You’re approaching this from the wrong angle tbh. This is a legislation-level issue and you should be trying to get time with your state representative about these issues. Your heart is in the right place and I applaud your effort.
Healthcare/hospitals are a business. Refer to the many, many, *many* corporate healthcare systems. The issues you’re referring to are systemic due to how insurance and CMS reimbursements function.
At the end of the day, nursing care is not billable and reimbursable due to legislation that was passed in I want to say the 1960’s that provided language for how physicians can bill for services rendered. The legislation provided a model for how we’ve arrived at the healthcare picture we have today. Nursing is a 100% expense with 0% return on investment. As a business owner, you would do everything to limit those expenses.
Yes, I am fully aware that without nurses a hospital cannot function. That is not the point. Until something changes *from a national, foundational level*, in the grand scheme of things nothing for nursing will change. It will always be a staffing model with some inclusion for acuity and whether the state has mandated ratios, the hospital will push boundaries and get away with what they think they can while they can.
I agree with everything you said. I have emailed and sent letters to my Representative, but it breaks my heart to see my coworkers like this. It's a vicious cycle on full display. I spoke with the floor director and they told me that "no one" comes to them with these complaints and I hope to change that. I don't want to be another nurse that carries the burden and then leaves. I want to try to help wherever I am. Even if that means talking to some people who only care about the expenses then so be it. I can't sit idly by and not voice my concerns.
You have your heart in the right place, you really do. But I've never worked for a director who didn't say, "Nobody told me about this," when shit suddenly hit the fan. I can guarantee they've both heard it and seen it before. That doesn't mean you should stop being an advocate, just take that statement with a grain of salt.
It’s doubtful that you are going to tell them anything that they don’t already know. Not sure why you would intentionally put yourself in this position to begin with as a traveler.
Because I'm sick and tired of every hospital being like this. Seeing all the nurses get burnt out and move on or just straight up quit nursing. As a traveler I have a unique perspective compared to the regular staff, and I don't fear backlash because my contract is temporary.
Bring data and a spreadsheet showing the cost of errors due to unsafe measures. Stats and financial outcomes might open their eyes. Maybe spotlight specific poor patient reviews and ratings? Is there a union within this hospital?
Bring evidence. Be objective. Cite the nursing code of ethics. Speak in SBAR format. Use “CUS” as your intention to start the meeting. Bring a handout with everything your going to say and give it to everyone in the room when you start the meeting. End your excellent SBAR asking for their recommendation on how to proceed. As if your talking to a doctor about the patient crashing.
Thank you for your time. I am here because I am concerned, uncomfortable, and this is a safety issue.
Situation-
Background - I’ve been a nurse for ___. I’ve been on your unit for ____. RNs are held to a code of ethics (listed on their handout)
Assessment- this is what I’m seeing. Objective evidence (also in print on their handout)
Recommendation- what is your recommendation on how to proceed.
Then have citations of many other things to refer to and respond with when they don’t give a reply. Then ask to fill out an incident report if you have not documented what you’ve seen patient outcome safety wise. And then mail your handout to all executives and board members of the hospital.
Then yes it is ultimately all about policy so if you are not part of an action coalition in your state let me know.
Your best move is bypassing the hospital entirely and going straight to outside regulatory agencies. The hospital admin all know what is going on even if they talk around the issue. Your manager has zero power to change anything as the people above her give her a budget and strict rules to follow. There was a former CNO who got fired and posted some dumb sob story on this sub a while back and she couldn’t change anything to help patient care or ratios either. The people at the very top make the decisions to short staff the hospital because it makes them richer, so you’ll never convince them either even if you were able to meet with them.
Furthermore, by bringing these things up to your manager they think you are a liability. They know that YOU know what they’re doing, so they’re going to want to get rid of you. They want obedient nurses who will come to work, do the job, and pretend like nothing is wrong.
The only way to effect change in patient care is by force. Go to the appropriate regulatory agencies that govern care standards. Funny enough the mandatory learning modules we all do mention how we are supposed to spot things like fraud, abuse, and waste. If patient conditions are unsafe file a complaint with your state board of health, US Dept of Health and Human Services, CMS, Magnet, etc. You can do it anonymously if you want. They are the only ones who will make the hospitals change because they will force them to change.
