Poor to non-existent management over the years has definitely had a trickle down effect on the rest of the staff on Labor and Delivery. In my time on this unit, seven years, I have seen four unit managers come and go, including the most recent interim manager. She actually seems to know her stuff somewhat. The rest of them - not so much.
The L&D staff (nurses, ancillary) have become such an almost out of the control bunch. No one is happy. We are chronically short staffed, overworked, and always asked for more, more, more out of us. Many shifts, I am asked to stay over for a few hours. Most times I say no, because I know my own physical limitations. If I can't physically work another hour, I certainly know it! Especially if it has been quite the busy, horrendous type of shift that it can be.
Yet, the powers that be say that our number of births are down from the previous year. About 4200 babies born in 2010, versus about 4500 babies born in 2009. Yet, we are definitely not any less busy. Probably even busier. Have they taken into account how many outpatient visits we've had? How about long term high risk hospitalized women who stay on L&D for days and even weeks at a time? The powers that be say that our productivity is low, as compared to the number of nursing hours worked. What type of calculation are they using to say this? Those powers that be need to come to our unit and observe what a typical eight hour shift can be like. It ain't pretty folks.
I was chatting with some of the ancillary staff (techs, clinical support staff) last evening. They have several people out on medical leave, so they're stretched super thin. And the middle management wants to cut them even shorter? They need at least two ancillary working on night shifts. Middle management wants to cut that back to one. Excuse me? One person to: be the secretary (a full-time job in itself), clean and restock the rooms at a rapid turnover pace (a full-time job for optimally two people to do, in order to turn rooms over quick enough!), and be available to scrub for c-sections. Too, too much for one person to do it all. Absolutely insane. I encouraged the ancillary staff to type up a letter addressing all of their issues and complaints, and to send a copy to the administration.
The insanity has to stop. This unit is a busy place - and we can't afford to lose anymore staff. Not nurses, no support staff!
13 comments:
where I worked, the hospital brought in an outside company (non-medical) to do a "statistical study and comparison between hospitals" and concluded we didn't need as many staff as we had compared to other hospitals. We were run off our feet, and it was downright dangerous at times and it was only luck that we didn't have deaths... I can remember running between three active patients, doing one delivery after the next while being in charge - due to short staffing. They want 1:1 for an active laboring mom but don't staff for it. Not a pretty sight.
I think this is happening everywhere. Do we see mgmt being cut or downstaffed due to lower pt census? Never! Yet the people who actually take care of the pts are cut and forced to take on heavier workloads. So frustrating. Hope things get better for you:)
Would going to the media anonymously (or writing a letter anonymously) maybe help bring attention to the issue? Or would that backfire on the staff?
We are struggling with the same thing at my work in lactation services - they say our productivity is down based only on the number of patients we are seeing, not the acuity of the patients. And we seem to have a lot of late preterm babies recently who can need a lot of intensive help with feeding. It's very frustrating when you spend a whole shift being run off your feet and then being told that you're not productive enough!
Can you collectively point out to management what you've pointed out in this post?
I have a letter that I am going to send to management. It's still in the process of being written, but they will be hearing QUITE the earful from me about how we are lacking on our unit.
I'm assuming that these struggles are due to $$$. Right? The hospital not making enough money, having too many cash-pay patients, HMO patients who don't adequately cover their costs, and/or just not enough patients? Do you know if that's the bottom line here? Do other L&D units manage these challenges better? What do you see as an answer?Just curious. I feel for you. It's sounds overwhelming and exhausting.
Camille - I honestly don't know what the answer is. Yes, it comes down to money. Our unit, as whole, spends more than it brings in as income. We are not profitable. Nursing staffing is a huge part of the expenditures. We have tried to increase our system of charging for more things, specifically nursing time. However, just because we charge for it, doesn't mean we get reimbursed for it.
We also have a high state medicaid patient population - which as many people know, does not reimburse nearly as well as private health insurance does. Pennies on the dollar.
I recently heard about the new AWHONN guidelines for perinatal nursing that, among other things, recommend 1:1 nurse/patient staffing for mothers being induced or mothers having unmedicated labors. Any chance that the new guidelines will influence staffing at your hospital? I don't know how much weight these kinds of guidelines carry.
You are not alone with your problem. We are experiencing the same things at my hospital. Numbers are "down" (?), yet we feel just as beaten down at the end of the day. It seems that every week or so, at least one RN gives her two-week notice. Something bad's gonna go down, but I pray it's not when I'm there, you know?
Sometimes I swear we work on the same unit...same BS is happening where I work. It's incredibly frustrating.
In my small 32-bed ED last month we had 24 admitted patients waiting for rooms. You can imagine what happens when you take a 50k visits/year ED and effectively make it an 8-bed unit. Patients in every hallway (there are no limits on nurse:patient ratios in the ED). Waiting room packed to the gills. Somebody's going to die out there -- soon.
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