I am doing a research project regarding problems that nurses and healthcare face on a daily basis. Who better to ask, than all of you dealing with issues on a daily basis. If you can, please give me a minumum of three, but would love to hear more if you have more. Part of my project is to see if there is a trend among nurses and what I could do to resolve the issue. I would appreciate any help on this, thanks so much in advance!
Sep 10, '12
Lazy locum tenens MDs/NPs. This is r/t shortage of healthcare providers and locums not being invested in the facility. Questionable practice/orders can lead to moral distress/ethical dilemmas for the nurse.
Lofty ideas of electronic charting but in reality it's duplicate work because we use electronic charting AND paper charts. This is a systems problem r/t an application mismatch between implementation/reality.
Stubborn, obstinate techs who don't earn their pay. See next item for root cause.
Nurse managers who are afraid to affect/force change. Lacking nursing leadership. R/t lack of training/education in leadership? Lack of top-down leadership?
Nurses who gossip instead of going about their work in a straight-forward business-like manner. This is a lateral violence related issue commonly found in female-dominated occupations, IMO.
Last edit by Multicollinearity on Sep 10, '12
Sep 10, '12
Wish I could 'like' the above comment
Sep 10, '12
There could be an endless list of issues.
1) Healthcare is a limited resource.
2) Healthcare interventions without regard to item 1
3) Too many interventions without better healthcare outcomes.
4) Escalating costs to both employee and taxpayer.
5) Increased number of uninsured/underinsured.
6) Little regard for the nurse's health and safety.
7) Aging nurse population.
8) Poor planning/processes.
9) Patient having little prior information or control over costs.
10) Lagging or questionable technological implementation in nursing.
11) Defensive medicine
12) Higher U.S. prescription med costs vs other countries.
Sep 10, '12
1) Lateral violence. I never would've guessed in a million years that I would be affected by this in my very first nursing job.
2) As Multicollinearity said, nurse managers who basically fail to do their job. Which allows #1 to happen, because "I cannot write someone up because of a behavior issue. That's not a nursing issue"
3) The gossip, which keeps going because of number 2, which leads to number 1.
Sep 13, '12
1) Multicollinearity said it best - unreasonable expectations about electronic charting. The technology isn't bad - just that it is usually designed and implemented at the facility level by nurses, who tend to be anal, nit-picking, and create excess work.
2) A lack of nursing leadership (again, Multicollinearity). Managers are not rewarded for effecting change.
3) A general sense that nurses are their own worst enemies. See comment #1 - they will never fail to engineer complexity and useless work into their routines. Just look at the DNP trend. Who gives a crap about doctoral trained NP(s)? Instead, they added two years of time and expense onto a degree with no tangible benefit in terms of money or prestige.
Jun 17, '14
I think the greatest challenge to the delivery of care I have faced over the past 30 years is the loss of autonomy. I am unable to do what I know I need to do as the result of the systems that have been put in place. Here are some of the things that have changed the delivery care model.
1) Electronic Health care- Requires duplicate data entry into multiple screens/ The required selections don't always mesh with what you are seeing yet I must select the best option/ Data extraction demands have added complexity and time to complete these screens (ie. asking food preferences, religious preferences, suicide queries, etc), Changing and upgrading software and increasing the complexity before the screens are understood proficiently. As an educator I've had to develop special programs for night shift staff to relearn how to discharge a patient. As with all complex systems there is an increase in time and repetition required to be able to perform the task.
2) Administrative delays- In order to change any of the system problems a proposal must be written and it must then pass through an administrative channel. This process can take up to a year sometimes or it can be lost in a vast ocean of greater priorities. Most of the staff do not know how to navigate this passage so they develop a work around process. According to the IHI work arounds are many times the result of a process that does not work well for the task it is designed for.
3) Reduced staffing levels- In the last 5 years our staffing levels at the bedside and even more so at the support level have decreased tremendously. The one department that has added positions is the IT department as the greater push into electronic healthcare has developed.
4) Equipment availability- Hi tech equipment is great when you have it. Unfortunately as censuses go up and down we must now chase down the items to do our jobs. I have no answer for this since I like the equipment. Unfortunately there is only so much of it to go around so I suppose we'll keep spending time looking.
5) Regulations and Liability- There are so many rules now that many decisions that used to be made in real time in the individual units must now be approved administratively so that we can proceed. These have also added directly to the development of some of the screens that go into our EMR.
I will stop here. Unfortunately simplification of process is a lost concept. It allows the individual who is delivering care to do it in a more efficient manor. Much of what the practitioner does today especially with the EMR has been designed by people who want to track and acquire data. It is going to be a challenge going forward to change this so that a system is designed with nursing workflow in mind to foster some of the efficiency and autonomy that has been lost.
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