Do you feel you have enough time to safely care for your patients?

AMcGee · May 28, 2000

I work in a very busy OB/Gyn office as well as first assisting the surgeons in daily hospital surgery. We take call with our physicians every other night and every other weekend. We average 2 major surgeries a day, then rush to the office to see 20-25 patients. And these are complete head to toe exams, ordering multitudes of diagnostic tests, drawing labs and making sure to Doctor remembers everything. In between all this we average 40 calls a day. I never get a break and average 1 lunch a week. I love my work and I love being a nurse and making a difference in the lives of women each and every day. But there isn't enough time, and I find myself waking up a night trying to remember if I called an insurance company or oredered a sonogram. I find myself calling patients and apologizing as I ask them if I had done something because I can't remember! I work Labor and Delivery in the hospital one or two shifts a month just to keep my skills up, and I find the hospital to be a joy for me. It's always crazy and I have to mop floors after deliveries to get ready for the next patient. But it's nowhere as stressful as the office. I think all RN's should try working in a busy office practice once in awhile and see what most of these doctors go through in one day and what it takes to get a patient to surgery or admitted to the hospital, it would be an eye opener.

Nurse Entrepreneur · May 31, 2000

I work OB in a military facility in the Midwest as a contract nurse to keep my clinical skills up to date and I also own my own consulting business. I don't believe that our patients receive safe care because our LPNs are being replaced by UAPs and our staff atient ratios are unsafe. We don't have the supplies we need for basic patient care due to Department of Defense Budget cuts and spend too much time searching the hospital for supplies that often are not there instead of being at the bedside. I see too many practice and medication errors being made because of poor training and personnel management but it is the nursing staff, not management, not the system, that gets punished.

leia · May 31, 2000

I have to agree with the nurses that said they don't have enough time to safly care for their patient,because nine time out of ten you don't. I have to admit so that ever since I am working on a Stroke/Neuro. ICU things got a little better,usually I have 2-3 Patients to take care of and that is better than on the Station ( Oncologie) I was before.I used to have 12-15 Patients to take care of.For me that was very frustrating because Cancer Patient need a lot of care physically and mentally and I always hated that I somtimes had to leave dying Patient alone just because I had 14 other people to take care of , just hope that never happens to me!! I never had somthing major going wrong on my shift( Thanks God) but it could have easily,because with so many Patients to take care of you can't possibly remember everything.I love my job ,but I know I'll never want to work anywhere else then on a ICU ,at least I just have 2-3 Patients and believe I do a much better job now and the Patients also feel that I have more time to deal with their needs.It is still stressful but much safer!

JillR · May 31, 2000

When I have a hard day at work and get discouraged I come here and read these posts. I work med/surg on the 3-11 shift and usuall have between 4-7 patients with one or two admits, and usually no CNA. After reading these posts, I realize I have nothing to complain about. I am even thinking about printing out some of these posts and taking them to work to show my co-workers. I have no complaints.

angelwings · Jun 1, 2000

I work in a skilled nursing unit at a local hospital and our pts come from the med/surg floors. You can bet that they are just as sick when they come to our floor as they were on the acute side. There are IV ABTs, tube feedings, rehab, wound care, isolation cases, etc. Nursing is also responsible for the respitory treatments. Staffing allows for one licensed nurse and one CNA for up to nine pts. When there are 10-14 pts (and there usually are), we have one and a half nurses and one CNA. We have 12 hr shifts, so one nurse will work half a shift. This works well most of the time, and overall, our pts get very good care. However, there is considerably more paperwork (as well as computer-charting) than on the acute floors, and if it's a busy shift (a pt going downhill; another is agitated and pulling out any tube he/she can get a hold of, or even more time-consuming - a new admission to do), it can be difficult to find time for all that needs to be done.

It all seems to come down to the fact that the skilled nursing unit is for all legal intents and purposes considered long-term care, when in fact, it truly isn't. Most pt stays average 2 to 3 weeks (Medicare doesn't usually allow pts to stay longer). A rare few experience longer stays of 2 or 3 months, but this is not the norm.

