• Chaosfeminist

    #NursesTakeDC 5/12/16

    • Perhaps I’m too cynical, but I’m pretty sure that by the time this happens it’s going to have almost nothing to do with nurse:patient ratios. It’s going to be used to push political issues that are at best tangential to patient safety. There will probably be more said about unions, increasing taxes and electing Bernie than about ratios or other staffing issues.\n\nPerhaps I’m too cynical, I would be very happy to be wrong about this.

      • Kristine Fry

        Our goal is to take the momentum of this moment in time, and to make the issue of patient ratios known to the public. If people knew all the statistics regarding how dangerous the higher patient load is to the patient terms of morbidity and mortality, they would demand more nurses at the bedside!\n\n https://www.facebook.com/groups/929997953713716/

        • That may be your goal, and if so it is a laudable one, and one I support wholeheartedly as a nurse that has spent 25 years taking care of too many patients at once. However, your organization is a labor union and a Bernie “Super-Pac” that has spent around a million dollars to support him. That pretty much makes me think the whole patient ratio thing is kind of a bait and switch. If all you do at that rally is talk about patient ratios I will be ecstatic that I was wrong, but my expectation is it will really be a campaign rally.\n\nI will be watching with great interest, please surprise me and show me I’m wrong.

          • Kristine Fry

            Our organization, is not union backed. Our Facebook page is run by volunteers, and we are not affiliated with any union. Yes the ratio law in California was backed by the union, but we are a group of individual nurses.\n\n Check us out;\nhttps://www.facebook.com/groups/929997953713716/

          • I hope that’s true. However, the May 12th event you posted about, and that I replied about, is being put on by National Nurses United, a labor union and a Bernie Super-Pac. \n\nAgain, I sincerely hope I’m wrong, I’ve long been known for being far too cynical. I would love to see a nation wide law similar to that in California.

          • Kristine Fry

            I am sorry you are wrong- I know the organizers, was actually a group of ladies that met and coalesced in the group that I started. They are individual nurses, working with a group called show me your stethoscope, and nurses for national patient ratios, they are not a union, or union affiliated

          • IF that’s true then you have been co-opted by NNU. Nearly all search results on the topic point to them and they talk about the rally as if it were there own. If that rally happens and does not turn out to be a campaign rally I will become your biggest supporter.

          • Janie Harvey Garner

            The rally is happening, and it doesn’t belong to any organizations. It belongs to nursing.

          • Of course it’s happening, the “if” was meant to apply to whether it was actually just about the claimed purpose or just a campaign rally. I hope I can run into you all online on May 13th and give a huge, contrite, mea culpa.

          • SuzanShinazyRN

            You sound like the hospital association. Make any motive for safe patient care look like a bad one. So, you will become a supporter after the fact but cannot believe it now? Also, nursing unions do march on DC, but this is not one of those marches. You could have your dates mixed up.

          • Wow. Nothing I said comes close to implying that I think this is a bad idea. Just the opposite. What I think, based on what I see in searches and tweets and such, is that this march on Washington is going to be a Bernie campaign rally and not actually have much to do with patient ratios. I sincerely hope I am wrong. It would be nice to see an organization fighting for this nationally. But in a campaign season, and given the amount of campaign material that searches about the rally bring up, I am skeptical. \n\nCan you tell me, if you are one of the organizers of this, will campaigning for candidates be allowed as part of the rally? Will other political issues be pushed or just this one very important issue? Will any candidates be invited? Are there plans for representatives from candidates to speak?

          • catstks

            As one of the organizers of the event… we are not union, we are not campaigning for Bernie Sanders. We are a handful of working nurses who want nurses to stand up for what is right and use their voice for patient safety. The link you provided that was in reference to the national nurse unite looks as though it may be their page from a rally last year, as this year May 12 falls on a Thursday, not a Tuesday. Are you a nurse? If so you can join the group on Facebook dedicated to the cause and learn more. https://www.facebook.com/groups/929997953713716/

          • Kristen

            This rally has nothing to do with Bernie Sanders! Are you even part of the SMYS group? WE co-opted the hashtage nursesunite!

          • Chaosfeminist

            We will be in DC May 13 speaking to our representatives in congress.

          • Kristine Fry

            Can you post some sites where you are seeing that, I want to look into this

          • http://www.nationalnursesunited.org/press/entry/nurses-to-demonstrate-in-dc-for-patient-care-bill-against-va-mgmt-attacks/\n\nwww.safepateintratios.org (forwards to NNU site)\n\nMuch of what you find in those searches refers to “#NursesTakeDC” which brings up a huge amount of Bernie Sanders tweets.\n\nI take it you folks are from SMYS? That doesn’t show up on the first couple pages of results.

          • Kristine Fry

            I can totally understand your concern, we have worked very hard in all of our groups cooperating in this effort to be inclusive of all nurses. I personally do not believe that it will take a union to do this if we all unite. Yes NNU was working on this before we came along. But we are a group of individual nurses, plus multiple Facebook groups, that have banded together for this movement, and this rally. We respect everybody no matter what their political beliefs, religious beliefs or personal belief. We are about ratios, and patient safety. That is all !

          • I would find that very refreshing indeed, especially in a campaign season. Hopefully there is a lot of media attention for the rally, hopefully I can see it turn out to be what you say on CNN and seen by millions.

          • Kristine Fry

            Thank you, that’s exactly what we want, a platform from which to speak. If every day individuals knew how much ratios affected their care, they would be very interested

          • Kristen

            I’ve forwarded the info on the rally, and what I learned about my own state (PA) onto my own fb page, and it has been shared several times. I’m hoping it keeps going. I know there have been several lay people that are friends of mine or friends of friends who have taken an interest.

          • Chaosfeminist

            Search results are determined by a proprietary algorithm. This is still a relatively small group. Look on the rally page at how many are going. This is why it’s not yet in search results.

          • SuzanShinazyRN

            This is funny! Bernie Sanders is famous for not having a Super-PAC!

          • No, only for claiming to be against them. A Super-PAC is just an organization that is not part of the official campaign and not controlled by the candidate that spends money on ads supporting the candidate. If you and I gather a few friends, pool our money and by an add to support our favorite candidate, we are a Super-PAC. Bernie can’t stop his supporters from spending their money to support him, even if he does want to. The one I mentioned, the NNU, has spent nearly a million dollars on Bernie adds. I’m not saying it’s wrong for them to do that, just the opposite in fact.

          • SuzanShinazyRN

            There is no union involved. I know Deena and I can honestly say, this is a patient safety issue, period. Medical errors are the 3rd leading cause of death in the U.S. Most are caused by a chaotic system, and poor staffing has been proven to lead to poorer outcomes and more deaths. These nurses have a good heart, they care about their patients and the nurses are paying for this rally themselves. Here are the good healthcare workers standing up for patient safety. We should applaud them and be very thankful for them.

          • I hope so. If the rally happens with no campaigning for any candidates and no pushing other political issues I will never have been happier to be wrong and I will become one of their biggest supporters.

          • Chaosfeminist

            It has nothing to do with NNU. I’m a member and the union is not organizing this. The Rally in DC is for national nurse to patient ratios. We have intentionally kept unions and political campaigns out of it.

          • Kristen

            I think the confusion is also that we are not NNU. we are #nursesunite!

          • Deena Sowa McCollum

            I have been a nurse for 22 years and have 25+ still to work.. Any awareness to the issue is a push in the right direction. There is a great quote”Someone once told me not to bite off more than I can chew.. I said I’d rather choke on greatness than nibble on mediocrity”. I would rather die knowing I tried to make it better than to know I didn’t. \nPlease take the risk with us and join the fight!

        • Pleased that it didn’t turn into just a campaign stop and you were right. Still more campaign stuff than I’d like to have seen though. Attaching this issue to a candidate or party would be a serious mistake because it would make folks opposed to those candidates go against when they might otherwise be swayed.\n\nI think this at least highlighted the problem to some folks, but it probably didn’t move anything. Looked like maybe a thousand or so people when it should have been a lot more. That and the federal bills being pretty much dead in committee makes the whole thing a little disappointing. Hopefully at least state bills get a little help from this.

