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 had adult orthopedic patients overflow on this floor. My shift was 7p-7A. This was a 45 bed floor and we routinely took 15 patients each. We were always full. On a good night, we had four nurses which means that 3 of us had "only" 11 patients while one of us had 12 patients. Those were considered "good" nights and they were rare. There was absolutely no IV team and we had to draw our own admission labs as well as blood cultures on the adults for some reason. We were also responsible for signing off our own charts. Naturally, I had anywhere from 10-12 hours overtime every paycheck because I had to stay late to finish charting, etc. Nurses who couldn't get it all done were excoriated. (guess which category I was in?) One of my coworkers who was actually one of the sweetest, nicest nurses I have ever known told me that they used to provide care to ventilated patients on the floor back in her first days in nursing.
When I moved back to GA, I switched to med-surg. On 3-11 shift, we had 12 patients each but there was an IV team who did everything including giving prn and routine meds. The charge nurse signed off all the orders and made all the phone calls to the docs. I thought I was working at a resort. But in a short period of time, this became harder and harder. The IV team began to be phased out. Staffing ratios were decreased but the patients began to be harder to take care of. We started to provide care that used to be done exclusively in the units.
When I finally left a couple of years ago, we were down to 1:5 ratio on day shift but I was working harder than ever. Patients were sicker, family and doctors were more demanding, and the hospital actually employed nurses whose only job was to walk around and making sure we were spouting our "scripts" and evaluate our customer service abilities. Our nurse manager routinely made comments about how she couldn't understand why we couldn't get our work done when we were taking care of fewer patients. This observation was meant to induce shame and guilt in us nurses. It didn't work on me.
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?
Since I've started, I've noticed the acuity is a bit worse. I've noticed ICU bed are much more in short supply so sicker patients stay on the unit, or they take a long time to get transferred out.
I've also noticed while we've gone to computer charting and flow sheets, instead of those dreaded long narrative notes, we keep getting a new form to fill out, either by hand or on the computer. Usually the forms are driven by JACHO or to prevent lawsuits, or in response to a lawsuit we've had. Things forms include pain control issues, restraints, and teaching, all of which have been a major focus of JACHO.
Since I've started nursing there have been major studies published about the prevalence of medication/hospital errors, as well as studies proving better patient outcomes/safety, as well as less nurse burnout related to lowered RN to paitent ratios.
No, I don't long for the good old days, they were rough then and are still rough. I try to do my best, to advocate for better, but if I didn't like it, I can always quit and find another profression or job.
I might add that when I advocate and complain about my current 8:1 ratio, it does me no good whatsoever to say "when I was a nurse in the old days I had 12:1, so quit your whining".
Last edit by 3rdShiftGuy on Feb 13, '05
Feb 13, '05
I've only been a nurse since 1997. I am fairly new to the game, but my family has a LOOOONG history in nursing going back to my grandmother graduating her school in 1922. I have two cousins whose nursing careers span greater than 35 years.....So i guess I can't talk about the 'bad old days" but I am not blind or unable to hear and see what used to be and also, what is going on today. I think in some ways, things are getting worse than better.......(HMOs and insurance companies running things, not good)....however....
I do like that nurses are standing up for themselves, the profession and their patients much more..... THIS I see as very positive. I see some AMAZING people here at the boards and feel proud to be in your ranks.
Now if only we could unite on the other huge issues facing us.
Last edit by SmilingBluEyes on Feb 13, '05