Is there any help for this old nurse lost in new age nursing??

[coolnurseclub, RN]

I have been a med surg nurse for 20 plus years. I worked at the same hospital for 20 of those years. I was terminated because I simply cannot keep up any longer. I have accepted and learned CPOE. med scanning,computerized charting, etc. BUT...I cannot go completely "paperless" and always chart in "real time" . ( just to mention two out of many gripes).

The last year of my employment at this facility that I loved and grew up with, changed administration when 2 new hospitals opened in the area. During that time most of us "older" nurses (highest paid) either mysteriously left or retired early after years of employment, all being replaced by new grads. No offense to new grads, you are very much needed and have been trained in the new ways.

I feel like an old dog being kicked to the curb. I am a good, caring nurse. Spent "too much time with my patients". Forgot twice to document if smoking cessation education was given and no flu and pneumonia vaccine status documented. That won't happen again!

So what if I was trying to keep my patient from coding trying to get a transfer to ICU all by myself while all the docs and charge nurses and supervisors were at their morning meetings and not responding to pages "in a timely manner" sooooo... I didn't chart or give all my meds in that "timely manner" many times and have been doing the same since I was a new nurse. That is fact and I'm sure many of you will agree you've had to do the same.

I guess I just don't know how to be a nurse any longer. Can anyone relate to this?

I don't know what to do. I can't retire (lost most of it in the '90's) and had to live off the rest when I lost my job. Its a dog-eat-dog world out there and new nurses are in demand. I am 53 years old and never thought the career of my dreams would end up this way.

I do start a new job in a LTC facility next week. Maybe this will work out. I'm too old and poor to go back to school now.

My greatest advice to all you new nurses is, hang in there and take good care of me when I need you, and start putting in a lot for your retirement right from the start. I truly have been traumatized to the point I feel incompetent and I know that is not the case.(PTSD)

Please help me guys! I need feedback!

[NursesRmofun, ASN, RN]

I'm an old nurse. I have worked many areas, but mostly hospital med/surg and oncology. I am a ASN, but started as a LPN for the first half of my time as a nurse. I can understand your feelings. The new charting and systems are not pleasant for me....but I see their value...at least the medication one. I think I might just make it until retirement from a working nurse point of view, but it won't be easy. I liked the old ways better....but all we can do is what we can do. Were you fired or asked to resign? That is tough. LTC might be better for you, though it really isn't all light and sun beams either- by a long shot.

[CBlover, BSN, RN]

I feel so sorry for you!! What a shame you feel kicked to the curb. I'm a young nurse (27) so I'm familiar with all the space age stuff, but I've worked with some much older (and better nurses!) and they struggled too. I hope your new job goes well. ((Hugs))

[GuEsT78]

For a time, I wondered why my parents rebelled against computers. My dad never learned how to use them and my mother retired from the Department of Agriculture to avoid learning computers at work. They drew the line at using a cell phone as a phone only.

Then I recall all the changes they had adopted in their lives. My father, born in 1921, grew up in a home lit by candles and kerosine lanterns. There were no radios. News came days later through a newspaper. Virtually everything they needed, they grew or made themselves.

And yet they adapted and changed. As a boy, my dad helped put in and maintain an electric generator to light their home. He and his neighbors strung wires from tree-to-tree to give the community a phone system. His home was the "switchboard" between the north-south line and the east-west line. In World War II, he gathered weather data in central Africa. While I was growing up he managed a power company supplying power to rural areas. After he retired, he and my mother traveled all over the world on vacation. Compare the last to my mother's parents, who rarely traveled more that thirty miles from their farm.

The changes they went through in the lifetime—and accepted—were far greater than anyone living today will have to cope with. Changing from a feature phone to a smartphone and a smartphone to a newer model is nothing in comparison to adapting to electric lighting, air travel, radio and television. That's why it's wrong to claim there's something wrong with the when, faced in their seventies with computers and the Internet, they threw up their hands and say "no more."

And keep in mind that they knew far more about the changes they went through that those going up today. My dad knew how to create a phone system and fix a Model T. Do today's adults, with their cell phones and complex cars, understand how they work or how to fix them? Almost certainly not.

You're a generation removed from my parents who, were they still alive, would be in their nineties. But like them, you've probably seen more changes in nursing than those younger will ever see and adapted to them well. You've also kept your attention directed to where it matters, on your patients.

------

Recently, I underwent my first hospitalization ever, three nights for prostate woes. The nurses who care for me were great, but I could also see with them, and with my family physician, that computers and other gadgets are intruding in the physician-nurse with patient relationship. A machine took my blood pressure, which they then need to enter into a computer. Half their time in my room centered on fiddling with it. My family physician spends about half his time with me staring at a computer screen because he now has to enter so much data it can't wait until later. And the hall at my urologist is filled with screen after screen, one for each exam room.

All that draws attention away from the one-on-one interactions that are so important at giving good care. I suspect soon hospital floors will look like our streets. Rather than looking up and out at patients and other staff, each nurse will be staring down at a screen, confusing it with the more important things in front of their eyes. It'll be like one of the scenes in a Pink Panther movie, where Inspector Cleauseau hassles a man about whether he has a license for his monkey while the bank behind him is robbed.

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Years ago, when I worked on a Hem-Onc unit caring for kids from birth to nine with cancers, particularly leukemia, I rebelled against some of the expectations the hospital had for me. I was expected to collect numbers, record them (then on paper), and report when any got out of line. I did that, but I also watched my young patients like a hawk, looking for the subtle changes in behavior that can come before the numbers go bad. On two occasions, I was able to get intervention in play before those numbers turned sour. Both needed to be rushed to the ICU. I speeded that up.

One reason I was able to do that was because I had no screens to draw off my attention. Our paper notes were expected to be terse. We weren't expected to be data collection engines for who knows what purpose. That was good. What's going on today, nurses becoming little more that data scribes, may turn out to have serious downsides.

----

There's even a chilling parallel coming out of research with college students. They've compared students who take notes the traditional way with those who enter them on laptops. The result was clear. Those taking paper notes learned more and did better on tests.

The researchers surmise that, because handwriting is slower, those students had to understand what the professor was saying and process it enough to summarize the content. On the other hand, students using computers could type fast. They took more extensive notes, but what they were noting was almost verbatim what the professor was saying. They weren't listening. They weren't processing. They weren't learning. They were simply stenographers.

My fear is that nursing as data collection with have similar results. The focus will be on getting numbers from one source and transcribing them into another with little thought as to their meaning. That could be bad.

----

Aviation has an example. I believe it was in the 1990s that a Florida-bound plane leaving a DC airport failed to achieve enough speed to get airborne and crashed into the icy Potomac River. Their were a number of causes, but one of the critical ones came when the pilot and co-pilot were going through their pre-flight checklist. One said "Anti-icing?" The other said, "Off." Keep in mind the context. Everything outside the plane was iced over and covered with snow. Why did neither see that they're not done a vital step to configure their plane and its engines to take off in below freezing conditions?

They were too caught up in a process to think clearly, and that because our machines blind us to physical realities. We get focused on abstractions on screens and forget the patients lying in front of us.

-----

If you have the time, you might watch this documentary about could have been the worst single-plane aviation disaster in history and one that would have taken place on the most sophisticated and computerized airline in existence, the giant Airbus 380. The pilots brought it in safely because they learned to see beyond the distracting data their computers were spitting out and simply fly the plane themselves, using their own judgment about what to do. They used "old school" flying.

Machines only see what we program them to see. One of the wonders of the human mind is that we can see beyond mere data and draw on our intuition for answers that defy explanation. Anything that distracts us from that will have bad consequences.

------

Things may be changing now, but if you wait, I suspect hospital nursing will again recognize the value of your hands-on, patient-centric "old nurse" skills. If we don't learn to master our machines, they will master us.

To paraphrase J. R. R. Tolkien. "All that glitters is not gold. All that's new is not better."