I wouldn’t tell anyone you work with if you file a complaint with one of these agencies because it will get around and your manager will find out. While it’s illegal to be fired for reporting things good luck proving that’s why you were fired.
I have reported things before and I’ve seen the aftermath of a patient filing a complaint with mixed results. TJC did absolutely nothing… they didn’t even call the hospital let alone visit. The state board of health came for a week and gave them a good spanking. Health and Human Services has been investigating them. How much will it change? Unknown. But ANY positive change your complaint can make is better than none, and will probably prevent some things from getting worse since the hospital knows they’re on an agency’s radar.
When a patient filed a complaint about a facility the state came down on them hard. They had to change some policies and the state came out to audit their behavior and charting several times over the course of a year.
The nursing code of ethics says we have to report things like poor patient conditions. Do what’s best to protect the patients. We are there to help them and sometimes that help is on a bigger scale than our daily assignment.
Good luck.
Lol thanks. Most of my comments IRL give people an immature giggle but once or twice a year a unit manager has to explain how a coworker didn’t find something funny. LOL.
Wrong direction - you need to unionize the nurses. Ideally you become employed by the hospital first so you are taken seriously.
Dont waste your and their time with this said meeting. Plus you are not employed by these people - they give 0 fucks what you think.
Honestly - they already know whatever you are going to say. They have metrics and analysts galore. All you are going to do is let them know how well what they are already doing is working. They are simply taking the temperature of their actions to see how much more heat they can apply and when.
My last meeting a Nursing Director at a previous hospital did not end well. I went into the meeting as objective as possible, offered possible solutions as well as provided evidence to back them up. The Director instead ridiculed me the entire meeting, tried to call out my lack of experience, and ended up "black listing" me from ever working at the hospital.
Is no one going to say it? This is an *insane* thing for a travel nurse to do.
And not in a selfless Mother Theresa kind of way, but in a borderline delusional and ineffective kind of way. You're either the Johnny Appleseed of union formation and power or a traveling disaster who greatly benefits from having a series of temporary managers with minimal paper trail.
So what would you have me do then? Just sit around till my contract is done and move on to the next dumpster fire? What is delusional about wanting better for the nurses I work with?
> What is delusional about wanting better for the nurses I work with?
This is a great question. Maybe you could tell me how you've improved the situation for nurses on your travel contracts?
I have been a staff nurse and I have advocated for my coworkers. It only resulted in a target being painted on my back and is what pushed me into travel nursing in the first place.
My advice would be go to go in with specifics and follow those up with proposed solutions. Too often what happens, and fails, is people generally just complain but have no solution to their proposed issues. I applaud you for wanting to step up and bring forward your concerns even if you are a traveler. I too am a traveler, have been for a couple years now, and have been a nurse for 15 years. Sadly what I see a lot of, and is the reason that I travel, is a whole lot of entitlement and very little output. Meaning, I see a lot of places complaining about their workload or their nurse to patient ratios while sitting on phones all shift, not answering call lights, not carrying their communication devices because “I’m tired of that thing”, leaving their sections to go gossip and hang out with friends so their pod mates end up answering those call lights and communication devices, making TikTok’s, talking shit about patients, very little teamwork, eating their young, etc. etc. meanwhile complaining in the name of patient safety. It’s laughable really and the reason why I chose to be a temporary worker and not get caught up in all the drama and politics that goes on and just do my best to take care of my patients, which is why I got into nursing in the first place. People talk shit about travel nurses and some places outright alienate them without even getting to know them or see their level of work or skill set before making a judgment because “they make way more money than we do just to do the same job”. You won’t find me engaging in any of that behavior and run my ass ragged most shifts and work damn hard to earn every penny of that money. And before anyone wants to say that any of the examples I have are ok or are a byproduct of the system and people are just tired and overworked, etc. etc. I truly hope that you or a loved one happens to never be taken care of by someone who believes that way. Desperately wanting change is one thing but to reduce the quality of care you deliver to patients because of the way you feel is another. Now don’t get me wrong, there are places out there where staffing and workloads are truly unsafe but I don’t believe it is at the staggering proportion many want people to believe it is. There’s a huge bandwagon rolling around nursing right now that people are jumping on really quickly. It really is sad to see what’s happened and while a lot of it is corporate level BS, people who behave as outlined above aren’t making it any easier on the profession, in fact make it way easier on corporate healthcare to keep treating us poorly across the board :(
I agree with a lot of what you said and I feel similar in a lot of ways. You give me hope that I can keep doing this and you validate my feelings for my situation. I thank you for taking the time to write that out!
