Understaffing in Healthcare
Published on the 26 June 2016
Published on the 26 June 2016
Understaffing can be a problem in any professional workplace, particularly in healthcare where care may be compromised as a result. From time to time we all find ourselves in situations like this, but when the odd occasion starts to become the norm you have to ask yourself: does management know, or are they totally oblivious to what is actually going on in their facility?
If you notice understaffing that is dangerous, you have a duty to report it.
Of course, you don’t want to go outside the chain of command. You don’t want to go to the director of nursing before you consult with your manager. As you can probably imagine, this will not be an easy conversation, and you may get a great deal of excuses: “We are trying to hire,” “We can’t help when people call off,” “We just don’t have it in the budget to hire more help.” When this happens, then you need to go to the next highest up the chain. In some cases, you may even get the government involved, but the process starts with talking to your manager.
The first step is to recognise that you are dangerously understaffed. Nurses unfortunately have to face that some understaffing is inevitable. This should not be acceptable, but it is the reality. People call off, resulting in increased patient loads for the remaining nurses. On call nurses may be a solution, but many facilities are not willing to pay for nurses to come in on call in the case of short staffing. Then of course, there’s the problem of still being understaffed even when everyone shows up. When you have more patients than you can safely handle, you are dangerously understaffed.
What is dangerous about this? When you miss assessments or you are unable to recognise that a patient is in distress, you are probably understaffed. In some cases, it may just be a question of being overworked. If you can’t get a toilet break, can’t eat lunch, or can’t even breathe, this situation is dangerous for you and potentially dangerous for patients. When this happens constantly, you have a situation that needs to be addressed. Even when everyone is there, if you are still running your tail off, you may have a problem with understaffing that needs managerial attention.
Usually, you aren’t the only one noticing that you are severely understaffed. Your coworkers will know, too. However, the conversation doesn’t go beyond the level of gossip, complaining, and threatening to leave the facility. None of these are particularly helpful because they will not result in any change. The only way you will get change is to address the problem with your manager, and not many coworkers will want to do that. Some are afraid of losing their jobs, but some just don’t think that it will make much of a difference. If it is truly dangerous, then you all have a duty to do whatever you can to protect patient safety. This means that you need to organise your supporters.
A petition may be persuasive, but it is better to have a few representatives of the nurses to confront the manager. If you simply go yourself, it may look like you are complaining and that’s all. When you go with a group – two or three others – then you have more weight behind your statements. Try to pick nurses who have been with the facility for many years and are generally respected by the rest of your coworkers. If you have a small cadre of nurses who are passionately dedicated to safe patient care, you stand a much better chance of having your concerns heard.
With a group of nurses, make an appointment to see your manager. It is better to have the time set aside than to merely attempt to catch them in between shifts. You need the time and concentration to have your problems heard. Try not to blame your manager. They may merely be doing what they are told from higher up. However, you should make your concerns known. Tell your manager how dangerous you feel the staffing is. Let them know why you feel you need to bring it to them. You must make it absolutely clear that the safety of the patients is greatly impacted by the way they are running the unit.
You will often meet resistance or futile commiseration. Yes, they know of the problem, but there is nothing they can do. Invite them to come to the meeting with the next highest person on the totem pole – the director of nursing, for instance. Even if your manager wants nothing to do with it, you must press on. Take it to the director. If that doesn’t work, take it to the CEO. If that doesn’t work, you may have to take it to one of the overseeing boards created by the government. No one wants to be a whistleblower, but if the conditions are truly bad, then there is nothing else you can do. Follow the chain, though, before jumping to that step. Give them the chance to fix the problem, and if they don’t, then take your concerns as far as you can for the safety of your patients.
Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions.