has nursing changed over the years?

Id like to wax eloquent and comment on some of the changes I have noticed.

I started out in nursing in 1976 as a NA on an Ortho floor in a small hospital. Our Head Nurse came in bright and early each morning with a stiffly starched white uniform and cap. She made rounds with each of the doctors as they came in. She knew the progress of each patient on the unit of about 20 beds. She oversaw the care of all of the patients and participated with the entire staff in each doctor's plans for each patient. She also knew the staff as individuals. I still shake in my shoes to think of displeasing her in any way, it was a tightly run ship. Head Nurses arent like that anymore, it seems. They are not even called head nurses anymore in a lot of cases and usually dress in street clothes. They focus more on the financial aspects of running a unit, not the clinical. Now, as a patient, you may never meet the "Unit Director" and if you do, you may not know it is an RN. Patients do not remain in the hospital for recovery like they used to, unless the federal government gets involved. Units are much larger and direct care is often given by a group- for example, PT gets the patient up in the chair, someone from dietary drops the tray on the table, a med nurse rushes in with pills, an assistant will offer a pan of water then be back in an hour to make your bed, if its linen change day. Housekeeping tidies your room etc, etc. Care is more fractured and less consistant. To keep the money rolling in, there has to be more patient turnover. In some instances, more money is made if the patient isnt even admitted at all.The nurse has more tasks (ie:drawing blood since they no longer have plebotomists) on more patients who stay a shorter time but are sicker overall. The "nice" things I used to be able to do for patients and families are no longer possible. Think of an inverted pyramid shape, all the directors and managers and ancillary departments are on the shoulders of the nurse trying to give care- which leads me to mention what hasnt changed.....

Hospitals still have enormous profit margins, the profits are just better disguised. Nursing salaries are not what they need to be when compared to Physical Therapists and other professionals. Sometimes, benefits are sacrificed in order to give the appearance of better wages- for example:trimming down sick pay,vacation pay and holiday pay into one "lump" which sounds pretty good, but equals less paid time off, increased co-pays and deductibles on insurance, trimming back or elimination of retirement plans and pensions. Its a quagmire of politics and profit protection- those at the top continue with their great salaries and bonuses and the "little guys" continue short-staffed and underpaid.

That is my thesis for tonight. :)

Originally posted by lisaloulou

...................I started out in nursing in 1976 as a NA on an Ortho floor in a small hospital. Our Head Nurse came in bright and early each morning with a stiffly starched white uniform and cap. She made rounds with each of the doctors as they came in. She knew the progress of each patient on the unit of about 20 beds. She oversaw the care of all of the patients and participated with the entire staff in each doctor's plans for each patient. She also knew the staff as individuals. I still shake in my shoes to think of displeasing her in any way, it was a tightly run ship. Head Nurses arent like that anymore, it seems. They are not even called head nurses anymore in a lot of cases and usually dress in street clothes. They focus more on the financial aspects of running a unit, not the clinical. Now, as a patient, you may never meet the "Unit Director" and if you do, you may not know it is an RN.

This is soooooo true, lisaloulou! Sad, but true today in hospital nursing and management. It's all about managing the budget and to heck with the patients.

a couple of good thread on the OB boards oughta enlighten you more as to what renee and the others above are saying.

it's about big fat salaries for CEO's and adminstrators....

patients be damned.

it's scarey out there.

lisaloulou you summed it up quite nicely!

thank you all so much for taking the time...i appreciate it!

Nurses need to realize that when hospitals say they have no $$, what they are really saying is we have it but don't want to give any to you.