      • Boone

        What is wrong with unions?!?! It was the CNA that polished the California legislature into becoming the first state in the nation with mandatory safe staffing ratios! A UNION did that because a UNION speaks for the many! Of course unions support candidates who support nurses!! These laws save lives and that were brought to you BY UNIONS!! The Facebook group that’s organizing to get national safe staffing laws is forming a union! They are trying to influence the political process by changing laws just as CNA did and the NNU is trying to do nationally. Get over yourself. Nursing unions save lives!!

        • Nothing, what makes you think I said there is anything wrong with unions?

        • Nothing, what makes you think I said there is anything wrong with unions?\n\nWhat I said is this rally is unlikely to be primarily about the issue presented, but rather will likely have more to do with campaigning for Bernie and and many other union political issues. I really, really hope I’m just being too cynical and turn out to be wrong.

          • Boone

            My point is that safe staffing IS a political issue. The laws come from the legislatures. I HOPE that any rally supporting safe staffing laws also supports politicians who will make the changes. They are connected.

          • If you seriously think that safe staffing is only possible if we implement the sweeping political changes demanded by Bernie then you are one of those folks P. T. Barnum was talking about when he never actually said that famous quote. Safe staffing could be achieved regardless of who was President, the President doesn’t even have things like that on his or her radar.

          • Boone

            Did I mention Sanders? I thought my point was that laws come from the political process. You can’t advocate for one without the other.

          • You can’t advocate for a law without advocating for a specific candidate? Wow.

          • Liz Bee

            I wholeheartedly believe that any legislation that is meaningful to the 99% will not pass unless we have a centrist or progressive president and a Congress that is not dominated by extremists who obstruct anything that the 0.1% opposes.

          • You have a really serious misconception there if you are lumping together “the 99.9%” Personal freedom and low taxes do not benefit only 1 out of every thousand Americans, and a massive controlling government and huge tax increases do not benefit 999 out of every thousand. \n\nIn my family, for instance, we are two nurses near the top of our union pay scales. That puts us in about the top 6%. We are the ones that would bear the brunt of the tax increases that any “progressive” would bring, and the ones that would be most hurt by it. \n\nYou can’t possibly pay for all that free stuff for everyone in the bottom 50% or whatever by taxing, or even by confiscating all the assets of, the top 0.1%, and no progressive is even claiming they would do that. Your revolution will happen on the backs of those of us that work hard and advance in our professions, not on the back of Bill Gates and Warren Buffet.\n\nYes, we make a good living; each of us makes about a hundred thousand a year, we have a nice house in a nice neighborhood, and get to take pretty good vacations every year, but we worked out behinds off in ERs and ICUs for a quarter of a century to get where we are. Why do you “progressive” types what to punish that?

    • Kristine Fry

      Join us to fight for a national patient ratio law\n\nhttps://www.facebook.com/groups/929997953713716/

      • Chaosfeminist

        Already done. I’ve been there since the beginning?

  • Chaosfeminist

    Just take your wife to DC for your anniversary Dr Damania.

    • Teresa RNC-OB

      Yes! Ask your wife to do it for that L&D nurse she appreciated!

      • 🙂

        • Janie Harvey Garner

          My members are trying to get me to send you romantic spots around DC. 🙂 Have a wonderful anniversary. Thank you for the support and respect.

  • Don

    I have been a RN in emergency for nearly 25 years and only recently took a position in administration. I have also worked as emergency department manager/leader in a civilian facility as well as a military facility. What I can tell you is the motivation for civlian leaders in hospitals are more motivated on Press Ganey scores and budgets than patient safe outcomes. When the sh*t hits the fan these so called seniro leaders will throw the staff nurse under the bus, while providing physicians snacks and coffee in their breakroom. Overtime isn’t allowed often and holding admiited patients in the emergency department is a daily practice. I have seen this in many states, in private for profit and non-profit hospitals. I have seen the least clinical qualified make decisions regarding staffing ratios and such, disregarding the more experienced staff. This, in my experience is a norm and not the exception.\nHowever, when I compare that experience with the military I see a different set of issues. In the military hospital you have a combination of military nurses and civilian GS staff. The military doesn’t make a profit, but need to remain within budget. The military mission is to have trrops healthy for their missions, and they do this very well. Could be better, but very good none the less. The military has staffing issues too, but they can’t fix it without congress approving budgets, nor the system that hires civilians, or the reduction of active duty staff. The Army just released a list of overstrength nurse officers, so we lose more experienced nurses. In our state and in the military hospital we can’t hire new graduate nurses, so we can’t replace what we lose, and the system isn’t nimble enough to move to fix that problem. The military hospital I work for cares about it’s nurses, care about staffing ratios and strive to make these issues better, given their constraints. I can not say the same for the civilian hospitals I’ve worked for.\nI respect and applaud ZDogg’s efforts here. I have been a big fan for years.

    • Teresa RNC-OB

      What is an over strength nurse?\n

      • gwen rothberg

        Redundant. Too much seniority and command responsibility for the bedside. Correct me if I’m wrong. I got out in 96.

        • Teresa RNC-OB

          As in, with military rankings you can be considered too high ranking and thus too “good” to do the lowly work of patient care? If I’m translating correctly, that’s just sad. I’m glad my manager still puts on scrubs and joins the trenches when we are drowning in patients.

  • Susie nurse

    Let’s imagine if every hospital admin could experience an inpatient admission, through the ER, e.g. for chest pain. Then that admin would be transferred to a med surge cardiac floor. That admin’s RN would have 5 additional patients, d/c’s and admissions, giving meds, checking new orders, physician phone calls, etc. We all know how it is. And THEN let that admin get really anxious/discouraged/angry because he/she has only seen the RN once in the past 4 hours. Maybe THEN admins will understand the importance of safe nurse/patient ratios. In a utopic medical world…….

    • The thing is, when those administrator do get admitted, everyone knows they are administrators. Despite what they would claim they expect, and receive, special treatment and never actually see what it’s like to be a patient. We’ve all taken care of administrators or board members and seen this.

    • Jennifer Rebecca Howell

      That would never happens because Admins NEVER see reality. In my institution we pull out silk sheets and they are given so many VIP perks it is BETTER than a 5 star hotel!

  • KG

    I find your logic to be spot on with all topics. I find that nurses often are their own worst enemy. I find leadership to be quick to blame and nurses quick to complain and doctors that just want to get paid. No one owns the machine. The hospitals that are run based on their mission and values provide better quality of care than the those that are focused on the bottom line. Both should complement. Anyways, this was a long comment that simply means that I agree wholeheartedly.

    • Teresa RNC-OB

      Yes, nurses complain, just like doctors. Plenty of nurses would like to be part of the solution. But go to a hospital board and watch how the nurse speakers just get paid lip service, then ignored.

      • Meagan

        Lip service would almost be nice. When people have spoken up here they’ve been encouraged to pursue employment elsewhere.

  • Janet Kissane

    It’s all about the $. I retired from nursing, partially because of the PUSH TO TURNOVER THAT BED. The level of entitlement from patients and their families was also a huge factor. I do not miss it for one single, solitary minute. I was no longer allowed to be a NURSE. I was only a facilitator to get that patient out. I hate what nursing has become. Thank you for this platform to speak.

    • Kristine Fry

      We need a national nurse to patient ratio law, like they have in California \nJoin us in the fight\nhttps://www.facebook.com/groups/929997953713716/

    • SuzanShinazyRN

      Right? Turn over that bed! That is more important than anything else you might be doing for another patient, including if your other patient is deteriorating, and some admin will be abusive to the RN to get that bed turned over now!