Our med/surg floors staff according to pt acquities and the average is 6 - 7 pts per nurse, with one CNA for up to 12 pts. This doesn't seem too bad to me.....

goldilocksrn · Jun 3, 2000

I think it all depends on my luck. 95% of the time I don't have the time I need. Once in a while, there are times when I think I am dreaming, that I can actually sit down with a cup of coffee and chart for 30 minutes uninterrupted, and get out on time for a change. (Those are the times I am sure I have missed something major) I have just decided that I can't take the shortage personal anymore. I am going to do my best, and leave the rest. That is why there is 24 hr nursing care in the hospital.

Mijourney · Jun 4, 2000

Hi,

It is a challenge to have the time to provide quality patient care in any setting. As long as health and medical care are defined in the context of an industry and not a ministry, the issue of time will always be a problem.

tweetieRN · Jun 5, 2000

With the increase in silly paperwork in the last 10 years, I frequently don't feel we have time to give the best care. Our ICU beds have increased, but not the staff. It seems like a lot of the time management only cares about the head count and not the skill levels, so we're often given floats who aren't qualified to care for vents, swans, etc. It also makes things more stressful for them.

stimpyRN · Jun 5, 2000

I don't really think their are any real safe settings left in nursing. With the technology and the turnover we see, just to make a buck, no care is truly good, safe care. I currently work on a surgical floor. On the average-7a to 3p you have 9 to 14 patients, many who are fresh post-ops, on 3 to 11p you can have 14 or more. By the time I go home it is a blur as to what I did do and didn't do. I am currently transferring back to Home Care because I feel I can give better, total nursing care. I am proud to be a nurse. One day soon, when we are in a major nursing crunch our facilities will wake up and make some much needed changes. We all need to hang in there and give our all.

rncountry · Jun 13, 2000

I love nursing, but am currently looking at other career options because it is so difficult to take care of patients with the numbers we work with every day. Does anyone really wonder why there is a nursing shortage? There is a severe shortage where I live and I can no longer feel comfortable working with the staffing we have nearly every day. I hope to start my own business where I can control my hours and family. If I'm going to have to work 60-70 hours a week than I'd rather do it for myself. I will miss nursing a great deal though. I just wish I could run my practice safely and competantly, something the corporate I work for does not consider.

GraceLPN · Jun 20, 2000

I work for an agency primarily in long term care. I could tell you stories that you would not believe. Last night, I worked the night shift in a 100 bed facility with only one other nurse. As an agency nurse, of course I had the skilled side. I was responsible for 48 residents, 15 G-tubes (11 of which were on continuous feeds and 4 bolus feeds), 10 residents on oxygen, 5 residents on antibiotic therapy, one contact isolation, one trach, thirty qshift charts, six diabetics (one brittle with q4hr accuchecks and a S/S), four wounds with dressing changes and all of the other busy work that goes with 3rd shift (calibrating the glucometer, checking the temp of the fridge, etc.) It is a very dangerous situation, however this is not an uncommon situation to walk into. There is such a nursing shortage right now, that it does not matter when I call for a shift, one is always available if I want to work. I do the best I can when I am there and chart like crazy. It has gotten to the point where even if I so much as rub lotion on a patients feet, I chart it. It is a shame that the nursing profession has turned into such a cya situation. I would love to be able to just sit with a resident and talk to them instead of constantly worrying about what I am taking time away from by doing that. Getting out of a facility on time is a rarity anymore. I often refuse to go to places where I don't feel comfortable working (the facility that I was in last night is now on the top of that list).

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"Still defiantly smiling"

Daisy · Jun 21, 2000

Our med/surg unit went to a TEAM concept.This was recommeded by consultants who were paid big bucks to tell us how to do our job. As a RN my team is now 8 or 9 patients with a nursing asistant or sometimes a LPN. Last week when we were really short I had 11 patients with a LPN and a Aide. Did I safely care for the patients? Yes , thanks to my "team", did I feel good about it, no. I really didn't know them by the end of the shift. All I did was task work to get through the day. As a RN, I see that my role should be as a coordinator of care, educator, discharge planner etc. What I am now is a task master with excellent skills. Its a shame what has happended to the profession.