Do you ever feel like you short-changed someone?

flightnurse2b, LPN · Sep 24, 2009

unfortunately alot of people feel this way.

with the way staffing is done in health care today, there is only so much you can do in 12 hours. you can give your very best and still not get everything you want to accomplished--there is always one patient i feel like i didn't pay enough attention to or always one thing i wish i could have gotten done before shift change.

you have to just do the best you can with your circumstances. i work on telemetry/PCU and we have 8 patients a peice as nurses and our CNA's can have up to 25. believe me we all wish we could go the extra mile for our patients but with that many, it's sometimes hard just to provide scheduled meds on time and make sure everyone's hiney is dry.

when i was a new nurse, i would stay after until like 0830-0900 sometimes (i get off at 0700) trying to change the IV's i didnt get to, clean up the med cart i left sloppy or provide that extra patient teaching and education to the pt i didnt have time for. i really started to get burnt out and i realized all i could do was the best with what i was given and that nursing is a 24 hour job.

good luck to you.

NotFlo · Sep 24, 2009

I feel like that almost every day. I work a rehab/subacute unit in a LTC place and it's crazy. I have fifteen patients right now we have a very high level of acuity (for the level of staffing we have). To be honest the couple of quiet, stable, uncomplicated people (the ones I would love to spend more time with, do some education with and generally just get to know a bit better) are the ones that I can barely manage to do anything more with than throw a few pills at them.

There are a couple of patients with a ton going on (IVs, trache, bolus G-tube feeds, on precautions, etc.) and they simply require 45 continuous minutes of my time twice a day. I have other IVs beeping and other people waiting on pain pills and on and on.

It seems like every last person wants everything done by 8am these days...all their pills, all their dressings, their shower, and while I'm at it a new water pitcher, could I make a hair appointment for them, get them new ice packs, why doesn't the History Channel come in clearly on this lovely new flat screen TV, can you make sure there's extra bottles of ginger ale and ice in here for my family, the ten of them are coming in an hour and will be here all day and on and on...meanwhile the CNAs are coming to me every ten minuts telling me "this one and this one can't breathe, that one wants to be suctioned, the other one is clutching her throat and wrote GET THE NURSE on her whiteboard, and these three people want pain meds."

Alarms are going off, and we're short CNAs again, so the call bells never stop, and we have several fall risk patients who are busy getting up and trying to fall CONSTANTLY. Meanwhile the first patient is ****** when I run back in an hour later with the extra ginger ale and a card with the hairdressing appt. wondering why I took so long. Then when I finally get around at 11 am to getting the last of my 9am meds done, OOPS, they are at therapy, or bingo, or god knows where, or the housekeeper has her cart blocking off the door and floor sopping wet so that I slip and spill the 30 pills, five liquids, 3 lidoderm patches, spiriva and advair inhalers, nose spray, Voltaren Gel, the person's hearing aide, the lovely metamucil and miralax cocktail and the eyedrops this person requires each and every day just to stay alive all over the floor gloriously. Guess I shouldn't have tried to take it all in one trip! Excuse me, I'll just be crawling around under the bed trying to find that stray xanax so it can be wasted...

wooh, BSN, RN · Sep 25, 2009

You can only do what you can do. I do the best that I can, and at the end of the day, that has to be enough. I just make a conscious effort to think through all the things that I can do, and make a priority of the ones that will have the most impact.

oldladyRN · Sep 25, 2009

I don't know how those of you who work at the bedside do it, but my hat's off to you. You are a remarkable group of people. The original poster's frustrations are the exact reason I'm not able to do it.

When I was in nursing school, everyone had the same question for us..."What hospital you gonna work at?" (I live in Texas, so that's really how the question was worded, by the way).

I never had any interest whatsoever in working at the bedside in a full-time capacity and I felt like there was something wrong with me for feeling that way while I listened to my classmates excitedly chat away about where they had interviewed. I knew that bedside nursing was not my calling.

I have been very happy working in a variety of settings including case management, urgent care clinic, ER, psych and QI. The "few and far between" times when I have worked a bedside shift through agency, I've darn near crawled to the car at 0730 the next morning, trying to remember (through my exhausted haze) exactly where I parked it.

Thank you to all the excellent nurses that efficiently, skillfully and compassionately deliver excellent bedside care.

oldladyRN

Miss Mab · Sep 25, 2009

I suggest that a great majority of nurses feel this sentiment to some extent each and every shift.

I also submit that it is this same internalized(and falsely) sense of failure happening on a repetitive basis that leads too many good professionals to job burnout and eventual career abandonment.

Many claim nurses 'don't care' so much nowadays.

I witness much more of the opposite.

meadow85 · Sep 25, 2009

At the end of the day if you did your best then that's all that matter. We're only human. We can't do it all, although sometimes we wish we could.

nursesRbeautiful · Sep 25, 2009

I worked home health for a year in a rural area, and there were moments like that. I had this one lil old lady who lived alone,she was disoriented at times , her living conditions were heartbreaking. I didn't want to get out my car and go into her home my first day, but I had a job to do and I'm the type who likes a challenge and besides we become nurses because we care right ?.. I walk in and her house was pretty clean at first glimpse, I introduce myself and I realized she was a bit hard of hearing ,but once you got around that, you couldn't stop her from talking, she had a beautiful smile . I started my assessment and I noticed a few roaches crawling but I didn't get worried at this time, but as I continued on and I had to look around for her B/S monitor I opened a drawer where it was and a whole lot more roaches came out. I looked in her cabinet to get a glass so that she could get something to drink with her meds and a lot more came out,I opened her fridge to get the water pitcher and even more roaches came out. The longer I stayed the more noticable the bugs became.They were on the ceiling, the floors ,and the chairs. I stood there with my bag on my shoulder, B/P cuff in one hand attemping my assessment without putting anything down, it was horrible, . I felt like a greedy salesman trying to get paid.I reported to the supervisors ,but of course they already knew of her condition. I did buy a can of spray around my 3rd visit to her home it helped just a lil. I was told later after I left the company that they finally got someone to come in and put something a lot stronger down around the home.

