Strategies to Cope with Short Staffing in Nursing

By Jennifer Ward on Thu, Nov 14, 2013

In the patient care arena, nurses and unlicensed personnel strive to provide optimum patient care. However, this becomes more difficult when their work load is increased. In a concerted effort to satisfy budget constraints, the ratio of nurses to patients is regulated.

Unfortunately, when short staffing in nursing occurs, both licensed and unlicensed personnel on duty need to have a series of coping mechanisms in place. Such strategies have resulted in improved patient outcomes and improved job satisfaction for health care professionals. The purpose of this article is to offer staff nurses and administrators coping strategies for those unfortunate situations when they are faced with short staffing. These evidence-based strategies intend to improve patient care and enhance overall job satisfaction as reported by staff.

Linda Laskowski-Jones, RN, APRN, CCRN, CED, MS, and Kara Toulson, RN, CEN, BSN, (Linda Laskowski-Jones & and Kara Touslon, 2007, vol. 37 #10) have worked in collaboration to offer several strategies for short staffing such as follows:

  • Prioritize assignments. Nurses should start with most important assignment first. Then, they should tackle the assignment with medium priority. Assignments such as patient education might fall under this category. However, preparing the patient for a surgical procedure that is scheduled for that day demands immediate attention.
     
  • Improve on delegation skills and use unlicensed staff wisely. Effective delegation is increasingly important when there is a reduction in staff. Consider the following situation: there have been two call outs on a busy medical-surgical unit, and the primary nurse is now caring for six patients versus four. Two of her patients struggle with end stage renal disease, and they require daily weights. Weighing a patient can be done by unlicensed staff; however the interpretation of the data rests in the hands of the nurse. Nursing delegation is a key to effective time management.

    Consider the following scenario: the primary nurse has an increased work load and she is caring for two dialysis patients. In this situation, she could delegate weighing those patients to unlicensed staff. The interpretation of the data, however, rests in her hands. Similarly, obtaining blood pressure measurements or blood glucose readings can be efficiently done by unlicensed staff, but the interpretation and treatment is the responsibility of licensed staff. Similarly, one nurse should not routinely have the heaviest patient load. Dispersing the severity of the patient load improves the nurses’ morale, and it improves overall patient safety.

     
  • Be a team-player. This means that the nurse is dedicated to working with her colleagues in an effort to provide supreme patient care; her needs and feelings come next. Laksowki-Jones, RN, further added that being a team-player improves the morale on the unit, and it motivates the staff to, “…continue doing what they are doing.” Similarly, being a team player makes the staff feel as if they are part of a great plan: to provide supreme patient care. And, this plan can be done even in lieu of short staffing.

    Organizing the work load in an equal and efficient fashion is another method to demonstrate teamwork. And, it allows staff to accomplish their goals in lieu of short staffing. Effective delegation between licensed and unlicensed staff also reduces the fatigue of one person, it reduces overall negativity, and it enhances morale in a fashion similar to teamwork.
     
  • Involve the family in patient care activities. This can also reduce the work load, and it can increase their sense of self-efficacy and involvement. Many times care-givers are afraid of providing care, but if they are offered the opportunity to practice in a safe-environment, their comfort level is likely to increase. In this safe-environment, families or friends will have the opportunity to ask questions that they might have. Likewise, this time of sharing and intimacy can make the patient and the care-giver view themselves as a unit in the treatment process.

In a similar article, Christina Orlovsky (Orlovsky, 2005) encourages Nurse managers to be an ally for their staff nurses. Orlovsky proposes that nurse managers could call in other staff and offer ttired nursehem incentives to come in to help. Or they could inform the hospital’s nursing administration and network appropriately. In many cases, staffing agencies can be used to recruit personnel. However, if short staffing situations are a pattern, it is the nurse managers’ duty to examine the cause and to propose solutions for repair. In the wake of short staffing, the house staffing officer should be notified. In her article, Orlovsky proposes,"… that managers should notify administration as soon as they identify the need for staff, or they could call in off-duty staff and offer them incentives to come in to work. When possible, nurse managers could assist with patient-care on their unit." 

