Nursing Notes

February 17, 2010

Poor planning results in busy nurses

ER Nurses
Image by Todd Ehlers via Flickr

This is an interesting article that I found on a blog at Respiratory Therapy Cave and I thought was worthy of a repost here.  Let me know what you think of this article, won’t you?


She was an RN. Her boss sat next to her as she was finishing her charting and asked her if she would work tonight. The RN said she was unable. The boss lectured her that “we are all in this together, and part of being a team means we all need to do our part.”

The RN said, “I am doing my part. I work my one day a week and that’s all I want to work. If I wanted to work more I would schedule myself for more.”

The boss was dumbfounded. She picked her ear with one hand, and with the back of her other hand wiped away the drool swirling around the corner of her lower lip as it dropped almost to her jaw.

I thought for a moment she might cry. I, for a brief moment, felt empathy for this boss. Finally she said, “We need you. We’re in a crisis here and we really need you.”

“Look, I don’t mean to be disrespectful,” the RN said, “But poor planning on your part doesn’t constitute an emergency on mine.”

That ended the discussion. I won’t go on about how it ended. I won’t explain how I so happened to be there to hear the discussion, for neither of those facts matter.

Tonight I was sitting in the ER. I noticed that the charge nurse was sitting at the unit secretaries desk putting in all the orders. From time to time she’d get up, run to a patients room, do some chore there, and return to finish typing away, and flitting through sheets of paper.

“Why are you doing all this work?” I asked, knowing she didn’t have time to talk with me.

She leaned back in her chair and smiled, “The unit secretary went home at 2:00 in the morning. The rest of the night we have to go without her and without any nurses assistants or techs to help us out. Plus Janet is going home at 3:00 and so is Jim. So basically it will be just me and Susan.”

“So basically the powers that be want you guys to work at unsafe levels.”

“Wow! That words it about right.”

That was the end of that discussion.

A few years ago another nurse named Peggy was sitting in the nurses report room about 40 minutes after her shift was supposed to start. I said, “Why are you sitting in here when all the nurses out there appear to be overworked.”

She said, “I’m refusing to take report because they want me to take 14 patients, and I think that is unsafe. I’m not going to put my license on the line because of their poor planning on their part.” She was referring to the RN boss.

Due to her persistence another nurse arrived a half hour later and Peggy finally took report on seven patients, a load that she said was safe.

With respect to hospital bosses it is not possible to know when business is going to be swarming and when it’s going to be slow. But still, poor planning on their part does not constitute an emergency on the part of the nurse.

RT Cave Rule #41: Poor planning on the part of administrators, bosses and supervisors does not constitute an emergency on the part of the staff.

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  1. Shirley, you have a knack for posting articles that cause me to pause and reflect back on my own nursing career. So many times when I worked in clinical care I was the nurse who couldn’t say “no” when I was asked to work extra shifts or take on an unsafe patient load “because there isn’t anyone else and the patients must be taken care of.”

    In some ways I applaud these nurses who set firm boundaries. If there were enough of them, it might re-shape the way nurse staffing is handled. In over 20 years of nursing, I have never seen any real improvements in the way staffing is handled. Can you imagine other industries copying the staffing patterns of nursing? No one ever asks an airline pilot to fly an extra 12 hours without sleep because his replacement called in sick and these folks HAVE to get to Seattle! In fact, on a recent flight from Chicago to San Antonio the plane was diverted to St. Louis to attend to a sick passenger. They estimated the flight would be back in the air within 30 minutes, but wait . . . the FLIGHT ATTENDANT had exceeded her maximum hours! The flight would be grounded for an additional 2.5 hours whiled they called in a new FLIGHT ATTENDANT! Imagine if our firefighters and police officers were staffed like nurses…bare bones staffing without planned backup. Sorry guys, I realize there are only two of you here tonight to fight the blaze in this burning building, but march right in there and do your best!

    As a manager, I can also sympathize with the other side. A nurse manager often doesn’t really have control over the planning part, staffing metrics are determined by administration and the manager just has to deal with it. There are times when no amount of planning can prevent a staffing crisis, and those are times when nurses can and should be expected to rise to the occasion. When I worked 30 hours straight in the NICU without sleep because of an unexpected blizzard, I knew that any nurse would do the same. When I watched the coverage of hurricane Katrina and saw nurses (and doctors) working for days in the worst conditions imaginable, I knew that they were heroes. When I see nurses worked to the point of exhaustion because we consider them expendable resources that can fluctuate with the census instead of providing stable, permanent staff, then I know that we need change.

    Comment by kitchrn — February 20, 2010 @ 4:40 pm | Reply

    • Heidi,

      Again, you leave very interesting and valuable comments and I thank you. As you can probably see from the type of posts I leave, nurse staffing is something that I really fear will “shoot us in the foot” with the shortage.

      I currently work the floor and frequently have 8-9 patients at a time. Since I have been doing this quite a while, I can do it but I still struggle. The new nurses on my floor, however, have a really hard time getting everything done.

      As a nurse manager, I have been plagued with staffing and call-ins. I am of the mind-set that I don’t want sick nurses at work and have frequently had to cover shifts because no one was available to do so. Not all places think like I do, so frequently you have sick nurses coming to work and getting everyone on the unit sick. Then you do have a crisis!

      I don’t have the answer, but I feel that there is one out there somewhere. I only hope I live to see it.

      Comment by Shirley Williams — February 20, 2010 @ 5:47 pm | Reply

  2. How about this one. OB department was warned 3 months in advance 2 nurses would retire. No new nurses were hired due to hiring freeze. Then warned for 9 months 2 nurses would be off on maternity leave. No new nurses hired.

    So now guess what? Instead of paying 2 new nurses regular pay, they have no choice but to pay 2 rental nurses twice the normal nurses wage.

    Interesting hey? Poor planning on your part…

    Comment by Rick Frea — August 3, 2010 @ 9:31 pm | Reply

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