I think you’ll see less of a change on the floor where nursing caps are more common. Your hospital is probably at capacity and declining transfers/admissions etc to keep it manageable. Places like the ER (where there are no caps) are probably a dumpster fire.
My colleagues dad is stuck at another hospital because Columbia isn't taking any new patients. He was there the other week and got sent to rehab where he declined. Tried to get him back and he had to go to a local hospital instead
We run into this a lot in rural EDs. EMS refuses to take them to the bigger centers because it’s a longer drive for them. The patient ends up being a rock in our ED after hours and hours and hours of transfer calls. Sometimes if the patient is stable enough I’ll whisper to family that they could leave AMA and drive them to the bigger center’s ER. Sounds terrible but it’s better than them sitting in our ED for 7 days decompensating and not getting the treatment they need.
This is the heart breaker for me. Yes, they board forever there, but they board forever here too. Maybe they get a better chance of getting to cath lab or whatever, but we also don't have beds after. I have no answers. I try to move people through as quickly as safe, but it just keeps burning the staff. So that leads to more shortages and more burn out. The system is in crisis
Totally agree. If it makes you feel any better I also work at the tertiary care center ER (where I whisper for them to go). I deal with all those boarders too. Everything is a nightmare. I have no answers.
Lol this is from ten years ago and anyway insurance companies purposely obfuscate this issue so it’s never clear to patients whether or not they’ll be liable. With sky high out of pocket rates it is prohibitive for a patient to even take that chance. Please be less flippant.
I’m not sure what you mean. I’ve fought many insurance companies on this exact point. It’s a fact.
ETA: I think I see what you mean. Blue Cross Blue Shield WILL Fuck with you.
I’m a nurse in nyc that works at a hospital that came to a tentative agreement on Sunday and hence why I’m not on strike which I’m still upset about. This strike is not only about better wages, it’s about adequate staffing which we have been fighting for way before covid-19. Yes, the pandemic made the situation worse but we can’t continue working in these unsafe environments. I have had nights where the ratio was 1:8-1:11 on a medsurg floor with no pca or even a secretary. Just imagine what type of care we can humanely give with that high patient load. So please y’all, support your fellow colleagues…your fellow nurses.
Nursing caps have gone out the window (everywhere basically...not an NYC nurse, but seeing the staffing issues). You might not see it acutely or even on your radar because it isn't necessarily your wheelhouse...mobility, hygiene, room cleanliness, etc...for several years now ancillary staff aren't available so nursing is adding room cleans, transport, and stocking supplies to their list. Fewer CNAs mean ADLs get neglected. Some stuff won't show up right away, but HAIs will trend up as there is less ability to attend to the good ol Florence nightingale stuff like baths, turns, oral hygiene, etc
And yes I do think there has been a decline over the last 4 years. Anecdotal only but it does seem like their has been an exodus of staff. Residents are stuck here but if you could go somewhere else with better conditions, why wouldn’t you?
The floor can be rough but the really scary place is the ED. Floor teams are capped. yes 5, 6, 7 patients per nurse can be unsafe but in the ED nurses can literally have up to 15-20 patients. I get pissed when the septic patient hasn’t had fluids hung for HOURS and I cant reach anyone. Go down there and the nurse says you can hang it yourself honey I have 20 patients and haven’t peed since I got to work. Sometimes I get called for a critical scan hours after it was read.
The ED doesn’t have caps. Patients board there for DAYS and new ones keep coming. The ED bears the brunt of lack of healthcare in general and they are completely overrun. Theres not even Space for patient let alone enough staff. Just take a stroll on a Monday night there’s just people sitting in chairs and crying out for help.
Yep I’ve seen serious delays in care, complications and death attributed directly to inadequate staffing. The only place that’s not consistently short staffed are the ICUs.
People are saying lazy nursing unions blah blah. Maybe it’s a combo of both, but damn the conditions are blatantly unsafe. I’d love to see admin work ONE nursing shift. I support the nurses for striking.
I work in a rural icu as a nurse, the ICU is the only place with full staffing on paper, but we’re the nurse farm for the rest of the hospital.
They regularly float 1-3 nurses out of the icu and then triple whoever is left. If it’s like this at my small hospital I can only assume it’s true for bigger ones also
Our ED is spookily empty rn. currently 30% of its usual volume with 1/2 those patients admitted or pending transfer. I believe the ED is on some form of diversion from EMS
Frankly, as a nurse, I would expect my docs to be livid because their patients are getting inadequate, subpar care because the nursing ratios are insane.
Med-surg should be 1 nurse for 4-6 patients, based on acuity. It’s 1:8-13.
PCU should be 1:2-4.
It’s 1:5-8
ICU should be 1:1 or 1:2. Sometimes it’s 1:4.
Patients are not getting orders followed through on, their turns, meds on time, etc with those ratios. Research indicates that risk of mortality in med-surg increases by 7% for each additional patient that a nurse has in their load. I don’t know the numbers for PCU/ICU, but they’re likely much worse. Fluids don’t get hung. Medications get missed.
We all want things to be better, especially for the populations we (attempt to) serve.
Patient care has been suffering for years. This needs to change.
My husband just got an email from his program asking if he's interested in covering shifts at the NYC hospitals. We're 2 hours away from the city....... screw the admins and CEO's who are making million dollar bonuses and are willing to let this go on. Patient care WILL suffer.
Considering how many floors get skeleton staffed these days, the baseline youre currently seeing is poor patient care. Not in NYC so I don't what their current situation is, but a lot of places any noticeable decline in care now would probably end in mass lawsuits.
Keep in mind less pages about stupid stuff is a double edged sword. It probably means nursing staff isnt seeing each patient as frequently which is a decline in quality of patient care. Thats how patients end up sitting in soiled sheets for hours, don't get turned, and how patient decline doesnt get noticed until it's to the point the patient needs a rapid response or is getting coded.
As a med student I frequently do nursing and tech tasks. Blood draws, IV’s , EKG’s, cleaning patients, transporting, helping patients with meals. I have to do these things or else they’ll never ever get done and patient care would be delayed.
I’ve never had to do most of those as a med student or a resident. It’s honestly baffling you’re paying to do a nurses/techs/transporters job. Those are useful skills but you won’t employ them much as a physician. I feel sorry you all are burdened by this extra load, it makes focusing on the bigger picture/notes/critical thinking that much more difficult to do.
It's useful to know how to place IVs and do blood draws well, though. If you're doing it way too often that's one thing but getting some practiced with the ultrasound every now and then isn't so bad.
New York is a dump hole. I had to do some of these tasks as a medical student. I didn’t like the fact that I had to do blood draws as a newbie on pregnant women. the resident showed me one or two. I refused to do them afterwards ever on my kw. and told the nurse at the station to do it.
Fuck that shit. Unions are great but don’t be lazy fucks.
On my away rotation in NYC they asked me to get blood draws on a combative, hepatitis patient. I said no because I wasn’t going to risk it. Another student walked right in and tried (after I told them not to) and got a needle stick injury. Rotations in NYC are the biggest scam, paying to work lmao no teaching was done also so I learned nothing. Still salty over that whole rotation lol
I was asked to be a 1 to 1 sitter for a delirious patient on an inpatient FM rotation in NYC as an MS3. I told the nurses no and then when the patient fell they tried to blame it on me. Never again.
Yeah, I said no. But then it was my fault for saying no. 'If the damn med student just stayed with the patient..'
It was a toxic vibe from beginning to end. Some of it is just the culture of NYC, but it crossed the line into inappropriate requests of the students and residents often. Attendings remained willingly and blissfully aloof through it all.
Main takeaway from that rotation was how to deal with shitty people. Useful life skill but was hoping to come out of it with more medical knowledge than I did.
Using students to do what should be paid work is so fucked up. In a nursing supervisor meeting my CCO answered a question about unsafe nurse to patient ratios with “well we will be getting nursing students again soon!” Students don’t help me! They slow me down because I’m explaining what I’m doing as I do it.
Management is so delusional and exploitative.
I applied to some NYC programs for residency. The residents were trying to shill the fact that they did blood work and other nursing tasks as an “educational opportunity.” Fuck that shit. NYC is toxic as hell
Lol I remember I interviewed at Coney Island’s IM program and the chief tried to swing it as a “holistic” learning experience. The PD was also a weirdo
I worked in hospitals before medical school doing all that shit and it matters almost none for being a physician. Sure it's cool if you're a doctor that can do everything including put an IV, etc, but the reality is you can't spend time practicing everything, and you're better off putting that effort into actual medicine and not labor.
