Having been a nurse for over 18 years, I have endured a few Nurses Week. At first I was lured into the charm of my first “Nurses Week” bag. I had finally arrived – my first official nurses bag. I had arrived and for a full week, the folks at the hospital seemed to actually appreciate what we did for our patients. After a few mugs, key chains, beach towels and more bags, the charm quickly grew off.
After awhile, you start to realize it is just a game of smoke and mirrors. You begin to realize that you had been tricked by the lures of trinkets, when in fact what you really want is respect, more staff and to be able to leave your water at your desk. What you really want is to be able to take care of the patients the way they should be. The way we are taught in school. Gone are those days of really knowing your patient – there are too many to care for each shift and too much documentation that needs to be attended to.
Ask most nurses who work at the bedside what they really want and most will answer more staff and better respect for their profession.
Unfortunately nurses are not part of the reimbursement for the hospital. Their care is bundled up in the “room rate”, much like the housekeeper in a hotel. By not having any tangible ties to reimbursement, nurses are the first to be cut and squeezed to work smarter and harder. Yet, the daily requirements continue to be stacked on.
Did the doctor order their bundle sets? Did you justify why the patient still needs a foley? Are your core measures and education all done? Did you document in the computer and in the patient’s folder? Have you documented in all three places that you turned and repositioned your patient and that their needs were attended to? Are their vaccinations screenings done? Fall assessments? Skin assessments? Delirium scales? The list goes on and on before we even touch the patient.
If you ask most hospital administrators, they will tell you they staff their units “based on acuity”. The humor in this – no one monitors acuity any more. It is all about the grids and matrix. Essentially, they can do as they please and hope no one gets harmed in the process. But, ask the nurse who barely drank, ate or went to the bathroom, they may disagree about who was harmed that shift.
To add insult to the mix, now hospitals are held hostage with patient satisfaction surveys. No longer do we want to know if patients received good care, we just want to know if they perceived they received good care. Instead of rewarding the hospitals for being good manipulators of statistical data, how about we reward hospitals for having safe staffing ratios and good outcomes?
But, what are good staffing ratios? Well, that goes back to the grids and matrices that any hospital can create. Repeatedly research finds that the more patients a nurse cares for on their shift, the incidence of death to the patient will increase. Yet, despite the evidence, nurses are required to care for more and more patients each shift. Often caring for 6-8 patients on a medical surgical floor and up to 3 patients per nurse in the intensive care units. As for the emergency room, it is free game – whatever the hospital deems as “safe”.
And the irony of it all, we have to practice according to evidence, but apparently not them?
Things looked like they were changing in 2004, when the state of California mandated revolutionary safe staffing ratios for hospitals in an effort to improve patient care. But, why, after all these years are they still the only state? Why 12 years later and after multiple attempts are national safe staffing ratios still being debated? Again, what happened to evidenced based practice?
Well, we all know it comes down to the money, because money is power. Nursing is one of the largest expenses for any hospital. This equates to being the biggest target for cutbacks. Unfortunately nursing does not “bring in the money”, so they do not wield the power and will continue to be treated like the liability they are perceived. This will continue to get worse as hospitals are more frequently run by bean counters who know nothing of patient other than what they read in books.
But, what if hospitals were rewarded for safe staffing? Or what if nursing care was actually reimbursed just as the other professional colleagues? Instead of asking the patient if they perceived good care, what if hospitals actually were reimbursed for not having high turn over of staff? Maybe even for having high STAFF satisfaction survey results?
So what do nurses want for Nurses Week?
They want a patient load that doesn’t bring them to tears by the end of the shift. They want to go home knowing they did all that they could for their patients because they had the time and support to accomplish it. They want to know they are valued and worth more than a mug or tote bag.
This is our year. This is the year we stand up and fight for our profession, our patients and the future of health care. This Nurses’ Week, instead of complaining again about the lame trinket your hospital gave you; join the conversation for safe staffing. Go to the rallies being held all over the country at state capitals. Join me in DC to rally and bring attention to the need for safe staffing. Write your congressman and ask for support for S. 864 (National Nursing Shortage Reform and Patient Advocacy Act) and H.R. 1602 (Nurse Staffing Standards for Patient Safety and Quality Care Act). Do something to be a part of the solution.
Make this the year that is more about good care and safe staffing and not about grids and matrix.
Make this the year the nurses stood together and spoke up.
Make this the Nurses’ Week we all want.
Thanks for letting me get my thoughts out. But, I want to hear your thoughts? Leave a comment below on what you would want for Nurses Week? Dream big, believe big and be the change.
Take care, be safe and wash your hands!