As most of you know, Sandi is a critical care nurse at Eastern Maine Medical Center. Things at EMMC are in pretty dire straights right now as nursing contract negotiations (which began in July) have hit a stalemate and, as a result, the nurses are on strike today.
I'm not a nurse but I have the honor of watching one of the world's best nurses get toasted from over extension in a job that already requires massive amounts of giving. I have had the privilege to be cared for in the hospital by some stellar nurses who went above and beyond just completing tasks of care and instead actually took "care" of me.
EMMC decided it wouldn't be worth their while to replace nurses for a single day and so they locked them out this past Saturday and Sunday. Nurses were considered trespassers if they showed up on hospital grounds and were written up as such. Guards stood at the door to escort the last of the nurses out in preparation for the lock out.
Those nurses are dangerous indeed. Hard telling what a bunch of super smart caregivers will do when they want safer working conditions (i.e. more nurses) to care for sicker and sicker patients, and reasonable health insurance from an institution whose business is health care. Hard telling.
Sandi, in addition to losing pay from the lock out, has been really frustrated with the whole situation, feeling that both sides are asking for too much. It has been difficult, hostile and insulting to pick up the newspaper and read some of the ads the hospital has paid for misrepresenting the nurses. While there is much community support for the nurses, as a result of EMMC's spin on the situation, many community members are attacking the nurses for being selfish and greedy.
Yes, those greedy nurses who want more staff. What will they want next, pedicures at lunch time? Oh, wait! They barely get to eat lunch, or pee, or sit down in 12 hours...
Sandi wrote a letter to both the hospital administration and the nurses union. She has sent it wherever it would be read, hoping that both sides will realize the need for a middle ground. Here is an excerpt:
I won’t pretend to understand what each aspect of healthcare costs these days. Nor do I grasp the magnitude of effort it must take to ascertain balance regarding income vs. expense, necessary vs. unnecessary, “employees” vs. “owners.” I am an owner. This is my hospital. These people are my family. These patients are people I love and care for. I understand healthcare at the patient-care level. And that is from where I speak.
I understand that it is unfair to ask for staffing ratios that are different than what they are. I do not believe that is the answer. The way things operate are adequate from a numbers, paper and pencil viewpoint. But at the bedside, they are not adequate. The nurses are right in voicing concern. Most of the time, we as a hospital, can get through a day, appearing successful. It is not safe, adequate, or “patient-first” in any way when floors are so overwhelmed that their resource and charge nurses are pulled to take assignments. Acuity fluctuates, census fluctuates, nursing availability and expertise fluctuates. Access to resources fluctuates. And we are adaptable, but we cannot expand to be more than what we are in numbers. We don’t have enough resource at times to expand to what is required.
When I am in charge or acting as resource, it is not uncommon for a “floor” patient’s health to take a downward turn… and for them to spiral quickly if not attended to promptly. The resource nurse covers the ENTIRE hospital and is often tied up in tests, other RRTs, or with a critical patient in the unit. If a critical care bed is not readily available, then the patient on the floor stays on the floor. And if that floor happens to have pulled its resource and its charge to take an assignment, someone’s or several someone’s care is compromised. And I see the floors. They are overwhelmed with tasks and documentation.
In my opinion, a nurse’s best assessment skill in forboding illness is instinct. And a nurse has to have a pulse on the situation prior to any instinct kicking in. Assess, assess, assess… and then assess some more. That’s how I was taught. On a “normal” day, the floor nurses likely have time to do this. But on more days than should be happening, the nurses are overwhelmed and expected to expand beyond what they should be. When a resource nurse on the floor gets pulled, the charge nurse is the fallback. When the charge nurse has an assignment, the housewide resource is burdened that much more when he/she is responsible for the entire hospital. That’s when patients don’t get lasix in time and come to the ICU in respiratory failure. That’s when patients turn septic and instead of being treated in “warm,” compensated shock, they are on their way downward into uncompensated territory, on pressors, and destroying organ tissue. That’s when peminic reports are filed because unnecessary med errors and falls take place because there isn’t enough time to get to everyone’s needs.
I know it must have been budget driven to change our numbers the way it happened last year. And likewise, the switch from 8 and 9-hour shifts to 12’s must also have been related to money. I understand that. But what I don’t understand is that when nurses say, “this is unsafe,” how is it possible that nobody is listening? And if anyone is listening, does anyone believe it?
I, personally, have worked week after week of extra and overtime. I have been in charge when we’ve been scheduled short the next shift and spent hours calling on the same people over and over to find someone who will work extra to fill in the void. We will stay hours into the next shift to cover patients who would otherwise not have proper coverage. Our fallback is our department head nurse, who will reliably come in and bail us out by working the ICU or PICU. It should not be her responsibility to work above and beyond her hours on a consistent basis.
We need a bigger pool of resource from which to draw in unsafe situations. Charge nurses need to step up and say when situations are unsafe. Department heads and administration need to know when this is happening. Attention needs to be placed on patients primarily and on tasks/documentation second. Nurses need to eat. They need to breathe fully. They need to be relaxed enough to make safe assessments and decisions. It has become far too common for nurses to work through lunch, barely look up during the day, and then go home sore and exhausted- physically, emotionally and spiritually. We, as nurses, have accommodated the downsize, in shift to shift expenditure, in extra time and overtime. We have accommodated census fluctuation in pulling from every last resource available. But it is not safe or healthy. Ratios are not the answer -acuity changes too much. The resources available need to be there. I personally don’t want to float to other units. However, if we are going to be paid for the time, I would rather be on call to help a unit that is barely afloat than sit at home oblivious. I don’t know the pool nurse situation floor to floor, but in my opinion, there need to be more available pool nurses when necessary.
A whole is greater than the sum of its parts. Our parts are operating more independently than they should. No, a pediatric nurse should not be expected to assess a full assignment of post-op heart patients, but that pediatric nurse can be of help as a resource or with low acuity patients. I am asked to help in the ER in overwhelming or extraordinary circumstances. I don’t know the ER or its world, but I am a nurse, and I can offer help of some sort. The nurses need to give a bit in this arena.
I don’t know the solution, as I don’t know what kind of financial commitment is involved in hiring more nurses. But I do know that we are the second largest hospital in this state. We are a level II trauma center. The people who arrive and stay in our institution are sicker than they used to be. With the complex nature of the human system and ever advancing practice of medicine, we cannot expect to do more with less when it comes to the nurse.
(I love you, babe. You'll always be my favorite nurse. I'm super proud of you for standing up for what you believe.)