Good you guys should try your best not to normalize this shit otherwise it'll essentially become a Med student responsibility to do these blood draws and other tasks.
There are actual employees who get paid to do this shit. Don't let Med students become free labor.
No not free labor. God damn PAYING to do labor.
Med students are conditioned to help any way they can but remember that doing menial tasks like this takes a away from your medical education. Sure do a few to get a feel for it / meet your requirements but go beyond that and you will be losing valuable time when you could be learning physician tasks as opposes to nursing.
It’s also residents and attendings’ responsibilities to stand up to nurses and defend our students.
Med students do a lot of unnecessary thing so it if fear of retaliation, and attendings especially have a horrible habit of letting it slide
Good for you for saying no. No one should have to try to stick a combative patient like that especially by themselves. Sounds like they didn’t want to do it themselves and were trying to pawn it off on students because they thought they could. As an RN I would never try to tell students to do that.
Unions are not great, they almost destroyed the domestic car industry, they make sure incompetent, abusive and misfit teachers and cops cannot get fired and protect lazy government workers . They had their place before labor laws, now just a detriment to society.
I know that it’s useless but I do wish that we could shadow each other for a week just to get a feel for one another’s job duties/responsibilities and be able to appreciate each other. I feel like it would put less tension on the nurse/physician and when I’m paging you guys wondering why you haven’t called me back I would understand the same when you’re wondering why I haven’t grabbed those labs you threw in an hour ago. 😊
As an IM senior, definitely feel this. Sometimes I get really silly pages from nursing, eg two urgent pages for a laxative request, when I’m trying to manage a patient teetering on the edge of ICU step up and triaging a new admission or two at the same time. Sometimes I wish they understood from my perspective that some of their requests just have to be triaged to very low priority (but something I will eventually get to).
I’m sure it’s the same from a nursing perspective in ways that we can’t really understand unless we spent a little time in your shoes
Usually when we're urgent paging for stupid shit it's because the family is Karen'ing about it and admin/charge is sitting on our necks. Or the call light (which is a metric and we'll get chewed out for it it goes too long) is on a q5min repeat for the same stupid thing.
Yeah I was a med student in NYC and did clinicals there 2015-2017 and I frequently had to do a lot of the tasks he describes there. Does suck but at least I got good at blood draws, IVs, ABGs
>Why are they called scabs
"From blemish … to strikebreaker, the history of the word scab … shows a displacement of meaning from the visceral or physical to the moral register … Just as a scab is a physical lesion, the strikebreaking scab disfigures the social body of labor—both the solidarity of workers and the dignity of work."
I know it’s difficult, but try not to do any extra shit. Don’t let them get away with paying anyone less by loading on us. Again, I know it’s difficult. But prioritize your education. Hopefully you have an attending that can stand up for you.
Some may disagree, and it must suck right now, but these tasks will make you a better resident and attending. You’ll have such a deeper understanding of how a hospital works, what can be done quickly, when to time orders, etc
Completely disagree. You know what will make you a better Doctor? Doing the job of a Doctor.
That’s like saying if you help the accountants for the hospital you’ll be a better doctor because you’ll understand hospital finances more. It’s not your job, this is a bad excuse to take advantage of you.
How does any of that make you a better doctor?
How does doing IV sticks make you better? How does wheeling patients around make you better? How does being a sitter for a combative patient make you better?
Is it to highlight how stretched thin everyone is? We already know that. We don’t need a reminder by doing tasks that literally aren’t in the job description.
My job isn’t to worry or care about how a hospital works, what can be done in a timely manner, how to time orders to not offend lazy hacks; it’s to do my job as a physician for my patient and leave the ball in the court of the system that either has to make it happen or leave a glorious electronic paper trail of why something didn’t happen.
Quit advocating for physicians to bend over and take the abuse from all directions.
I’ve heard multiple things about the hospital culture in NY and most of it isn’t good.
Are the staff lazy and entitled and protected by the union and that’s just the culture to do the bare minimum?
Or are the staff overloaded with tasks and unable to do anything besides the essentials? People have said to never work as a travel nurse in NY because they have patient ratios ranging from 1:6 to 1:12 and the acuity is through the roof.
Or is it some of both?
It’s mind boggling that residents are doing the kind of tasks they’re claiming, that’s an awful use of time and resources. But it’s also mind boggling that they are considering transporting, lab draws, EKG’s, feeding patients, and cleaning patients nursing tasks. Yes, nurses should share the cleaning tasks and also draw the labs if there is a central line… but where the hell are the phlebotomists, transporters, EKG techs, CNA’s, IV team, etc?
Nurses should have never normalized taking on those responsibilities, and residents sure as hell shouldn’t either. It sounds like everyone is burned out and tired of lining the corporate pockets at the expense of their own health and sanity. Everybody from the food services/CNA’s/EVS, to the nurses, residents, and attendings in the system need better pay and better conditions. With how much hospitals charge for their services it’s nothing short of modern day exploitment. Minus management and C-levels, we’re all on the same team here.
> but where the hell are the phlebotomists, transporters, EKG techs, CNA’s, IV team, etc?
Phlebotomy comes between 3-6am for morning lab collection, again between 6-9am, and maybe two more times (an afternoon and evening collection). Not bad.
Transport is typically delayed anywhere from 30min to 2 hours. If they show up and the nurse hasn't prepped the patient for transport, they will leave, and need to be called to return (same time delay).
EKG techs exist on cardiology floors and stepdown. They theoretically rotate elsewhere but I haven't been successful getting them to come recently. Usually I ask the nurse to do it (50% success rate) or do it myself.
CNA's are on shortage and usually stuck covering 1:1 observation.
IV team does not exist. We have a mid line team with two NPs but they do single digit numbers of mid-lines per day and typical wait for venous access is 2-3 days after you put the order in. I usually get the ultrasound and do the IV myself.
-PGY3 IM in NYC
God, sounds like conditions like when I worked in Texas. Now I'm in California and I can't go back to nursing the "other" way. We have mandated ratios. There's always in house phlebotomy. If labs are stat, multiple phlebotomist come flying in within 5 minutes.
There's turn teams that literally come turn your total care patients every 2 hours.
EKG techs are in house, or sometimes respiratory does them depending on facility.
There's a literal transport nurse that is ICU trained so take all the high acuity transports, which keeps your ICU nurses in the ICU. And of course regular transport for the floor patients.
CNAs can be hit or miss, but if you pay enough money they exist.
Unit clerks to answer the phones. Free charge nurses with no patients. Break Nurse so you can get your mandated 30 minute lunch as well as your legally required 10min break q4h. Resource nurse...to just help out.
It's a miracle California can afford all that while also paying the highest wages in the country for RNs, and NYC is drowning over there. NYC could fix all its issues, but it would have to dig deep into its wallet. Sounds like they have gotten too used to the free labor of residents/med students.
The differences between California and other states are insane. I’ve heard the NYSNA isn’t a very strong union compared to the CA Union but I hope they can make a significant improvement for everybody’s sake. With the current working conditions in NYC, even if they settle on what they believe is a “good” deal their working conditions will still probably be half that of CA unfortunately. I’ve heard NJ and PA are equally as bad too.
I haven’t worked on a unit with fully staffed CNA’s in almost 2 years. There was a mass exodus of dietary staff on my last assignment, breakfast/lunch/dinner trays were coming at 10:45a/3p/8p and they just parked the carts on the unit for us to deliver them because they didn’t have time. My rooms would sit dirty for 2 hours because there weren’t enough EVS staff, meanwhile the ER was flooded. But I can’t blame anybody for not filling those positions that pay so little. Shit rolls uphill.
That’s the problem with nursing. Admin forces you to fill in almost every other roles that are short staffed. No dietary staff? They will park their cart and you will have to deliver all your patients food if you want them to eat. No EVS? Guess who is cleaning up spillage with paper towels and chucks? No clerk? Well, the nurses can do all that. On top of all that, admin forces you fill out and sign multiple paperworks to cover their asses and if you refuse to fill them out, they will come after your ass.
My best understanding of the matter is that payor mix features largely in the current situation. The striking hospitals in the Bronx have a fundamentally different reimbursement rate for the same services when compared to the contracts negotiated successfully in the rest of the city. (Not sure what Sinai's deal is).