In a related article, titled “Hospital Nurse Staffing and Quality of Care,” Mark Stanton encourages nurses to maintain a positive attitude. Patients and their families can sense when a nurse is frustrated or overworked, and being positive equates to improved patient satisfaction and outcomes. Similarly, he suggests that nurses take good care of themselves and ask for what they need. Much too often, nurses feel that they have to carry the entire work load on their shoulders, and this can lead to dissatisfaction and compromised patient care. However, simply by delegating or asking for what they need, the situation can be resolved. Nurses need to take care of themselves; this means that taking breaks for meals is important and getting the proper amount of rest is crucial. Hunger and fatigue can negatively affect performance and attitude.

Short staffing is one of the perils of any profession but it can be a more severe problem in nursing. Having the right number of staff to care for the number and the severity of patients on the unit, without exceeding the proposed budget, is difficult to achieve. And, its success depends on understanding and practice. In this article, it was the author’s intention to provide her nursing colleagues with a variety of evidence-based strategies to cope with short-staffing without compromising the care of her patients. 



39 COMMENTS

Marrizhiela Obleada 1 week ago
Nice Idea, I'm really particular how to staff nurse in a hospital, but with the tips you mention above it will really help them to maximize and utilize their job performances. Although you have to consider some factor like delegating work. You must properly identify who is qualified for each job assignment you must screen their skills. unlicensed should have different task than licensed to avoid necessary difficulties in taking care of patients. In recruitment process you can ask help or do a partnerhip with trusted recruitment agency. A friend of mine was hired through a naperville staffing agency and as of now she's still working as nurse.

Anonymous 9 months ago
It's easy to see the author is clueless about the conditions of employment for RN's working in acute care. I work in a VA hospital. After 30 year working on the outside I thought when I got this federal Job all my conditions of employment and patient care issues would be over. After all they government oversees on the wrong doers in healthcare. WRONG! The VA is the worst place for nursing abuse. 1. You climb the ladder by serving the boss above you not the patient. 2. Management turns staffing problems on us. We complain, they retaliate by prohibiting us from using a cell phone, from drinking water while on duty, or making our load so tough we can't take any kind of break. It's evil as it can get. We have yearly surveys to assess how happy we are. The numbers are always low. I stopped filling them out when nothing ever changed. This year our nurse manager stoop as low as appoint the lowest self esteem nurse to head our unit based happiness committee and pressed her to write out solutions to our problems as if we were responsible and management had no part in it. This document is then sent to the hospital chief or on the outside CEO. So I ask the author, how many coping mechanisms would you like me to be using when I take care of you or your family? Should work under enough stress that I have to employ a psych doctor to provide you care? STOP PLACING BLAME ON NURSES. We do the best we can. We want to provide good care in very difficult working conditions. And for that you write garbage like this to give our abusers cover. I wish I would write. I kick myself everyday for not learning how to write like you. I would then expose the fraud and abuse that's going on in hospitals all over this nation. Patients are not getting care. IT's lip service. IT's brainwashing, Everyday I hear the word used in regards to OBAMA CARE. There's no care in Obama care. There's no care healthcare. It's all just brainwashing.

Anonymous 3 years ago
I am just now getting involved. I really enjoyed the article. There were some valid ideas, however, it is true that 1)There is no one to delegate to any longer. CNA's often have 20 patients or maybe there is not even a CNA, and 2)Our tasks are often already prioritized and it is this:It all has to be done and it has to be done right now! I am fearful about the repercussions of the productivity. Hospitals have to have the money or there will be nowhere to work, but there is more to do than can be done at times.

