How would you change patient care?

  1. I have grown weary of the posts about what is wrong with healthcare. Maybe there are those of you out there, who have great ideas about how to deal with high patient acurity, and patient/staff ratios. I'm not talking about, what education level you must have, or who is better at what. But how would you change nursing care, in this present environement, to improve patient care. I know we all don't work in the same settings, but I also beleive there has to be a way to deal with understaffing, as this is what is out there now. How would you use your staff to maximize their skills, and their time. What methods do you use on the floor, unit, to plan out how you will give care each day. How do you organize your day, so you're able to care for the patients assigned.

    I have been asked this question by a new nurse, who was struggling, trying to manage her time more effectively. Maybe this would be a way for new nurses, nurses coming back into the professions, and or others to learn something helpful. It may also be a way for the more experienced, to learn from the new nurses, who may have fresh eyes, and new ideas, we could benefit from. I hope you will find this worthy of your input. Thank you.

    Brownie

    [This message has been edited by Brownms46 (edited March 30, 2001).]

    [This message has been edited by Brownms46 (edited March 30, 2001).]
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  2. 5 Comments

  3. by   kjmta57
    Nurse to patient ratio is a big issue I feel.You dont know some days if you did your best because your to busy trying to stay afloat.I would like to see states get very involved in step-up programs for nurses,in fact I'm a big advocate in this area,because time and money is a big issue in nursing education.I think insurances should have to give a certain % to these programs.Vacation and retirement plans should also be a mandatory basis of employment.And the hospitals that say they cant afford it I see very few that cant.Team nursing is a must.Hospitals have gone from it and wished they never did that.But honestly I work in a prison and our issues to a certain point are a little diffrent.
  4. by   Brownms46
    Originally posted by kjmta57:
    Nurse to patient ratio is a big issue I feel.You dont know some days if you did your best because your to busy trying to stay afloat.I would like to see states get very involved in step-up programs for nurses,in fact I'm a big advocate in this area,because time and money is a big issue in nursing education.I think insurances should have to give a certain % to these programs.Vacation and retirement plans should also be a mandatory basis of employment.And the hospitals that say they cant afford it I see very few that cant.Team nursing is a must.Hospitals have gone from it and wished they never did that.But honestly I work in a prison and our issues to a certain point are a little diffrent.
    I also agree, that team nursing was a better approach to care for patients than primary care is. In theory primary care would be the idea way to care for patients, but with the high acurity of patients now, it's doesn't seem feasible. One patient can bogg down a nurse, so she doesn't get to spend as much time with her other patients. In team nursing, as some hospital here use, your team members can help you out more. I worked in a hospital here per diem, and they're again using team nursing. The charge nurse also only takes patients in a pinch, and is more available to help others. The RN, and the LPN would start their rounds together, assessed the patient, obtain vital signs, etc, etc,. We would ask the patients pain, and other needs on our first rounds, and provide all care needed at that time. If one had to go to another room, to answer a call light, the other would continue to care for the other patient, they had started on. It's also a way to get feedback from someone, without asking someone else, who has their own patients to deal with. When you need help preforming care, you have the help there.
    We would continually kept each other updated, as to what was going on, and this eleviated the fear of something not being done. Sometimes in primary nursing, you can come to the rescue of a nurse drowning in demanding pts, who are freg. on the call light. But most of the time, everyone is just too busy themselves to help.

    I wonder how others feel about primary nursing, and if they see it as something that should be changed. Does anyone else think team nursing is the way to go, or is there a better way?

    Brownie


    [This message has been edited by Brownms46 (edited March 30, 2001).]
  5. by   Q.
    I'm not too familiar with team nursing - we seem to focus mainly on primary nursing at my facilities.

    For Labor and Delivery, this is an excellent model and I think works very well. Post-partum is another issue. This is where I think team nursing may be helpful.

    As a charge nurse, we are expected to take a full load of patients, act as a resource for the other nurses, and coordinate and plan for staffing for the following shift. This is a serious drain and often deflects away from patient care. Post-partum teaching is where it is hit the most. When you have 5 mom/baby diads that all need assistance with breastfeeding, assessments, and perhaps social issues that need to be addressed, teaching gets tossed to the wayside. This is where I think the team nursing may help. If we had LPNs to round with us, we as RNs could focus on the patient teaching a little more so that these new moms aren't tossed out of the hospital in 48hours without any clue on how to take care of a brand new baby.

    I don't have many ideas on how I would change patient care, but for post-partum, your model seems to be a good fit.
  6. by   Brownms46
    Originally posted by Susy K:
    I'm not too familiar with team nursing - we seem to focus mainly on primary nursing at my facilities.

    For Labor and Delivery, this is an excellent model and I think works very well. Post-partum is another issue. This is where I think team nursing may be helpful.

    I feel, that if you're in charge, there is no way, you have a pt load. If at all possible, you should be free to take care of the adminstrative, problem solving
    As a charge nurse, we are expected to take a full load of patients, act as a resource for the other nurses, and coordinate and plan for staffing for the following shift. This is a serious drain and often deflects away from patient care. Post-partum teaching is where it is hit the most. When you have 5 mom/baby diads that all need assistance with breastfeeding, assessments, and perhaps social issues that need to be addressed, teaching gets tossed to the wayside. This is where I think the team nursing may help. If we had LPNs to round with us, we as RNs could focus on the patient teaching a little more so that these new moms aren't tossed out of the hospital in 48hours without any clue on how to take care of a brand new baby.

    I don't have many ideas on how I would change patient care, but for post-partum, your model seems to be a good fit.

    I feel it is wrong for the charge nurse to take on all those extra responsibilites. I think this is sometimes why some nurses don't want to be in charge. It is a strain on them emotionally, as well as physically. You can't be everything to everybody, even though I'm sure most of us try.

    I was wondering how your L&D is setup.
    Do you labor more than one patient? Do you have birthing rooms? Are NICU nurses present when there is a possiblity of an baby in distress? Does your unit utilize techs? Who transfers your new moms to the post partum unit? What unit are your preterm moms roomed on? I would just like to know, how your unit functions, and how you organize your shift. Thanks for the input!

    Brownie
  7. by   Mijourney
    Hi Brownms46. I agree with posters who say we need a team approach to patient care; the interdisciplinary team that is. Nurses don't work in a vacuum, and I think that therapists, pharmacists, support staff, etc. should be strongly encouraged to become more engaged and proactive then they currently are in direct patient care without the turf battles that seem to follow when they are consulted.

    Question: Do you feel that it is okay for a therapist to directly contact the physician about a patient after discussing it with you? Or, if a patient was in therapy, and the therapist called the doctor about their findings, would you feel that your authority or care was being threatened?

    As long as nurses are expected to coordinate all aspects of patient care, I feel we should utilize a primary model of care. This will require a significant reduction in the patient load and a readjustment of resources at the administrative level.

    Until we get a true interdisciplinarian team approach to patient care in all settings, I don't feel that any nursing structure of care will work. All practitioners must be unified, without resentment or arrogance, for patient care to truly help the patient.

    PS: Team nursing is a concept I feel that is partially used by management to justify employing less RNs. Irregardless of whether the composition of nursing bedside caregivers is made up of RNs only or a combination of RNs, LPNs, CNAs, the patient load needs to be reduced. As a home care nurse, I'm finding that there are too many patients and families leaving the hospital without the tools needed to be successful at home.

    [This message has been edited by Mijourney (edited April 01, 2001).]

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