Are you able to provide "ideal" nursing care for your patients?

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    I am curious how the reality of the kind of nursing care you can provide for your patients compares to the standards of care set up by your organization or that you learned in nursing school. Do you have any specific examples of the gap.

    [This message has been edited by Anita_novice (edited December 15, 2000).]
  2. 12 Comments so far...

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    Oh my word! Do you know what you're asking? I can think of one in particular. I was working TCU, assigned twelve patients. The unit is shaped like a C, and I had the back end, starting close to one end of the hall, around the back end, and down the other side. I was so swamped, that I could NOT get to the other side of the hall for a full two hours. I did not know if my patients were dead or alive. This is so unsafe! Many times, on Rehab, there are just two of us, trying to get all the people up, toileted, dressed, am care, etc., and we have NO idea what's taking place down the hall; who's out of bed without help, who wet the bed because they HAD no help, who may have fallen because they have a TBI and they're impulsive, with poor balance, and no short term memory? I know others will share their stories. Now that I've written these, I can think of some absolute horror stories, that I'm trying to forget!
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    Hi Anita. We have been experiencing a culture clash between "business" and "humanity" for lack of better terms. The reality of nursing practice is that direct care nurses are expected by their patients/families/physicians to provide compassionate, prudent, competent care. The problem and reality is that money dictates how much, when, what, why we administer care. Nursing as a group is still ranked high by patients on the satisfaction scale. However, it is increasingly difficult to provide the type of care we were trained to because of having to clear hurdles of stringent rules, regs, licensure, accreditation, insurance approvals, legal concerns, and so on. We are to the point that we can no longer shield our patients from vultures, parasites, and cowardly management. The sad part about it is that if nursing educators were providing all this reality to nursing students, I believe we would see much less interest in nursing then we do, and the graduation rates would be even lower. I don't know if socialized medicine in its current state is the solution, but I do know that for a country (USA) that utilizes the lion's share of the world's resources, it is pitiful to see the same type of rationing of services and care that we are told that socialized countries engage in. Our problems, in my opinion, are mostly due to greed, irrational thinking, and poor assessment of the long-term consequences of exploiting sickness, among others.
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    The only time I have felt like I was providing "ideal" care is when I have had a one on one pt asignment (I do ICU so it does happen every few weeks).Even with the baddest sickest patient, then EVERYTHING gets done, all mouth care, turns, suctioning, cultures/labs/ABG's, vitals q 15 min if need be, and discussing the situation realistically and appropriately with the family.
    My Max assignment is two pts and even with that small amount if one gets busy- has tests/problems, sometimes I feel like the other pt is not getting 100% care, or the family is not getting their questions answered appropriately. A lot of this has to do with the rules and regs MiJourney pointed out- there is a ton of double documentation being done, and a lot of messing around tog et orders that are needed. I know I am in a good position with only 2 pts, but even then, the needs that they have sometimes preclude really 100% good care. (I don't know how Med Surg nurses do it, I freak if I get floated to a step down floor where only some of the pts are on tele. I am always paranoid the non-tele ones are going to have their heart quit and no one will know!)
    One of the best things in school that helped us prepare for reality was a rotation where we took 5 pts each and had one student be "in charge" of three others, quite the eye opener. I knew from that experience that I had to go to ICU to give the kind of care i wanted to give, (and to see the kind of sickie pts I like).
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    I have to tell you I am very disappointed I am a new RN but I have been around pts for over 10 yrs now (emt, aide secretary) I never thought that"I" the big patient advocate as I thought I was would become a RN only to have less time with my pts. I truely thought becaoming a proffesional would allow me to make a difference in someones life HA!!!All I do now is learn how to play beat the clock and treat pts not people. I have only been a ADN RN for 1month and I have already started preparing for my BSN. I cant stay here there is now room for "really caring for people" on the busy med surg units .Wow am I disappointed!!! Any feed back whole be greatly appreciated
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    Ah Yes Anita . Can we give the ideal care? I still strive for it. I know most of the replies were from acute care nurses, but it isn't ant better here in LTC. Just this morning I arrived to my unit (22 pt. early Alzheimer), the night nurse had worked alone and she had no previous experience on the unit. Needless to say she didn't have the usual night shift duties done. Well, on top of that none of my Cna's showed for work.(2) So here I was with 22 confused residents and one hour to get them up for breakfast. I was dripping wet within minutes. (of course the boiler was screwy too, it was 80 degrees)Ideally everyone would have had help getting A PTA cleaning, assist getting appropriate
    clothing etc. Talk about doing 10 things at once. Everyone got up and ate within 30 minutes of their usual time. I did finally end up with help after a couple hours. This is just a small sample of what happens daily. Lets not even talk about things like no linen, towels clean clothes. Long term care is fraught with problems, short staffing and over worked staff are justpart of it. Luckily I love my job and know I may be the only ally these residents have, so I hang in there. We do need to always strive for the ideal. Mary LPN
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    How about showing up to work with 40 LTC (long term care/nursing home) patients and all they had on 11-7 shift was one nurse and one assistant. You are there, breakfast is coming, meds, insulin checks are way past due, etc., and you still have only one nursing assistant. Residents are wet, dirty, decubs are getting worse. You are on the phone, calling and looking for ANY warm able bodied person to come and help you. Of course, you have to help feed all the spoon fed residents, because one may be your mother and they have to eat. Then when you are finally able to start giving 9:00 am meds at 10:30 am, well, it gets worse. The administrators are reluctant to fire the "no show CNA's" because they have a hard time filling the positions. Who can blame the CNA's for not showing up? They can get a job at Wal-Mart making more money. LONG TERM CARE CNA'S NEED BETTER PAY! I have been there and done that way, way too many times. I have talked to many LTC nurses and assistants and it is like this everywhere. With all the new Medicare restrictions (old MDS nurse) and the increased documentation, it is getting worse and worse.
    There are more and more family members seeing the increased "lack of care" and going to lawyers in droves. My last 6 months of nursing was seeing my administrators more and more going to court.
    Very scary. Keep your nursing malpractice insurance in force. That is my best advice.

