areensee 1,769 Views
Joined Aug 11, '05.
Posts: 68 (37% Liked)
I am so sorry you are experiencing this........... Life is so short, I was so mad I just quit right there and I was out of work for about a month.......
Nursing care is always a balancing act, as is medicine. We try to do the most good and least amount of harm. If you do a search of research articles you will find a great deal of evidence that interrupting sleep does do harm to patients. Now that isn't to say there aren't times when the scale tips in the other direction, and vitals every 4 hours are beneficial, but those decisions should be based on medical necessity, not a blanket policy. We need to move away from doing things because "that's the way we've always done them". If there isn't real proof that what we do is best practice, we can't just pretend that it is and do it anyway. I'm afraid that is the case for routine Q4 hr vitals. Such nursing is not much different than was done in the 1950's and fails to keep up with what we call the science of nursing.
Vitals are done Q4 based on EBP to keep people from crashing, so we can catch the early signs.
And for people with normal circadian rhythms, BPs are usually lowest between 2-4 in the AM.
So, you probably shouldn't "scream" when you're wrong. Louder isn't necessarily better.
I don't doubt that you can catch problems, but that can happen any hour of the day. There's nothing magic about 0300. Besides, as I challenged, where's the evidence based research? Anecdotal evidence is just that, anecdotal. The telemetry unit I worked on also had BP designed to go off automatically, we didn't even need to step in the room, unless the cuff had been removed. I would also question what symptoms of a stroke did you see and how did taking a blood pressure lead you to that determination? And again, give me some sources! Even if you catch one stroke in your lifetime, does that justify the damage done to dozens of other patients through disrupting their sleep?
I see a trend that concerns me greatly over the past 10 years: Students are coming out onto the clinical floors and need waaaaaaay more direction than they used to. The students used to be assigned to the PATIENT, and seek out direction from the Clinical Instructor for guidance.
NOW, the Student Nurse appears to be assigned to the Patient AND the RN, with the Clinical Instructor off somewhere else.
By subjecting patients to unnecessary sleep interactions are we helping or are we increasing the incidence of problems? Give me a source that shows that doing vitals every 4 hours is GOOD for patients! Also, patient's in telemetry are monitored around the clock. If anything goes wrong with the vitals, it is most likely going to be picked up by the person monitoring the telemetry, not the nurse in the room. I'll look into this, but I'm pretty sure there is ample evidence to show that sleep disruption is bad for patients and effects the outcome. If you can find anything to the contrary, post it here. Let's start a real evidence based discusssion.
Wake me up at 0300 and my blood pressure is likely to be abnormally high! Why should this surprise anyone, and why do vitals at 0300? Does it really provide any useful data that can't be obtained 3 or four hours later? Obviously the ICU would be an exception, but in routine acute care! The reason that vitals are "routinely" done every 4 hours is because of the lawyers, not because there is any real evidence to suggest that it is necessary or helpful. I for one reject senseless application of "nursing" tasks that are based on sacred cows and not real scholarly research!
Aside from the fact that the hospitalist in this case is a first class jerk, I've been thinking more about the practice of frequent vitals and all the other horrid things we do to people in the middle of the night. Here's an interesting question. I worked acute care for 15 years and have done vitals at all hours of the day and night. My question is this, is there any evidence that doing so makes any difference in the outcome for our patients? Is there any best practice, any, evidence based practice guidelines? If so, I've never seen them! SO . . . how about some nursing research into the subject? Any takers? Are we simply doing what the administration thinks will open up a bed sooner ($$) or do the things we do actually improve the lives of our patients?
So who authorized the enema on the dementia patient? I'd want to have a word with them. Being a hospice nurse this sounds like something that should not have happened. This very well may have BEEN an assault. It angers me to no end when the right to dignity and comfort are forfeited just because a patient suffers from cognitive impairment. Why wasn't the patient at least given medication to relax him prior to the procedure. Don't we do this much for our pets? Why do we treat our elders with such disdain and dishonor? This is one of the big reasons I left hospital nursing after 15 years. I just got tired of trying to convince people they needed to have painful treatments done that they didn't really want.
I can see something of both sides of the issue, however I think sometimes we forget all about the growth and development theories we learned in school. New nurses are entering the workforce at a very different level than I find myself in, being an RN of 20+ years. Erikson's stages of development would place most new nurses in the "intimacy vs isolation" stage (age 20-25). In this stage, the individual is just learning about the complexities of relationships and learning the value of tenderness and loving. If we approach a person who is working through this stage and tell them "it isn't about your feelings", we ignore the realities of what the new nurse is struggling to learn. It isn't just about learning how to do nursing tasks, it's learning how to relate to a myriad of diverse relationships, colleagues, doctors, patients, families. In response to this, a little understanding and a lot of compassion goes a long ways to retaining and encouraging our new nurses. To do otherwise is not only detrimental to the new nurse, but to the future of nursing as a whole!
Yep you're gonna get flamed. I think you're confusing bullying and personality issues. I've been an RN for over 20 years and I've seldom met nurses who are just whining and don't have an actual concern about the way they have been treated. Certainly this happens, but nurses "eating their young" occurs much more frequently, and is a very clear and present form of bullying!
It's a good idea to talk with the hospitalist before he goes to bed and find out what he wants to awakened for. Ask for parameters. This aside, the hospitalist in this case was a [fill in your favorite word], and nothing will change that. I've been tempted to say, "It's your job you moron! (and hang up on him!). I haven't done this, but ooh have I been tempted! Welcome to the world of nursing! By the way, I don't get too excited about one BP that's different. Trends are what matter. Repeat the BP in an hour and go from there.
Yes, get out of there! You have what is known as a hostile working environment, and you may be in very real danger. I very much appreciate those civil rights pioneers who risked their lives (and those who lost their lives) to further the cause of social equality, but your life may be in danger and no job is worth that!
I am a hospice nurse and am also in an RN to BSN program. For my capstone I have requested to complete the requirements in a parish nurse program. This article speaks to exactly why I am going this direction. Thank you for sharing.
I see this all the time with family and with nurses caring for the patient. I believe this stems from many different reasons including the lack of hospice training in nursing school programs as well as general attitudes and beliefs of society in general.
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