dannyc12 · Sep 25, 2009

I feel like that all the time. I just worked my first shift as a CNA in about a year, returning to the LTC Transitional Care Unit I previously worked on.

The admissions department has been bringing in people who need much higher levels of care (quadriplegics, stroke victims, morbid obesity, persistent vegetative state) and decreasing the number of patients who need minimum and moderate levels of assistance like hip and knee replacements, amputations, and other ortho surgeries.

This brings the facility more revenue. However, they have not added resources to do this additional work. As the op mentioned, some of these heavy care people require you to be in their room for over a half hour.

The end result is that I had residents that did not receive the level of care or attention they deserve. I felt guilty because I was grateful that two residents on my list were in the hospital! Not to worry though, I paid a penance by getting a new resident returning from the hospital who would not stay in his bed or wheelchair and spend the evening falling. I had no chance to keep an eye on this gentleman or even hear his tab alarm go off while busy in other residents' rooms.

Admissions is always trying new ways to increase revenue through population selection. A while back, they decided that bringing in a lot of opiate and alcohol addicts with ZERO treatment for the psychosocial aspects of their addiction would be a good choice. I suppose their rationale is they don't require a lot of ADL assistance so they won't tax nursing resources so much. Shockingly, this type of admission had massive behavioral issues (You don't say!!)

This dunderheaded mix of people with severe impulse control issues with tons of unstructured time on their hands with other extremely vulnerable residents caused some serious safety issues. I saw one non-ambulatory resident leave AMA in tears because the addicts were storing booze in her toilet tank and she was powerless to stop them.

This may very well affect whether I work there much longer. I am a great CNA I work very hard to take care of my residents. But I don't know if I can continue given the current policies.

NurseKatie08, MSN · Sep 25, 2009

I feel like that almost every day. I work a rehab/subacute unit in a LTC place and it's crazy. I have fifteen patients right now we have a very high level of acuity (for the level of staffing we have). To be honest the couple of quiet, stable, uncomplicated people (the ones I would love to spend more time with, do some education with and generally just get to know a bit better) are the ones that I can barely manage to do anything more with than throw a few pills at them.
There are a couple of patients with a ton going on (IVs, trache, bolus G-tube feeds, on precautions, etc.) and they simply require 45 continuous minutes of my time twice a day. I have other IVs beeping and other people waiting on pain pills and on and on.
It seems like every last person wants everything done by 8am these days...all their pills, all their dressings, their shower, and while I'm at it a new water pitcher, could I make a hair appointment for them, get them new ice packs, why doesn't the History Channel come in clearly on this lovely new flat screen TV, can you make sure there's extra bottles of ginger ale and ice in here for my family, the ten of them are coming in an hour and will be here all day and on and on...meanwhile the CNAs are coming to me every ten minuts telling me "this one and this one can't breathe, that one wants to be suctioned, the other one is clutching her throat and wrote GET THE NURSE on her whiteboard, and these three people want pain meds."
Alarms are going off, and we're short CNAs again, so the call bells never stop, and we have several fall risk patients who are busy getting up and trying to fall CONSTANTLY. Meanwhile the first patient is ****** when I run back in an hour later with the extra ginger ale and a card with the hairdressing appt. wondering why I took so long. Then when I finally get around at 11 am to getting the last of my 9am meds done, OOPS, they are at therapy, or bingo, or god knows where, or the housekeeper has her cart blocking off the door and floor sopping wet so that I slip and spill the 30 pills, five liquids, 3 lidoderm patches, spiriva and advair inhalers, nose spray, Voltaren Gel, the person's hearing aide, the lovely metamucil and miralax cocktail and the eyedrops this person requires each and every day just to stay alive all over the floor gloriously. Guess I shouldn't have tried to take it all in one trip! Excuse me, I'll just be crawling around under the bed trying to find that stray xanax so it can be wasted...

Cynop...sounds like my floor!

**NickiLaughs, ADN, BSN, RN** · Sep 25, 2009

I've learned that nursing is 24 hour care. I work nights and often day's will pass stuff onto me, and I dont' complain, I know they're busy. And I do the same on occasion if I can't get it all done (though they complain sometimes....). One of my favorite nurses always says "nursing is 24 hours you just pick up where they left off." He teaches all his orientees that. As long as the previous nurse took care of major important tasks, the minor ones are no big deal. I would rather have had the blood given for a Hgb of 7.7 then the foley dumped and the room clean or the patient washed.

I'm learning that nursing is all about the big priorities, and the little things should never be stressed. Finding a unit where most nurses see that is a blessing.

Good luck!

fiveofpeep · Sep 25, 2009

my mom always says "nursing is a 24-hour job" and I think this is just as applicable to aides as well...

she uses that mantra to prevent herself from being overly critical of herself or others when things inevitably cant all be finished by change of shift.