Anonymous 3 years ago
Dear Lou D. Perhaps nurses are angry because they are unable to do what they went into nursing to do...care for patients as we would want to be cared for ourselves. Don't talk about professionalism. Professionals are those people who want to feel success about fulfilling a job well done. So often the nurse feels as though she hadn't done enough or what has she missed when something goes wrong with the patient. It is important to make money to keep a business afloat, but nursing is a unique business that is dealing with the physical,and emotional needs of people. This issue is a system problem. Not a problem with nursing professionals.

Anonymous 3 years ago

Wow !!! I am frustrated and came to this article to maybe have some great advice to help my floor run more efficiently , instead I'm angry by a few things. One, prioritize!! Omg what nurse out there do you know that does not do that!!the nurse that wrote that I'm so sure sits at a desk and comes up with this crap. I am a clinical leader in a small community hospital where I work with some of the most amazing nurses around. I spend most of my day out on the floor helping whoever needs me, washing patients, talking with dr's, families, doing wound care, starting iv's. We recently took a nurse away from our floor and each nurse has 5 patients. The upper management does not care. They are told to crunch numbers, but what they are crunching is the staff, people do not want to stay in this profession. So instead of bitching about this how do we make it better?? I really think that upper management is way too heavy, maybe if we lightened up that end we could put thoses moneys into having more nurses on the floors, and giving our patients better quality of care, and being a safer environment . Ps have to put this in our new nurses need us to direct them, we need to give them suggestions, support them, and praise them for a great job, remember we were there once. The young women and men that I work with are wonderful young people that grow everyday with a little help from us.


Anne Ryan 1 year ago
I had the same idea, at this time my unit that is split into two different areas, away from each other, we are working 2 nurses for 10 patients in each side, no Tech or CNA, no secretary, one charge nurse that works in one side or both sides running up and down. The best scenario is when we have three nurses, one nurse place orders, help with vital signs, discharges, and admissions, and the other two do the rest. Our manager oversees five departments and she has a director that monitors her. If they decided they could take the director position out, bring CNAs and secretaries, and the workload would be feasible for nurses to accomplish.

Anonymous 3 years ago

I wonder if the authors of this article have bothered to read the comments??


Anonymous 3 years ago
Zettie C., that's interesting. The typical nurse today looks like me - somewhere in her 50s. We came up in a different era. Our expectations of ourselves and our employers often no longer jibe with what we find out there. We have a real sense of professionalism and responsibility to our patients. We're no longer treated like professionals. So it makes sense that today's new nurses have not been trained to think of themselves as professionals or act as such. These young people will probably fit in much better with the corporate culture - big on profits, small on everything else. I feel sorry for the patients, and I don't even want to think about the time when myself or my husband enters this system as a patient. Not my idea of nursing, but I'm old...

Anonymous Anonymous 3 months ago
Agree with you 100% and am the same age.....tired of coming home exhausted trying to care for patients with no staff and being the age I am. I am ready to leave the profession entirely, even with 20 years in, because now they want us to go back to school to get a BSN which is even more work on us at home and no compensatory pay increase for that education. I used to love nursing, but am fed up with the politics of it, the corporateness of it, and am willing to take a severe pay cut to go do something else less stressful and less frustrating.

Anonymous 3 years ago
When I saw the title of this article, I taught it was going to tell me something new. I agree with some of the other comments. This was written for Nursing students not for seasoned Nurses who have already tried some of your suggestions and then some. When addressing the Shortage and dissatifaction in our profession, please do not insult our intelligence and come up with something new, something that can really help us.
Thank You

Anonymous 3 years ago
Useless articles like this are just more proof of the low regard in which working nurses are held - and of how out of touch with real nursing nurses like the writer are.

Anonymous 3 years ago
I've learned that one nurse can only do so much in a certain amount of time. Prioritizing is definitely the key, but everything won't get done every shift. Nurses today are forced to choose what is most important for the patient.

Anonymous 3 years ago
We have no charge RN, no CNA, no secretary, just 3 RNs. Who may I ask do we delegate to?

