New York City – The Concrete Jungle where dreams are made of – unless you happen to be a NYC nurse, or even worse, a NYC patient.
Lets start by providing a little background story:
I have been working with a large travel nursing agency for approximately 2 years and have completed three contracts in the Baltimore, MD area prior to accepting a contract at a large NYC hospital in January of this year.
I excitedly accepted the contract and was looking forward to working at another prestigious institution, as I have had the pleasure of obtaining several years of experience with the Johns Hopkins Hospital System here in Baltimore. Ready for change and eager to explore the Big Apple, I was certain that this contract was going to provide me with an opportunity to find my niche in clinical nursing.
From previous contracts, I understood that travel nurse hospital orientation is limited, and can be greatly inadequate. To my surprise, the orientation schedule that was given to me was pretty impressive – three entire days of training! One day was to learn the ins and outs of their electronic documentation system and to learn how to use their handheld patient verification scanner devices for medication administration and lab specimen collection. The second day was a unit orientation with an assigned preceptor, where patient care, documentation, medication administration, and lab specimen collection were expected to be completed for a minimum of three patients. The third day was the hospital orientation for nurses, where the use of PCAs, IV pumps, glucometers, policies and protocols were taught and demonstrated back to ensure nurse competency. All of this training was to be completed prior to starting my first independent shift – Not everything worked out as planned.
My first independent shift was scheduled before I received the hospital orientation for nurses, so I was put in a situation of frantically attempting to learn how to use foreign equipment such as PCA pumps, IV pumps, glucometers, bedside monitors, ventilation equipment, etc. When I brought my concerns regarding patient safety to the nurse manager, also known as a Patient Care Director or PCD, I was basically told to deal with it and move on.
As any good nurse would, I provided the best care for my patients within my ability, and resourced additional assistance from the charge nurse, respiratory therapy, and various other staff members who were familiar with the equipment, policies and protocols of the institution. At the end of the shift I was congratulated by the charge nurse for my determination to provide the best care possible within the chaotic circumstances provided. At the end of the day, although I was concerned about lack of support from management and other potential safety issues that could arise, I felt pretty good about my performance that day, thus leaving the facility content.
The next day I received an unexpected phone call from my travel nursing agency site manager. She proceeded to explain that the Patient Care Director reported my behavior during my first shift as “unsafe” because I accepted an assignment that I was not adequately prepared for. I explained that I approached management with my concerns and that I was expected to complete the shift regardless. My site manager continued to state that the PCD was terminating my contract.
I was shocked and couldn’t believe that this was happening. I explained to the site manager that I pride myself in upholding the highest standards regarding patient safety, and the fact that I informed management of my concerns prior, during and at the end of my first shift should reflect that. My site manager emphasized that I did everything I should have, but unfortunately this was a situation where neither of us have any say in the matter. Just like that, I was out of a contract.
Transfer to Another NYC Facility
Since I have worked very hard in creating a good name for myself within my travel nursing agency, and have strived in obtaining excellent professional references at each position I’ve held, my agency worked diligently with the large hospital group to get me another contract at a different facility. It actually worked out better for me for a few reasons. 1.) It was a much easier commute via public transit. 2.) It was my original facility of choice because I wanted to attempt networking with some of the nursing educators while on contract. 3.) I have considered pursuing a PhD at their university.
Recuperated from the previous week’s stressors, I was eager and very grateful for the new opportunity ahead.
From the very first shift, I could identify many differences between the two facilities. The nursing staff at the new facility were much more approachable, friendly, and willing to help each other out with their patients. We were allowed to make our own schedule to better meet the needs of the nursing staff, as well as optimizing unit coverage to ensure adequate numbers allowed per shift. I thought to myself, “Wow! What a major improvement from the last facility I was at.”