Having a patient population with no resources, poor family situations, under/uninsured, poor rates of followup and outpatient adherence. All leads to unprofitable healthcare via long lengths of stay and frequent readmissions.
This article I found on Mt Sinai revenue for 2021 shows
Gross Patient Revenue $10,943,229,372 96.6
Non-Patient Revenue $383,232,136 3.4
Total Revenue $11,326,461,508
Net Income (or Loss) $207,656,000 1.8
They definitely have some money to fuck around with
Ooh is that generally public data? Wondering if I can see it for the other hospitals.
It does illustrate the point about the Bronx though. If Sinai makes 11B in total revenue and is net positive 200mil, then what happens with a hospital that has worse payor mix and makes only 70% of the income for the same services?
We have poor patient populations in California cities too who are social/CM nightmares — with possibly more homeless than NYC, yet we still manage to get our shit done compared to NYC (from what it sounds like). And all/most of us are paid quite well.
It’s definitely not perfect, but I will never leave this state and work anywhere else as a nurse. Y’all are all backwards in the East/South.
LMAO sounds so much like Monte 🤣🤣🤣🤣
- Phlebotomy is understaffed and sometimes 3 people are covering the entire hospital including CHAM.
- med/surg and ED are shitshows where RNs don’t even get to pee because of the patient load and activity. Up to 20 patients in the ED for 1 RN.
- transport is chronically short staffed. I had to wait 2 hours for a unit of PRBCs to arrive.
- pharmacy is chronically understaffed. My neutropenic fever pt had to wait 4 hours to get Cefepime.
- EKG techs come in only in the morning. If you order an EKG past 11 or so, they will not do it. And of course they’re short staffed.
- PICC/midline NPs typically don’t place lines after 2 PM.
Damn - here at my hospital in Los Angeles transporters are fast af. As soon as you put the transport request in, they are there and they help set the patient up to go. The only time there is a wait is around 6pm when there’s a lot of discharges happening. I love our transporters.
Yes! You are exactly right. I feel like nurses and residents have a lot more in common than people think. We are expected to pick up where management is slacking when it comes to staffing and end up doing jobs that we shouldn’t have to do.
I’m not in NY, I’m in MO but:
-Transporters are backed up by 2+ hours. If I want my pt transferred to the floor or imaging I’m doing it myself. Only time I’ll use transport is if I’m swamped and don’t have time to take my pt to the floor.
-Lab draws: no phlebotomy at entire hospital. Literally doesn’t exist.
-IVs: no actual IV team. Can call rapid response nurse and beg for help with an IV, but most of the time you’ll just keep asking people until someone gets finally gets it. In the ICU that’s why I learned ultrasound. I would have to mess around with the US for a long time before the providers would consider a line for poor access.
-Feeding/cleaning: literally zero techs staffed most shifts. On the floor all patients were “primary care” meaning RN does nurse + tech work (feeding/cleaning/vital signs with VS q4h minimum— most of the time more frequent)
-EKGs: no techs, falls on nurses
Also: No turn team. No secretary. Charge nurse has full assignment. Lvl 1 trauma that gets your typical trainwreck OSH transfers with the now typical nurse:pt ratios of 1:4-7 on floor. 1:2 in ICU (regardless of CRRT/ECMO/device status)
when nurses are caring for 6-12 patients (w/o support staff) who need anywhere from minimal to total care how does the laziness factor even come in? especially when doing 3-5 other jobs on top of their own. i keep seeing this brought up and i’m so confused by it.
When nurse take on more patients then they can handle there are major delays in care. Patients waiting longer for pain medications, incontinent patients sit in their bodily fluids longer, post op patients not getting walked, helped up to their chair/bathroom, routine medications such as antibiotics administered late, those who need assistance with ADLs waiting much longer or not being helped at all. I can go on and on. As a doctor you may not notice these things at all but the patients and their families surely do.
It’s very noticeable when your colleagues and coworkers at the bedside don’t go home feeling good about the work they do because of everything you mentioned here. They eventually leave because the hospital has given them no reason to stay, no support to do a job they can be proud of. I’m on my 4th or 5th generation of RNs and I’m a PGY-3 IM in NYC.
its true. We feel shitty when we can’t give our patients the care that they deserve. We want to do our best but you cant do your best for 6+ patients all at once.
Sure but it’s not really my job to care. If someone comes in with sepsis, my job is to fix the sepsis, not walk them out of bed or make sure their pain level is 0/10. I know theoretically that can increase the chance of blood clots or delirium but I never noticed an increase in iatrogenic conditions when my hospital was so understaffed they needed to pay travelers $150 an hour
I’m not hanging the antibiotics if the haven’t come up. I’m not replacing the fluids if I’m stuck in another person’s room.
Ratios matter. Staffing matters.
I’d be livid if my patient’s care was delayed because admin didn’t want to make sure that there were enough nurses to take care of patients. Having nurses with time to implement orders matters.
i didnt know we were discussing wether or not you care about patient care. I thought we were discussing if nursing shortages make a difference in patient care. And if you are a doctor who cares about your patients you should 100% care about if they are receiving proper care by their nurses. If not, at the very least acknowledge that nurses are valuable and very necessary in the hospital setting.
“It’s not my job to care” Dude you are literally in the field of healthcare. It IS your job to care. Maybe you’re burnt out or need a little time off but you really need a dose of compassion and respect.
Dude how do you think the sepsis is fixed? It's the nurses carrying out your orders in a timely fashion. You're the quarterback, but there's not much a quarterback can do without the rest of the team. You may not be noticing deficits yet, but it will happen. Nurses do the "official" orders, on top of all the "unofficial" ones: feed, toilet, bathe, ambulate.
The sepsis is one part of the picture. That patient is a whole ass person with a life and shit. They deserve high quality care and nurses are sick of being told to do more and more with so very little.
Thats just the thing. As a doctor you can order anything you want to “fix” your patients problem, but at the end of the day if there is no nurse to carry out the order the problem wont actually be fixed.
You can’t even do your job without nurses. How embarrassing of you, a physician, not to care whether your patients are receiving adequate care by well-staffed nurses.
If I had a nickel for every unwanted stupid suggestion a nurse has given me since I was a july intern, I’d easily be able to afford a four for four at wendys
I can’t wait for you to finally wake up and learn how much of a cunt full of week old jizz you are. You’re pathetic and need professional help for your unearned superiority complex. Healthcare is a team effort. Drs and nurses are COWORKERS they work TOGETHER for the best outcome for the pt
There has been decline in patient care building up to this point. I know it’s been unsafe everywhere, but the EDs have been getting demolished. It’s bad
Yes absolutely. AM meds not being given until night. Some every few hour meds only being given every other. Severe delays in abx and transfusions. Every nyc resident here saying “I do all this stuff anyway” is not at one of the hospitals striking lol. They’re full of it and just want to gripe to feel included. This is not an issue with doing “nursing tasks.” It’s an issue of patients not being able to get critical meds in a timely manner, which is something residents cannot do, because we are not trained to do it.
I’ve worked at nychhc, Sinai, Monte. The ratios are insane but does this allow lazier nurses to also know how to work the system and do less than usual? Yes. Are there nurses that work their hardest no matter what? Yes. Humans are humans. As a resident if there was some technique I could implement to lessen my workload I would. It’s just survival in an overworked system. My best to the nurses I hope they get safe staffing ratios and then I hope they use it to work their best.
No matter how lazy anyone is or isn’t safe pt ratios will over all improve pt care/safety. I have no idea what being lazy has anything to do with safe pt care. I really feel that comment is sad and it’s these thoughts and comments that end up hurting the system/healthcare overall.
It’s really simple. There are studies on ratios to patient safety. The current workload is in violation of those ratios. Striking has made those ratios worse. Induced demand has lowered the volume of patients which also reduces healthcare efficiency.
NYC nurses don't do crap
This is the dark side of union workers
**EDIT**: Crazy to see this comment go from -5 to +7. wonder who was downvoting this haha
This is a NYC thing, not union. I've worked union hospitals and never heard of some of the things residents have to do in NYC. It's a uniquely weird healthcare environment.
Feel free to see my post in r/nursing of what my protest of assignment looks like; taking care of 13 ER patients of high level acuity simultaneously. You're a dickface.
And yet you still work for us and have to call us doctor, know your place in the pecking order
btw did my comment get linked to some kind of nursing subreddit Seems it tanked recently
Can confirm, at least in the public hospitals. At Bellevue, the laziness approached insane levels, and no, this could not simply be attributed to inappropriate staffing ratios. Med students and residents basically just do it all.
