Nurses have long been the canaries in the coal mines of Health 2.0. When will we listen to warning they’ve been giving us?

Share this live rant, leave your comments and ideas on safe staffing and the future of nursing, and help us build Health 3.0 together. And happy Nurses Week!

Catch the audio of the episode on #IncidentReport, a top-rated podcast in Science and Medicine on iTunes!

Please subscribe to and review our podcast, it helps us grow the show! Don’t wanna use iTunes? Stream us here.

Join the conversation in the comments on the original Facebook Live video.

  • Esparkee

    LTACHs ARE hospitals. We titrate gtts and intubate and manage complex wounds, etc. I think you are confusing longterm acute care hospitals with longterm care facilities or LTC.

    • Sandy Long- Bloodgood

      true, we are often not seen for what we really do. But staffing ratios are not 40:1, but even 6-7/1 is “intense”.

      • Esparkee

        I missed my chance. I moved back to OK from Moscow, ID in July…

  • Mary Bailey

    I am an RN in Ontario, Canada and everything you say rings true here too. 100% fact! Healthcare is being scuttled by staffing cuts…”do more with less”…and endless bureaucracy… and mindless policies. Less time with the patients cannot lead to best outcomes. Thank you for supporting us.

  • Jessica Clark

    Love you ZDogg. Thank you.

  • Lynn Landseadel

    Well said. It’s really hard as a Nurse Educator to teach Quality Improvement lessons with a straight face…it’s all about profit. And unless we Americans admit to it and CHANGE it, this short staffing will continue…along with the poor patient outcomes.

  • Jane Kendall

    When the shit hits the fan, nurses need hands on help. Many of the administrators have “RN” behind their names, but do they roll up their sleeves and take check some vital signs? Do they get their hands dirty and toilet the patient who has to go NOW? Do the strain their backs and turn the total care obese patients to prevent pressure injury? No, they give us a plate of the same artery clogging muffins used for comfort care carts. But the very next day they expect you to float to a unit you have no business being on because in their minds a nurse is a nurse is a nurse, like lego pieces that can be pulled from here and used over there.

    Its impossible to keep up with all the mandates and protocols while still fulfilling our entire purpose for being there in the first place; to take care of human beings. Nurses are afraid to be too vocal because then they become targets who’s charting gets audited and if you forget to click one box, you may end up like this nurse.

    https://www.google.com/amp/www.oregonlive.com/articles/16993650/jury_awards_3_million_to_legac.amp

    It may feel like a train wreck now but I fear the real disaster lies ahead with the changing demographic where the system is flooded with baby boomers many of whom have multiple chronic illnesses and there’ll be no one to take care of them. Why are we not talking about this? Why are we so short sighted?

    http://healthaffairs.org/blog/2017/05/03/how-should-we-prepare-for-the-wave-of-retiring-baby-boomer-nurses/

  • Paula Marie O

    Well said – you missed a few points, but you do mention the complexity involved, and I’m guessing that covers the bases. I’m an OR nurse, and OR nurses are well aware that we help the OR generate a great deal of money for most hospital systems. The OR spends a lot, too – but we make a big portion of the dollars that keep hospitals going. I’ll never forget a past CNO at my facility, at the end of what was supposed to be a motivational mini-speech, saying (OUT LOUD) “go make me money!” What a colossal gut punch to my soul! I’m working at a “top-notch” nationally acclaimed academic Level One eastern facility. I don’t think nursing is done, but I do think that there are a lot of chiefs and not a lot of braves; why? Because admin keeps coming up with goofy ideas that continues to screw nurses financially, emotionally, and physically. I don’t want another key chain, another water bottle made in China, or gift card that can only buy a half a cup of coffee in the cafeteria. Who wouldn’t want to go up the food chain to make more, get away from having to lift ridiculous amounts of weight (be it a patient or instrument trays), be actually able to take vacation (even when you have 200+ hours of PTO)…the list goes on. I love working with patients and staff. Half of my weekly hours are in patient care, and half are as charge and maintaining policies and procedures. I’m lucky. I no longer take a bucket load of call, and I work days only. But it took 15 years to get to this point. Would I love it if the institution would find ways to make my life easier, absolutely; I don’t expect it. I’d say a little less than half the MDs I’ve worked with over the course of my career actually care about me, let alone know my name. They’ve got plenty to do, educating residents, their own ax to grind, and have an overwhelming caseload (backload) of patients wanting surgery, with not enough block time. But actual person-to-person communication, moment-to-moment is simply not happening. We should be a team, but communication break-down is so sad.

