When Hospital Administrators Ask for Suggestions, Do They Really Mean it?

In my experinece, the answer to that question is a resounding "NO!" They are simply going through the motions...saying the asked...and ignoring every suggestion offered by frontline hospital staff. Ath which point they embark on whatever stupid, ill-conceived, half-baked, bonus-securing plan they were goinbg to do anyways. But here goes anyways...

Firstly, stop treating the frontline staff...nurses, PCT RT, PT/OT, Rad techs et al...like plug-and-play devices for a computer or tv. We're not. Speaking from a nurse's perspective, every unit has a specific skill set that can take 2-3 years to achieve competency. Five, or more years to achieve mastery. You cannot simply take nurses from one clinical setting or new hires/travelers , drop them into another clinical setting and expect them to function at an optimal level. We try mightily, but often leave at the end of a shift full of doubts, misgivings and the stress of caring for patients in a setting we are simply not familiar with or prepared for. We toss and turn in bed at night, reviewing the day in our heads, second guessing ourselves and arising from bed in the morning physically and emotionally exhausted, thus setting us up for failure as we come into work already depleted.

Secondly, you cannot continue to have nurses "flex up", accept a greater number of patients than normal, without facing consequences that adversely impact patient care and outcomes. This is especially true on critical care units where the patient mix runs the gamut from ventilated and proned COVID 19 patients to patients on CVVH, Impella and/or multiple vasoactive drips that require constant monitoring. Despite our best efforts, something will get missed. Someone will die because of a forced error, and the nurse will be left traumatized and burdened with the emotional anguish and guilt that accompanies such an outcome. If we do not have the staff to safely care for patients in the beds we have...we simply cannot continue to try and fill empty, unstaffed beds with more patients than we have staff, and not expect there to be adverse outcomes...for both patients and the nurses caring for them.

Thirdly, we have been hemorrhaging experienced staff for months. A chronic problem exacerbated by the pandemic. On more than one occasion, I looked around at the nurses I was working with on a given pod, and didn't know a single face. When nurses, with years of experience on a unit leave, they take with them those cumulative decades of institutional memory and clinical experience with them. There is no one left to precept new nurses...to serve as resources for those just out of orientation, or those with two or three years of experience, and still turn...and rightfully so...to their more experienced co-workers with questions and advice regarding the patients under their care. This loss of experineced nursing staff can have adverse, long term events on patient care and safety. Speaking from my own experience, I recently left bedside care after 13 years in the ICU. I could no longer bear the physical, and emotional, pain that acocmpanied the end of a 12 hour shift. Much as I loved what I did in the ICU, there was simply no available role which allowed me to distance myself from direct patient care, yet serve as a resource to my co-workers, both new and not. And this is the case with so many of us who, because of the physical toll bedside care has exacted on us over the years, can no longer pay that price. We are simply cast aside, our experience...our knowledge discarded and wasted. Make a place for us, so we can continue to be relevant to the units we have given so much of our professional lives to...so we can continue to use our knowledge and experience in contributing to safe, quality patient care and help our co-workers be the best they can be.

Finally, staunche the hemorrhaging of experienced staff. If this means more than a 20 cent an hour "market adjustment" to the payscale, do it. By providing younger, less experienceed staff with a larger "market adjustment" that that of older, more experieinced staff, the appearance of valuing that older staff to a lesser extent than those younger, less experienced staff members was created. And while many of us remain at the bedside for more reasons than just the pay and benefits, the pay and benefits need to be commensurate with the responsibilities we, as nurses are being asked to bear on a daily basis, especially during this pandemic.