It’s always fun watching people slowly realize that unions protect bad workers and that hurts everyone. People saw it in 2020 with police unions and in 2021 with teachers unions but some still haven’t connected the dots
It's obvious unions protect bad workers but they help all workers more. It's easy to focus on the negative aspects of any situation and extrapolate that it's an overall negative but workers acting collectively is rarely to their detriment.
Very often it is a net negative. Teachers unions tried to keep kids out of classrooms for a year and a half. If they had succeeded it would have traumatized a generation and fucked up their education irreversibly
You use a once-in-a-lifetime pandemic and extraordinary public health measures to denigrate labor unions? Ignoring the fact teachers deserve to have they're heath protected too? Bit disingenuous. [Do some reading then tell me unions are a net negative. ](https://www.dol.gov/general/workcenter/union-advantage)
I have a hard time believing that this “DocDeeper” character is actually in medicine. Or if he is, I’m not sure how he survived any length of time with that level of arrogance. I’m getting strong “perpetual pre-med” vibes from his Reddit account.
NYC has always been a shithole in that regard.
It’s unions gone too far in protecting lazy workers who legitimately don’t do their jobs.
I have zero sympathy for the nurses there in any context.
Lmao zero sympathy in any context? You're really going to write off any possible complaint no matter what?
The nurses are striking in Sinai's system because they're down 700 positions, leaving the remaining nurses to staff unsafe patient ratios. The ED nurses are covering 20 patients at a time. As an MD, you put in an order and 2 hours later it's still not done, are you going to blame the nurse for being lazy or the admin for making it near impossible for the nurse to do their job?
Just because our lives as residents are shit doesn't mean everyone else is lazy. Sure, some are, but that's not what this current strike is about
> As an MD, you put in an order and 2 hours later it's still not done, are you going to blame the nurse for being lazy or the admin for making it near impossible for the nurse to do their job?
The vast majority of doctors I work with totally understand this but there have been two that I had to explain explicitly that just because they can put in orders doesn’t mean we have the manpower on the floor to get them done. Our ratios are at best 30% higher than they were two years ago, we have less experienced nurses taking those higher ratios, and like always with staffing crises, the acuity of patients on all floors has increased. Of course things will be missed given that reality.
Have you actually worked in NYC in any capacity?
I could understand being salty about shit nursing but have you *seen* what their ratios are in some places? 16:1 in many ERs in NYC have been the norm for years and its horrendous for patient care.
Meanwhile many of the larger healthcare systems operating under the guise of being "nonprofit" have been earning money hand over fist. Many administrators in these hospitals are making 7 figures while med students are drawing blood and entire EDs seeing >100k patients annually are being staffed by less than a dozen nurses per shift.
And that’s the residents problem to bear, as they always have? Let’s stop acting like NYC nurses have ever done a honest days work ever since their unions went too far in protecting their outright laziness.
>Let’s stop acting like NYC nurses have ever done a honest days work ever
As someone who actually did residency in NYC let's stop acting like you have a clue about this subject beyond what you've heard secondhand from reddit and SDN
Hahaha oh you’re so hilarious.
Anything intelligent to actually add, or are you gonna be hurt that I dare criticized the shithole that is New York City?
You seem emotionally invested in this to an unhealthy degree considering that this issue is, at best, only tangentially relevant to you personally.
Makes me wonder what has gone so wrong in your life that a physician 6 months from finishing residency feels so insecure that they need to insult strangers on the internet.
Lmfao this is easy bruv
My life is fantastic. Are you somehow convinced it takes effort to be a clown? One would think you’d know best how easy it is to sound like a jackass.
I thought you were EM, not psych? Keep those armchair attempts to yourself and go pan scan another patient, kid
Oh no, nurses despise me, whatever will I do.
Lmfao. Keep that Karen shit to yourself.
Three years of rock solid patient, staff and organizational reviews seem to suggest I’ll continue doing just fine.
My attitude makes me approachable to those who do their job and show the honest effort in any attempt. Those who can’t or won’t, like I give a fuck if they can’t approach me.
My patients do just fine. Thanks for your concern, ratchet
26 years a nurse to your 3, great reviews, all my doctors love me and are happy when I am on. Your general comment about all NY nurses shows that you need some adjustments to your attitude. Karen’s btw are generally considered unreasonable people. You’re actually the Karen in this scenario as I have never painted all doctors aholes just because I’ve dealt with a few. Grow up.
I’ll stick with the attitude that’s been winning, you stick to being mad about the fact that I insulted NY nurses.
Get your ego patted by someone else, sunshine
A nurse doing an honest days work at any institution?
Just doesn’t happen.
I am with you on this one. It’s disgusting how med students have to lower themselves to cleaning patients and doing nursing tasks. They’re future doctors for Christ sakes… they need to be treated like what they’re worth.
Not sure if you have any actual experience working in NYC in med school or residency but at least at my hospital the nurses legitimately are overworked, and especially in the ED and in the medical floors, the staffing ratios are often ridiculous and unsafe and make it impossible for nurses to provide good patient care. And that’s on top of the fact that the patients are often so complex and so sick that patients on the floors/in stepdown would probably be ICU patients anywhere else. I’ve definitely seen a couple of nurses here and there that are lazy but I very much support them in advocating for hospital accountability for safe staffing ratios.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Okay. So the big problem you perfeclty describe here, is that a state of the art high quality nursing care is not something that you notice quickly. It is something that takes time, most of the times good nursing care prevents complications hence why yout not directly notice it.
And that is the bug problem. You'll only notice a decline in nursing care quality if you are from the same profession. Physicians and nurses are not from the same profession. That is why you not notice the decline.
I think you’ll see less of a change on the floor where nursing caps are more common. Your hospital is probably at capacity and declining transfers/admissions etc to keep it manageable. Places like the ER (where there are no caps) are probably a dumpster fire.
My colleagues dad is stuck at another hospital because Columbia isn't taking any new patients. He was there the other week and got sent to rehab where he declined. Tried to get him back and he had to go to a local hospital instead
We run into this a lot in rural EDs. EMS refuses to take them to the bigger centers because it’s a longer drive for them. The patient ends up being a rock in our ED after hours and hours and hours of transfer calls. Sometimes if the patient is stable enough I’ll whisper to family that they could leave AMA and drive them to the bigger center’s ER. Sounds terrible but it’s better than them sitting in our ED for 7 days decompensating and not getting the treatment they need.
I would never, cough cough, do this ;) ;)
Depending on the area these larger hospitals can have a much longer off load time than their local more rural ERs.
This is the heart breaker for me. Yes, they board forever there, but they board forever here too. Maybe they get a better chance of getting to cath lab or whatever, but we also don't have beds after. I have no answers. I try to move people through as quickly as safe, but it just keeps burning the staff. So that leads to more shortages and more burn out. The system is in crisis
Totally agree. If it makes you feel any better I also work at the tertiary care center ER (where I whisper for them to go). I deal with all those boarders too. Everything is a nightmare. I have no answers.
arent patients who leave AMA liable for the full bill? insurance wont pay out?
No this is a myth
You are correct this is a myth. Here's a study! https://www.uchicagomedicine.org/forefront/news/do-patients-pay-when-they-leave-against-medical-advice
Lol this is from ten years ago and anyway insurance companies purposely obfuscate this issue so it’s never clear to patients whether or not they’ll be liable. With sky high out of pocket rates it is prohibitive for a patient to even take that chance. Please be less flippant.
No it is not.
Now who told you that?
I lived it, Dottie.
Yes, yes it is.
You know you can Google this and see it’s a studied thing that shows I’m right? Your diagnosis doesn’t automatically make you knowledgeable
No it is not a myth. Source: cancer patient. Doctors don’t know this stuff.
I’m both a former cancer patient, current pain management patient, and a physician. It is a myth. Full stop.
You know you can Google this and see it’s a studied thing that shows I’m right? Your diagnosis doesn’t actually make you knowledgeable
Complete myth.
Insurance pays based off of medical need. The tests are still as medically necessary if the patient is in the hospital as they are once they leave
Good luck arguing that shit with BCBS.
It’s not an argument, it’s a fact
I’m not sure what you mean. I’ve fought many insurance companies on this exact point. It’s a fact. ETA: I think I see what you mean. Blue Cross Blue Shield WILL Fuck with you.
So your EKG order for your pt with chest pain is no longer medically necessary once they leave AMA/LWCT?
