Are You Providing Great Patient Care?

This article points out the difference between good and great patient care. I use an example from my experience with my recent orientee. Also, it shows what appears to be great time management is not always indicative of quality patient care. Nurses Announcements Archive Article

I thought about this question as I reflected on my day with my new orientee who has been with me for almost two weeks now. She is a new grad but does have previous military experience as a medic. She has far exceeded my expectations so far during this orientation. We were extremely busy the other day but still able to provide great care for our patients.

These are patients with new head and neck cancer with flaps that have new tracheostomies and require a lot of teaching. We were successful in ambulating all of these patients and teaching them to the best of our ability.

Now, I know what you are going to say. These are just part of basic nursing care.

That is true, but some nurses will avoid those tasks since they can get through the day without actually having to do them. What I mean by that is these are often things that need to be initiated by the nurse since the patient does not know they need to be done or is not motivated.

The point is, I have been a nurse for a while now and have noticed through the years that some nurses seem to always have their work done and this is not always indicative of a job well done.

The nurses that seem to have it all figured out from a time management perspective do not always provide a high level of patient care. I will see these same nurses talking about personal issues or navigating the internet when there are things that can be done to raise the quality of care they provide to their patients. This does not surprise me and I am sure it happens in every profession, but I think some nurses label themselves as slow when they are actually just providing great care.

My orientee and I did not have to ambulate and teach these patients as much as we did and we did not have to think critically or keep their rooms as clean as we did. We did it, because it is the best thing for the patient, and it will allow them to recover faster and have a more successful transition back into their normal life with a decreased chance of re-admittance.

That day my orientee seemed to be a little worried about her time management as she observed other nurses having an easier day. I pointed out to her that she has only been on orientation for two weeks and she is providing a very high level of care which she should be proud of. I told her it takes more time to provide high level care and others may not be doing the same.

Almost always there is something that can be done to improve your patient's level of care. If you have time after providing great care for your patients then be a team player by helping another nurse who is struggling. This will help her bring up her level of patient care. In the end we all want what is best for our patients. What is one example of where you have gone the extra mile to provide better patient care when you did not have to?

In the rural setting I work in several of us routinely provide great care. That includes bathing/showering them, cutting their hair if need be (on the men) and setting the old ladies hair in curlers and painting their fingernails. I also go around when I have a moment and trim off the whiskers on the old ladies. I also routinely shave them men who shave. No lady wants chin hairs regardless of how sick they are. A lot of time if a patient looks good, they feel better. Especially the older ladies who are used to always having their hair done. It's a small thing in the big scheme of nursing but I like to think they spend less time on the call bell when we can pay a little extra attention to them.Their families also like to see their people cared for. Sure I have a million other things I could be doing, but sometimes we need to remember patients are still people with families that love them. I would rather spend some time with them and listen to them than answer 40 call bells because they are lonely. Plus bathing or showering your people lets you get a good look at their skin condition, see any bruises, potential bed sores etc. A warm bath can sooth old bones and aches and pains. After a bath they get lotion, Which always includes a good back rub, warm blankets and are far more settled for the evening. It is also a chance for mobilizing them on the walk to the tub room. I have brought in treats for patients who need cheering up and routinely buy the curlers, hair gels, hair spray and deodorant we use for people. This doesn't always get to happen, based on the acuity of all the patients, but it's nice to get back to looking after the whole person at times. Not all shifts can go that way depending on meds, treatments and things like running blood. Time management is important but I figure I am being paid to work while I am there so I may as well get to it. I am fortunate in that most of the people I work with are not lazy and have developed excellent time management skills.

Specializes in LTC, Psych, M/S.
Oh knock it off. He said "do not always" not "never." Having been the hospital aide stuck with the lazy-ass nurses texting, facebooking and surfing travel sites for their next vacation while complaining that I don't have vitals done on all FIFTEEN of my patients on time for their med pass when I've literally been up to my elbows in poop for a solid hour...... I feel complete comfort with saying some nurses deserve to be called crappy because they ARE. (And especially the cowardly charge, who told me, a brand new CNA three months out of school and in my first job, that *I* should speak to those nurses about this recurring problem when I brought it to her. Honestly, if you're afraid to discipline people, you have no business being in any management position.) Nothing that was said in the article states that all nurses who get out on time do so because they are skimping on patient care. If you're having unwarranted defensive reactions to this, you need to figure out why that is.[/quote'] Excellent point! When I first started M/S I could not figure out why I did not have time to sit and chit chat with all the other nurses. Finally I saw another nurse enter into a room - just hand over the meds and not do any kind of initial assessment like I had been doing. You know, assess LS, BS, pain, ect.

I am just asking - when do you nurses with excellent time management skills do your assessments....or do you?

I just attended a mandatory inservice that was about patients being "delighted" with their care as opposed to "satisfied". In order to make that happen, again with the scripting. So if a nurse follows the script, they are hitting key words and phrases enough times hopefully the patient will get the illusion of being overwhelmingly delighted, and the nurse could spend in essence of 4 minutes per room....