  • gwen rothberg

    1. Pay us as if we are a male dominated workforce. When goals are met, I want a bonus, not a cinnabon. 2. Unionize, Nationally or locally. Its the only legally binding recourse we have against perverse incentives. 3. Stop trying to industrialize nursing with manufacturing strategy. We are in the health restoration business, not building cars. My patient needs to know that he’s not a customer and therefore not always right. No, you may not have some phenergan and a pastrami samich an hour before surgery. I know you see value in that, but the goal is for you to live thru your procedure. There us more but start there. I guess I’m going to DC in May…

    • “Pay us as if we are a male dominated workforce.” The elephant in the room, well said.

      • That has long been a problem and it’s not changing near fast enough.

      • Corisline

        Indeed.

  • Karen Waymack

    I am glad to see you addressing this. I have 17 years of bedside nursing experience and 7 years as a nurse manager. Women and Children’s services (L&D, PP/Nursery and NICU) traditionally have maintained much better nurse-patient ratios than other areas. They also often have better staff and patient satisfaction, quality outcomes, and are the “gateway” for the family coming to the hospital. (Mom has a good experience> takes kids to ED when needed> refers parents there, etc.) Unfortunately, it is not the moneymaker that orthopedics or cardiac services are. Staff are always asked to do more (all areas, not just nursing) and nurses can feel administration are only interested in their bonuses. I cannot hire more staff if I don’t meet productivity targets especially if I am managing a small or less lucrative unit. I know many nurses work very hard, but I also know of nurses who are just doing the minimum, clicking the boxes not working to their full potential. This is where it gets difficult for administration to see a need for more staff. \nAdministration has to look at the bigger picture how do they grow the business to keep everyone employed and to provide raises? How do they turn a profit when there is no payment for readmission in less than 30 days? Then how do they meet the quality indicators so CMS reimburses the hospital at the full amount or even get some extra? No one wants to leave some of the money on the table, because that goes to your competitor. \nSolutions are not easy, but I believe we need to start with a dialogue with government, insurers, staff and patients. Everyone needs to hear the issues everyone else is dealing with and needs fixed. Patients have to be held accountable for decisions they make, but we need to be sure they can actually do the things we tell them If they have no way to get to the pharmacy or pay for the meds, how can they avoid a readmission? The government wants better outcomes, but withholding payments makes it nearly impossible. Nurses want more staff then they need to help hold peers accountable ; no bullying, teaching the new nurses and working together and not in silos.\nAfter the FB discussion, I tried to contact HHS Secretary Sylvia Mathews Burwell. You would think there was a simple way to comment on the site, get an email address or something, but the only contact information for general comments is the physical mailing address. We need to use an EMR but cannot contact them by email? Another symptom of the many problems. We have to speak up as healthcare providers no matter our role and start a discussion to achieve effective change.

    • Teresa RNC-OB

      Karen, very good summary and insight. Thank you.

    • Meagan

      Very well said. We need to get everyone to the table and have a real conversation.

    • Excellent discussion and insight.

  • Wendy Harmon

    We need to turn down the entitlement. How can we make it clear to the patient that we are NOT here for refreshements and narcotics, but here to make sure you have the best healthcare possible. I had 3 ICU patients in the ED……..and a “VIP” (ie not too sick, but gives buttloads of $$ to the hospital, so I had to hold her hand (which I don’t mind at all) but my DKA, NSTEMI and GI bleed were waiting…….we need to re-educate. That will happen when I’m long and dead, I fear.

    • Teresa RNC-OB

      Wendy, I feel your pain. It’s not just healthcare though. Money talks (and is worshipped) in every industry. That’s our pathetic society and its lost values.

  • Kristine Fry

    Oh for the power to make a change…\n\nWe are nurses, we are the single largest profession in the healthcare organization, and we have a voice!\n\nThe problem? Nurses have bought into a false narrative. There are some of us, many of us, that believe it is a valiant to work an 8 or even 12 hour shift without a break or meal. There are even some that believe that mandatory overtime, coming to work while you’re sick, and mountains of untaken vacations is part of the job, and makes one a better nurse.\n\nI submit to you that it is dangerous not only for a profession but for patients!\nNursing fatigue has been proven to have a causal link to errors. Nursing burnout damages our profession, patient safety, and our work-life balance, not to mention the toll that it takes upon our families.\n\nWe must unite with one voice and take back our profession!\n\nPlease join us to demand that our legislature enact mandatory national nurse to patient ratio’s!! \n\nFor more information; \n\nhttps://www.facebook.com/groups/929997953713716/\n\n

    • Teresa RNC-OB

      I’m in California where nurses have unions. There are still the same pressures from administration to produce more with less, but we do get our overtime, sick time, vacations, and breaks (orcompensation for missed) because the unions put pressure on the administration to keep labor conditions safe and fair for us. Now administration wants to avoid the cost of missed breaks. When I first moved to CA, I had a corrupt Teamster’s image of unions just helping bad employees stay employed, etc. I learned quickly how much better put unions are. Travelers tell us frequently how much better working conditions are here. Other states would be wise to follow CA’s model.

      • Kristine Fry

        I’m in California as well, but I am fighting for this long because it is needed to make healthcare across the nation better

        • Teresa RNC-OB

          I agree with national changes. From your initial post, I thought you were in the midst of forced overtime, uncompensated missed breaks, etc. My apologies.

          • Kristine Fry

            Please don’t apologize, I used to work in a state that had all of that. I moved to California, and the difference in my ability to be a caring and competent nurse is amazing. I want everybody to have the experience to have this kind of nurse, and every nurse to have the experience of being able to be this kind of nurse

    • Kristen

      AMEN. Nurses mistake abuse (of their bodies, of their time, of their abilities) for being noble.

  • Traci Garrett Carter

    So many times the clinic nurses are forgotten when staffing is discussed. I’ve been a nurse for 20 years and have worked med-sug, post partum, and L&D, and have landed in a very busy Ob/Gyn office. We are, as one doctor I work with called it, “a hospital within a clinic.” Just because we are supposed to work Monday through Friday 8-5, doesn’t mean we do. We have been begging for a Nursing Assistant to help us draw blood, take vitals, assist in procedures, but we keep getting the same answer: “But you’ve made it work up until now.” Yes, we have, but only barely. We are often at work until 7-7:30 each night returning calls and sending results letters and sending consults and referrals out. Not to mention working through lunch to log specimens in from the morning and to cross every “t” and dot every “i” in that horrible EHR our administrators chose. So instead of getting that “cushy” clinic job that is 8 hours a day with no weekends or holidays, we work 10-11 hours, 5 days a week and some of us come in on Saturday to scan records in to our “paperless” system because somehow it’s cheaper to let the RN do it instead of hiring a Medical Records clerk. \nAnd the administration wants us to see more numbers. “More patients! Your numbers are down!” We are double booked and no help in sight. Labs are at risk of being missed, referrals are at risk of not being made. Abnormal screenings are at risk of not being followed up on. Patients are at risk!!! Clinic Nurses need HELP TOO!!!

  • Stacey Bond Robinson

    Whatever happened to caregiving as a team? Utilizing CNAs, LPNs, and RNs as a team to provide care to more patients. The current trend is RNs caring for multiple – often total assist patients themselves. Admin wants to save money by removing the less expensive members of the team and mandating BSNs rather than teams of caregivers with varying levels of education. Seems backwards to me.

    • SuzanShinazyRN

      After California passed the nurse:patient ratios here, the hospitals retaliated by laying off CNA’s and secretaries, monitor techs, etc. The RN’s job was expanded to include all of these positions….not good. I want to know my nurse has time for me, or my loved one, and I mean time to watch trends, verify new meds or any mistakes in the system. RN’s must have time to be vigilant to keep patients safe. Otherwise, before I am admitted I can go to a hospital that does have a nurse that has time for me.

    • Over the years the team nursing and primary nursing models have come and gone. As someone who started out as a tech I prefer team nursing, I think it provides the best care and allows the nurse to maintain a big picture view of her patients. It’s also the best way to build new nurses. \n\nUnfortunately I Think Suzan is correct in implying (or perhaps I am just inferring?) that hospitals moved away from team nursing to punish nurses and pit the CNAs and other unlicensed folks against them when the law mandated lower ratios. I would expect the same to happen nation wide if ratios are mandated nationwide.