  • KathyRN

    In home health we are also seeing increased acuity, decreased staffing and a boatload of charting. I spend my whole visit with my patient off the tablet but then have to go home and chart for hours. I refuse to stare at a computer during patient care.

    • DDRN

      I saw this first hand while caring for my elderly mom at home. The visiting nurses were slaves to their computers and protocols that were not always in the best interest of the patient and family. And then it really went downhill. They were treated like game pieces. Their schedules and locales switched arbitrarily. Longterm patient relationships broken without a second thought. And they worked in isolation, unable to band together. I don’t know how they did it. And this comes from a nurse who has worked 40 years in ICUs. BTW-Most of these RNs rose above these conditions. They made a HUGE difference in our lives. You make a difference!

  • MB

    Nursing can be saved if we start working with each other to better our working conditions and change how we are treated by administrators, providers, and even some of our own cohorts. If we would unite for a positive change or changes we can make things better. We could have better patient nurse ratios, raises, ancillary staff to assist us with our duties, mandatory breaks, and support systems to combat bullying, unsafe practices and etc. We as nurses have to be the positive change agents. We can no longer depend on others to advocate for us.

  • Jennifer Welborn

    Thank you for your voice and encouragement. The healthcare industry has changed quite a bit in the last 25 years (with the last 14 years being in ER) and not necessarily for the better. The art of caring has diminished greatly with too much back biting. The problem has stemmed from multiple things, but not having enough human interaction and a whole slew of folks expecting microwave-like management of their health is certainly a big part of the issue. I love being a nurse, but I do not love the bureaucracy that has gotten in the way of caring. Data entry specialists is a spot on description. Anyway, thank you for your humor and honesty.

  • Fiona Green

    I would love to share my stories of bureaucracy over nursing with you, but I’m afraid of retaliation. Is there a way to message you privately?

  • DameNickum

    I have worked for 17 years as a CCRN, and spent another 10 as an ER nurse, when I got to the point I couldn’t breathe well, (asthma) I worked as an advice nurse. I did this job because I care about people, and I want to help.
    In all those years, with all the extra education, I loved helping my patients feel better, drop their fear and listen. Yet, in all that time, the only clue I was ever given about my performance as a nurse was every doctor anywhere I worked knew my name. And they yelled it often. Of course, busy or not, I always found the time and energy to help my MD’s, even it that meant I didn’t get a break, patients always come first. One doctor apologized to me by saying, “when you are the best, the only reward you get is that the doctors know you and you get run to death over a long shift.
    Thank you for recognizing the real talent and contributions that nurses make. We are not “a dime a dozen, and interchangeable” we are specialist in our own right. And I am old, and tired, beaten into retirement as I can no longer walk and breath, I loved being a nurse, but I have rerouted all three of my daughters, I don’t want them in nursing. It is a hard, underpaid and thankless job. Keep up the fight, I’m behind you! L.

  • Nay Saechao-Finley

    Can you come to NTI conference for critical care nurses and speak one day??? This was very empowering. And I needed it!!!! You see us and you hear us. Thank You.
    The humorous music videos alone are refreshing too !!! Keep it up. We need more of this to change nursing and healthcare for the better.

  • Jamie DiCroce

    I actually cried! This is exactly what is happening to our jobs. I’m a Clinical Nurse Educator and I orient and educate cohorts of new grad nurses. They come to me crying, talking about the insane level of acuity, and massive amount of charting. I can see the ” this isn’t what I thought I signed up for” look on their faces. I feel like all I can say is “I know”.

