BedsideNurse 2,986 Views
Joined: Sep 12, '09;
Posts: 125 (69% Liked)
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If the patient was stable enough to wait until the next shift, okay to wait for your preliminary rounds, + get cleaned up, packed up and medicated, you probably didn't need a physician escort.
Another piece of the problem no-one has mentioned yet is that nursing education has changed and the priority in (some?) BSN programs appears to be grooming students for nurse practitioner school. Some nurse educators who participate in this forum have intimated that this is the case. It is not uncommon to read comments on this forum from students who express shock, disappointment, and confusion that they are not receiving the bedside clinical training/experience they had expected and believed they would receive when they signed up for their program, and to hear them say they don't feel prepared to be nurses. I heard this myself from generic BSN students during my ADN-BSN program many years ago. In my observation/experience, health care facilities expect to hire new graduate licensed nurses who have been trained and are able to provide acute care bedside nursing at the beginner level, and many facilities expect new graduate nurses to be able function safely at a beginner level without having to commit a lot of resources beyond orientation to teaching new graduates things the facility believes they should have learned in nursing school.
It's not just southern non union hospitals that have crappy staffing. I've worked in northern union hospitals where the ratios sucked too.
Legalized ratios seem to be working in CA. It was great when I worked there, but that was years ago. Quite unfortunately hospitals in MA have undercut the ratio law by "acuity tools" that manipulate the numbers to make the law meaningless. So, ratio laws are not the end all be all unless it is stipulated that the numbers can't be manipulated by hospitals. Basically 2 patients must = 2 patients, 3 patients must =3, etc... (vs. "he's not that sick" so he counts as 1/3). I was so happy when the MA ICU staffing law was passed and now it's just worthless. *Super* disappointing.
Errors arise from the absolute panic nurses are in trying to get everything done. Often units have no secretary, and there are one to two techs for an entire tele or med-surg floor, and one of them may have to be a sitter....ICU is lucky to have techs, even when taking 2-3 patients, frequently with multiple admissions & transfers, answering phones, dealing with families & visitors, + passing meds, turning and suctioning patients + giving other basic nursing care, and God forbid if you have someone who is trying to circle the drain. Rapids, code blues, outrageous charting requirements, and if you've drawn the short straw, charge duties so you can deal with patient assignments and staffing issues. It's way too much everyday.
Change has to come from the top. All this is upper management squeezing the life out of the supervisors and unit managers to have bare bones staffing, regardless of staff feedback and the negative patient care effects. Somehow, CEO's are going to have to actually start believing that on the ground hands on care makes a difference in patient outcomes, and they are going to have to actually want good care for the patients, at least want it enough that they are willing to pay a little more to get it. As we can see, for now, they are not. We all hear about "patient care is our first priority" at the orientations or occasional pow wows, but we know it's just bs, because if they actually believed "Patients are #1" or whatever, they wouldn't leave one tech and 5 nurses for 30 patients. That's sh*t care and everybody knows it. If one patient goes bad it's a disaster. Pt outcomes and satisfaction suffer terribly because we just need "another set of hands" to help us. No one is lazy; we just want to be enabled to give proper nursing care to all our patients if we bust it for our entire 8 or 12 hour shift.
Anyhow, because of staffing, instead of practicing Nursing Excellence, we are more often than not practicing Seat of Your Pants Nursing, mainly putting out fires and barely keeping the head above the water. That means rush-rush-rush, & by necessity nearly ignoring some patients while dealing with the other needier ones, with very little time for double checking, reassessments, and thinking things through, and hence the perfect storm for errors. Then when someone makes an error that we get dinged for, everyone swoops in so this "never happens again." What happens then? Instead of looking at the root cause and giving the floor more HELP, they add more processes, checklists, and paperwork to an already overwhelmed nursing staff.
Now management is coming back in with that ridiculous and insulting "huddling" crap they had going years ago. Yeah, we are woefully and potentially dangerously understaffed, but we are supposed to just huddle, and if we work together as a team, then we can get through it.... Like it's just us not working as a team or putting our heads together that's the problem. Scripting, huddling...my head is going to explode. A long and meandering answer, but in a nutshell, in looking at error prevention, it's generally all about staffing.
You could just tell them you're trying to get healthier and decided cutting out alcohol was a good place to start. You could throw in something about trying to eat better or exercise too. Usually people will get start talking about different diets or the next 5k, what they are doing or did, or heard about, successes/failures, etc..and get side tracked off the alcohol. I wouldn't order the Blooming Onion after saying it, but...it sounds like something reasonable, and then you don't have to keep thinking up reasons. Just be loose-y goose-y about it. You're self conscious about it and plus not doing it leaves a void, so it seems like a bigger deal to you than others, even if they poke you a little about it. Also, once you stop drinking for a while it won't be so integral to your activities and you'll start forgetting about it. Reminds me of years ago when I quit smoking. I didn't realize it before I quit, but my whole life revolved around when I was going to smoke next. Going for coffee, having a drink, weddings, up to the cabin; all very un-fun when I first quit smoking. Driving or studying was nearly unbearable. Lol. You might you appreciate the teatotaling after a while. There is something to be said about being clear minded. Good luck.