[middleagednurse]

Hospitals prefer new grads. Older nurses usually do get kicked to the curb. You need to look for the jobs that the kids don't want. LTC, Home Health, etc. Your experience will be valued.

[2k15NurseExtern4u, BSN, RN]

I have been a med surg nurse for 20 plus years. I worked at the same hospital for 20 of those. I was terminated because I simply cannot keep up any longer. I have accepted and learned CPOE. med scanning,computerized charting, etc. BUT...I cannot go completely "paperless" and always chart in "real time" . ( just to mention two out of many gripes). The last year of my employment at this facility that I loved and grew up with, changed administration when 2 new hospitals opened in the area. During that time most of us "older" nurses (highest paid) either mysteriously left or retired early after years of employment, all being replaced by new grads. No offense to new grads, you are very much needed and have been trained in the new ways. I feel like an old dog being kicked to the curb. I am a good, caring nurse. Spent "too much time with my patients". Forgot twice to document if smoking cessation education was given and no flu and pneumonia vaccine status documented. That won't happen again! So what if I was trying to keep my patient from coding trying to get a transfer to ICU all by myself while all the docs and charge nurses and supervisors were at their morning meetings and not responding to pages "in a timely manner" sooooo... I didn't chart or give all my meds in that "timely manner" many times and have been doing the same since I was a new nurse. That is fact and I'm sure many of you will agree you've had to do the same. I guess I just don't know how to be a nurse any longer. Can anyone relate to this? I don't know what to do. I can't retire (lost most of it in the '90's) and had to live off the rest when I lost my job. Its a dog-eat-dog world out there and new nurses are in demand. I am 53 years old and never thought the career of my dreams would end up this way. I do start a new job in a LTC facility next week. Maybe this will work out. I'm too old and poor to go back to school now. My greatest advice to all you new nurses is, hang in there and take good care of me when I need you, and start putting in a lot for your retirement right from the start. I truly have been traumatized to the point I feel incompetent and I know that is not the case.(PTSD) Please help me guys! I need feedback!

I am SO sorry that this happened to you. You seem like a caring and respectable and COMPETENT nurse. None of us are perfect and we all make mistakes, but for the hospital to let you go after you gave them 20 years of your life is tacky as hell and the scum of the earth. Total and utter BS that they would treat you this way. I dont graduate til december, but i will DEFINITELY take your advice to heart. I feel for you sister. You are in my prayers. Hang in there..

[2k15NurseExtern4u, BSN, RN]

There's even a chilling parallel coming out of research with college students. They've compared students who take notes the traditional way with those who enter them on laptops. The result was clear. Those taking paper notes learned more and did better on tests.

The researchers surmise that, because handwriting is slower, those students had to understand what the professor was saying and process it enough to summarize the content. On the other hand, students using computers could type fast. They took more extensive notes, but what they were noting was almost verbatim what the professor was saying. They weren't listening. They weren't processing. They weren't learning. They were simply stenographers.

[/i]

THIS!!! I thought it would be more effecient to bring my laptop to class and type notes in lecture. I was right. It was more EFFECIENT but wayy less EFFECTIVE than taking hamd written notes. I did the worst that semester and barely passed.

[2k15NurseExtern4u, BSN, RN]

Hospitals prefer new grads. Older nurses usually do get kicked to the curb. You need to look for the jobs that the kids don't want. LTC, Home Health, etc. Your experience will be valued.

I wish it wasn't this way. I look forward to learning from seasoned nurses in the hospitals. I had one nurse, that was very much older than me, as a clinical instructor last semester and she was the absolute best. Under her wing, I learned more in one shift than i had in the whole semester. I will never forget her.

[Libby1987]

I'm 50, educated in the 80's, and managed to keep up with the technology and have tried to help our older nurses make the transition. I'm sorry that it has been rough and demoralizing for you.