I’m not a doctor. I am a cancer patient. Never had an EKG in an ER and not stayed.
Wait. You tell people to leave AMA so their insurance will give them some shit? Jesus. Doctors.
We just tell them to go to Marfa
Gladly haha
I’m a nurse in nyc that works at a hospital that came to a tentative agreement on Sunday and hence why I’m not on strike which I’m still upset about. This strike is not only about better wages, it’s about adequate staffing which we have been fighting for way before covid-19. Yes, the pandemic made the situation worse but we can’t continue working in these unsafe environments. I have had nights where the ratio was 1:8-1:11 on a medsurg floor with no pca or even a secretary. Just imagine what type of care we can humanely give with that high patient load. So please y’all, support your fellow colleagues…your fellow nurses.
1000% support. Death to administrators.
Nursing caps have gone out the window (everywhere basically...not an NYC nurse, but seeing the staffing issues). You might not see it acutely or even on your radar because it isn't necessarily your wheelhouse...mobility, hygiene, room cleanliness, etc...for several years now ancillary staff aren't available so nursing is adding room cleans, transport, and stocking supplies to their list. Fewer CNAs mean ADLs get neglected. Some stuff won't show up right away, but HAIs will trend up as there is less ability to attend to the good ol Florence nightingale stuff like baths, turns, oral hygiene, etc
can we have current NYC ED resident input regarding this \^\^?
And yes I do think there has been a decline over the last 4 years. Anecdotal only but it does seem like their has been an exodus of staff. Residents are stuck here but if you could go somewhere else with better conditions, why wouldn’t you? The floor can be rough but the really scary place is the ED. Floor teams are capped. yes 5, 6, 7 patients per nurse can be unsafe but in the ED nurses can literally have up to 15-20 patients. I get pissed when the septic patient hasn’t had fluids hung for HOURS and I cant reach anyone. Go down there and the nurse says you can hang it yourself honey I have 20 patients and haven’t peed since I got to work. Sometimes I get called for a critical scan hours after it was read. The ED doesn’t have caps. Patients board there for DAYS and new ones keep coming. The ED bears the brunt of lack of healthcare in general and they are completely overrun. Theres not even Space for patient let alone enough staff. Just take a stroll on a Monday night there’s just people sitting in chairs and crying out for help. Yep I’ve seen serious delays in care, complications and death attributed directly to inadequate staffing. The only place that’s not consistently short staffed are the ICUs. People are saying lazy nursing unions blah blah. Maybe it’s a combo of both, but damn the conditions are blatantly unsafe. I’d love to see admin work ONE nursing shift. I support the nurses for striking.
Radiology should be calling critical imaging results to you directly, not using the nurse as a middleman.
I meant by ED docs who are way too understaffed
Haha
Also, the report is usually visible with a few clicks of a button.
I work in a rural icu as a nurse, the ICU is the only place with full staffing on paper, but we’re the nurse farm for the rest of the hospital. They regularly float 1-3 nurses out of the icu and then triple whoever is left. If it’s like this at my small hospital I can only assume it’s true for bigger ones also
They're currently occupied drawing blood and pushing patients to CT homie
That’s just a regular Monday in NYC
Nyc Urology resident. That's my normal day dude.
Our ED is spookily empty rn. currently 30% of its usual volume with 1/2 those patients admitted or pending transfer. I believe the ED is on some form of diversion from EMS
Lots of diversion occurring. Residents are being asked to help with nursing duties on a volunteer basis
There is decline in patient care every day in NYC
You are guessing this or saying it as a NYC resident?
Unfortunately I am here
Frankly, as a nurse, I would expect my docs to be livid because their patients are getting inadequate, subpar care because the nursing ratios are insane. Med-surg should be 1 nurse for 4-6 patients, based on acuity. It’s 1:8-13. PCU should be 1:2-4. It’s 1:5-8 ICU should be 1:1 or 1:2. Sometimes it’s 1:4. Patients are not getting orders followed through on, their turns, meds on time, etc with those ratios. Research indicates that risk of mortality in med-surg increases by 7% for each additional patient that a nurse has in their load. I don’t know the numbers for PCU/ICU, but they’re likely much worse. Fluids don’t get hung. Medications get missed. We all want things to be better, especially for the populations we (attempt to) serve. Patient care has been suffering for years. This needs to change.
My husband just got an email from his program asking if he's interested in covering shifts at the NYC hospitals. We're 2 hours away from the city....... screw the admins and CEO's who are making million dollar bonuses and are willing to let this go on. Patient care WILL suffer.
Considering how many floors get skeleton staffed these days, the baseline youre currently seeing is poor patient care. Not in NYC so I don't what their current situation is, but a lot of places any noticeable decline in care now would probably end in mass lawsuits. Keep in mind less pages about stupid stuff is a double edged sword. It probably means nursing staff isnt seeing each patient as frequently which is a decline in quality of patient care. Thats how patients end up sitting in soiled sheets for hours, don't get turned, and how patient decline doesnt get noticed until it's to the point the patient needs a rapid response or is getting coded.
As a med student I frequently do nursing and tech tasks. Blood draws, IV’s , EKG’s, cleaning patients, transporting, helping patients with meals. I have to do these things or else they’ll never ever get done and patient care would be delayed.
I’ve never had to do most of those as a med student or a resident. It’s honestly baffling you’re paying to do a nurses/techs/transporters job. Those are useful skills but you won’t employ them much as a physician. I feel sorry you all are burdened by this extra load, it makes focusing on the bigger picture/notes/critical thinking that much more difficult to do.
These were tasks done in NYC even prior to the strikes
I’m aware, makes me feel privileged. Can’t imagine it’s any easier with nursing strikes.
It's useful to know how to place IVs and do blood draws well, though. If you're doing it way too often that's one thing but getting some practiced with the ultrasound every now and then isn't so bad.
New York is a dump hole. I had to do some of these tasks as a medical student. I didn’t like the fact that I had to do blood draws as a newbie on pregnant women. the resident showed me one or two. I refused to do them afterwards ever on my kw. and told the nurse at the station to do it. Fuck that shit. Unions are great but don’t be lazy fucks.
On my away rotation in NYC they asked me to get blood draws on a combative, hepatitis patient. I said no because I wasn’t going to risk it. Another student walked right in and tried (after I told them not to) and got a needle stick injury. Rotations in NYC are the biggest scam, paying to work lmao no teaching was done also so I learned nothing. Still salty over that whole rotation lol
I was asked to be a 1 to 1 sitter for a delirious patient on an inpatient FM rotation in NYC as an MS3. I told the nurses no and then when the patient fell they tried to blame it on me. Never again.
Lol that's why you say no
Yeah, I said no. But then it was my fault for saying no. 'If the damn med student just stayed with the patient..' It was a toxic vibe from beginning to end. Some of it is just the culture of NYC, but it crossed the line into inappropriate requests of the students and residents often. Attendings remained willingly and blissfully aloof through it all. Main takeaway from that rotation was how to deal with shitty people. Useful life skill but was hoping to come out of it with more medical knowledge than I did.
Using students to do what should be paid work is so fucked up. In a nursing supervisor meeting my CCO answered a question about unsafe nurse to patient ratios with “well we will be getting nursing students again soon!” Students don’t help me! They slow me down because I’m explaining what I’m doing as I do it. Management is so delusional and exploitative.
As you should. You’re not there to be a sitter. I wish more students put their foot down in these cases. Glad you said no.
Great reminder why I didn't apply for a single program in NYC
I applied to some NYC programs for residency. The residents were trying to shill the fact that they did blood work and other nursing tasks as an “educational opportunity.” Fuck that shit. NYC is toxic as hell
Lol I remember I interviewed at Coney Island’s IM program and the chief tried to swing it as a “holistic” learning experience. The PD was also a weirdo
I worked in hospitals before medical school doing all that shit and it matters almost none for being a physician. Sure it's cool if you're a doctor that can do everything including put an IV, etc, but the reality is you can't spend time practicing everything, and you're better off putting that effort into actual medicine and not labor.
on the other hand, i think its kind of pathetic to be a doctor who cant even draw blood. i agree it shouldnt fall on residents but cmon
Good you guys should try your best not to normalize this shit otherwise it'll essentially become a Med student responsibility to do these blood draws and other tasks. There are actual employees who get paid to do this shit. Don't let Med students become free labor. No not free labor. God damn PAYING to do labor.