      • Kristen

        I don’t know the motive for doing away with Team nursing. I’ve done both primary care nursing and team nursing. Both have merits. Primary care nursing allowed me to assess certain body systems more in depth IF the staff patient ratio was what it should be. Team nursing allowed me to concentrate on assessment and coordination of care for more patients….but I was not as easily able to do things like skin assessments, or mobility assessments.

  • Chaosfeminist

    Might I suggest Ludacris’ “Get Back” to epitomize the issue we nurses face \n\n”and another one …. and another one \nare you outta your mind? \none more patient when Im already in a bind”\n\nor something

  • martoya

    YES, YES, YES! Everything you said, YES! I don’t want to leave nursing so my plan is to be the biggest PIA in Colorado and DO something about it!

    • h2obabie

      Good luck with your plan. That attitude would get me an immediate escort to my car. If Admin is interested in my opinion they will give me one. We have an administrator that came in a few years ago that was almost unbearable. Yet, stay he has. We have lost SO MANY wonderful nurses under his dictatorship. I am trying to hang in there 7 1/2 more years to collect a little hard earned pension. I tell myself that daily now.

  • Kristine Fry

    Help us fight for a national nurse to patient ratio law ;\n\nhttps://www.facebook.com/groups/929997953713716/

  • Jennifer Mueller-Wesselmann

    I hate to say it, but with so many uncontrolled factors, is there really a solution? Because of the large percent of non-paying patients (or low paying resources such as Medicaid), hospitals must charge high prices. Liability insurance, attorney fees from frivolous lawsuits, cost of medications ($1,000 for a pill), etc. Too many factors to list. After working as a floor nurse for 16 years, I had to move to management. The physical and psychological stresses wear one down. Our younger generations see this and firmly state, “Why the hell do I want to put myself through all of that? There are so many other options nowadays.”

    • Kristine Fry

      There is a solution, and California we have nurse to patient ratio’s, and hospitals are thriving ;\n\nWe need a national nurse to patient ratio law\nhttps://www.facebook.com/groups/929997953713716/

  • Jessie

    I seriously Could not LOVE you more. I was NYC nurse lived in Cali ( Fellow Stanford Alum)and have now moved back to NYC. Im in surgery now so its one patient at a time so I am surviving. I would not be able to work in NYC again as staff nurse. Even though I miss and would love a chance to do ED nursing. I just won’t do it. All of my nurse friends are burnt out. We don’t hate being nurses we hate what nursing has become. Nursing came from the word nurture (thanks code black) . I Can’t be nurse with out caring for my patients, not just giving meds and checking off boxes. Like hold your hand and cry with you care, know your family members by name care, know what all my patients did before they retired and became grey and wrinkly. I can’t answer call buttons with 8 patients on tele, and give good care , care that makes me proud I’m nurse, so I left the bedside even though I’m good at it and its rewarding. I wish all 50 states had Cali ratios, and cared about nurses as much as we care about patient satisfaction scores. ( which are not even a good reflection of care. ) I know so many burnt out nurses who wish we didn’t become them. Its so sad because they are rock stars and would save your life but can’t take hospital life anymore.

    • laurie zimmer

      “We don’t hate being nurses, we hate what nursing has become”. Best quote ever!

      • Tami Creek

        I couldn’t agree more!

    • WORD.

  • Justina Lodato

    I love being a Nurse. BUT I go home at the end of my shift wondering what I forgot, who got ignored, or do I do right by my patients.I am lucky enough to have gone to a good school. I still think student nurses should have to work as a tech prior to starting nursing school. People drop out because they have no idea what nursing entails. Thank you for making our voices heard.

  • Angela Orth

    I worked in a hospital for a number of years. When I started, I worked with a great group of nurses who were willing to teach newbies as long as they were willing to work hard and truly wanted to learn. The nurses also had time at that point to continue our training and help us when we didn’t know enough. School will never teach nursing students everything they need to know. Experience and mentoring are the best way of raising competence in nursing. With constantly worsening staffing, The experienced nurse did not have the time for needed patient care let alone assisting and training those who still need it. Patients suffer. Patients die. I currently work in hospice which I love. I am, sadly, seeing even hospice go the same way. More patients per nurse, higher acuity patients in homes, more difficulty getting dying patients the medications and supplies that they need. We used to see the “average patient” two to three times a week. With the increase in patients per nurse and the sheer overwhelming volume of increased documentation, the patients are now being seen once a week. If they are having horrible symptoms they are seen more often. These are dying, unstable patients being cared for at home by their families or in some cases, who are living alone or with a “caregiver” as debilitated as they are. I remember the struggle at the hospital quite well, but never forget that patients in all areas are suffering more due to unsafe, inadequate staffing numbers.

    • Kristen

      Also, with regard to seasoned nurses: hospitals are not only bypassing us for jobs, they are also firing seasoned nurses for one reason or another, and nurses don’t have the money to pay a lawyer to fight back. Without seasoned nurses, there is nobody to support and teach new nurses the ins and outs of the job and how to handle situations that come up. New nurses are burning out before they’ve even been there 5 years!

  • Aimee Sundeen

    Legislating ratios is the only way to force things to change. Nurses and support staff are not expensive compared to CEOs salaries. Most direct care nurses only make about $50K per year. At least, here in Ohio, as best as I can tell. Just add one more nurse per unit.

  • Deena Sowa McCollum

    Thank you ZDoggMD. I was one of three who made the dream of a rally a reality. Thank you for your support. My Dad died in 2014 due to medical errors, delay in care and misdiagnosis. I’m on a mission to make his death have value. \nThank you \nDeena MCollum, BSN, RN\nTexas 22 years

    • Sorry for your loss Deena, and thanks for making a difference!!

      • Kristine Fry

        ZDogg – Deena has been working tirelessly as a patient advocate. She’s been working with our group since last summer, and started the rally group a few months ago. There are nurses huge hearts are really in this fight, to protect their patients and to protect their own practice. We love our patients, and we want to give them the care they deserve. Thank you for the recognition of this issue !

    • Kristine Fry

      You were the one that made this happen, you have a lot to be proud about, and now you’re going to lead in this group for the fight for a national ratio law;\n\nhttps://www.facebook.com/groups/929997953713716/

  • Bart Windrum

    Z: m’man, it’s WallStreet. Tell you what: how about hopping up to Colorado this summer or fall to do something for ColoradoCare, the nascent universal coverage plan Coloradans WILL BE VOTING ON this November? Hmm, maybe we put our heads together and cowrite a ditty? If you produce it you won’t have to hop up unless you’d really like to hike under The Flatirons :). Recall I’m the guy who TEDx’d the Never Say Die Rap. I’m not down on pop culture so a tune to parody doesn’t “pop” into mind. Let’s start here: if some song comes to mind for you I can take a first pass at a stanza or two. Point is, the real solution is probably gonna be universal plans. And Colorado is poised to the first state in the union to enact. IF we can can counter what is certain to be a zillion bedpans worth of Koch money opposition (it’s already begun). Cheers, Bart

  • Vanessa Patricelli

    Through our union SEIU 1199NW, we bargained a contract with dedicated break nurses for all day shift acute care nurses. They are added to our matrix not taken from it. On the 2 units that have had it for almost 2 years of has made a HUGE DIFFERENCE!!! Imagine getting to go outside to eat your lunch for 45 min. When you come back things have continued to get done just as if your patients have had a nurse taking care of them the whole time….. Because they have!!! It has been so helpful with nurse satisfaction and patient satisfaction on both units.