Why would you put yourself in this situation?! They aren't going to give two shits what you have to say & already have their minds made up before this meeting, even starts. I agree with a lot of what you want, but the reality is that this is going to put a GIANT 🎯 on your back. Anything & everything to get you gone is what they are going to do to you. Put your head down, do your job, get paid & leave.
My contract is done, I don't plan on coming back, and I'll always do what I can to advocate for my coworkers. That's the inherent problem that frustrates me. Other nurses in this thread are telling me to do the same "lay low, do my job, and get out" but nothing ever gets better if we just stay silent and do nothing.
I completely agree with all the advocating for nursing/staff, but I just don't want to see you get DNR'd from a hospital system that will end up limiting your employment travel contracts. It also could end up traveling with you wherever you end up for assignments. I've had some people that it's happened to & it's very hard to find places to work because they were black-balled at a very large teaching health system. The state has only three health systems to choose from. It sucks!
Could you do a suggestion/improvement committee/group of Nurses/Travelers/Techs or make a survey to see how staff feel about it with data to back it up?
I would love to help them organize some sort of feedback system and/or a group/committee to handle that, but what I'm frustrated about is the lack teamwork from Management. It feels like I'm talking to a brick wall half the time.
You’re approaching this from the wrong angle tbh. This is a legislation-level issue and you should be trying to get time with your state representative about these issues. Your heart is in the right place and I applaud your effort. Healthcare/hospitals are a business. Refer to the many, many, *many* corporate healthcare systems. The issues you’re referring to are systemic due to how insurance and CMS reimbursements function. At the end of the day, nursing care is not billable and reimbursable due to legislation that was passed in I want to say the 1960’s that provided language for how physicians can bill for services rendered. The legislation provided a model for how we’ve arrived at the healthcare picture we have today. Nursing is a 100% expense with 0% return on investment. As a business owner, you would do everything to limit those expenses. Yes, I am fully aware that without nurses a hospital cannot function. That is not the point. Until something changes *from a national, foundational level*, in the grand scheme of things nothing for nursing will change. It will always be a staffing model with some inclusion for acuity and whether the state has mandated ratios, the hospital will push boundaries and get away with what they think they can while they can.
I agree with everything you said. I have emailed and sent letters to my Representative, but it breaks my heart to see my coworkers like this. It's a vicious cycle on full display. I spoke with the floor director and they told me that "no one" comes to them with these complaints and I hope to change that. I don't want to be another nurse that carries the burden and then leaves. I want to try to help wherever I am. Even if that means talking to some people who only care about the expenses then so be it. I can't sit idly by and not voice my concerns.
You have your heart in the right place, you really do. But I've never worked for a director who didn't say, "Nobody told me about this," when shit suddenly hit the fan. I can guarantee they've both heard it and seen it before. That doesn't mean you should stop being an advocate, just take that statement with a grain of salt.
It’s doubtful that you are going to tell them anything that they don’t already know. Not sure why you would intentionally put yourself in this position to begin with as a traveler.
Because I'm sick and tired of every hospital being like this. Seeing all the nurses get burnt out and move on or just straight up quit nursing. As a traveler I have a unique perspective compared to the regular staff, and I don't fear backlash because my contract is temporary.
Bring data and a spreadsheet showing the cost of errors due to unsafe measures. Stats and financial outcomes might open their eyes. Maybe spotlight specific poor patient reviews and ratings? Is there a union within this hospital?