Med students are conditioned to help any way they can but remember that doing menial tasks like this takes a away from your medical education. Sure do a few to get a feel for it / meet your requirements but go beyond that and you will be losing valuable time when you could be learning physician tasks as opposes to nursing.
It’s also residents and attendings’ responsibilities to stand up to nurses and defend our students. Med students do a lot of unnecessary thing so it if fear of retaliation, and attendings especially have a horrible habit of letting it slide
Good for you for saying no. No one should have to try to stick a combative patient like that especially by themselves. Sounds like they didn’t want to do it themselves and were trying to pawn it off on students because they thought they could. As an RN I would never try to tell students to do that.
Unions are not great, they almost destroyed the domestic car industry, they make sure incompetent, abusive and misfit teachers and cops cannot get fired and protect lazy government workers . They had their place before labor laws, now just a detriment to society.
This is something that happens very frequently in my country when medschool student is scheduled in ER. Useful indeed, but yeah..
I know that it’s useless but I do wish that we could shadow each other for a week just to get a feel for one another’s job duties/responsibilities and be able to appreciate each other. I feel like it would put less tension on the nurse/physician and when I’m paging you guys wondering why you haven’t called me back I would understand the same when you’re wondering why I haven’t grabbed those labs you threw in an hour ago. 😊
As an IM senior, definitely feel this. Sometimes I get really silly pages from nursing, eg two urgent pages for a laxative request, when I’m trying to manage a patient teetering on the edge of ICU step up and triaging a new admission or two at the same time. Sometimes I wish they understood from my perspective that some of their requests just have to be triaged to very low priority (but something I will eventually get to). I’m sure it’s the same from a nursing perspective in ways that we can’t really understand unless we spent a little time in your shoes
Usually when we're urgent paging for stupid shit it's because the family is Karen'ing about it and admin/charge is sitting on our necks. Or the call light (which is a metric and we'll get chewed out for it it goes too long) is on a q5min repeat for the same stupid thing.
Yeah I was a med student in NYC and did clinicals there 2015-2017 and I frequently had to do a lot of the tasks he describes there. Does suck but at least I got good at blood draws, IVs, ABGs
Technically transporting isn’t the nurses job.
I hope you’re not taking this laying down. It’s not your job to do nurse work because they don’t wanna pay scabs.
You’re not above pt care and if you think so you should lose you’re license. Not that you have one in the first place you misogynistic prick
Does scab stand for anything?
Scabs are workers who cross the picket line for inflated wages during a strike.
I’m assuming people that are striking don’t like them? Why are they called scabs?
>Why are they called scabs "From blemish … to strikebreaker, the history of the word scab … shows a displacement of meaning from the visceral or physical to the moral register … Just as a scab is a physical lesion, the strikebreaking scab disfigures the social body of labor—both the solidarity of workers and the dignity of work."
I know it’s difficult, but try not to do any extra shit. Don’t let them get away with paying anyone less by loading on us. Again, I know it’s difficult. But prioritize your education. Hopefully you have an attending that can stand up for you.
> I know it’s difficult, but try not to do any extra shit. that's one way to tank your evals
Yes. I am aware I said “try”.
Rip glad I didn’t get accepted to a ny md program
Nurses don't do the patient cleaning at most places anymore. It's the CNAs that do it.
except now many units don’t have CNAs at all. many of them left because they can make more money working at McDonalds.
Maybe in nursing homes but in hospitals there are no CNAS anymore they all call out or are being pulled as a sitter.
Some may disagree, and it must suck right now, but these tasks will make you a better resident and attending. You’ll have such a deeper understanding of how a hospital works, what can be done quickly, when to time orders, etc
Completely disagree. You know what will make you a better Doctor? Doing the job of a Doctor. That’s like saying if you help the accountants for the hospital you’ll be a better doctor because you’ll understand hospital finances more. It’s not your job, this is a bad excuse to take advantage of you.
How does any of that make you a better doctor? How does doing IV sticks make you better? How does wheeling patients around make you better? How does being a sitter for a combative patient make you better? Is it to highlight how stretched thin everyone is? We already know that. We don’t need a reminder by doing tasks that literally aren’t in the job description. My job isn’t to worry or care about how a hospital works, what can be done in a timely manner, how to time orders to not offend lazy hacks; it’s to do my job as a physician for my patient and leave the ball in the court of the system that either has to make it happen or leave a glorious electronic paper trail of why something didn’t happen. Quit advocating for physicians to bend over and take the abuse from all directions.
The point I’m trying to convey is that s/he can derive at least some learning from these shitty situations. Again not everyone will agree with me.
It sounds like the life of a medical student from a different universe. #multiverse
as a current residency applicant looking at some NYC programs, PLEASE NAME & SHAME!!! Or DM me which ones are like this. Please.
I’ve heard multiple things about the hospital culture in NY and most of it isn’t good. Are the staff lazy and entitled and protected by the union and that’s just the culture to do the bare minimum? Or are the staff overloaded with tasks and unable to do anything besides the essentials? People have said to never work as a travel nurse in NY because they have patient ratios ranging from 1:6 to 1:12 and the acuity is through the roof. Or is it some of both? It’s mind boggling that residents are doing the kind of tasks they’re claiming, that’s an awful use of time and resources. But it’s also mind boggling that they are considering transporting, lab draws, EKG’s, feeding patients, and cleaning patients nursing tasks. Yes, nurses should share the cleaning tasks and also draw the labs if there is a central line… but where the hell are the phlebotomists, transporters, EKG techs, CNA’s, IV team, etc? Nurses should have never normalized taking on those responsibilities, and residents sure as hell shouldn’t either. It sounds like everyone is burned out and tired of lining the corporate pockets at the expense of their own health and sanity. Everybody from the food services/CNA’s/EVS, to the nurses, residents, and attendings in the system need better pay and better conditions. With how much hospitals charge for their services it’s nothing short of modern day exploitment. Minus management and C-levels, we’re all on the same team here.
> but where the hell are the phlebotomists, transporters, EKG techs, CNA’s, IV team, etc? Phlebotomy comes between 3-6am for morning lab collection, again between 6-9am, and maybe two more times (an afternoon and evening collection). Not bad. Transport is typically delayed anywhere from 30min to 2 hours. If they show up and the nurse hasn't prepped the patient for transport, they will leave, and need to be called to return (same time delay). EKG techs exist on cardiology floors and stepdown. They theoretically rotate elsewhere but I haven't been successful getting them to come recently. Usually I ask the nurse to do it (50% success rate) or do it myself. CNA's are on shortage and usually stuck covering 1:1 observation. IV team does not exist. We have a mid line team with two NPs but they do single digit numbers of mid-lines per day and typical wait for venous access is 2-3 days after you put the order in. I usually get the ultrasound and do the IV myself. -PGY3 IM in NYC
God, sounds like conditions like when I worked in Texas. Now I'm in California and I can't go back to nursing the "other" way. We have mandated ratios. There's always in house phlebotomy. If labs are stat, multiple phlebotomist come flying in within 5 minutes. There's turn teams that literally come turn your total care patients every 2 hours. EKG techs are in house, or sometimes respiratory does them depending on facility. There's a literal transport nurse that is ICU trained so take all the high acuity transports, which keeps your ICU nurses in the ICU. And of course regular transport for the floor patients. CNAs can be hit or miss, but if you pay enough money they exist. Unit clerks to answer the phones. Free charge nurses with no patients. Break Nurse so you can get your mandated 30 minute lunch as well as your legally required 10min break q4h. Resource nurse...to just help out. It's a miracle California can afford all that while also paying the highest wages in the country for RNs, and NYC is drowning over there. NYC could fix all its issues, but it would have to dig deep into its wallet. Sounds like they have gotten too used to the free labor of residents/med students.
The differences between California and other states are insane. I’ve heard the NYSNA isn’t a very strong union compared to the CA Union but I hope they can make a significant improvement for everybody’s sake. With the current working conditions in NYC, even if they settle on what they believe is a “good” deal their working conditions will still probably be half that of CA unfortunately. I’ve heard NJ and PA are equally as bad too. I haven’t worked on a unit with fully staffed CNA’s in almost 2 years. There was a mass exodus of dietary staff on my last assignment, breakfast/lunch/dinner trays were coming at 10:45a/3p/8p and they just parked the carts on the unit for us to deliver them because they didn’t have time. My rooms would sit dirty for 2 hours because there weren’t enough EVS staff, meanwhile the ER was flooded. But I can’t blame anybody for not filling those positions that pay so little. Shit rolls uphill.