  • Lisa

    I am a 20 years ED nurse and appreciate all of your fun! I left the ED 2.5 years ago to become the charge nurse of a very busy Urgent care for the great company . That urgent care and is exactly the same as the ED without all ancillary staff. I have now become an administrator for the same company in the same medical office building as the urgent care. I have been a patient as a administrator and as a staff RN. Yes we give our own special treatment . I truly enjoyed being the charge of the urgent care but dislike my job as an administrator. Yes I “drank the cool aid ” as we call it. I thought I could still make a difference. Guess what ? I cant …. I don’t even have anyone to go to because its so bad in administration they eat their young way more than when I was bedside. We have work flowed the life out of nursing. My young nurses cant even think without a workflow , or running to the union. It obscene. It makes sad when a ask for an assessment and they tell me they cant or wont . That the EHR they want a flow sheet for their workflow!Becuase of the EHR we checking over chaecking and checking again. I have to audit all those EHR charts for mistakes and note error and tell an RN you forgot ato push a button and if you do it again you will be written up. Medicine as whole has gotten away from it intended purpose ! To help sick people!Every patient survey and every member complaint I have to not roll my eyes! I received a written complaint from a member who wanted to be reimbursed for his ED copay because our Urgent care should be open 24 hours. He had to go the ED in the middle for doing something he shouldn’t have been doing and cut himself! That’s just part of it…The fact that our nurses have to take all the ill manner members and just kind of smile and apologize. 16 years ago I remember a mentor telling never to apologize in this business because we are always trying to help or save a life or care for someone who come here for our care. That same mentor has moved up in the company as well and does not have the same views now .I loved being a nurse even if I had to double and triple chart everything . But I do miss all the TLC I used to give our member before the EHR. Its evil. \nLove your work!!

  • Linda

    I wish there was more MDs like you, I have been a critical care nurse for 16 years, and remember when we had 4 patients on night shift on a cardiac stepdown unit (with the crash bed) busy as hell all night then “they” said you need to take another patient because… well that one extra that one time became 8 patients piece all the time,and covering the LPN’s 4 (plus being the charge nurse) so I left along with many of my teammates all who were seasoned RNs. I went to another hospital which promised the staffing ratio would never be more than 4 to 1 on night on stepdown and 2 to 1 in ICU well in the matter of months that ratio started to change, now where I work I can have 2 vent patients, another one on a drip and possibly another one or two on dialysis, (and most of these patients now seem to weigh over 300 pounds) All this and needy families that think I am the hotel maid/server and the private duty nurse to their family member., I am getting burnt out and so tired of worrying about the Press Ganley scores, patients and their family member complain their needs are not met ( the doctor not coming when they want, they are not allowed certain foods, we don’t answer the call light fast enough,their pain meds are not strong enough, etc) I actually had a family member of a patient down the hall come into a room while we were coding a patient to ask for a glass of water and got upset when told to step out. What ever happened to respect? They always have surveys that list nurses as the most respected profession, Well if we are the most respected and get treated the way we do, I really hate to see how the least respected profession gets treated. And you are correct we are losing the good nurses and the new grads don’t seem have their hearts in it. The new grads are already back in school for their NP because they don’t want to be floor nurses. Scary to think that when we all get old there will not be any good caring floor /icu nurses.

  • Liz

    I love that nurses are beginning to unite for the issue of staffing ratios. I regularly have dreams (sometimes nightmares) about staffing. It seems like no one listens to us, but I know we can have a strong voice together. I know that sometimes it feels impossible to muster the energy to take this on when we are burnt out and exhausted from working hard, long, short-staffed shifts. Heck, some days we’re too exhausted to do what we should for our families, much less ourselves. Many of the newer nurses I graduated with are already fatigued, depressed, or burnt out. The ones who have been nurses for years want to do something else. I’ve heard nurses say they hope their daughters go into any field but nursing. Thanks, ZDogg, for having our back!

  • h2obabie

    I work in a small hospital in an outlying area from the great mother ship/major medical facility… Our occupation is under a lot of unnecessary stress right now. Almost daily we are pummeled with unattainable goals and expectations set for us by people having NO clue how to carry them out. Personally I go home exhausted wondering how I’ll make it through another 7 1/2 years (I am counting them down as are many of us!) or if I’ll somehow manage to trip myself up in the maze of ridiculousness dished up to me. Yes I am a believer Admin has laid the trap with which to ensnare us with and simply toy with us until we become too costly to keep on staff… oh, and train your replacement on your way out the door. Yet, we are all in this together. United we could revolutionize our profession. May we never forget that. Thank you for the platform. And YES PLEASE, we need other ways to measure satisfaction. I have been in nursing long enough to remember the pride once felt entering the hospital doors. Once upon a time nurses were looked up to and had a little clout in health care. Today I sometimes feel more like a punching bag. I will say middle management feels quite the same way but their hands are tied… And yes there are those making HUGE salaries while we can’t even have a nsg assistant in my department!! \nPeace out ZDogg!!!

  • Cindy Kautzmann

    I was a critical care nurse for 8 years in an academic hospital before I bailed (yes, I said that) and joined our education dept. I’m so glad you talked about the need for teamwork and respect going BOTH WAYS, because we’re all on the same team. Yes, MDs treat RNs like crap sometimes. But YES, I’ve heard quite a few RNs treat MDs – especially the new ones – like crap too. I’m ashamed to say I’ve had my guilty moments. Why is it so hard to understand that we’re all on the same team, that we want the same thing: safer, healthier patients?? \nOn a much grander scale, if the AMA and the ANA could learn to share the sandbox, treat each other with respect, speak with one voice to fight for the same goals, imagine the political power we’d wield. The mountains we’d move. Not only staffing ratios but patient satisfaction that makes sense (because I believe patients DO need to be satisfied, they just need to be educated about what they need to be satisfied with instead of expecting the “Hilton Hospital”) and EHR’s that make doctors and nurses jobs easier and more intuitive with evidence-based tools that can be easily used to improve patient care instead of endless documenting in six different places for documentation’s sake.\nSorry, I’m done ranting. Peace out.\nCindy

  • Kristine Fry

    Administrators are making million-dollar salaries, and bonuses galore, while nurses do not have the time they need at the bedside to care for the patient. Come join us and fighting for a national patient ratio lo administrators are making million-dollar salaries, and bonuses galore, while nurses do not have the time they need at the bedside to care for the patient. Come join us and fighting for a national patient ratio law!\nhttps://www.facebook.com/groups/929997953713716/\n

  • Tami Creek

    Wow! Thank you for this very articulate, inspiring and heartfelt video. The reality is that it’s going to get worse. I see two main problems. 1. Not enough RNS graduating to meet demands. 2. Too many RNS leaving the field increasing the demand. Some are retiring, many go in to advanced practice, some leave the bedside altogether. I thing this is exacerbated by being overwhelmed, unsupported, and feeling like at the end of the day I couldn’t do enough. Nurses are stretched too thin. \n\nI wish I had a solution guaranteed to work. More money spent incentivizing RNS to return to school to teach so in turn we can produce more RNS seems obvious, but not a quick fix. But it is a starting place. \n\nNurses being part of the discussion in a hospital is a must. Self governance. \n\nAnd someone please tell me why reimbursement is tied to patient satisfaction? The squeaky wheel gets greased…but that leaves the nurse unavailable to provide cares for his or her other patients. I’m not sure patient satisfaction surveys have done anything positive for our profession. \n\nThank you for this forum and your support. RNS need to realize they have power in numbers and speak out.

  • Ali Melle

    Thank you ZDoggMD. You are a genius with your fresh rhymes, and you “get it”. I have been a nurse, CRNA, administrator, and now working on DNP/FNP. You are so right about it all! This info needs to go viral, so there is more public outcry at the distressed state of healthcare in our country. The lay people dont see it until they are there, and CMS is basing reimbursements from their satisfaction?? WTH? Thank you for helping us to be heard! Love you! -peace!

  • Buster

    thank you. And yes, if you get no break, you should be able to have food at the nurses station.

  • Meagan

    Thank you for this! This conversation is so incredibly important. Life very literally hang in the balance.

