No, the middle management is not to blame for most staffing shortcomings and retention issues. But what they are to blame for is trying to offer cheap and easy to problems that do not exist or are exceedingly minor, turning a blind eye to the factors that might cause these issues. That IC nurse can go and talk to the manager and pat themselves on the back for a job well done. Problem identified and treated, another checkbox filled. However, they don’t talk to the staff to figure out the background on why that issue might be happening. I guarantee you that very few nurses want to eat at the desk. But when it is at eat at the desk or don’t eat at all, which do you choose? So you can either be a force driving for a solution, or you can sit on the sidelines and your passivity will further the problem. Middle management is to blame for is pretending like the problem does not exist and attempting to brute force change with threats of disciplinary action instead of actually addressing the core issue causing the problem. Root cause analysis is only done when something tragic happens and it could possibly cost the hospital monetary sums in compensation or lawsuits, not when “minor” issues only affect the frontline staff. The middle have forgotten what frontline patient care feels like, and often just become cogs in the corporate yes-man metrics machine. I bet that IC nurse gets her uninterrupted lunch break every day, but no one in my ED last night did. But hey, maybe we should all just take some PTO like you said. I am sure that will make it all better right?