Anonymous 3 years ago
No ancillary staff to delegate to most of the time. Nurses are upset Lou and Nettie, who are out of touch with pt care obviously, because being short staffed and loaded up with patients, is not safe!!! We are thinking of the patients!!! I want to be a good nurse, my patients deserve the best care. It is not possible when you have so many pts to care for you can't even find the time to pee for 12 hours. Eating anything is out of the question. Patients will not get the care they deserve when the nurse is streched too thin no matter how well she or he prioritizes. I work in CA too but at a non union hospital. Ratios are non existent here. Management is out of touch and really does not care. It makes me laugh to think they would ever come in to help on the floor. That is so funny.

Anonymous 3 years ago
wow, what I have read is the same way I feel. Delegation is great if one has someone to do that with. The frustrations i feel and see causes me great concern for the patient. Short staffed can be from call offs or from trying to decrease the bottom number in order to make money. I have never seen so much craziness in a hospital setting. really is sad to see this happening. I cant wait til i get out of nursing, that is sad to say, because i am a good nurse but so not like what is going on in healthcare. the staffing and the care that is needed isnt there anymore. It is called greed. the patient use to come first, oh one claims to put the pt first, but in reality the hospital and all the higher ups get the money, its all about money, and some of them call themselves nurses. makes me sick.

Anonymous 3 years ago
I am not an RN but an LPN unit manager on a very busy sub-acute unit. We have CNA'S who come from a culture of livind in natural conditions and poverty. They don't always understand the administrators constant need for there to be bedspreads on the patients beds when their family members are sleeping in tents in the dirt with no bathrooms. I'll be dealing with an emergecy discharge to the hospital and she'll be asking me why there are dirty trays in the kitchen and get someone to remove them. Ok I'll just stop and do that for you-not. There is no reality in the world of upper management. Our floor is " staffed to census" It doesn't matter about accuity because some 30 years ago a nurse went around to see how much time is needed to care for each patient, and has not been updated since. Managers have no control on staffing. Agency nurses? Whats that? We haven't used them in 13 years, they are too expensive! I love how the jewish staff have to have their holidays off no matter what but when it comes to Christmas too bad your working. When asked why can't you get agency? We don't use agency- they are too expensive! Talk about low staff morale. I am not a predjudice person but am speaking to the career of nursing. Uor facility also has the rule no vacations during holidays, but there goes our diector of nursind 3-11 supervisor and weekend supervisor on vacation for 2-4 weeks over the major holidays! The CNA'S are already doing weights and all non-licsensed duties. You try to delegate to the staff nurses but you are lucky if they understand the english language. The families are so demandind and "priveleged" they would not lift a finger to help their own family and don't care about other patients on the floor's needs. One time we had a patient coding and another patient was mad because she had to wait for her medicine! Also ?no towels available" for patient care what do we do? Give me a break. People need to wake up and see reality. Patients sometimes go home and give negative comments to our facility but don't realize that most facilities in Massachussetts are even worse and it's budgets causing poor care most of the time not the nurses and CNA'S

