By Shawn Kennedy, AJN interim editor-in-chief
After I last wrote to you from the NTI (the American Association of Critical-Care Nurses’ annual National Teaching Institute and Critical Care Exposition), I headed back to the exhibit hall to check out the helicopter and the Army’s mobile operating tent. But I didn’t get to either one, because I met a young critical care nurse from a regional hospital in Missouri. We chatted about her workplace, and it was obvious that she was very proud of the work she and her colleagues did. When I asked her, “What’s your biggest issue?”, she said that it was probably staffing. I expected her to cite the shortage and the difficulty of finding qualified critical care nurses. But that wasn’t what she meant—rather she was talking about bare-bones staffing because of tight budgets. Her hospital routinely switches between two tactics: it sends nurses home when the patient census is low (when this happens, the nurses are paid only $2 an hour to be on call, but must still use a vacation day to retain full-time benefits, a tactic that rapidly depletes their vacation time); or, when the patient census is higher, the hospital imposes mandatory overtime, creating havoc in nurses’ schedules, finances, and personal lives. And people wonder why there’s a nursing shortage!
This practice isn’t new; we covered it in “The Other Side of Mandatory Overtime” in our April 2008 issue. Still, when I speak with nurses who work under this system, the injustice strikes me anew. Yet nurses seem to think this is the norm. Why is this an acceptable practice?
I “get” tight budgets. I don’t get why it’s always the nurse staffing budget that’s cut to make up a budget shortfall. It’s especially irritating when one realizes that hundreds of thousands of dollars are spent on technologies that haven’t yet been shown to make a difference in outcomes—while the substantial evidence on the relationship between nurse staffing and patient outcomes continues to be ignored. (We’ve covered this many times, including “Nurse Staffing and Patient, Nurse, and Financial Outcomes” in January 2008; and look for a related story in the July In the News). Professional nursing organizations and unions have made significant strides against mandatory overtime. But if hospital workplaces are going to work for nurses, they need to address mandatory “off-time,” too.