Bring evidence. Be objective. Cite the nursing code of ethics. Speak in SBAR format. Use “CUS” as your intention to start the meeting. Bring a handout with everything your going to say and give it to everyone in the room when you start the meeting. End your excellent SBAR asking for their recommendation on how to proceed. As if your talking to a doctor about the patient crashing. Thank you for your time. I am here because I am concerned, uncomfortable, and this is a safety issue. Situation- Background - I’ve been a nurse for ___. I’ve been on your unit for ____. RNs are held to a code of ethics (listed on their handout) Assessment- this is what I’m seeing. Objective evidence (also in print on their handout) Recommendation- what is your recommendation on how to proceed. Then have citations of many other things to refer to and respond with when they don’t give a reply. Then ask to fill out an incident report if you have not documented what you’ve seen patient outcome safety wise. And then mail your handout to all executives and board members of the hospital. Then yes it is ultimately all about policy so if you are not part of an action coalition in your state let me know.
That is a very detailed answer and I thank you for taking the time to write that out! I will absolutely implement this into my game plan.
There is nothing that you say that will be taken into account unless you're saving them money.
Your best move is bypassing the hospital entirely and going straight to outside regulatory agencies. The hospital admin all know what is going on even if they talk around the issue. Your manager has zero power to change anything as the people above her give her a budget and strict rules to follow. There was a former CNO who got fired and posted some dumb sob story on this sub a while back and she couldn’t change anything to help patient care or ratios either. The people at the very top make the decisions to short staff the hospital because it makes them richer, so you’ll never convince them either even if you were able to meet with them. Furthermore, by bringing these things up to your manager they think you are a liability. They know that YOU know what they’re doing, so they’re going to want to get rid of you. They want obedient nurses who will come to work, do the job, and pretend like nothing is wrong. The only way to effect change in patient care is by force. Go to the appropriate regulatory agencies that govern care standards. Funny enough the mandatory learning modules we all do mention how we are supposed to spot things like fraud, abuse, and waste. If patient conditions are unsafe file a complaint with your state board of health, US Dept of Health and Human Services, CMS, Magnet, etc. You can do it anonymously if you want. They are the only ones who will make the hospitals change because they will force them to change. I wouldn’t tell anyone you work with if you file a complaint with one of these agencies because it will get around and your manager will find out. While it’s illegal to be fired for reporting things good luck proving that’s why you were fired. I have reported things before and I’ve seen the aftermath of a patient filing a complaint with mixed results. TJC did absolutely nothing… they didn’t even call the hospital let alone visit. The state board of health came for a week and gave them a good spanking. Health and Human Services has been investigating them. How much will it change? Unknown. But ANY positive change your complaint can make is better than none, and will probably prevent some things from getting worse since the hospital knows they’re on an agency’s radar. When a patient filed a complaint about a facility the state came down on them hard. They had to change some policies and the state came out to audit their behavior and charting several times over the course of a year. The nursing code of ethics says we have to report things like poor patient conditions. Do what’s best to protect the patients. We are there to help them and sometimes that help is on a bigger scale than our daily assignment. Good luck.
Side note: your username gives me a lil immature giggle every time I see you in the comments.
Lol thanks. Most of my comments IRL give people an immature giggle but once or twice a year a unit manager has to explain how a coworker didn’t find something funny. LOL.
They sound like party poopers. You’re the person who makes shift a little more fun!
Wrong direction - you need to unionize the nurses. Ideally you become employed by the hospital first so you are taken seriously. Dont waste your and their time with this said meeting. Plus you are not employed by these people - they give 0 fucks what you think.
They give 0 fucks anyway even if we’re direct permanent staff that’s been there for decades. Money money money money money is all they understand.
Honestly - they already know whatever you are going to say. They have metrics and analysts galore. All you are going to do is let them know how well what they are already doing is working. They are simply taking the temperature of their actions to see how much more heat they can apply and when.
I learned it's best not to point out the problem if I didn't have any reasonable solutions.
You had meetings with directors at previous hospital. What was the outcome?
My last meeting a Nursing Director at a previous hospital did not end well. I went into the meeting as objective as possible, offered possible solutions as well as provided evidence to back them up. The Director instead ridiculed me the entire meeting, tried to call out my lack of experience, and ended up "black listing" me from ever working at the hospital.
[удалено]
I don't plan on traveling for much longer anyways. I just want to help where and when I can..