  • Janet T

    Everything that you’ve said is everything that I’ve been thinking for years. I’m an old chick with an ADN. I’ve been practicing since 2006 and have watched the decline from the trenches. I left an acute care hospital after working on a cardiac PCU that I loved for 7 yrs because I could not continue to work every day in fear of losing my license. We were spread so thin and our acuity was insane. Getting yelled at to check someone’s blood sugar while I had my hands in a pt’s dehisced abdominal wound trying to stop the bleeding was the day I was DONE! I took what I thought was a cushy gig at a physician owned surgery center. It was cushy, for about 15 minutes. Then the docs got greedy and the nurses were pulling 15, 16, 18, 20 hour days waiting on patients to come out of the OR at 1 a.m. after a 6 hour radical neck or 8 hr cervical 360, with only a skeleton crew. I have had to stop working for the past 17 months while taking care of my daughter with ESRD (and a litany of other ailments). I believe that she’s still here with me because of her nurses, and my incessant advocacy. Praise God that He spent 14 yrs training me to deal with her complexity. But I digress. I’m currently working on my BSN, because I’m not going to be able to get a job without it. I am on class 6 of 11 in an online program and am sitting with a 4.0. But I have not learned one single clinical thing. Not one. It’s all research, ethics, theory, leadership and how to write a stupid paper that no one cares about in freakin APA format. I, like many in this honorable profession, did not become a nurse to write papers, work in administration, or work for 12 hours in a cubicle on a computer. I chose this noble career because I love people and want to care for them. But we spend 90% of our time worrying that their tray table is in the right place, or shoveling narcotics in them at such a volume that they couldn’t pass a field sobriety test if they tried – all so that they’ll say that they were ALWAYS satisfied and that their pain was ALWAYS controlled on the bloody HCAPS. What happened to – are you still alive?? Did your nurse help to make sure that you were breathing or that your heart is beating?? But by all means let me go get you a turkey sandwich and a diet coke to go with your morphine, phenergan & benadryl cocktail and hope that you are always very satisfied. And then I’ll go spend the rest of my shift charting that all of your P’s were addressed every hour. Click box, cubicle nursing. Stop the 2.0 madness! Help us ZDOGG!!!

    • MOET

      I am also an Associate of Applied Science (ADN). It’s getting on my nerves and making me feel super disrespected that I get the feeling my education and experience is frowned upon. I’ve heard, ad nauseam, that “you better get a BSN, and soon, ADNs are becoming obsolete”. Now, my eyes roll so far in the back of my head I swear I can see my brain sometimes. I’m in school, but it’s for me. For me. Nothing more, nothing less.

      • Janet T

        The RN to BSN program is the biggest moral beat down. I fail to see what the mastery of APA format has to do with my ability to care for my patients.
        Give me some advanced pharmacology, or an entire refresher or advanced course just on freakin electrolytes (imbalances, cause & effect kinda stuff). How on earth is posting on DQ forums or writing a paper making me a better clinician? Ugh!!!

      • DameNickum

        I am also an ADN, and I spent LMOST 30 years working in ICU or ER. I too was warned that I needed a BSN if I wanted to continue to work as an RN. (a bunch of sarcasm here) It’s not like we sat at the same state boards to obtain our license, or that we were required to have the same amount of clinical time, or were responsible for the same educational content. Oh, wait, YES we DID! Same boards, same education content, except we did not learn how to be the boss. We learned how to care for people not paperwork. I retired, because I worked until I broke. The new working environment is brutal. The argument over ADN vs BSN is an old one, I graduated in 1983 and it was a whisper then. Our diploma nurses were also threatened, but there are no more diploma schools. That’s a shame, you live on campus and breath nursing. One of the best nurses I ever worked with came from a diploma program. If outcomes are the measurement, the work needs a different ruler. I am in school, for a BA in English.