  • Steffi Fiallos

    ZDoggMD thanks for your support. As an ED nurse for the last 4 years it has been eye opening that patient ratio is a major problem. They want customer service satisfaction but give you 5 even 6 patients sometimes in the ED where it is crucial not to have such high ratios in a fast paced hectic environment where it can mean someone’s life. I recently had an experience where one of my patients became hypotensive in a matter of 30 minutes while I was taking care of 2 of my other patients. I finally became aware and focused on that patient but it only take a few minutes and a patient becomes critical. How can we treat medicine like its customer service when we have people’s lives in our hands?! My fear is that I will get burnt out or leave nursing in the future not because I hate nursing, but what it is becoming. I love the feeling of saving and touching lives, but I will be destraught if someone gets hurt under my care.

  • Deborah

    I ehave felt for a while now that there has to be a change coming because the caring is getting lost in the tasks and documentation. I am actually considering going into a management position to try to simplify nursing.. Back to basics. Technology is great but perhaps we need to create a new job – health care scribe. Someone who likes to be more of a secretary, who understands what nurses are doing and document with/for them. I have often thought nurses should have a fast food recording Mike head set that would document as we talked… A true record of care given… Maybe a go pro camera on our heads would solve a lot… Free up our hands to care instead of type and free up our time to health teach and listen to our patients… And capture images of wounds, assessments and even good or not so good exchanges between nurses and docs as well as between patients. They would serve not only as a record of health care provided but allow for learning and improvement for ourselves and others…

  • Daniela Martel

    I went to nursing school in my 40’s and have been a RN for 3.5 years now, still a new nurse. First job couldn’t get in a hospital so I went to long term care and was given 32 patients per night. Brand new nurse. Thank god for the experienced LPN (yes an LPN) who taught me lots of what I needed to know. I found out that since I was an RN that it could show on my license if an LPN made an error on my shift even if they were at the other end of the building. I went to work at an acute care rehab hospital. There I had 8-12 patients for a 12 hour shift. I worked with a patient care tech that had between 12-20 patients. I felt completely inadequate and like I was just pushing meds, in the computer and keeping people from dying. I went to home care. Thank god I can do more than pass meds and actually be a nurse. Now however the tide is changing, medicare changed it’s rules and they are wanting more care for less money in this area as well. Coupled with much higher acuity at home. In the past week I’ve sent patients out 911 four times. I love being a nurse, but this medicine as a business thing is really insane.

  • Cindy

    Great commentary. And thanks for actually doing something and not just complaining.

  • Cindy

    Well said – can’t thank you enough doc – love you! \nAs an ICU RN, our ratio is one or two patients per RN, but have been told recently we now may need to take on 3 patients! Our community hospital is admitting more and more patients, often being on “Peak Census,” more now than ever. Talk about dangerous – one patient circling the drain, another GI bleed, and now you have an admission???\nYou’re right, something needs to be done by us, and soon!\np.s. HATE Jcacho – YES food should be allowed along with water!!!!!

  • Penny Derauf RN, OCN

    I am lucky to work in a union hospital in northern Minnesota. We occasionally have unsafe staffing situations due to a lack in available nurses. What the administrators need to know is, we are not making widgets. “Productivity” is a dirty word and an oxymoron to “compassion”.

  • Bertoldo Jessica

    Trying to find information on the rally on May 12th…anyone have any informatio?

    • Chaosfeminist

      Here’s the flyer…

  • Melissa Brown

    Thanks, Dr. Z, from the Gang of Three who originally came up with the idea for the rally in DC: Pam Barcomb, Deena Sowa McCollum, and me. 🙂 We were thrilled to partner with Show Me Your Stethoscope’s advocacy arm, SMYS for Change, in early February! \n\nIf anyone wants to learn more about the rally (or even better,join us!) visit the Rally for National Nurse-to-Patient Ratios group on Facebook: https://www.facebook.com/groups/1528010070852117/

  • AmitaPatelRN

    Everything you talked about is exactly what’s going on at my small LTAC hospital right now. When they hired me, they told me I would have 5-6 patients but most days I have 7 and here lately I’ve seen 8 a couple of times and when many of them are high acuity, and the hospital does paper charting with them continually adding more paperwork to be done by hand, 12 hours is not enough to care for the patients and write down everything they think I should be doing at the same time. The hospital hired a nurse who has only worked in an adult special needs facility for 18 years or so and she is so incompetent with the nastiest attitude and when I’ve brought up to the higher-ups that I can’t work with her, I’m ignored and blown off. I’m considering handing in my 2 week notice without even having another job lined up which is not like me at all but that is how fed up I am and as hard as I worked for my license, none of this is worth compromising my license over. I’m a dual degree nurse who completed an accelerated BSN program in 16 months. Someone will surely hire me with 3 years experience at this place under these conditions.

  • Stacey Hooker DeFrank

    I’ve worked in both a union and non union hospital and had much better ratios and felt like someone was actually protecting my position in the union hospital. The union negotiated our salaries and benefits (medical benefits were much better there), made sure we were trained properly and up to date on our competencies. Of course it was 2 different states (NJ-union, SC-non), but the difference between these two hospitals, how they were run, the demand on patient satisfaction and how it affected our positions, changing daily sometimes in SC, was immense. I think sometimes we do need some help from someone who is paid to have our backs. To let us be nurses and care for our patients holistically, not just scanning barcodes and having our faces in charts. I love the RN-refreshments and narcotics- statement. It really is what hospital nursing has become. Thanks for the video!

  • nurse fox

    I love you ZDogg MD. I work in intervention radiology now. I came from the ICU. I transferred because the patient load was just too heavy while I was pregnant. I would have 3 sick heavy patients 3 days a week. When the nurses complain the director will tell us we should feel blessed that we are not the ones in the bed. We went for a year without techs. When we finally did get some they did not have hospital experience let alone ICU. Radiology is no better the nursing department is run by a CT tech that has moved herself up in the ranks but still have no idea what nurses do or need to facilitate a safe procedure. The techs are rude and disrespectful until a patient CODES then it is a nursing issue. I truly understand that the hospitals are under a lot of pressure for patient satisfaction but this is why nurses won’t stay. I am currently thinking of going agency until I can find a better job to commit to.

  • Kaitlin Green

    Awesome! I know we all need to work on being respectful to each other… Attendings to nurses, nurses to the struggling resident. \n\nI work MICU at a regional medical center. We work with an excellent team, have all the latest technology, but staffing is always an issue. I cannot tell you how many times I’ve walked in to work and received a vented patient, maxed on 3+ pressers, receiving CRRT, and a full code and am expected to care for another patient….honestly, the other patient is usually cares for by our nurse tech, if we have one, or not at all. Our personal staffing issue is due to management. Our manager only uses negative reinforcement. It’s been almost a year since I’ve been told “thank you” by my manager….and I assure you, I work my butt of every time I come to work. \nHe also lacks flexibility and assertiveness. Those are easy things an individual unit manager can fix.\n\nBut our pay is absolutely terrible, I work like a slave for a minimal, or even sometimes, no raise. This is driving excellent nurses from the bedside to the classroom. In two years, all our young, extremely talented bedside nurses will be nurse practitioners, CRNAs or teachers.\n\nPatients and family members are utterly disrespectful and treat us like pieces of shit. They think they know everything and are extremely unrealistic. They are entitled and think the rules don’t apply to them. I am so tired of enforcing visiting hours, keeping people out of the halls and from gawking at the proned patient.\n\nI am a secretary, a security guard, a nurses aid, and a waitress all while trying to care for the critically ill.

