The unit has moved back downstairs to our regular haunts, now that the money-making Interventional Cardiac Unit is in its spiffy new digs, the remodeling of which we had to suffer through. My first night back after that occurrence, I was disheartened but not surprised to find that our patient:nurse ratio has been upped to 4:1. While we were upstairs our census had been increased to 7 patients, with one nurse having 3 and the other 4, and everyone predicted this was coming. Still, it was a nasty shock, even if expected. Adding insult to injury, we rarely have a tech any more; there's one who works days, but only 4 a week, and one who works 2 nights a week, but rarely when I'm on, for some reason. Depending on who the supervisor is, we *might* get one for part of a shift, though there's one who will almost always give us one if she has one to spare.
Oh, and the patients? Well, surprise, there's no decrease in acuity. We still have all the cardiac and vasoactive drips, our chronic vent, the recently extubated, complicated wound care, blood to give, and those who aren't too terribly tightly tied and like to climb out of bed and do "face plants" on the floor, not to mention a few who think they have a private duty nurse who will cater to their every whim. This morning we got a call "Can you take a labetolol drip?" (this is a continuous infusion of a heavy-duty blood pressure drug which can take a nasty turn if you're not careful) and the oncoming charge nurse said "No, not even if we had a bed, which we don't." Technically we *might* take such a thing, but it would be dangerous with the number and acuity of our current patient load. Oh, and the category I forgot......the gynormous, those weighing over 300 lbs., who are killing our backs and shoulders.
And how do they justify all this? It's being done in the name of "productivity," a model designed by the bean counters who have no clue about what really goes on out here in the world. Everything is measured by some formula which appears to be completely divorced from the reality of caring for the sick. "But we have to make money to keep going!" they wail. Right, and how many of YOU do we need? How much middle management is required to keep an outfit going, and why does the CEO need to make that much money? My dearest dream is that part of the curriculum for all programs in health care administration will include a year actually working as a tech, and at least 6 months closely shadowing nurses in a variety of units. In the best of all possible worlds......but it will never happen.
The result is burnout, despair, and a lot of bodies heading for the door. Our assistant manager left for one of the critical care units; one of our best day nurses took an assistant manager position at a smaller inner-city hospital; another went back to New Jersey; and almost everyone else has applications out or is looking either in the system or out. Of course there's a hiring freeze on in the system, it being the end of the year and all.
I thought about posting an account of what happened last night, but just thinking about it makes me exhausted all over again, and considering what we might have overlooked is painful. Meanwhile our other 7 patients went unattended, and one nurse was there for nearly 20 hours... ame in for day shift, stayed over for 4, and it was her patient that tanked, so she was there past 1:30 charting. Please tell me how this can be safe?