So Many Issues, So little Time. This is only one aspect, I'm sure, of why staff don't stay, but working around the hospital lately has made me think about the problems that result from our inability to retain staff.
In the olden days, all the staff on a given shift knew one another. They'd been through a thousand variations of every situation together; they knew what the possible outcomes were, the possible interventions. When a patient began to turn over tables, for example, the staff could communicate with each other with a look...You, get the others out of the milieau, You call safety, You and me go get this guy... I'll do the talking, you back me up...
Or, the milieu is getting revved...we need to calm it down...and with a few brief words, each member of the staff agrees to the necessary action and executes it.
Coordinated responses are possible because the staff are experienced and know one another,know policy, know what their choices realistically are, know what works, know who is capable of doing what. Safety for patients and staff is maximized, disruption is minimized, treatment is able to progress with reasonable efficiency.
It takes a certain preponderance of "old" staff to train "new" staff. This is because there is an entire culture that gets (or needs to get) transmitted to the new person. The new staff needs to be immersed in the culture for an extended period before he/she fully integrates it and can act as a member of the "team". I've worked shifts where there were two new grads and two pool staff. There's no one there to transmit the experience. The staff are winging it, making it up as they go along, hoping to survive the shift; the patients are insecure, get different answers from different staff, start testing limits. This is all worse in the evenings after the day shift goes home and worst of all on the weekends. The new grads.....alone....with all those crazy people.....
It reminds me of the nations' problem with immigration. Any group can create new members if it's large enough to predominate...(or is that preponderate) A lot of people worry now that the number of immigrants is so large that they can't become integrated into the original group...immigrants remain separate, culturally...living in the midst of but not a part of "America", for example, or "Italy". They remain identified with the country of origin.
Similarly, at the hospital, the new employees need a year at least, in the constant company of a preponderance of "old" employees, to become "old" employees themselves.
New staff don't know when the social worker's descriptions are biased and inaccurrate, when the treatment plan isn't making sense, when the dispo is bad. They often don't know if the patient is over medicated, under medicated, or inappropriately medicated. They don't know how to get a doctor who's ignoring medical concerns to take an interest...they often assume the doctor is right. Since they don't know, yet, the subtleties of what's going on, they don't complain as much and aren't as generally troublesome as older employees. They're also cheaper on the whole and more attrative. They're a good deal for management.
It's hard to find a good come back for that....the only possible grounds is quality of care.
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Excellent comments on mix of old/new staff. There is nothing that engenders a sense of dread like going to work on a Friday evening and realizing that you are the only experienced staff working with a new grad (probably the charge R.N.) and pool staff. Lets face it; it takes a minimum of a year to determine whether or not a new staff member is going to be an effective clinician. Assuming that they are it also takes at least that long to develop that intuitive sense of how one's coworkers are going to handle a specific situation. This employee will be leaving in the near future due in no small part to the situation you so eloquently describe.
Dear Anonymous, It sounds like you can relate to this. I remember feeling thrown to the lions when I was new to my home team. The patients could sense my insecurity and pulled all the tricks to get the best of me. What a huge learning curve that turned out to be. I felt abandoned by old staff but experiences turned out to be more telling than anything that could have been said. Instead of bailing completely out, I urge you to join a different team. There is good work going on out there and good, caring individuals are needed. Get to know the old staff. It's worth it. See Holy or Christ. They can help you.
I'm confused...do you mean that prayer will help? Holy and Christ?
HOLY CHRIST!!!!!
Sorry, didn't help.
Interesting underlying point you were making however. I'll get to that.
Yes, Gadde's reminisence is right on. It was easier back then. You could depend on each other. We need to know that our colleagues will be there for us and they need the same from all of us. Believe it or not, that includes management.
We worked to transform lives and provide hope. We worked to survive a shift and come back tomorrow and do it all over again. We were a team, a well oiled machine.
And now to your underlying point; we have also slowly made it very very hard for greenies, newbies, whatever you want to call them, to assimilate into the fold, to join our family as it was. Much to our demise, I might add.