  • Kristine Fry

    Oh for the power to make a change…\n\nWe are nurses, we are the single largest profession in the healthcare organization, and we have a voice!\n\nThe problem? Nurses have bought into a false narrative. There are some of us, many of us, that believe it is a valiant to work an 8 or even 12 hour shift without a break or meal. There are even some that believe that mandatory overtime, coming to work while you’re sick, and mountains of untaken vacations is part of the job, and makes one a better nurse.\n\nI submit to you that it is dangerous not only for a profession but for patients!\nNursing fatigue has been proven to have a causal link to errors. Nursing burnout damages our profession, patient safety, and our work-life balance, not to mention the toll that it takes upon our families.\n\nWe must unite with one voice and take back our profession!\n\nPlease join us to demand that our legislature enact mandatory national nurse to patient ratio’s!! \n\nFor more information; \n\nhttps://www.facebook.com/groups/929997953713716/\n\n

  • Mallory Covington

    Thank you so much for this video!. You speak so much truth about nursing and healthcare in general. I have been a nurse for 4 years and already feel burnt out. I know I have not worked long enough to feel that way, but I do. Most of it is because, like you said, I feel like I am put in impossible and hopeless situations with nurse-patient ratio and patient acuity. I also feel like the standard of patient satisfaction is completely screwed up. I feel like I am a slave when I go into work and get no appreciation for what I do. I also think that we are taking patient satisfaction scores too far. Patients (usually) are not health care professionals and should not be able to dictate their care. I had a patient who had refused a bath for a week and my CNA insisted on bathing him. The patient complained to the nursing manager and the CNA was written up because of the “poor performance”. Was it in the patient’s best interest to have a bath to prevent pressure ulcers, infection etc.? Yes! Was she doing what was best for the patient? Yes! So in this instance the quality of care was high, but rated low by a patient, and was in turn deemed low by management. Being a patient in the hospital is not the same as being a customer. The patient isn’t always right, but they are treated like they are, which in turn makes my title as Registered Nurse obsolete. If they are always right and get to treat us like a consumer then what good is my nursing judgement? Who am I to say they can’t have salt on a healthy heart diet? \nAnd please let me eat at the nurses station! \n\n\nMallory Covington, BSN, RN

  • Yo Z… word up. Love the ZdoggMD movement, been a part since the start. Thanks for the Nurse love (Nurse Practitioner here).\n\n I would love to see my Nursing profession utilize the power of social media in a positive and proactive manner instead of using it as the colloquial bathroom mirror. Our profession still uses social media as a sounding board and scream profanities and smear passive aggressive shouts to the silent majority. A sad punchline to a very old joke. I think this march in D.C is a singular step in the right direction, but it should be a starting point… and hopefully not an ending statement.\n\nIt’s going to take a grassroots effort of the many. Including a collaborative effort between other healthcare professionals (the entire team)\nto stand up for what we and our patients deserve. We need to start playing nice in the (virtual) sandbox. \n\nIt’s time to lower the volume of screaming and provide possibilities.\n\nIf you want to be taken serious, you going to have to get serious. \n\nThanks for the props. Keep on keepin’ on.

  • Melissa Brown

    Thanks, Dr. Z! Pam Barcomb, Deena Sowa McCollum and I are the original rally planners. Now we are partnered with the national group “Show Me Your Stethoscope” and “SMYS for Change.” I can’t believe how far we have come in five short months! Your support means so much to us.

  • Tamarah Chancellor

    You rock, ZDoggMD. I am a new, well trained RN. Our clinical rotations were in various sites and I saw the variety of staffing issues. The variety of patients in one rotation at a small, rural hospital ranged in age from 6 month (respiratory disease) to elderly (post-op with dementia.) \nI have worked as a CNA in a nursing home (am/25:1, noc 50:1), an LPN in a residential State Hospital for people with developmental disorders (30:1) and as an RN in a prison clinic and a local hospital on a med-surg floor (max 7:1) I am now at a State Psychiatric Hospital. As an RN float not a patient. (30:1)\n\nSome people may think that psych should be “easy.” But our hospital sees the poorest of poor who also have no insurance, many times are homeless and found themselves being adjudicated unable to care for themselves due to a mental disorder. So, we patch people up, regulate their physical issues, get them clothes, glasses and dentures. Then, there is no place for them to go at discharge. There is no support system outside of the hospital. They get to be homeless again. Then get into difficulties because of no meds, no foods and no medical care. And our hospital is vilified for being heartless, cruel and uncaring. There is also the issue of law enforcement thinking that our hospital should be a dumping grounds for violent offenders that they cannot control. (A tech was raped and nearly killed at our facility last October)\n\nStaffing issues exist. They are important. They are the tip of our ice berg at our place. \n\nThen, it seems that the administration is more concerned with CMS hoops that staff safety sometimes. ( I know it is not true, but that is the gossip on the wards.)

  • Melissa Brown

    ZDoggMD, please join us on our FB page Rally for National Nurse-to-Patient Ratios! Our rally is scheduled for 6/12/16 in DC. The rally organizers are Jalil Johnson, Pam Barcomb, Janie Harvey Garner, Cathy Stokes, Doris Carroll and myself. \n\nYesterday, our group hosted a Twitter Party and ended up trending on Twitter for about ten hours using our hashtags #NursesTakeDC and #SMYSOfficial!\n\nHere is our group. We would love to have you! \n\nhttps://www.facebook.com/groups/1528010070852117

  • Melissa Brown

    ZDoggMD, please join us on our “FB page Rally for National Nurse-to-Patient Ratios!” Our rally is scheduled for 5/12/16 in DC. The rally organizers are Jalil Johnson, Pam Barcomb, Janie Harvey Garner, Cathy Stokes, Doris Carroll and myself.\n\nYesterday, our group hosted a Twitter Party and ended up trending on Twitter for about ten hours using our hashtags #NursesTakeDC and #SMYSOfficial!\n\nHere is our group. We would love to have you!\n\nhttps://www.facebook.com/groups/1528010070852117

    • Done! Congrats on the momentum you’ve achieved!

      • Melissa Brown

        Thank you for your continuing support, Dr. Z!

  • Ericka Gray

    I do my at the very least monthly rant on this very subject to the only person who seems to listen, my Mother. I just sent her this link. Thanks for sticking up for us!

  • Kristen

    Thank you so much for your support. I enjoy your videos. I have a few comments I guess so I apologize ahead of time for the length. I am an RN that worked in critical care, and most recently in a “for profit” (yes that made a big difference) LTAC, turned new Nurse Practitioner in Family Practice. The EHR is definitely an issue. The EHR was supposed to save time, and all it has done is enable the “powers that be” (whoever that happens to be) to add more and more paperwork to be done (massive cash register is an excellent description). In the LTAC, in addition to the computer charting I had a 10 page paper booklet (in small print) that I had to fill out every shift on the patient (for my assessment). So much paperwork is added in fact, that I think we miss the forest for the trees. We are focused too much on crossing every T and dotting every revenue related “i”, and it takes so much time to complete it that we can’t RE-focus on the patient care we are trying so hard to provide. My son took my grandson to the hospital 2 nights ago, and commented that he thought everyone spent more time on the computer than they did with the patients. It makes us look like we don’t care, and creates stress between the patients (and their families), and the nurse. Nurses have always been about relationships. We work hard to establish relationships with our patients and their families, and I for one resent that the charting requirements disrupt that.\n\nI especially feel for the nurses and nursing staff at long term care facilities. In PA, only 1 nurse is mandated to be staffed for 150 residents. Compare that to a med surg floor with similar acuity where each nurse has 8 patients. For 1001 residents, only EIGHT RN’s need staffed on days, and SIX on evenings or nights. That is absolutely insane, and completely impossible to work with, especially when the boomers are aging, and the acuity is rising. The last time these ratios were ammended was 2002. \n\nI completely agree with us working as a team. As an RN that was important but I still did much of the work on my own, just because in ICU that’s how it was laid out. In LTAC I relied more on the team, but there weren’t enough team members. I can’t thank the CNA’s and the PT/OT department enough. Without them, pt mobility would never happen. As an NP, I’ve come to really appreciate the MA’s, the nurses, and the front desk staff. I’m still learning and they are several steps ahead of me much of the time. It makes a HUGE difference that they work like a well oiled machine as I try to find my way. I can’t imagine what it would be like without that! Anyway, all this to say that teamwork is so important, collective voice is so important, and I’m happy you are with us!