Anonymous 3 years ago
I work in a major inner city ER. We have a skeleton nursing roster. If one of my colleagues are sick or has a family emergency there is not another nurse to cover for the "call in" for when "life events" occur outside of work. The scramble begins in telephone calls pleading for a colleague that has already worked 40 hrs to please come in to help out.
I was hoping to be encouraged by this article but deeply disappointed. This author offers nothing new and would be best in directing this information to Nursing students.
Those of us out in the trenches fighting daily for adequate staffing fully understand the frustration. When patients and their loved ones come through the hospital doors it is their expectation the best care will be given.
Working short staffed even with a positive attitude, Emotional Intelligence, and team work has its limits if the patient acuity caseload is greater than the nurses staffed that day.
I dont need my Nurse Manager or Director of Nursing to come and give me a "pep" talk about "teamwork" or "positive attitudes". When we are short it should never be question or a remote event tha they actually roll up their sleeves and help out.
Stop paying the CEO's and higher management that have nothing to do with bedside patient care and take those bonuses to hire more nurses.
This will assist in creating an enviroment of safety for patients and nurses. STOP PUTTING FOCUS ON HOSPITALS MAKING MONEY BUT PLACE FOCUS ON PROVIDING BEST POSSIBLE NURSING CARE. GUESS WHAT, THE HOSPITALS WILL STILL MAKE MONEY AND PATIENTS WILL MOST LIKELY LIVE THROUGH THEIR HOSPITAL STAY TO SHARE THEIR POSITIVE EXPERIENCE.
Higher Management IS PLAYING RUSSIAN ROULETTE with
patient's lives and increasing the chances for an undesirable outcome by placing the burden of overextending the nurse.
We are nurses who utiliize teamwork, competency, compassion,delegation, EBP and Emotional Intelligence each shift to make a difference.
Many of us provide and do the best we can with the skeleton crew hoping that this wont be the shift that a patient has an undesirable outcome or worse yet dies as a direct result of working short staff. THIS IS WHAT WEIGHS SO HEAVILY ON MY SOUL EACH SHIFT WE WORK WITH INADEQUATE NURSE COVERAGE. THE DAY I KNOW LONGER REOCOGNIZE THE SERIOUSNESS AND HAZARDS OF INADEQUATE NURSE STAFFING FOR OUR PATIENTS, IS THE DAY I HANG UP MY STETHESCOPE FOR ANOTHER PROFESSION.

Anonymous 3 years ago
I was hoping for a fresh view. Obviously not. And when you've been overwhelmed and overworked long enough, you really DON'T care anymore...it's called burnout. Caused by uncaring and inept management.

Anonymous 3 years ago
One huge reason why Nurses who have been in the business longer have retired early and/or no longer want to work in todays healthcare world - and that is due to longer (unsafe) hours (most places having gone to 12hour shifts) and unsafe staffing. And it isn't due to a "shortage" of nurses more than it IS due tothe bottem line which we all know is MONEY.

Anonymous 3 years ago
There does seem to be a sense of "poor me" with some nurses, and sadly this is often taught by senior staff to new nurses both at my hospital and where nurse friends work.
I am frustrated by comments from nurses that they are always over worked and understaffed. We work in a profession that is busy and has great expectations for performance and professionalism. If it is too much for you - get out- we don't need you. There were 600 applicants for 7 new positions in my department. Young new grads who, if mentored well, would be wonderful nurses. Nursing is not for everyone. If you have passed a point of being able to do the work with some passion you should - for your sake and for your patients and coworkers - find a new profession. It is NOT the responsiblity of the hospital or managers to instill you with joy in your job, or to make you happy.

Anonymous Anonymous 3 months ago
AMEN -- we do not want to be "made happy" we want adequate staffing to care for human beings..... OUR PATIENTS. The original commenter probably has a job that has adequate staffing and is not a life and death area like an ER or OR. You are patronizing and demeaning to RNs who have worked in this profession much longer than you have, and care for their patients and want to give the best care possible but find it impossible with todays staffing reductions due to meeting the ever present bottom line of profit.
And if there are 600 nurses to take the place of each one left? Why are there still job postings by the hundreds for RNs? I'll tell you, because like one comment stated, they are popping out new grads that don't care and are in it for the money only and may well be taking care of YOU one day. Letting you go without what you need when you are sick and when they lose their license for it one day, far after having cared for you? They will still not care.

Anonymous 3 months ago
I've read many of the comments. I do not see people asking for hospitals and managers to make them happy. There are valid concerns which boil down to, I think, expectations being out of line with the resources available. Nurses who are doing excellent work often feel dissatisfied because there is no way to successfully fulfill expectations. The comment "If it is too much for you - get out - we don't need you" is patronizing and demeaning. It intentionally mischaracterizes nurses professional concerns for their patients and their sense of responsibility to meet their patients needs as some sort of character flaw.