Well, the “grass isn’t always greener”. See, what I didn’t understand right away was that the charge nurse and senior nursing staff of the unit had been on a mission for a long time to provide some form of incentive for the nursing staff. By role modeling strong team work ethics, implementing self-scheduling, encouraging peer-to-peer accountability, and creating a fun working environment, the nursing staff had found ways to better “deal” with the absurd institutional demands placed upon them.
What I didn’t comprehend initially was that the hospital administration’s set staffing ratios were incredibly stressful and undoubtedly unsafe, only providing 1 RN per 7 to 8 patients. The unit was considered lucky if they got to keep 2 nursing attendants for the entire unit per shift. What confused me even more was the fact that this was the NORMAL institutional staffing expectation and not the result of an acute situation that called upon nursing to take on additional patients.
Unsafe is an Understatement
It’s needless to say that I was overwhelmed every shift I worked while in NYC. Some of my shifts included the direct care of as many as 14 patients in a 12 hour shift due to the pace of patient discharges and admissions. There were several incidents were the hospital transporters would park patients in the hallway and leave the unit without ensuring that a RN was aware that a new patient arrived to the unit. Many times I was floated to a different unit, without an orientation, and still expected to care for 7 or 8 surgical patients. Despite my diligence in attempting to provide the best care possible for my 7 or 8 patients, there wasn’t a single shift that past by where I didn’t go home disappointed because I couldn’t give each patient the care they deserved.
After a couple weeks went by, I had a lengthy conversation with the charge nurse and she provided me with some history regarding how the nursing staff have been fighting with hospital administration for many years to obtain safer staffing, and that their union was in the process of establishing contract negotiations with their hospital and other private hospitals throughout the NYC area. Of course I was interested in learning more, so she connected me with our unit union nurse representative. I then learned more details about the contract negotiations, that this was a city wide issue, and that other NYC hospitals were also enforcing unsafe staffing ratios as a means to make a larger profit.
Since I felt the pain of both the NYC nurses, as well as my poor patients who deserve better care, I began reading up on the events and happenings of the New York State Nurses Association to see what was being done to resolve this issue. To my surprise, I apparently came into NYC nursing at a time of transformational change. The NYSNA had been very busy and I was immediately on board!
NYC Nursing Initiatives
According to NYSNA– New York State Nurses Association (2015) “There is a crisis in New York patient care – a staffing crisis. As nurses, we see every day how this crisis hurts our patients. But hospital administrators are trying to stop us from solving the crisis, by campaigning against safe staffing ratios. Nurses are being forced to take on 9, 10, or more patients at once. That’s too many. We’re fighting for a law to set safe staffing ratios.”
PRNewswire-USNewswire reported on May 7th, 2015, “Registered Nurses at Montefiore Medical Center’s Weiler Hospital in the Bronx were threatened with arrest and escorted out of the hospital today after speaking out about staffing shortages. The nurses, who are members of the New York State Nurses Association (NYSNA), were attending a breakfast to celebrate National Nurses Week in the Weiler Hospital cafeteria when, in the midst of discussions with fellow nurses about staffing conditions in the facility, were told to keep quiet and were escorted out of the hospital. Seven nurses were removed from the facility.” As a result, the NYSNA has pushed harder in their negotiations with Montefiore and 13 other NYC private hospitals, while maintaining a strong focus on safe staffing.
Also, I just received information from a NYC nursing colleague that the nurses union at NYP Hospital had participated in a strike vote last week, where 95% of the union nurses voted “Yes” to strike. Now the union holds the right to strike and will provide a 10 days notice to the nursing union members should they proceed.
I was delighted to be able to take part in the NYSNA rallying that was taking place during my time there. It felt good to be able to voice my concerns along with hundreds of other nurses. I sincerely hope that the nurses of NYC and the NYSNA can quickly come to a resolve with the proposed negotiations that have been placed on the table. We all know that nurses deserve more for what they do on a daily basis, but the ones who ultimately deserve these changes are our patients! Safe Staffing Saves LIVES!
To see more of what the NYSNA is up to, and to connect with NYC nursing to promote positive change, you can click this link and read up on their latest initiatives.