When Registered Nurse Cindy Lussier goes home from work each day, she leaves feeling frustrated. Lussier, who works for the Zambarano Unit of Eleanor Slater Hospital, is frustrated because she says hospital staffing shortages are forcing her and nurses around the state to compromise care. Maybe she can’t get around to give people their medication on time, or even to turn them when they should be turned. Maybe she doesn’t have time to fully explain to patients how to take care of themselves when they leave.
Or maybe she has been forced to work a 16-hour day because no one was available to take her place when her 8-hour shift ended.
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”You tend to cut corners,” Lussier said. “Every single day work isn’t being done that should be done.
”You don’t want someone 15 hours into their shift taking care of you,” she said. “You really don’t.”
But that is just what’s happening according to a new report released by United Nurses & Allied Professionals, the largest health care union in Rhode Island. The union recently surveyed 16,000 Registered Nurses and other health care professionals about the state of nursing care. Those who responded painted a bleak picture.
Eighty percent said the quality of patient care has declined at their facility in the past year, while 93 percent reported that their patients do not always receive adequate teaching on how to manage their health needs after they leave the hospital. Further, 87 percent report that their patients do not always receive their medications as scheduled – meaning, within an hour of the time the medication was supposed to be delivered.
All this means that patients suffer, nurses say. For example, turning a patient is critical procedure. It gives the nurse a chance to check on the patient after surgery to see if any complications are developing. It’s also a time for the nurse to talk to the patient. These things have to be done and done on time, nurses say. And they shouldn’t be done by someone who’s working mandatory double-shifts, they say.
”They’re exhausted, and they’re making life-saving decisions on behalf of patients,” was how Jan Salsich, a Registered Nurse at Westerly Hospital put it.
Lynn Blais, a Registered Nurse at St. Joseph’s Hospital’s Our Lady of Fatima unit in North Providence and president of the union, said hospitals use forced overtime in lieu of hiring more staff. Depending on the hospital, nurses receive either time and a half or double time pay when they work overtime.
In addition to being forced to work overtime, nurses are also being “floated” to units that are unfamiliar to them, according to the report. More than 1,000 people responded. The survey results were based on the first 800 responses, which the union said was a statistically significant sample.
Many factors are contributing to the problems nurses face, said Mary Dowd Struck, senior vice president for patient care at Women & Infants Hospital. Struck, who has been a nurse for 30 years, said hospitals are not conspiring to make nurses work long hours. The problem, she said, is that hospitals are facing federal Medicare cutbacks that have made operating the hospital difficult. Further, a nationwide shortage of nurses has made it difficult for hospitals to find qualified people, despite their best efforts.
”I think hospitals are under a lot of pressure – they’re not getting reimbursed for the cost of care,” Struck said. “Staffing at acute care (hospitals) has nothing to do with the unwillingness on the part of the hospital to provide adequate staff. Hospitals are having a difficult time recruiting and retaining registered nurses.”
The average age for a nurse in Rhode Island is 45, she said. Rank and file union nurses should band together with nurses in management and administrative positions to improve the image of the profession and to recruit young people, especially men and minorities, she said.
Struck added that the profession faces more competition from other fields than it once did. Further, hospitals are forced to compete with other areas of the health care profession, such as pharmaceutical companies, for Registered Nurses.
Struck said that when she was in school, “Smart girls became teachers and nurses. Now there’s lots of options for girls who are smart.”
And many are choosing those other options, Blais said. But she added that the problems nurses face cannot be blamed solely on the shortage of nurses. Administrative salaries could also be scrutinized, she suggested.
The General Assembly will consider measures to deal with these problems. Bills filed in the House and Senate would limit mandatory overtime to no more than four hours beyond a regular shift, and require hospitals to report each occurrence of mandatory overtime to the state Department of Health.
The House and Senate will also consider bills that would deal with another problem nurses say plagues them: hospitals’ propensity for hiring lesser-skilled professionals to do work that was formerly done by more highly-trained staff.
For example, a bill filed by state Sen. Donna Walsh, D-Dist. 25, would require hospitals to provide a “sufficient staff and skill mix under Department of Health Regulation.”
A third set of bills deals with a suspicion some nurses have that administrators are paying themselves well while squeezing the rest of the operation. The House and Senate will consider bills that would require hospitals to provide more detailed disclosures of hospital expenses, executive salaries, consultant fees, advertising budgets, and “potential conflicts of interest by board members.”
Lussier, of the Zambarano Unit of Eleanor Slater Hospital, said nurses are more directly involved with patient care than administrators, Lussier said. Patients may not notice when an administrator leaves for the day, she said. But if a patient’s nurse is unavailable, he or she will notice, Lussier said.
”In all the years I’ve been a nurse, they’ve (patients) never asked me for their administrator,” she said.
