Short Staffed AGAIN!?!? Here is what to do to Survive & Thrive!

Another call-off, no replacement. Here's how you can protect your license and your peace of mind. Look, let's face it, short staffing is not an actual staffing issue. It's a retention issue. It's a strategic plan to cut budget. It is a really terrible reality of our healthcare industry. A for-profit industry. But you don't have to be on the receiving end of chaos and confusion. There are 3 things that you can do to protect your license or certification, to improve the way that you work with the staff who are there to help take care of the patients or residents, and to make sure that you're leveling up your nursing career so that way you have longevity and you can thrive despite the challenges that are being thrown your way. So stay tuned, 'cause here are 3 strategies to help you develop strategies for success. The first thing that you need to do to make sure that you're successful in a shift where you're short-staffed yet again is you really need to be able to hone your skills of prioritization. You have to be able to spend the first 10 to 30 minutes of your shift really discerning between who are the patients or residents that need to be seen first, who are the people that you need to delegate to your CNAs to go check on real quick so they can alert you if the patient or resident seems to be having abnormal vital signs or abnormal signs and symptoms. You want to make sure that you get eyes on those people first. So for the rules of prioritization, if you want more information on that, I have amazing resources for or you just reach out to me and I can go through those with you. But you really need to spend the first 10 to 30 minutes of your shift after you get report developing who are your priority patients and residents, delegating that effectively, and making sure you keep on those folks that need more attention. Okay, so the second thing that you have to do is communicate explicitly. What that means is that you have to, from the very beginning of the shift, you have to notify the charge nurse, the nurse manager, the nursing administration, like the assistant director of nursing or the director of nursing or the chief nursing officer, wherever the chain of command may lie for you, you have to communicate explicitly that with these ratios, it is an unsafe assignment. You are saying right out front that it is humanly impossible to expect you to be able to timely get to all of your residents or your patients, to make sure you're doing the assessments in a timely manner, to make sure that you're assessing their vital signs, that you're looking at the labs, that you're reviewing orders, that you're delivering the medications or treatments on time. Because timeliness is everything when we start to have changes in condition. And so you're saying from the very beginning of the shift, whether you're a nurse or you're a CNA, it doesn't matter. You have every right to protest that assignment. Now, a protest in assignment, and other states might call it something different. I'm in New York State for everyone's information. But a protest of assignment is not a release of responsibility. I mean, you could choose to just say, I'm not taking the assignment and leave, but you do have the potential to be fired or terminated from the position. And most facilities have every right to terminate you if you're failing to satisfy the job requirements, which means showing up and doing the work, right? But a protest of assignment, a documented one for that matter, kind of puts in a legal loophole for you to help prevent you from being accused of neglect or failure of treatment. As long as when you do identify things that are going wrong with your patients or residents, that you're escalating that to the appropriate chain of command, whether it's the providers whether it's the charge nurses, the supervisors, whatever it might be in your specific facility, you have to do your due diligence and communicate that and try your very best. However, that protest of assignment documented at the beginning of the shift is a way to keep the liability solely off of you, the licensed or certified healthcare provider. So you have to communicate explicitly when you are unable to do certain tasks. So if there's medications that are gonna be delayed or omitted, if there's going to be treatments that are delayed or omitted, assessments, vital signs, anything that is a delay in treating or assessing a patient or resident, you need to communicate that. It needs to be clearly communicated. Any omissions need to be clearly documented that it was not done and that the doctor, the nurse supervisor, the manager, whatever was notified that this was not provided. And you always have to summarize your note with the presentation of your patient. Patient vital signs are this. Patient offering no complaints of pain or distress noted. Like, you have to make sure you're documenting and communicating explicitly. So don't hold anything back. Be matter of fact. And the things that you cannot do, You just have to make sure you're escalating it to the appropriate people, and that will keep you out of trouble. The third strategy to managing a short-staffed unit is to make sure you really work hard on building positive working relationships with your team members. Whether you're a CNA or a nurse, you have to have a positive attitude. You have to be willing to help each other, and you want to create a very strong buddy system. If you create a strong buddy system, then there's no reason why you guys can't have each other's backs to really kind of level up the way that you're monitoring and caring for the patients or residents. Now, is it still inhumanly possible to take care of 40 patients with 1 nurse and 1 CNA, or 1 nurse and 2 CNAs? The answer is yes. It is not possible to be able to be in those rooms as timely as we would need to prevent falls, to prevent, you know, other kind of injuries or accidents, to make sure we can identify when people's vital signs start to change. Because in long-term care settings, subacute rehab settings, home care settings, or if you're in a hospital, they don't always have the technology that can alert the staff when they have vital sign changes. Hopefully that changes in the near future for most of the facilities, but I can tell you here in New York City, many facilities do not have those capabilities unless you're in like an acute care setting with monitored patients on telemetry or hooked up to bedside monitoring. There will be some of that technology coming out in the near future. There's several companies out there providing kind of wireless monitoring systems, but that doesn't matter because even if the wireless monitoring system starts alarming and there's only one nurse and one CNA and you guys are already in other rooms taking care of residents or patients, you're not going to be able to respond to those alarms timely either. So having that strong buddy system allows for you to group your care, get in there together, boom boom bam, get those patients or residents cared for as quickly and efficiently as possible. And then you have each other's backs, right? You answer each other's call lights, you report to each other when you're identifying issues, you call on each other when you need help. When one person's caught up and the other person's still in the weeds, you jump in and you help them out. When you guys work together, you're able to manage the assignments more effectively. This works for a fully staffed unit and especially for an understaffed unit. So just buddy up. You have to create those relationships. And if you're working with people who don't seem interested in creating those types of working relationships, then you should be working very hard to convince them otherwise or speaking with leadership to see if there's a way that we can get through to those individuals and hopefully change their perspective so that they can be more of a buddy and a team player. Because at the end of the day, We can't afford to have non-team players on the team. Like, we just can't afford it. The nursing staff, the patients, residents, family members who are depending on us to take care of the patients— none of us can afford to have people working alongside us who are not team players. So we got to work together to change that behavior. So I'll just wrap up by saying this: short staffing is not your fault, but you're often left with the burden of being short-staffed, and you can cry and complain to leadership as much as you like. I've been on both sides of the, the field, so I know what it's like on both sides. Leadership does not always have the power to change it. They should be working diligently to improve the staffing ratios, improve retention efforts, try to convince the people who own the companies to increase wages and increase benefits to make it more enticing to keep people there. But we know that the work is hard and a lot of people are going to phase out from full-time positions to part-time, even per diem, to create the schedules they like. That creates some short staffing, right? In addition to the nurses and CNAs out there who just don't want to put up with the unsafe or unfair working conditions, right? So, and I support everything across the board. I support when people make a choice to leave a place that is toxic or is not supportive for them. As a professional or even as a person, right? I fully support that. But at the same time, if we're going to be somewhere, if we're going to clock in, if we're going to do our very best, we have to level up and we have to do our very best to implement strategies that work. So my name is Damion Jenkins. I've been a registered nurse for 15 years. I have all the strategies to help you level up your nursing career, whether you're a CNA or nurse, nurse leader, Nurse executive or business owner. So I hope you found this helpful. If you have some strategies that you can share with others that helps you to manage a short-staffed unit, please drop it in the comments below. You'll help hundreds of other individuals develop strategies for nursing success. Until next time, take care, be well, and remember that nursing staff really can do anything. Talk to you later. Bye.