How do we freely pass on our expertise to others? How do we trust? How do we welcome? How do we engage? How do we assume our responsibilities?
Do we observe and guide; or just watch and ignore?
Do we nurture and create; or do we hinder and cajole?
Do we lead by example; or do we slink further into the shadows?
Sound familiar? Just what do we perceive of those above us?
Can you see it? Can you feel it?
Shine the light!
A nurse who just turned in her notice will be going to Denver Health......The reason she said bottom line she will be making 1,400 more a month.......So leave ya she is leaving........
If you mean Chris C. in the nursing office ?? She is leaving too...... Fri day is her last day.......
Perhaps someone outside the madhouse should investigate the reasons for the ongoing departures?
Of course that would mean that they could rise above their blatant disregard for all that has occurred.
Was there some nursing meeting where it was announced that due to the hospital spending TOO MUCH $$ on patient care,
RN 1 and 2 positions will not get any raises!! ?
What all does that imply?
RN 3's and above will get raises. The retention of supervisors will be assured. A class system painfully evident in a state organization.
Entry level RN's will have to look else where if they want more than substandard wages.
Those that stay will be glad handed to make them feel part of some important cause. Trying to rescue a failing system, (what is that term when loved ones keep buying drinks for an alchoholic?)
Tying wages and patient care together sets up an ugly correlation implying that as patient care goes up wages go down.
Is that the culture we want to nurture at the madhouse? How do we orient the newest line staff to the hospital? The obvious messsage,fill out these papers so we can put them in your record to show how well we are training staff. The subtle message, don't send patients to get medical care because you may not be able to make a wage to take care of your family's health.
(cost of living is going up faster than the last 3 years pay increases).. (unless you are part of management?)
Please some one say that this is a result of being misinformed.
Kieth are YOU out there? Marva? What are your intentions?
Give those Doctor and your selves 30 to 60 thousand dollar raises if that is 33% of your salaries.
You and the other doctors deserve it, We need great doctors and attract new ones too!! If we get enough Doctors, they will have time to help orient new line staff, and this could become a teaching facility. Lets work towards substance.
E2
First off very interesting site. I have been at the house about 2 year worked at inpatient psych at some good for profit hospital and some that could qualify as prisons/warehouses for those in need of treatment. The hospital I came from was very similar to this one with the exception of actual treatment to clients. I think it has to do with insurance oversight becouse being a for profit that groups had to be done, patient's safety actually be taken into account. But this being a nonprofit many things are disregarded and others that are minimally important are expanded upon. I agree there are to many admin positions created that are not essential but positions that are needed are lacking.But that is also what happens when insurance companies that pay the bill of private insurance patients are not involved. I continue to work here I'm still loyal, but always have another job. But I believe this could be a greaor at very least a good hospital but it starts at the top. Morale is low which trickles down to direct care treat each other, you can go one some units not even get a hello becouse you are pool which creates resentment for those who are coming to the unit to help out or working a day that they should be off. Though the admin is for the most incompetent in regards to cutting cost in places that it is needed and not placing more funding in those programs, staff, and hospital units where it is needed. Regardless we should make sure to make those that are new feel welcomed, show a little interest in them ask a few questions , help them out in knowing the unit with being a drill sargeant and commanding. Those staff will remember the units that treat them well and will likely work an extra shift when asked to help out. In regards, to younger generation of workers(which I belong to) they are mobile and have no problem leaving a job for another when it is beneficial or job demands, stress do not equal pay or feeling of importance within an organization. I will not becouse I have worked at some places that make this look like a group home(military, really crazy hospitals)(easy). In addition, have other things that I do outside of work which this works around. Sometimes, pool staff term seems to feel like they are actually saying idiots when said by certain staff. We just need to make sure we are treating other in good regards and confronting/educating staff in propers ways as to no create animosity or arguments. In conclusion, let me say that not all admin are not incomptent, I have met some who great ideas but they are not heard. If this hospital closes it will be the fault of those at top that waste money, resources and do not create loyalty to the company by making everyone from those at lowest rungs to the greatest heights within this company feel essential. Just my thoughts.
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