When we point out concerns within the system in an effort to advocate for our patients, we are at risk of being labelled in some negative way - but it is our professional responsibility to bring our concerns to administration so that they may be addressed.

I, too, work with amazing nurses. We have a had a recent, significant staff turnover. We have many new grads being oriented under very difficult conditions - the affects of this on the quality of their orientation, as well as on their introduction to the nursing profession
(not to mention the effect on patient care) is terribly negative.

One other comment. The author suggests prioritizing patient education lower than other, more immediate concerns. That is, of course, what happens. One result of this lack of prioritization of patient education is higher readmission rates. If patients are dc'd without fully understanding their meds/ssx to report/how and when to take, disease process, wound care, safe activity routines, diet restrictions, plan for follow-up....how can we expect them to maintain their health when they are dc'd?

We DO NEED nurses who professionally voice concerns - the day we stop advocating for our patients, the day we start turning on nurses who demonstrate their professionalism by trying to bring systemic problems to light - THAT is the day we should stop practicing.

Anonymous 3 years ago
"Budget neutral" is the new word in our institution. They don't care. I too looked at this article for ideas, it was lame. Evidence base is all well and good-but it doesn't address the effect in the real world of short staffing. I really didn't see anything to support "evidence based" in this article. Our institution has adopted "Kaizen"-or in another words "change for the better" We have whole teams devoted to this (usually staff picked by management-these would be people who are the "brown nosers" and not someone who is really in touch with situation. It's been a disaster, but management thinks they have done a wonderful job at making our life easier-NOT! They spend a lot of time patting themselves on their backs for job well done, they have "team morale building activities" among themselves. The real world-nurses don't have time to go to the bathroom, have their meals, go on breaks, much less take care of pts with higher accuities & less resources. Being a patient is a dangerous situation.

Anonymous 3 years ago
As an RN who spent some years on the floor practicing bedside nursing, it is clear that not much has changed. To help people actually create health in their lives instead of just reacting to disease, I am no longer at the bedside but instead am implementing an MD led program that is proven safe and effective by Johns Hopkins University and the NIH that results in reaching a healthy weight, learning how to sustain that weight loss, get off expensive meds, and more. I now have the privilege of helping others truly get healthy. My schedule is my own, the compensation is great, and I've got more time to enjoy life. I no longer have to work in the settings that have been mentioned here and I am very grateful. If you would like to know more I am happy to simply share the info with you...I am just the messenger! You can reply to me at TakeShapeWithSharon@gmail.comor simply comment here. To all of you, though, I wish you the best working in your areas of expertise and for having the heart of a nurse who truly cares about her/his patients' experience and outcome. Thanks for all you do.

Anonymous 3 years ago
I thought this article would offer some new insight but i found it amusing instead..... Delegate and Prioritize, that is their suggestions..... WE ALREADY DO THAT DAY IN AND DAY OUT.....THAT IS WHAT OUR JOB CONSISTS OF..... You can only delegate so much, when everyone else is delegating also and the poor CNA is already working short handed as well, they are often times over worked too.... Prioritize, we do that automatically without even thinking about it, so that is not a helpful hint..... As far as asking patient families to get involved and help out, with perhaps feeding ect ect.... it's nice when we come across the nice family but its far and few between anymore.....I actually had a patient my LPN this weekend ..." That is what you are getting paid for". As far as Management coming in to help out...... Forget it, but they are good at telling us that we will not refuse to take any more patients when we are already feeling like we are drowning. Good times..... I agree with someone above who mentioned that our Ratios will not be changed until JACHO gets involved, Or until we move out West to arizona or california where my friends tell me how nice staffing is out there..... Good to know I'm not alone in my staffing frustrations and burnout, but it doesn't look as though it will change anytime soon. So please, save us your useless articles that offer suggestions that we already do daily.... this article was obviously written by someone who doesn't work on the floors or by someone all the delegatees dislike....ha ha ha....

