When I sat down to get report last night, the ED had two admissions waiting for us. We had four nurses, two CNAs, no monitor tech, no unit secretary, a 1:1 need, three vents, and five isolation rooms. One of the nurses would have to be pulled to sit monitors, and one of the CNAs would have to sit the 1:1. We had 17 patients. We put down our pens and refused to take the admissions. This isn’t a common scenario, but one that we do see looming on the horizon often. Luckily, our management that evening was able to find us the staff we needed to not only have a good night, but to take the pending admissions.

This brings up a larger issue. Nursing in many places is not unionized. In 2006, only 10% of healthcare workers were in a union. (1) How do nurses protect their licenses from unsafe practices, such as staffing shortages, when they are not backed up by a union?

Communication is key. This is achieved by assertiveness and respectfulness by all parties involved. The nurse who called our ANS with our refusal to take patients handled herself pleasantly, respectfully, professionally, and was concise. She did not get angry. She kept a smile in her voice. She listened to the other side of the situation, and was able to maintain her perspective. She used, “we feel ___ when ____ occurs” language to convey the emotional aspects of the problem. This type of language presentation designates emotional responsibility in a way that keeps dialogue open.

Another way to achieve nursing unity is by participating in council-based committees and meetings. There is no better way to have a voice than to be part of the group that makes some of the rules and policies. Self-governance is the hottest trend in achieving excellence in nursing satisfaction. This must be supported by the more centralized structure of the institution, and not be simply a buzzword. There may be different levels of success within one hospital depending on the management directly involved. Some managers fight harder than others to uphold the majority of requests from their staff, and this will be apparent in one or two conversations with the staff working on these floors.

If, after many attempts at sincere, cooperative dialogue, the nurse finds a trend in poor staffing and lack of support from management, then she should decide to move on. Just like a toxic person is to be avoided, so too is a toxic work environment. She should request an exit interview where she can convey her concerns and her reasons for leaving in an assertive, professional language. She should try to have more than just the immediate management at the meeting to lend a second opinion to the entire situation.

One last note, please be careful when you are working short to not tell your patients you are busy or short-staffed. This makes them feel that they are unsafe. It also significantly hinders their willingness to communicate their needs. The last thing a nurse wants is to find that their patient has been having pain for the last hour, but didn’t tell them because they were afraid to “be a bother”. Be sure to slow down your speech. Many of us, hyped on caffeine and adrenaline, will be talking at the speed of light, and not realize it. This is a non-verbal way of saying you are “too busy”. Be calm and steady with your patients so that they can relax and know you are in charge.

(1) http://www.bls.gov/oco/cg/cgs035.htm