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    Idealatry vs Idolatry?

    Well it all depends on what your "ideals" are. What is taught in Nursing school and spouted about by those who have time to write books, is a far cry from what happens where the rest of us work. My ideal day involves giving the best care that I can. I'll try my darndest to see that they live another 12 hours........unless it's their time to go and then I will do my compassionate best to see that their last few hours are painfree and hanging out with family if at all possible. There are many concepts that don't match reality. I can not count the times that weighing a patient (in the old days with some horrid lifting kind of scale) killed them. Or even turning them to clean the linen. So, that "turn Q2 and bathe daily" concept goes out the window, doesn't it? To me, "ideal" means whatever is the best thing that I can do within my 12 hour period, in terms of assisting another human being who is on the suffering end of the stick.

    p.rabbit
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    I have been a nurse for almost three years and I have YET to sit in a chair and chat with one of my pts--the aquity is so high now that all you are doing is tx, meds, walking, make beds, do baths, PAPERWORK and repeat again in two hours. Before you know it it is 1400 or 2300 and God forbid you should work 5 minutes passed your scheduled shift because then it's more paper work to justify to your manager why you were late punching out--
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    p.rabbit...in "the old days" with a lifting device to weigh people? We do that now! In our 18-bed ICU we don't have a single weigh bed or 'critical care bed.' We still use that old lifting bedscale device. It is HORRID.

    As far as providing ideal care...no way. I work in critical care and we are supposed to have no more than a 2:1 ratio. Hah. Has been running 3:1 for about 6 months now and guess what? Lately we're up to 4:1. Intensive care my a**. The ONLY patient I've ever seen get 1:1 care (as deliberate, not as low census) was a 36-year-old man with a PRIAPISM!!! The physicians (all male) were FREAKED and this guy got more attention than any single critical care patient I've ever seen. Also more pain meds than any one else. Yeesh.


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