Anonymous 3 years ago
I am a Nurse Manager of Community Mental Health Agency. I work longer hours, harder, faster, and care more about the clients than most of the new graduates. Med errors - who cares. Documentation that make no sense - who cares. Clients withdrawing from ETOH - no vitals or CIWA screened all day b/c "They were sleeping and I'm not waking them up." I am disgusted with the way nursing is popping out RNs like popcorn on hot grease and no skill, no care, no fear of losing their license. Nurses call off without worry of reprimand d/t staffing shortages. Lack of care for clients, co-workers, and/or nursing in general.

Anonymous 3 years ago
Upon reading the "editorial" above by Ms. Ward, I felt that she was speaking to first graders. In regard to the delegation issue, since a RN's license is always "on the line" because a RN is legally responsible for the results of their delegation,
it is no wonder why many RNs hesitate to delegate in the first place! My opinion, read my other opinions, in my new book on AMAZON.COM:
Frenchie's Hospital Survival Tips!

Anonymous 3 years ago
My nurse manager does not help yet takes 2 weeks off at christmas but we the staff are not allowed to request time during the holidays....we were swamped ...also they are counting our chart audits against us ....if we have 5 audits then they can put us in steps in one year.#6 then they can fire us.....less staff..more computer charting ...add to our already stress filled Icu unit when will it end?

Anonymous 3 years ago
Delegation is great when you have staff to delegate to. The CNO at my facility really wants the ICU staff to have 3 patients each. We have no secretary and even the charge nurses take patient assignments. When is someone going to figure out that short staffing leads to long term problems, i.e., less optimal patient care and less retention of good nursing staff.

Anonymous 3 years ago
When I read the title of this article I had hoped for some new ideas for nursing staff to incorporate into their workday.
I agree with the team philosophy. When a unit operates as a team the results can be very rewarding. However, these suggestions are not new. Prioritizing and delegating are suggestions often touted by administrators to make life easier for nursing staff. In theory they are very good thoughts but in the day to day activities it is a practice that often isn't possible. During a shift priorities can shift many times, several things can happen that a nurse is required to manage. It can be a domino effect and a nurse doesn't have control over her time.Delegation may not be an option, some staff may resent this or they may have as many things to juggle as the nurse.
Patients are the reason we are at work but to be more productive in the work place it is important to feel as though you have had a successful work day, have done your job well and managed your patient load with the care they deserve. These things, in part, are what lead to happy employees and quality nurses.

Anonymous 3 years ago
Delegation PLEASE we have one patient care (CNA) for 37 pts. And if we dont have at least 21 pts that one patient care tech is send home it is a horrible situation to be in. We as RN's spend entirely toooo much time doing non-clinical functions. We are known for entirely toooo much for what we do than for the knowledge we have. I spend entirely tooooo much time doing non-clinical functions then clinical RNNN functions. I could go on and on and on about the about lack of help that is needed to take care of patients but its just not worth the effort anymore its all about the money and how much they can get out of the RNS. Its a corporate world and big daddy calls all the shots. Nurse Managers might have the title but there not in control of the budget; administration is telling them there staffing needs. Until Joint Commission starts stepping in to make SAFE ACCEPTABLE RN to patient ratios that are based on the needs of the pt (full care, heavy assist, light assist, self-care etc.) things will not change because as we all know every hospital wants to make them happy.

Anonymous 3 years ago
Delegation is always been a problem for some people in the hospital, especially if you have the stronger nurses on the floor then the one in Charge at that time. I recall the worst day that is totally like Ab A's day, I started out with 7 patients, 3 needed blood because they would have surgery (so they had to also be prepped for surgery), and then 3 would have chemo. Before the afternoon, I had to send one of the patients that received blood (and had surgery) to ICU because she coded after she returned, and right after I finished with that--and had not had time to eat, of course, they were wanting to give me admits "because it was my turn". I thought I was taking my turn by doing my job, and more than I was supposed to anyway, without complaint, then the person that was suppose to take it decides it was "my turn." No thanks. When I am in the position of supervision I do not become weak as some do, I still do the work that needs to be done.