  • Nursey

    I would like to add one thing to all the nurses wishing for nurse patient ratios like we have here in California. I’m an RN of 22 years, originally from Chicago and worked and trained all over the USA. I honestly would just say be careful what you wish for. Remember, when California got the nurse patient ratios, all our support staff went out the window. So, we may have just 2 ICU patients per RN or 4 telemetry patients per RN, but we have NO nurses aides to help feed or bathe them, we have NO unit clerk to answer the phones, enter MD orders into those ridiculous computer systems, we have NO lab staff to draw their labs, we have no more kitchen staff to deliver their meals or even cook their food in some hospitals here. See, that is how they are paying for the additional nursing staff here, by cutting every single support person you can think of. Gone are the days of calling a nursing unit and getting a clerk to answer the phone, find the nurse, give out patient info and etc. Now it’s all on the nurse, from every single call light, every single bathroom trip, every single water pass, every single urinal dump, everything. It’s not as great as you think. In face, it is what made me retire from bedside nursing for good. I had a patient die on me because I was holding pressure on a man’s popped groin site from the Cath lab and couldn’t see that the monitor in the next room was alarming and the other two nurses on my unit were busy with their patients. We had no charge nurse and our monitor tech/clerk who was our backup set of eyes on our step-down unit (3 patients per RN ratio) was taken away to pay for the additional nurses. That was my last day working as a bedside nurse. I haven’t looked back. I now work in case management since 2012. Sad waste of my excellent skills and compassion but at least I know no one is going to die if I can’t take that phone call immediately.

  • Heidi Thompson Van Buskirk

    Amen!!! Night shift ER charge nurse in a rural 7 bed ER. Often triage and patient care in addition to orienting & assisting float nurses from OB or M/S, traveling RN’s & MD’s. 12 hour shifts with a rare potty break…angry waiting room…entitled “dental pain by ambulance” or “I wanna be screened STAT for STD’s at 0300”. I love ER medicine, but because of the lack of PCP’s the ER is itself dying…or heading into V-tach/fib. Help!!!! 911!!!! Oh! Wait- That’s me!!!

  • Anna

    I may be behind on viewing this video but man I’m glad I watched it! Every point brought up was spot on. Us nurses work tirelessly to provide the best care for patients. Meanwhile we have to keep it a secret that we are short staffed, that we are caring for more patients than is safe. And while this is happening, managers are asking us to take even more patients, “ED is in code help. And how soon is 10A being discharged?” Pushing people out the door just asking for those readmissions.\nDon’t get me started on the post discharge phone calls – “how could we have improved your stay?” 90% of the feedback is about the food or how someone didn’t get their linens changed. This is how we rate somebody’s hospital stay? And we don’t get reimbursed if patients don’t say their stay was top knotch? What about how we saved your life? \nTalk about burn out. \nThis all coming from a nurse who works at the “#1 hospital in the country” – Massachusetts General. \nMad love ZDogg. Thanks for always keeping it real!\n-Anna, RN

  • Jill Lazarto Burress Dickerhoo

    I’m an old RN…49….I’ve worked 90% of my career in the hospital setting, I fought long and hard for safe staffing which fell on deaf ears of nursing administrators who had ZERO clinical experience….I switched it up and went to work at a skilled rehab facility….even worse. “Technology” along with clinically inexperienced UMPS (upper management personnel) have made it insane. And if I hear work smarter not harder one more time…..

  • Mary Hull

    We have been working with a new grid for a little while now at my hospital. Some days are ok but the majority of the time I feel like I am chasing my tail. There are many days that I am the charge nurse, floor nurse and clerk. I have been close to crying many times. \n

  • Brewed

    I am not a nurse but I have been a lab assistant for 8 years and I was just accepted into BSN program. I work on both the computer/ordering side of things and the clinical/patient side of things. I see so many problems that could be solved simply by having resources shifted. We spend time and money on implementing AIDET and other training to make patients “think” they are getting better care but we could spend that money on a better computer based ordering system with bedside labeling and other fail-safes automated into the ordering process. There is so much turn over, so much abuse and advantage taken of good people, and so much distrust of CEO’s. I feel like there is an artificial, almost patronizing, way in which we as providers are told our voice matters. Not to mention the medicaid reimbursement system that is turning hospitals into expensive (and dangerous) hotels rather than safe places to heal. We also have horrible sick leave and vacation policies, terrible and unsafe staffing ratios (and not just in nursing, our lab has almost had to shut down on more than one occasion due to staffing issues), our CEO’s and hospitals are making record profits, and our patients are paying more than ever. What gives? Maybe we have to stop treating hospitals like businesses and treat them as their own distinct operation. They need their own models of operation. On the patient side of things, I had an ER visit this year and with insurance my one IV, 5 minute PA visit, 3 hours, and a few meds came at the cost of 6,000.00. Things are ugly all around.

  • David Poll

    Screw those patient satisfaction scores. If you pay more attention to making your employees happy you will have staff that will like coming to work. Stop cutting staff over this and maybe you will make the patients happy along with the staff happy.

  • Kim Pang

    Your video is my personal I have a dream speech. I work the swing shift in a busy NY ER and from the minute I come in to the time I have to beg to sign out my patients, it is hard and exhausting. And people are definitely getting sicker but also becoming less understanding and more demanding. A new thing too is younger nurses are going straight to grad school to become an NP because they are being warned by other older nurses about how “bedside nursing can kill you” that’s a direct quote that one of the nurses told me. But in regards with MDs, I know what kind of pressure they are under and they too get burnt out but MD to RN bullying does exist. It makes the job more difficult to love.\n\nThey need to mandate a pt to rn ratio. Or at least mandate a critical care ratio in the ER. Because I can have two ICU patients stuck in the ER and still keep getting new patients. It is dangerous.

  • Juniper Arnold Stewart

    Maybe we could get something recorded to play at the rally?

  • Kathleen Shields

    I am a psychiatric nurse in North Carolina and I have been voicing concerns about nurse-patient ratios for a while. On a day when we are fully staffed (that is 4 nurses to care for 26 acutely ill adult patients) the charge nurse has 2 patients and everyone else has 8. As we are rarely fully staffed because of turnover, that ratio is usually quite higher. Last Sunday, I was responsible for ELEVEN psychiatric patients. I have voiced my concerns to my manager who says we are hiring as fast as we can.\n\nI wish I could March with y’all on the 12th but unfortunately i couldn’t get the time off work. I will be thinking about y’all though!

  • Nancy Lipschutz

    ANA DOES NOT SUPPORT SAFE STAFFING RATIOS!!!!

  • Beth Wilkinson-Phillippe

    -For starters patient to nurse ratios. I have on average 20+ patients with high acuity every day. That includes 2 medication passes, 2 meals, all treatments, all head to toe assessments/vitals, all daily charting, etc in an 8 hour shift which always turns into a 12+ hr shift.
    -Next would be the pay. Majority of people around me make more money than me and they haven’t even been to college. In my lifetime I have had the initials CNA, LPN, RN, WCC yet my brother who pours concrete makes way more money than me. People working at walmart nightshift stocking shelves make more than CNAs.
    -Thirdly hospitals have winged out the LPN with 30 years experience who were able to teach all of the young freshy nurses how to be a nurse. Now you have nurses with a years experience teaching new nurses.
    -Society in general has this spoiled attitude which only becomes worse when they are sick which results in patients demanding more and doing less to help themselves. Patients are younger due to the inability of humans to take care of themselves, and all they want is narcotics around the clock.
    – And God for bid you just sign out a PRN on a piece of paper and move on, hell no you have 17 different places to chart and they’re all on a computer which is constantly updating, running slow, inputting your password 3,000 times a day, dies before you save it so you have to start over. Grrrrrr……
    -Burn out ratios are higher than ever. Average expectancy of an RN is around 7-10 years. Used to a nurse was a nurse for 30 years.
    I’ve been in the medical field since I was 16 years old when I became a CNA and boy have times changed. I am seeking a different career although I don’t want to because I am good at what I do but I gotta pay my bills and feed my kids without being so exhausted and broke. I support any movement towards a better Healthcare environment.