidence, I've been told - as if I give a damn.

Funny but the hotline number has disappeared and I can't find it anywhere. I wonder why THAT happened.

Fortunately, staffing has been adequate for months. I hope it lasts. If not, I WILL find that number.

Anonymous said...

I feel your pain, Jo. My hospital is going through the same crap - the problems with the patient-centered issues are all too clear to those of us who are actually spending the time with the patients. And the clicky-heel people in the upstairs offices don't seem to notice our cries for help: instead we keep getting warm bodies for staff, more policies and customer-service pep talks, and less and less respect for the ass-busting we all do every day. It sucks, and it's why a bunch of us are running. Sad.

woolywoman said...

Don't you have a union? Can you rat out the hospital to the DHS, or whoever your state agency is? Is there a big honcho neurosurgeon who values nurses and doesn't like his patients being on a short staffed unit? Are you carrying enough malpractice insurance? In times like these, it helps to not work any more overtime than you want. It will suck you dry. Hang tough, polish your resume, and make sure you don't hurt your back.

Anonymous said...

Sorry. I don't think ten minutes will do you any good.

If only.

shrimplate said...

Speaking of supply issues, for the last three days we've been out of spoons. Plenty of forks, but there are things you need to do that can only be done with a spoon.

GingerJar said...

Isn't it amazing how, especially on weekends, little things like foley catheters, spoons, and butterflies (needles...not the kind we probably will be running around *catching*) are in short supply, and you have to run all over the hospital to other units rather than staying in your area...and hello...working! Oh, and little things like pill cutters and crushers...Lord forbid those be supplied by the hospital...after all how hard is it to crush up 50 pills for the Peg patient???without a crusher???? I finally bought my own and keep it locked in my locker. hospital I worked at insisted that we could not get spoons...although there were thousands of them in the lunch room...but try sneaking some from the lunch-room to the ICU...and you practically got arrested....

Good Luck! Hope the staffing issues get better...after all winter is here with all the influx of patients.

GingerJar said...

I have tried numerous times to leave you a snappy little message...I love your blogs...they are very original...and true. Bog-hell seems to kick me out instead of posting.

rn2trauma said...

for days now, the PACU has been the place for overflow step down patients, and I have been trying to find a number to call to report it. No PYXIS. One RN for six patients. The ratio isnt that bad except when two of them go bad, like tonight. cramped area, no relief available for breaks or lunch because the charge nurse has critical patients in SICU. The nurse has to run 150 yards to the SICU to get meds for all six of the patients while leaving a CNA on the unit. Everything has to be cleaned up by day shift because there will be patients coming from OR in the morning. They wont go on SAT so the patients just keep on coming. Does anyone know the number to call for JCHACO or somebody to make the Veteran's Administration Hospital sit up and take notice? This is just plain bad practice.