She offers, however, that Dominican has a relatively lean administration and that any layoffs have been absolutely necessary. We use attrition, and we revise job descriptions so people can cover two jobs. We try to avoid straight layoffs, but there will be more. One of the factors is that a new hospital is coming in down the street. With the exception of emergency and critical care units, Dominican staffs its units solely based on number of patients, not acuity, and the increasingly sicker patients are placing a greater burden on the nurses.
Nurses also have more patients and staffing is often short, compelling nurses to work overtime.
Welch says one nurse in her unit had done six double shifts during a recent two-week pay period. Sometimes, if nobody is found for the next shift, the charge nurse has to be two places at once or the nurses will take a bigger load. We definitely need more nurses. Hospitals are required by the state accrediting agency to base staffing on acuity, as well as number of patients, but cost-conscious bureaucrats have been slow to implement such systems. At Dominican, Williams says, the hospital's Professional Practice Committee, a group that works with administrators on patient care issues important to nurses, has been working to set up acuity-based staffing in some units, but progress has been slow.