Nurses make things work. We make do. We save lives. Also, we strive to do better. I’m a nurse and my family has been sending me donated cloth masks. My favorite is one that says You and Me on it. There is also one covered in pink flowers that I like. If I have to work without an N95 mask, I want what I use in its place to represent me. Like many other nurses, though I know this will not be enough, I will continue to practice. We will also continue to express our needs, hoping our support systems acquire more equipment. We can do better. When nurses are a part of solutions, we do better.
Truth is, registered nurses that provide direct patient care across Illinois are familiar with vocalizing needs and receiving less than is safe. We should not hide deficits and, instead, build places to have system improving conversations about problems.
Previously I worked as a charge nurse in a small community hospital. We were frequently short two to three nurses. On those days, I was expected to manage three patients, the other nurses, and triage incoming ambulances. Supervisors pressured us to open special rooms for patients who did not need to be admitted to the hospital, even when we didn’t have a dedicated nurse for these rooms and the nurses all already had as many patients as they should handle. Understanding the needs of patients and the abilities of nurses, I had to determine staffing choices based on open rooms vs. ratio.
Making these decisions, I thought back on my first days in the ER. I was promised eight weeks of orientation with a preceptor. The preceptor had a patient and supervised me while I took three patients. In my fifth week, with an overloaded emergency room, a new physician and short-staffed, my preceptor had to also act as a charge nurse. That day I was, enthusiastically, directed to take on four emergency room patients and a fast track patient. My preceptor held her own set of 3 emergency room patients, directed incoming ambulances, performed bed management, and coordinated with the physician.
I knew I wasn’t ready and insisted that they were giving me too many patients too quickly. I wanted to continue my orientation as scheduled. The department manager called me to her office to explain that busy days happen and nurses have to step up. When I expressed hesitation, she replied with, “Perhaps you aren’t suited for the emergency room.” I was heartbroken.
Ultimately, I stepped up. Was that the safest thing for my patients? I don’t know. I like to think that I provided excellent care. But I was young, green, and new to ER care. It is a lesson that still resonates to this day–administrators set the tone for and govern management. The patients we care for govern direct care nurses. And while yes, there are busy days, we need to give the hardships and limits of new nurses credit.
Currently, staffing decisions often come from the top down to direct care nurses. Working as an emergency room charge nurse, it is not unheard of that I am urged to fill beds even when I am two nurses short. While management looks at staffing to meet hospital needs, direct care nurses understand the staffing needed to meet unique, diverse and ever-changing patient dynamics.
From experience, I know that it is critical that direct care nurses not only bring their staffing expertise to the table, but that those at the top of the command chain implement, or document rationale for not implementing, those nurses’ suggestions. It ensures that a regulatory body will investigate inadequate staffing complaints. Since nurses providing care within each individual institution are best suited to determine staffing limitations, it is critical that we consider their professional evaluations. Giving space for nurses to voice ideas, needs and concerns is a win for patients and hospitals. The public trusts nurses and will be more willing to trust hospitals that listen to nurses in making staffing decisions.
Systemic short-staffing means we are accustomed to less than preferred resources. And, in the face of the COVID-19 pandemic, I have my Me and You cloth mask. I, though, know we should have access to N95 masks. I will show up and take patients, but I know we could do better. Critical to doing better is giving direct care nurses a true voice in staffing decisions. It is essential to help hospitals best prepare for all patient care situations, including pandemics.
Lauren Wojtkowski RN, CEN