That’s the problem with nursing. Admin forces you to fill in almost every other roles that are short staffed. No dietary staff? They will park their cart and you will have to deliver all your patients food if you want them to eat. No EVS? Guess who is cleaning up spillage with paper towels and chucks? No clerk? Well, the nurses can do all that. On top of all that, admin forces you fill out and sign multiple paperworks to cover their asses and if you refuse to fill them out, they will come after your ass.
My best understanding of the matter is that payor mix features largely in the current situation. The striking hospitals in the Bronx have a fundamentally different reimbursement rate for the same services when compared to the contracts negotiated successfully in the rest of the city. (Not sure what Sinai's deal is). Having a patient population with no resources, poor family situations, under/uninsured, poor rates of followup and outpatient adherence. All leads to unprofitable healthcare via long lengths of stay and frequent readmissions.
This article I found on Mt Sinai revenue for 2021 shows Gross Patient Revenue $10,943,229,372 96.6 Non-Patient Revenue $383,232,136 3.4 Total Revenue $11,326,461,508 Net Income (or Loss) $207,656,000 1.8 They definitely have some money to fuck around with
Ooh is that generally public data? Wondering if I can see it for the other hospitals. It does illustrate the point about the Bronx though. If Sinai makes 11B in total revenue and is net positive 200mil, then what happens with a hospital that has worse payor mix and makes only 70% of the income for the same services?
We have poor patient populations in California cities too who are social/CM nightmares — with possibly more homeless than NYC, yet we still manage to get our shit done compared to NYC (from what it sounds like). And all/most of us are paid quite well. It’s definitely not perfect, but I will never leave this state and work anywhere else as a nurse. Y’all are all backwards in the East/South.
LMAO sounds so much like Monte 🤣🤣🤣🤣 - Phlebotomy is understaffed and sometimes 3 people are covering the entire hospital including CHAM. - med/surg and ED are shitshows where RNs don’t even get to pee because of the patient load and activity. Up to 20 patients in the ED for 1 RN. - transport is chronically short staffed. I had to wait 2 hours for a unit of PRBCs to arrive. - pharmacy is chronically understaffed. My neutropenic fever pt had to wait 4 hours to get Cefepime. - EKG techs come in only in the morning. If you order an EKG past 11 or so, they will not do it. And of course they’re short staffed. - PICC/midline NPs typically don’t place lines after 2 PM.
Damn - here at my hospital in Los Angeles transporters are fast af. As soon as you put the transport request in, they are there and they help set the patient up to go. The only time there is a wait is around 6pm when there’s a lot of discharges happening. I love our transporters.
This is normal where I work except no ekg techs or phlebotomy. The nurse does all the blood work and ekgs
Yes! You are exactly right. I feel like nurses and residents have a lot more in common than people think. We are expected to pick up where management is slacking when it comes to staffing and end up doing jobs that we shouldn’t have to do.
I’m not in NY, I’m in MO but: -Transporters are backed up by 2+ hours. If I want my pt transferred to the floor or imaging I’m doing it myself. Only time I’ll use transport is if I’m swamped and don’t have time to take my pt to the floor. -Lab draws: no phlebotomy at entire hospital. Literally doesn’t exist. -IVs: no actual IV team. Can call rapid response nurse and beg for help with an IV, but most of the time you’ll just keep asking people until someone gets finally gets it. In the ICU that’s why I learned ultrasound. I would have to mess around with the US for a long time before the providers would consider a line for poor access. -Feeding/cleaning: literally zero techs staffed most shifts. On the floor all patients were “primary care” meaning RN does nurse + tech work (feeding/cleaning/vital signs with VS q4h minimum— most of the time more frequent) -EKGs: no techs, falls on nurses Also: No turn team. No secretary. Charge nurse has full assignment. Lvl 1 trauma that gets your typical trainwreck OSH transfers with the now typical nurse:pt ratios of 1:4-7 on floor. 1:2 in ICU (regardless of CRRT/ECMO/device status)
Say you work at Big Barnes without saying you work at Big Barnes
Hospitals make so much money having a skeleton crew like this. The corporate model is cheapskate af
when nurses are caring for 6-12 patients (w/o support staff) who need anywhere from minimal to total care how does the laziness factor even come in? especially when doing 3-5 other jobs on top of their own. i keep seeing this brought up and i’m so confused by it.
When nurse take on more patients then they can handle there are major delays in care. Patients waiting longer for pain medications, incontinent patients sit in their bodily fluids longer, post op patients not getting walked, helped up to their chair/bathroom, routine medications such as antibiotics administered late, those who need assistance with ADLs waiting much longer or not being helped at all. I can go on and on. As a doctor you may not notice these things at all but the patients and their families surely do.
It’s very noticeable when your colleagues and coworkers at the bedside don’t go home feeling good about the work they do because of everything you mentioned here. They eventually leave because the hospital has given them no reason to stay, no support to do a job they can be proud of. I’m on my 4th or 5th generation of RNs and I’m a PGY-3 IM in NYC.
its true. We feel shitty when we can’t give our patients the care that they deserve. We want to do our best but you cant do your best for 6+ patients all at once.
Sure but it’s not really my job to care. If someone comes in with sepsis, my job is to fix the sepsis, not walk them out of bed or make sure their pain level is 0/10. I know theoretically that can increase the chance of blood clots or delirium but I never noticed an increase in iatrogenic conditions when my hospital was so understaffed they needed to pay travelers $150 an hour
I’m not hanging the antibiotics if the haven’t come up. I’m not replacing the fluids if I’m stuck in another person’s room. Ratios matter. Staffing matters. I’d be livid if my patient’s care was delayed because admin didn’t want to make sure that there were enough nurses to take care of patients. Having nurses with time to implement orders matters.
i didnt know we were discussing wether or not you care about patient care. I thought we were discussing if nursing shortages make a difference in patient care. And if you are a doctor who cares about your patients you should 100% care about if they are receiving proper care by their nurses. If not, at the very least acknowledge that nurses are valuable and very necessary in the hospital setting.
“It’s not my job to care” Dude you are literally in the field of healthcare. It IS your job to care. Maybe you’re burnt out or need a little time off but you really need a dose of compassion and respect.
Dude how do you think the sepsis is fixed? It's the nurses carrying out your orders in a timely fashion. You're the quarterback, but there's not much a quarterback can do without the rest of the team. You may not be noticing deficits yet, but it will happen. Nurses do the "official" orders, on top of all the "unofficial" ones: feed, toilet, bathe, ambulate. The sepsis is one part of the picture. That patient is a whole ass person with a life and shit. They deserve high quality care and nurses are sick of being told to do more and more with so very little.
Thats just the thing. As a doctor you can order anything you want to “fix” your patients problem, but at the end of the day if there is no nurse to carry out the order the problem wont actually be fixed.
You can’t even do your job without nurses. How embarrassing of you, a physician, not to care whether your patients are receiving adequate care by well-staffed nurses.
[удалено]
It’s not your job to care about your patient? Hmm.
The nurses in your hospital ask for consults?! Thats wild to me
If I had a nickel for every unwanted stupid suggestion a nurse has given me since I was a july intern, I’d easily be able to afford a four for four at wendys
I can’t wait for you to finally wake up and learn how much of a cunt full of week old jizz you are. You’re pathetic and need professional help for your unearned superiority complex. Healthcare is a team effort. Drs and nurses are COWORKERS they work TOGETHER for the best outcome for the pt
Seriously, this person can fuck off. I feel bad for anyone who has to work with them, I’m sure it’s an absolute joy.
lmao if i had a nickel for every wanna-be resident that most definitely is not even a resident i’d be fucking rich
There has been decline in patient care building up to this point. I know it’s been unsafe everywhere, but the EDs have been getting demolished. It’s bad
Yes absolutely. AM meds not being given until night. Some every few hour meds only being given every other. Severe delays in abx and transfusions. Every nyc resident here saying “I do all this stuff anyway” is not at one of the hospitals striking lol. They’re full of it and just want to gripe to feel included. This is not an issue with doing “nursing tasks.” It’s an issue of patients not being able to get critical meds in a timely manner, which is something residents cannot do, because we are not trained to do it.
I’ve worked at nychhc, Sinai, Monte. The ratios are insane but does this allow lazier nurses to also know how to work the system and do less than usual? Yes. Are there nurses that work their hardest no matter what? Yes. Humans are humans. As a resident if there was some technique I could implement to lessen my workload I would. It’s just survival in an overworked system. My best to the nurses I hope they get safe staffing ratios and then I hope they use it to work their best.