Anonymous 3 years ago
Are you kidding me? This is rudimentary stuff. How about every nurse on the floor has 6 pt all day everyday, (This is a cardiac floor with numerous cardiac drips). Two techs to handle 29 pts. Management knows and very obviously doesn't care. Have NEVER had a nurse manager hit the floor and help. Your lucky if your staff shows up - forget the smiles! Theres no team work if everyone is at there maximum output every single day. If the general public where aware of how dangerous the working conditions really are regarding pt care they would be in an uproar. This is the dirty little secret in hospitals today. Just wait 'till its someone YOU love thats getting this substandard care! Nurses need to unite. Its way past time for unions in nursing!

Anonymous 3 years ago
We have been purposely shortstaffed by our own manager to keep to a time line devised by administration. Her come in to work.. never. She is strictly 8 to 5 and no weekends; doesn't return emails and doesn't answer her phone. We are demoralized and tired.

Anonymous 3 years ago
Hey guys, this is not a new issue. I have never worked in any situation where there has been adequate staffing. We forget that providing medical care is big business and is treated as such. Nurses are emotional beings and feel badly if they take a stand on their behalf. We are often in the middle of all situations and support for us is practically non-existent. Families want the care they pay for and shareholders want a profit. What do we want? I don't want to sacrifice me for the wants of another when I can't provide it legally and safely. Our challenge has and still is walk on egg shells. Either we deal with what is or walk away. Solutions are never based on what's in the best interest of all parties. And no one faction wants to take a hit as it relates to what they feel they should get be it less care, less dividends ... etc. the suggestions stated above sound good and could work if "ego" was not most often calling the plays.

Anonymous 3 years ago
Delegation is only as safe as the person who is designee.In the article if person weighing pt gets wildly different weight because of improper technique,puts it on a postit note which is relayed to MD while the primary is at lunch break..that nurse is so toast.Will administration respond at 0630 when it is looking dangerous? Will they come in when it IS dangerous at 2130 on Friday? When it comes to agency staffing it comes around to accountability of designee. Agency nurse who has no computer,phyxis access not comfortable in this area is not really help. Delegating tasks to family??Is that covered on Press-Ganey?? What are the legal ramifications of this??
Effective safe delegation can only occur when there is opportunity to work as a team without duress teaching,communicating,being aware of strengths/weaknesses of all players. That used to occur in lower census times but now staff is cancelled to "keep it lean".Safety should never be optional,responsibility never is just 0800-1700 weekdays.

Anonymous 3 years ago
Agree with ab also...unlicensed staff think they have enough to do and enjoy hanging out and talking on cell phones in alcoves where they can't be seen.

Anonymous 3 years ago
I for one am sick of not having a unit secretary on eve/nights. Just keep piling on the nurses because after all we are responsible for everything anyways. I have solved this problem for myself. I just simply refuse to enter orders. I call the super and tell em they better get somebody up here to enter all the order sets as Im not going to do it. I will give the meds and han the fluids etc but I refuse to spend any time doing ANOTHER job just because they are too cheap to hire someone. Wake up people and put your foot down. They will keep heaping it on if you let em, you just have to call them out and be prepared to walk if they don't like it.

Anonymous 3 years ago
Delegation is integral as well as prioritizing, however hospitals are taking that away from nursing. Especially with lean flowing everything. Nurses no longer have the ability to prioritize as the hospitals are prioritizing for us. I was actually in a code, doing chest compressions when the nursing supervisor came in and asked when my discharged pts would be leaving so I could get an admit. She said the discharge was taking to long.......WHAT? "Hang pt that isnt breathing and is dying before my eyes....I need to discharge this other pt home so I can get this room cleaned and take an admit....."