[Jensmom7, BSN, RN]

I have been a med surg nurse for 20 plus years. I worked at the same hospital for 20 of those. I was terminated because I simply cannot keep up any longer. I have accepted and learned CPOE. med scanning,computerized charting, etc. BUT...I cannot go completely "paperless" and always chart in "real time" . ( just to mention two out of many gripes). The last year of my employment at this facility that I loved and grew up with, changed administration when 2 new hospitals opened in the area. During that time most of us "older" nurses (highest paid) either mysteriously left or retired early after years of employment, all being replaced by new grads. No offense to new grads, you are very much needed and have been trained in the new ways. I feel like an old dog being kicked to the curb. I am a good, caring nurse. Spent "too much time with my patients". Forgot twice to document if smoking cessation education was given and no flu and pneumonia vaccine status documented. That won't happen again! So what if I was trying to keep my patient from coding trying to get a transfer to ICU all by myself while all the docs and charge nurses and supervisors were at their morning meetings and not responding to pages "in a timely manner" sooooo... I didn't chart or give all my meds in that "timely manner" many times and have been doing the same since I was a new nurse. That is fact and I'm sure many of you will agree you've had to do the same. I guess I just don't know how to be a nurse any longer. Can anyone relate to this? I don't know what to do. I can't retire (lost most of it in the '90's) and had to live off the rest when I lost my job. Its a dog-eat-dog world out there and new nurses are in demand. I am 53 years old and never thought the career of my dreams would end up this way. I do start a new job in a LTC facility next week. Maybe this will work out. I'm too old and poor to go back to school now. My greatest advice to all you new nurses is, hang in there and take good care of me when I need you, and start putting in a lot for your retirement right from the start. I truly have been traumatized to the point I feel incompetent and I know that is not the case.(PTSD) Please help me guys! I need feedback!

When I got my first job as an RNLP, I was 22, fresh out of college, with a shiny new BSN. I passed Boards, earned the right to drop the LP, and started on my 36 year (and counting) journey. That was in 1979.

I was a bedside Nurse for 26 years, first in Peds, then MedSurg. I had no desire to go into management-mainly because I didn't like any of the people who were lol. I also had no desire to play the hospital politics game.

I realize most newly minted nurses now would probably consider me a failure, since I "only" wanted to do direct patient care, and they are trying to figure out how to get away from actually touching sick people as quickly as possible.

I know that I would not be able to keep up now, not after being away for 10 years. I wouldn't even want to try. The technology doesn't faze me, I love it. But I'm a dinosaur. That doesn't bother me, because over the last 10 years, I found my niche.

I did Home Care for awhile, but the driving and the feeling of wasting my time with noncompliant patients showed me that it wasn't what I was looking for.

And then I found Hospice. True, many agencies are on computer for charting, but the pace is less frenetic, there really aren't any emergencies in Hospice, it's fairly low tech (we have the occasional Pleurex drain for malignant pleural effusion, but that's about it).

It's a true team effort, you aren't expected to do ALL the things (yes, you manage the care, but you have people watching your back).

You might want to check out some agencies in your area. Most now have dedicated after hours and weekend staff, so on-call isn't the soul sucker it used to be. You may have a fair amount of driving, but some companies also maintain inpatient Hospice units.

Your MedSurg background would be a plus, and you would learn Hospice specific information during your orientation.

I work full time, M-F, and have almost no stress. This is what I plan on doing until I retire. You may have been kicked to the curb in favor of young blood who has known the technology practically since birth, but you do not have to stay there.

Taking care of yourself is your first and most important responsibility. Counseling may help you gain your confidence back, and teach you some effective coping skills.

[Oceanpacific]

I'm sorry this has happened to you. I would encourage you not to reject electronic medical records. This will limit you as every facility will be doing it. You may even come to see some of the benefits. Yes, some of it can be templates and clinical reminders BUT you can always add your own observations in your own words. The best records I read are from people who took the time to write a narrative note, even if just a sentence or two at the end of a template.

I'm not sure what you mean by needing to chart "in real time". Best wishes in your new position.

[Anna S, RN]

((((((coolnurseclubRN ))))))

Hugs to you.