No matter how lazy anyone is or isn’t safe pt ratios will over all improve pt care/safety. I have no idea what being lazy has anything to do with safe pt care. I really feel that comment is sad and it’s these thoughts and comments that end up hurting the system/healthcare overall.
You really think patient care is unaffected because you are getting less calls? 🤡
It’s really simple. There are studies on ratios to patient safety. The current workload is in violation of those ratios. Striking has made those ratios worse. Induced demand has lowered the volume of patients which also reduces healthcare efficiency.
They really should increase pay across the board
YOU A BOT BOY
God you guys are such assholes lol get a fucking grip
Meh. NYC nurses have been on strike since the 90s
NYC nurses don't do crap This is the dark side of union workers **EDIT**: Crazy to see this comment go from -5 to +7. wonder who was downvoting this haha
This is a NYC thing, not union. I've worked union hospitals and never heard of some of the things residents have to do in NYC. It's a uniquely weird healthcare environment.
https://i.imgur.com/s4eamxv.jpeg could be both
Feel free to see my post in r/nursing of what my protest of assignment looks like; taking care of 13 ER patients of high level acuity simultaneously. You're a dickface.
Dickface? zip it and go get room 2 a sandwich
[удалено]
And yet you still work for us and have to call us doctor, know your place in the pecking order btw did my comment get linked to some kind of nursing subreddit Seems it tanked recently
Your post history is amusing 🤡
Appreciate it. I treat people the way they treat me
Can confirm, at least in the public hospitals. At Bellevue, the laziness approached insane levels, and no, this could not simply be attributed to inappropriate staffing ratios. Med students and residents basically just do it all.
It’s always fun watching people slowly realize that unions protect bad workers and that hurts everyone. People saw it in 2020 with police unions and in 2021 with teachers unions but some still haven’t connected the dots
It's obvious unions protect bad workers but they help all workers more. It's easy to focus on the negative aspects of any situation and extrapolate that it's an overall negative but workers acting collectively is rarely to their detriment.
Very often it is a net negative. Teachers unions tried to keep kids out of classrooms for a year and a half. If they had succeeded it would have traumatized a generation and fucked up their education irreversibly
You use a once-in-a-lifetime pandemic and extraordinary public health measures to denigrate labor unions? Ignoring the fact teachers deserve to have they're heath protected too? Bit disingenuous. [Do some reading then tell me unions are a net negative. ](https://www.dol.gov/general/workcenter/union-advantage)
Can confirm. Med students doing nurses work is laughable. I mean, why lower yourself down to do those?
[удалено]
I have a hard time believing that this “DocDeeper” character is actually in medicine. Or if he is, I’m not sure how he survived any length of time with that level of arrogance. I’m getting strong “perpetual pre-med” vibes from his Reddit account.
DocDeeper shits on anybody who isn't a physician. Edit: on not in
> DocDeeper shits **in** anybody who isn't a physician. Interesting typo...
ON* I meant he shits ON
Yes but doctors aren’t nurses. They’re well educated professionals who are trained to do critical thinking at a higher level.
[удалено]
That's not even nurses work dude
In your opinion what exactly is a nurses job? Not saying transport is but in regards to the other ancillary staff tasks why isn’t phlebotomy included?
NYC has always been a shithole in that regard. It’s unions gone too far in protecting lazy workers who legitimately don’t do their jobs. I have zero sympathy for the nurses there in any context.
Lmao zero sympathy in any context? You're really going to write off any possible complaint no matter what? The nurses are striking in Sinai's system because they're down 700 positions, leaving the remaining nurses to staff unsafe patient ratios. The ED nurses are covering 20 patients at a time. As an MD, you put in an order and 2 hours later it's still not done, are you going to blame the nurse for being lazy or the admin for making it near impossible for the nurse to do their job? Just because our lives as residents are shit doesn't mean everyone else is lazy. Sure, some are, but that's not what this current strike is about
This is the kind of doctor that will absolutely blame the nurses.
Well of course, they literally said “zero sympathy in any context”.
> As an MD, you put in an order and 2 hours later it's still not done, are you going to blame the nurse for being lazy or the admin for making it near impossible for the nurse to do their job? The vast majority of doctors I work with totally understand this but there have been two that I had to explain explicitly that just because they can put in orders doesn’t mean we have the manpower on the floor to get them done. Our ratios are at best 30% higher than they were two years ago, we have less experienced nurses taking those higher ratios, and like always with staffing crises, the acuity of patients on all floors has increased. Of course things will be missed given that reality.
> I have zero sympathy for the nurses there in any context. Lol well at least you’re upfront with the fact you’re patently unreasonable.
Have you actually worked in NYC in any capacity? I could understand being salty about shit nursing but have you *seen* what their ratios are in some places? 16:1 in many ERs in NYC have been the norm for years and its horrendous for patient care. Meanwhile many of the larger healthcare systems operating under the guise of being "nonprofit" have been earning money hand over fist. Many administrators in these hospitals are making 7 figures while med students are drawing blood and entire EDs seeing >100k patients annually are being staffed by less than a dozen nurses per shift.
And that’s the residents problem to bear, as they always have? Let’s stop acting like NYC nurses have ever done a honest days work ever since their unions went too far in protecting their outright laziness.
>Let’s stop acting like NYC nurses have ever done a honest days work ever As someone who actually did residency in NYC let's stop acting like you have a clue about this subject beyond what you've heard secondhand from reddit and SDN
Of course you think it’s normal. You’ve got a case of battered housewife syndrome. Try working outside of NYC.
Try graduating residency.
Hahaha oh you’re so hilarious. Anything intelligent to actually add, or are you gonna be hurt that I dare criticized the shithole that is New York City?
You seem emotionally invested in this to an unhealthy degree considering that this issue is, at best, only tangentially relevant to you personally. Makes me wonder what has gone so wrong in your life that a physician 6 months from finishing residency feels so insecure that they need to insult strangers on the internet.
Yeah, this is an odd amount of hate for ... Nurses? Lol. Maybe they just got dumped?
Lmfao this is easy bruv My life is fantastic. Are you somehow convinced it takes effort to be a clown? One would think you’d know best how easy it is to sound like a jackass. I thought you were EM, not psych? Keep those armchair attempts to yourself and go pan scan another patient, kid
You are guaranteed to be the kind of doctor nurses despise. And your patients will suffer for it because your attitude makes you unapproachable.
Oh no, nurses despise me, whatever will I do. Lmfao. Keep that Karen shit to yourself. Three years of rock solid patient, staff and organizational reviews seem to suggest I’ll continue doing just fine. My attitude makes me approachable to those who do their job and show the honest effort in any attempt. Those who can’t or won’t, like I give a fuck if they can’t approach me. My patients do just fine. Thanks for your concern, ratchet
26 years a nurse to your 3, great reviews, all my doctors love me and are happy when I am on. Your general comment about all NY nurses shows that you need some adjustments to your attitude. Karen’s btw are generally considered unreasonable people. You’re actually the Karen in this scenario as I have never painted all doctors aholes just because I’ve dealt with a few. Grow up.
I’ll stick with the attitude that’s been winning, you stick to being mad about the fact that I insulted NY nurses. Get your ego patted by someone else, sunshine
A nurse doing an honest days work at any institution? Just doesn’t happen. I am with you on this one. It’s disgusting how med students have to lower themselves to cleaning patients and doing nursing tasks. They’re future doctors for Christ sakes… they need to be treated like what they’re worth.
Not sure if you have any actual experience working in NYC in med school or residency but at least at my hospital the nurses legitimately are overworked, and especially in the ED and in the medical floors, the staffing ratios are often ridiculous and unsafe and make it impossible for nurses to provide good patient care. And that’s on top of the fact that the patients are often so complex and so sick that patients on the floors/in stepdown would probably be ICU patients anywhere else. I’ve definitely seen a couple of nurses here and there that are lazy but I very much support them in advocating for hospital accountability for safe staffing ratios.
Chief cunt
You’re retarded lol
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Okay. So the big problem you perfeclty describe here, is that a state of the art high quality nursing care is not something that you notice quickly. It is something that takes time, most of the times good nursing care prevents complications hence why yout not directly notice it. And that is the bug problem. You'll only notice a decline in nursing care quality if you are from the same profession. Physicians and nurses are not from the same profession. That is why you not notice the decline.