I’ve been feeling so inadequate lately, and I need some outside perspective. I am constantly behind on everything, and I want to blame it on the fact that we are always running short, but part of me wonders if I’m just bad at time management. Since everyone on my floor is also struggling to keep up, I have no idea what a normal, manageable pace even looks like anymore. How do you judge your own performance when the whole ship is sinking?

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I’ve been in healthcare for 20+ years. You must judge your performance in the CONTEXT / ENVIRONMENT you are working in. If you are doing the work of 1.25 or 1.5 FTEs because you are short staffed then you’re being forced to lower quality and increase throughput just to barely get by. You’re in battlefield conditions and I would just myself as follows: Have I made a mistake that could have done permanent harm to patient? Have I followed the mandatory parts of various procedures? Have I raised the overallocation to management? What have they personally done to improve the ratios?

I would be willing to bet $10k that this isn’t a time management problem on you. This is a nurse manager / dept head problem. Why is the unit short staffed? Maybe THEY didn’t hire enough nurses when other people left. Maybe no one wants to work in the unit because it has such a bad reputation for treating the staff poorly. That’s on them.

Maybe they were clueless and didn’t properly plan for the average number of maternity leaves per year on the floor so they could budget for per diems or travelers.

And most importantly what is their solution besides running you and the rest of the staff into the ground… and putting patients at risk?Have they left their offices and started taking some patient assignments? I would be willing to be no … no they have not. And the reason in the end is that everything is working just fine from their perspective. Yup. They sit in their offices and hide. They aren’t running around, skipping lunch, being forced in mandatory overtime. So as long as they don’t personally feel the impact of their crappy leadership directly then they won’t change anything. Business as usual.

Please try to be kind to yourself. You are working in unsustainable conditions. Things are going to slip because you’re overallocated… and likely exhausted and frustrated. The system and processes in place by MANAGEMENT were not designed to have you doing the work of 1.5 nurses. So some things are going to fall behind or through the cracks. It’s unavoidable. And the solution isn’t for you to work harder. The entire staff actually need to work less … at 80% capacity because it sounds like all of you are exhausted and need relief.

Ask the management to…
1) hire 20% more people or however many you need to get not only back up to staffing but EXTRA so their is slack in the system and the current staff can ease up and rest
2) close some beds,
3) my favorite … send them an email documenting all the issues and at the end say “please reply with a “yes” that you understand (a) the unit is violating safe patient ratios per department policies and (b) you will take ownership of all patient safety risks and incidents as a result of the staffing crisis”.

They won’t reply with a yes. They won’t take any responsibility. Forward the email to HR and simply say “please place in my personnel file”. I guarantee HR will contact you and want to discuss the situation. When they do just say “I have been advised to only request that the email be added to my personnel file at this time. Please contact the unit management on the trail should you have any additional concerns”. That implies but doesn’t come out and say you contacted a lawyer. It ups the seriousness of the concern. What do you have to lose? The management sucks. They are putting your patients and your license at risk. Screw them. There is always money somewhere in a hospital. Trust me. They could pay per diems or travelers until they ramp up the staffing so you and the other nurses don’t get run into the ground. But they aren’t doing that because it’s working just fine for them. They don’t feel the need to go to the COO/CFO and get more money or close down some beds.

Nothing will change until the entire staff pulls a mutiny.

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This comment appeared after I came in outdoors where I was sitting and crying. I feel like a failure. I am not in medical health care but mental health care and in my experience, we are all overloaded. What they expect from me does not fit inside a 40 hour work week and I never finish anything and only reminded when I am lacking. Thank you sharing so that I do not feel that I am not alone.

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Of course!

It sounds like your own performance isn’t the issue if everyone is struggling to keep up!

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