The Bad Old Days - page 3
by SharonH, RN
I was reading nurscees's thread and some of the comments about nurse-patient ratios and I started remembering: Back in 1991, I started my nursing career at Thomason Hospital in El Paso, Tx on the pediatrics floor. We also... Read More
- 0Feb 14, '05 by medsurgnurseQuote from BETSRNI remember reading one RN say that they had to do a nutritional screening in ER. I mean, you go in for a sprained ankle and someone interviews you about your eating habits! And if any problems were noted they had to be refered to a dietician form the ER. Ridiculous. Preventive health care is wonderful but ER is not the place for it. I remember when I did ER, we had to do a pain scale, on a separate 20 question type page. writing it in our notes apparently wasn't good enough. And we also had to a patient education form about what was taught to the patient, again writing it in our notes was not good enough.I am on a floor with excellent ratios(LDRP) , but I keep wondering of the stuff JCAHO thinks up is supposed to keep us AWAY from patient care. Truly, I don't understand how one can do nursing care with all the extra crap we have to fill out, ask, etc. It's rarely vial to the patient's well-being.
- 0Feb 14, '05 by laurascQuote from SharonH, RNI graduated in 1985 and started on a General Surgery floor that specialized in gastric bypasses. (in those days it was a nasty procedure unlike now) It was a 31 bed floor, we worked 7:30AM to 7:30PM and staffing consisted of usually 4 RNs and 1 RNA. (nursing assistant, in other words she didn't do meds) We averaged 7 to 8 patients each and we practiced "Primary Nursing" meaning that we were responsible for all aspects of the patient care. We were assigned a patient when he/she was admitted and we were responsible for the care plans, for co-ordinating with the various services available. On the floor we did all the care including AM care, all the meds, ivs, procedures, etc, etc, etc. On top of that, because the RNA couldn't give meds and care for IVs, we also had to deal with her patients.What were your first days in nursing like? Do you remember those days with nostalgic fondness or a relief that its over? Are things better for you or worse?
That was on days.
On nights we were 2 RNs and 1 RNA. Since the evening started at 7:30 we were responsible for the various preps for surgeries. The most common was tap water enemas to clear...which usually means we had to subject the poor patient to several 1Litre enemas. Depending on the night and what was scheduled the next day, it wasn't uncommon to have multiple enemas and other preps to do not including the meds for our patients and for the RNA's as well.
To say we ran our fannies off was...well, an understatement. :chuckle
It was crazy. I haven't worked in a hospital for nearly 15 years and will never go back either. Partly because of that reason...too much to do and too little time. The other part has to do with "politics" but that's another thread altogether.
- 0Feb 14, '05 by snowfreezeA big difference is less ancillary assistance, no IV team, fewer if any nursing assistants, no more daylight and evening unit managers, and the managers we have now usually have an assignment too. Secretaries are few and far between and are responsible for more than one unit, when we are lucky to have one. Environmental assistants don't exist anymore, and when was the last time you saw a candy-striper? No security in many sub-acute facilities and none in long term care. No daylight nursing supervisor anymore, that is shared with the DON and ADONs, evenings and nights have only one supervisor for the whole facility and she is expected to fill in for call offs on the units. Off shifts don't have housekeeping anymore so you empty your own trash cans and quick clean a room for that unexpected admission at 2am. The work load is shifted a bit but it is still a heavy work load.
Families are rude and aggressive at times and no one to help you out cuz everyone has their hands full.
I remember when a fresh open heart was 1:1 for at least 24 hours, now you can get a fresh heart from the OR and take a second patient that is 2 days post-op ready to go to stepdown.
Organ donors used to be 1:1 in the ICU, now they are paired with another ready to transfer patient. If the charge nurse is busy with the patients they are assigned to you have to talk on the phone with the lab, the donor service in your state, the family and often the potential receiving facility, plus keep a dead person alive until donors are found to take organs. And possibly transfer your other patient to another unit. Then when donors are located you have to take your patient to the OR and/or assist with cornea extraction at bedside.
The last trauma unit I worked in, the only 1:1 was a kidney transplant that was VERY unstable. Usually a 48 to 72 hour old multiple trauma was kept 1:1 when ever possible because even the most stable crashed during that time.
Specialty flight team was the only job where the patients were all 1:1 because you can't fit more than one patient and the team in a helicopter or lear jet.
- 0Feb 14, '05 by SharonH, RNQuote from laurascIt was crazy. I haven't worked in a hospital for nearly 15 years and will never go back either. Partly because of that reason...too much to do and too little time. The other part has to do with "politics" but that's another thread altogether.
I totally understand your feelings. I left the bedside only a couple of years ago and sometimes it's hard for me to believe that I won't be going back. Everytime I even think about it... .....