Here is a really scary email I got from a nurse in a US hospital. She was kind enough to give me permission to reprint the email here and you can see my reply below.
I would love to hear your ideas on the healthcare industry. As you may know, hospitals reimbursement for Medicare are in part determined by patient satisfaction. Management, in turn, has adopted the “customer is always right” in order to secure positive feedback. As you can imagine, this has not worked.
At the same time, nurses are quitting by the truckloads. Employee morale is at a ridiculously low point and it has been so ongoing that the phrases you hear from nurses are, “Well, its better here than anywhere else”. This is particularly concerning since it is seemingly so bad here. Let me say that the nurses I work with absolutely love taking care of people. It is the hurdles that are placed in front of us that make the job frustrating.
We work at critical staffing levels routinely, are floated to areas we have not been adequately trained, and are given unreasonable patient loads. It is unsafe.
A patient died recently and was not on the monitor at the time. The organizations answer was to have staff sign a book at during the shift stating that the monitor was checked and all patients were on them… the reason the patient was off the monitor was because the nurse didn’t have time to do it.
We were critically staffed and even the charge nurse had a full team with 2/3 other nurses floated from a lower level of care and not trained to take care of this type of patient. When the house charge nurse informed management that the reason was related to staffing, she was written up.
I don’t know of a single nurse who isn’t afraid of being fired. Nurses routinely lie about this because to voice it would cost them their job.
It would be nice to be able to quit and move to another facility, however, it isn’t any different at other facilities. This problem is prevalent, endemic, and critical.
Here is an example of the culture…
The hospital policy is for every nurse to take a 30 minute lunch break (its actually the law)
If you don’t take a lunch you can be written up
There is nobody here to relieve you for your lunch
Not enough staff on the floor to safely leave for lunch so we all eat at the desk while we work
We are not supposed to lift patients. There are 3 lifts in the entire hospital so we have to lift patients
When I informed the wound nurse that the increase in pressure ulcers were from staff being given too many patients to take care of properly and no lifts, I was told that we had plenty of lifts and to use proper body mechanics.
I don’t know if you have any ideas….but I’m hoping that you do.
And here’s my reply:
Thank you so much for your email. I have worked with some Danish hospitals and I see many of the same issues you point to, primarily that budget cuts lead to permanent understaffing.It’s terrible. If there’s one industry where jobs should be fulfilling and meaningful it’s healthcare, because there you get to work directly on making patients’ lives better. But of course, this is impossible when you’re not given the resources to do the job well.What happens in that case is that jobs become incredibly stressful and frustrating because employees see that the system is hurting patients instead.Here’s what I think hospitals need: A rebellion. Nurses, doctors and other employees need to stand up and protest conditions in some way that management can not overlook.I gave a talk about being a workplace rebel – you can see it here:This will not be easy – but neither is the current situation.The obvious question is: What can a group of employees possibly do against a huge entrenched and uncaring system? And the answer is We don’t know. Nobody knows what we can do until we do it.I wish I had something more specific to offer but I don’t think there are any easy solutions to this situation.
2 thoughts on “I don’t know of a single nurse who isn’t afraid of being fired.”
Since the hospital seems to have nurses coming from many other places, could they share best practices?
Perhaps one of them knows of a smart way to do X and another has tried Y with some luck and combined small tweaks may make the whole thing more palatable.
When there is too big a distance from what is to what should be, it is easy to avoid doing even the things that can be done to better the situation. But when one has the experience of succeeding with one change it feeds the energy to change other things as well.
Perhaps you should send her the story about the elephant, Alexander. Even when the situation stinks – or perhaps particularly when it stinks – small acts of kindness can make a big difference.
Nursing is not a stable environment for nurses or patient safety. It has changed so drastically because the industry has changed. We can’t afford the rising costs coupled with a pathologically narcissistic corporate structure that does not value the people who work for them. Eventually it will all collapse.