Dispatches From Deep Inside the Nursing Shortage

I've just finished writing a statement for my employer about the job I had last night. I think it's illustrative of what the Nursing Profession is facing today, so I thought I'd share:


When I received the call to work at this facility, I estimated to the scheduler that I could be at there by 8pm. (Normal call time is 7pm, but she called about 6:30pm for a “late call.”) With a lot of effort I was able to arrive at 7:10 pm and reported to the Nights Supervisor, who was in report with her Days counterpart. I told her, “I’m here! Where do you want me?” Her reply was to wave and say, “Bye-Bye.”

I realize that I was interrupting her report, but I needed to (a) let her know I was there, and (b) where she wanted me to work. I didn’t need to be greeted with a smart-ass remark, Thank You. This is very typical of this particular Supervisor’s remarks not only to me but to all the staff and temp workers. She tends to be curt, rude, angry, dismissive, and annoyed that we do not know every single procedure that even the regular nurses admit they don’t know either.

This is not limited to Agency Nurses. I have heard several other staff from this facility complain about her belittling tone and negative comments – one comment I heard was “I get so tired of hearing her say everything we do is wrong; everything we do is bad; that we can’t do anything right all the time.” For instance, this supervisor told me to complete an admission on a new patient, then became angry that (a) the Day Shift had not completed the admission in less than two hours, and (b) I had never done an admission at there before. (The paperwork varies greatly from facility to facility; and considering that their payments from the insurance companies depend on getting this stuff right, its something a regular staff member should be doing – not an Agency temp nurse.) Her responses for the rest of the night were curt and had a snappish tone to them.

The next challenge was to find the medications required. The Pharmacy at this facility is notorious for shorting medications available to the medications carts, and the other nurses frequently resort to raiding the other patients carts for medications for their own patients. I was fortunate in that I only needed two bags of IV fluids to complete my medications. However, I had to stand at the door of the Pharmacy almost ten minutes while the pharmacy tech worked in adjacent room, ignoring calls from both myself and a staff nurse. Both the ten minute wait as well as the ignoring staff members were completely unprofessional and unacceptable behavior, as well as very frustrating personally.

That night I had 6 patients – Categories IV (2 patients) and III (4 patients) Acuity. (“Patient Acuity” categorizes patients according to how much work they will require and how ill they are. Category I$ is the most intensive and usually requires one-to-one care; Category III is still difficult but requires a nurse to only have two of these patients, etc.) Because we were short-staffed everyone had six patients, except for the staff nurse from this facility who had five. Even their “loaner” nurse from their sister facility had six patients. (Staff nurses were reassigned to their lower-acuity unit.) The last time I worked at this facilty I had five patients; Categories IV (4 patients) and III (1 patient who we transferred in the middle of the shift to Hospice.) So, we were critically short staffed. (This happens daily in most facility since Congress started cutting Medicare and Medicaid patients, and will only increase as the baby-boomers get older.)

There was more than just “angry tones” to the other staff. An LVN who is regular staff at Compass glared at the other staff members and temps alike, making deep sighing noises and responding to requests with either eye-rolling, grunts, or smart remarks. When I entered the Nursing Station he glared at me, then took his charts into another room to work on them. As he brought them to the other room he slammed them onto the tabletops with loud banging noises several times; so much so that I had to look to see if he was either throwing these charts at someone or had thrown them to the floor. At one point later he and I were working on a patient at the bedside, and he was all smiles, very pleasant, professional, and reassuring. Once we returned to the nursing Station, he immediately resumed his unprofessional and rude behavior.

Towards the end of the night on of my disoriented patients tore off her chest dressing. I had the Supervisor find and open the dressing cart for me, but the only supply I could find that the physician had ordered was Kerlex; no Idosorb or Adaptic dressings were available, either in the dressing cart or the supply room. (In fact, the dressing I originally saw was not according to the physician’s orders, either.)


So my shift at this facility was marked by a high work load, angry responses, smart remarks, deep sights, curt responses, being ignored by staff, insufficient supplies and medications, and what sounded like a violent temper tantrum in the room behind me. Oddly enough, I saw the parent company of this facility (Psychiatric Solutions) recommended on one of the Fox Saturday financial Morning Shows as a “Best Buy” recommendation. Well, I can certainly attest that they’ve found a way to save money – they don’t provide sufficient materials, and they overwork their nurses.