(Oops, meant to reply to someone and inadvertently posted again under my own post)
Ratio laws need to be written in a way that hospitals can't skirt them. Nurse-patient ratios have been made meaningless in many Massachusetts ICU's because hospitals started using bogus acuity tools to bring the actual nurse-patient ratio numbers down on paper. On our unit it says we average 1.5 patients a day, but rare is the day we don't have 2 patients a piece, and we often take a 3rd. It is commonplace to have transferred and admitted to where we've had 4-5 patients in an eight hour shift in ICU (including 2 sick admissions), yet on paper it says 1.3 or 1.5 patients per nurse month after month. I can count on one hand how many times I've had one patient this last year, and a couple of those were actual one to one's, which we have to fight over now as well. It's very disappointing they can do this. Ratios should not be able to be manipulated. 5 patients should mean 5, 2 should mean 2, etc...Not, well, he isn't that sick according to these calculations so he counts as as 1/3, or whatever. And then there's the "we can't turn anyone away" story. It's overwhelming and I'll be glad to retire, quite honestly.
I had trouble with my milk supply & I had to pump at work if I wanted to continue to breastfeed, and since my first son tolerated no formula, it was really a dire situation. It'd take 10 minutes to run to the bathroom, wash up, grab a drink, maybe get a small snack, then get my supplies together. I'd pump for 15-18 minutes, quickly put everything away and get back to work. I never took more than my 30 minute lunch. Honestly it was hard enough to leave the floor for a full 30 minutes and I never really took full lunches before that, but out of necessity when I was nursing I needed to. I did my best to nurse right before I left the house, and I'd nurse as soon as I'd get home, but I'd still have to pump once at work or I'd have issues. So it was rush-rush-rush to pump then back to the races trying to catch up after being gone for 30 minutes. It certainly wasn't a restful break. Anyway, the government puts these laws into place and then hospitals respond by punishing the other nursing staff in implementing them. I'm not sure what the answer is, but especially if you had several nursing moms on a unit, I can see how this would get pretty old. Nurses are stretched to capacity now and it's no small favor to have them holding the fort down every time they come in while people are off pumping. Women are encouraged to breastfeed for one year, and some people do it for longer. That's a lot of fort holding. Also, supposedly we should be supporting and encouraging breastfeeding mothers. If everyone around them is pissed and they feel resented, or they feel like they really just can't leave the floor because of further burdening the staff, then that isn't really supporting breastfeeding now is it? And then there are always the system abusers...It sucks. :/
I get that things are getting confusing, especially now that we've went from "you're born that way" to "you are whatever you say you are, and it's fluid." regarding orientation and gender, but I honestly doubt anyone--including grade schoolers--needs to have words like gay and bisexual defined. My kids are in high school and they've been inundated with gay and trans EDU near daily since about 4th grade. But even for the older nurses, unless they live under a rock, (and maybe even then), I think we all have that down. Just sayin.'
People also used to respect clergy, police officers, teachers, the military, and the president for that matter. Today almost nothing is sacred and the lack of respect for anyone is on the rise. It's called a rotting culture and I don't see that getting better. Nursing is rewarding in a lot of ways, but if you are looking to feel respected day in and day out you will wind up disappointed.
So funny!! Only three days a week! hahaha
I love/hate them. I too work nights. I basically spend my life mean, moody, sleep deprived and grouchy, in a dark and dirty house, not knowing one day from the next. But only on three days a week.
I used to like 12 shifts but now that I'm older they wear me out and prefer 8's, but only if not full time. 5 days a week is too many days at the hospital!
Ratio laws are meaningless in MA. The hospitals use bogus acuity tools and nurses in ICU get tripled up all the time. If there is a way hospitals here can wiggle out of ratios they will and they do and it sucks. I was so happy when the law passed and now it's clear it doesn't mean anything here. The nurses union has helped zero with enforcing staffing ratios. Very disappointing for nursing and most of all for the patients.
Before you quit you should keep in mind that CNA experience will help you in your psych endeavors, as CNA's are on the front lines. Not only do they provide necessary basic nursing care, they deal with difficult patients and families, life and death situations, acute and chronic illness and injury, sad scenarios, surprising recoveries, abusers and the abused, depression, anxiety, addiction...and that's a really short list. If you can try to power through the anxiety of being new and uncomfortable (and are willing to come to terms with the chronic understaffing you are guaranteed as a tech) you may find yourself deriving some satisfaction from the work, as well as learning a lot you can extrapolate to clinical psychology.
Incidentally, working in psych can be very overwhelming as well, from what I've seen. I've known a number of people that went to school for psych for years on end, but then when they had to start dealing with psych patients in a clinical setting they quit school, saying it wasn't what they thought, it was too stressful, not for them, etc... Not wanting to sound downtrodden, but if you haven't, make sure you do some self evaluation and are clear at what people actually do as clinical psychologists. I guess it goes without saying, but it isn't a walk in the park either. All patient care has some common denominators.
It sounds like their every other weekend policy isn't really the policy for everyone, so it would seem you have a chance to get your Sundays off. Also, if that was an agreement during hire I would think you could bring it up to your boss.
I've never seen a place that was flexible about the weekends. In all the hospitals and other facilities I've worked at, everyone except management rotated every other weekend, and where I'm at now, you can't even request one of your weekend days off. You have to find (non existent) coverage yourself. It sucks because, basically, if anything comes up that you'd like to go to on your weekend, a concert, a child's recital, a sporting event, whatever, you're pretty much screwed. :/
But as far as church goes, until it gets sorted out, you could go to church on your Sunday off, and then on the Sunday's you work just watch church online with the family Sunday night, vs. being stressed about being late for work and dealing with potentially irate coworkers waiting for you, etc...Good luck.
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