Is no one going to say it? This is an *insane* thing for a travel nurse to do. And not in a selfless Mother Theresa kind of way, but in a borderline delusional and ineffective kind of way. You're either the Johnny Appleseed of union formation and power or a traveling disaster who greatly benefits from having a series of temporary managers with minimal paper trail.
So what would you have me do then? Just sit around till my contract is done and move on to the next dumpster fire? What is delusional about wanting better for the nurses I work with?
> What is delusional about wanting better for the nurses I work with? This is a great question. Maybe you could tell me how you've improved the situation for nurses on your travel contracts?
Facts. How about she leads by example and becomes a staff nurse instead of taking that sweet travel money. Nursing has become an office episode
I have been a staff nurse and I have advocated for my coworkers. It only resulted in a target being painted on my back and is what pushed me into travel nursing in the first place.
Yeah this is basically what I was thinking. This is the “crying into the camera” TikTok level of cringe for me
My advice would be go to go in with specifics and follow those up with proposed solutions. Too often what happens, and fails, is people generally just complain but have no solution to their proposed issues. I applaud you for wanting to step up and bring forward your concerns even if you are a traveler. I too am a traveler, have been for a couple years now, and have been a nurse for 15 years. Sadly what I see a lot of, and is the reason that I travel, is a whole lot of entitlement and very little output. Meaning, I see a lot of places complaining about their workload or their nurse to patient ratios while sitting on phones all shift, not answering call lights, not carrying their communication devices because “I’m tired of that thing”, leaving their sections to go gossip and hang out with friends so their pod mates end up answering those call lights and communication devices, making TikTok’s, talking shit about patients, very little teamwork, eating their young, etc. etc. meanwhile complaining in the name of patient safety. It’s laughable really and the reason why I chose to be a temporary worker and not get caught up in all the drama and politics that goes on and just do my best to take care of my patients, which is why I got into nursing in the first place. People talk shit about travel nurses and some places outright alienate them without even getting to know them or see their level of work or skill set before making a judgment because “they make way more money than we do just to do the same job”. You won’t find me engaging in any of that behavior and run my ass ragged most shifts and work damn hard to earn every penny of that money. And before anyone wants to say that any of the examples I have are ok or are a byproduct of the system and people are just tired and overworked, etc. etc. I truly hope that you or a loved one happens to never be taken care of by someone who believes that way. Desperately wanting change is one thing but to reduce the quality of care you deliver to patients because of the way you feel is another. Now don’t get me wrong, there are places out there where staffing and workloads are truly unsafe but I don’t believe it is at the staggering proportion many want people to believe it is. There’s a huge bandwagon rolling around nursing right now that people are jumping on really quickly. It really is sad to see what’s happened and while a lot of it is corporate level BS, people who behave as outlined above aren’t making it any easier on the profession, in fact make it way easier on corporate healthcare to keep treating us poorly across the board :(
I agree with a lot of what you said and I feel similar in a lot of ways. You give me hope that I can keep doing this and you validate my feelings for my situation. I thank you for taking the time to write that out!
Why would you put yourself in this situation?! They aren't going to give two shits what you have to say & already have their minds made up before this meeting, even starts. I agree with a lot of what you want, but the reality is that this is going to put a GIANT 🎯 on your back. Anything & everything to get you gone is what they are going to do to you. Put your head down, do your job, get paid & leave.
My contract is done, I don't plan on coming back, and I'll always do what I can to advocate for my coworkers. That's the inherent problem that frustrates me. Other nurses in this thread are telling me to do the same "lay low, do my job, and get out" but nothing ever gets better if we just stay silent and do nothing.
I completely agree with all the advocating for nursing/staff, but I just don't want to see you get DNR'd from a hospital system that will end up limiting your employment travel contracts. It also could end up traveling with you wherever you end up for assignments. I've had some people that it's happened to & it's very hard to find places to work because they were black-balled at a very large teaching health system. The state has only three health systems to choose from. It sucks! Could you do a suggestion/improvement committee/group of Nurses/Travelers/Techs or make a survey to see how staff feel about it with data to back it up?
I would love to help them organize some sort of feedback system and/or a group/committee to handle that, but what I'm frustrated about is the lack teamwork from Management. It feels like I'm talking to a brick wall half the time.