  • MOET

    I have said for the last 10-15 years that the ART of nursing is disappearing. It is an artform.
    20 years ago, my mother, a nurse of 41 years now, literally, cried when I changed my major to nursing. Now I know why, as I fought tears when, not one, but 2 sons decide on nursing as a career. I don’t want them to be disrespected, co-dependent, and/or overlooked for choosing a career built on blood, sweat, and tears.
    I am proud of all of the opportunities that nurses have with further education, but, again…who will take care of me? Who will know and love the ART of nursing?
    I am very supported by physicians I work with (I work nights and don’t interact with management often, don’t have the luxury of a PCA or a unit secretary because we are nights, in a CVICU). Can I lose my job for posting this. Yes.
    Communication between all disciplines is integral for patient centered care. It’s high time that all of us realize this and work harder to improve this. It’s also high time that speaking positively or negatively should be encouraged.
    How else does one improve processes; not by ignoring them, for sure.

    BTW. I’m glad you were a doctor as a patient. Nurses suck as patients. Including me ;).

    • Oldretirednurse

      I felt the same way when my granddaughter announced she was going to be a nurse.

  • Elizabeth Belt

    I feel like nursing the chart needs to come second to nursing the patient.

  • Dezzy

    This is so true. I’ve been a nurse for two years now and I get asked all the time how it’s only been two years because I have the critical thinking a lot of new grads are lacking. I credit it to my father who is a paramedic and taught me how to think in situations instead of be a robot. I’ve worked for two companies that need a lot of help in staffing and ratios with acuity. They think Clarivia is the answer but they make the number so high it is just doing the exact same thing as before or worse. I see the path they are taking and honestly I’m a little scared for my patients and my license. I wish there could be a complete reset button for healthcare and I think you are going in the right direction which gives me back the hope I had in school. Thanks ZDoggMD!

  • Laura

    I’m a 6yr trauma ER nurse & I’m currently in process of leaving the field related to “click-box charting” & constant new unit requirements that take away what minimal patient care time I have left. I signed on to help people & safe lives, little did I know I’d be a desk jockey charging equipment, procedures & medications for the hospital to bill for.

  • Annemarie Gatchell

    This is exactly how I feel. I have discouraged my own daughter from the field of medicine due to the increased level of patients versus the benefits of nursing in general. The human aspect of nursing has been replaced with electronic and technical requirements. Hourly rounding in general is a good thing but with the amount of patients the work is never done so you are constantly rounding. On a MedSurg unit you could have anywhere from 5 to 7 patients (on day shift) when you do hourly rounding you spend 5 to 10 minutes in each room asking them the questions, “do you need to go to the bathroom, are you having pain, do you need to be repositioned” so on and so forth. Well, if you have six patients and spend 5 to 10 minutes in each room there goes your entire hour. So it seems like nursing is just constantly hourly rounding and if that’s the case when do you have time to connect with your patients or educate them on their disease process, pass medications or do that god-awful electronic charting? There’s just there’s not enough time in a shift to do what is expected of all of us as it’s related to our staffing ratio.
    You also mention California and laws surrounding nurse to patient ratios. When I lived in Texas I was on many committees. The end result is a lot of talking to get shut down by the CFO and the amount of available finances to achieve such a goal. No matter how a unit or facility committee vote, the bottom line is the facilities bottom dollar. Regardless of explaining how increased staffing will increase outcomes which will increase the Centers for Medicare and Medicaid reimbursements. I’ve done multiple research projects on staffing issues to complete my BSN. Even when presented with peer reviewed and scientific studies to prove my point, no one up high seems to care.

  • Sylviem12

    Extremely well said!! Thanks very much for all that you do! I guess, as a group, nobody has ever shown Nurse’s how they can impact things… I wish we knew more how to use our potential power as a group! We all think and say pretty much the same thing but as you say… they keep us so busy that we don’t have the time to think about how to organize our actions as a group.. Thanks a lot ! We are watching, learning, participating as much as possible..
    Sylvie