Specializes in hospice.

Oh God...scripting. What a horrible practice. The staff feel forced, artificial, and constantly under threat incase they say the wrong thing, not all the right things, or all the right things but in the wrong order. And if I were a patient, I can assure you that discernible talking points would have me giving you lower grades, not higher. I'm not stupid and don't need to be told what I think about my own experience. Having worked in a hospital where it was required, I understand why it's happening, but that doesn't make me hate it any less. There just have to be other ways. I don't know, how about staffing the floors adequately and ACTUALLY giving great care. Crazy, I know.....

Specializes in Critical Care; Cardiac; Professional Development.
Excellent point! When I first started M/S I could not figure out why I did not have time to sit and chit chat with all the other nurses. Finally I saw another nurse enter into a room - just hand over the meds and not do any kind of initial assessment like I had been doing. You know, assess LS, BS, pain, ect.

I am just asking - when do you nurses with excellent time management skills do your assessments....or do you?

Absolutely I assess every single one of my patients, head to toe! I get out by 1930 90% of the time at night. My time management skills are excellent and my patient satisfaction scores are noted regularly by management as being exemplary. It is NOT impossible to have excellent time management, provide excellent patient care AND keep the patient happy. Every single patient every single time? Probably not. But the vast majority of the time? Definitely. I love being a nurse and am proud of being good at it in today's nursing environment. We work our butts off. I hate seeing nurses cutting at other nurses.

Specializes in Pediatrics, Emergency, Trauma.
I am just asking - when do you nurses with excellent time management skills do your assessments....or do you?

I am wiling to share...

After I receive report, I get/give report to my tech; that takes about and additional 3 minutes; introduce myself to my patients, perform safety checks, assessments. I ask questions about their condition, pain evaluation if they received pain medications, what's effective etc while going through the systems evaluation; that's possible. When surveying my environment and through my assessment, I can tell what nursing diagnoses I need to tackle. I also check skin during assessments because my auscultation is done stethoscope to skin, and I explain that I have to check the skin. When there is a complex pt; for example, airway, wound issues, both, etc; I will go in with a tech and assess, assist with a turn schedule; because most complex pts need help to turn and need the consistency of a turn schedules. If a pt needs to get up; they get up; most of the time it's during AM care; if medically possible.

Depending on the individual pt, it takes about 1-3 minutes per pt; it doesn't take long when you are clustering the RIGHT way, communicating effectively (I DON'T use scripting, EVER) and, as a prudent nurse, are rounding; my own clinical practice included rounding WAY before most hospitals "required" it.

Those aspects I have in my nursing practice I learned in nursing school; one of the factors my instructors STRESSED was although we are in school, it is best to lean how to create a clinical practice; by the time I had a job with a 6 pt load; including a wound vac and a trach/vent I was done with assessments in 15 minutes, pulling and giving meds in 20, if bathing/showering (depending on the setting-Rehab hospital/hospital experience here) needed to be done, I was in there with my the tech and my patient, washing hair, etc; and if the had wound care or a bowel routine to be done, it got done; the most complex took about 20 minutes; I would then do a quick peek/round to put my pts on notice that I am around and will be back; some are willing to allow for time and could care LESS; some are the ones that were grateful and in prioritizing, those were the ones that were to be seen first, unless there is a more acute or critical risk that needs to be seen; my time with them will be less in a moment than the ones that need it; but their needs will continue to be met. I have time for unexpected issues or changes that arise; that's due to good assessment and continuous assessment and evaluation. I usually do not stay longer than a half or an hour if there is an acute issue; and I don't let anyone stay over either.

That is the use of nursing process and nursing knowledge in action for EVERY factor or aspect of your shift or practice, including time management.

My point is, UNLESS you are a fly on the wall, or the actual pt or doing extra work because the work wasn't done or a complication arises, one has NO IDEA what a colleagues practice is, and personally, UNLESS there was miss or a serious issue that occurred; I couldn't care less; it's a 24 hour business it will (or may have been-I'll assess that as well) be done.

I followed one nurse one day and one pt wanted me to stay and hear them complain; I stopped the pt (politely) and stated: "That had to be VERY frustrating, however I am here; what can be done NOW as much as possible while we are here for (insert shift times- 8, 12) hours?" Not trying to be dismissive or rude, I do follow up, and allow for venting sessions; but there is a new nurse in the room; a new relationship, and if the work gets done or it's a bad day, or a product of a nurse's practice, I don't get caught up in those intangibles; meaning, I still have a job to do and a standard of care; I don't go around comparing myself to others or even talk about my practice regularly- I decided to share, because there seems to be a prevalent attitude that "the average nurse" doesn't go the "extra mile"; I don't believe in an "extra mile"; there are many intangibles of giving great care that is needed patient-wise and I do so, REALISTICALLY; and competently; that's why I am in this business. :yes:

There are times where a pt load is so laid back that they don't need anything but their scheduled meds; some may be very complex; some may be a mix; that's the nature of nursing. :)

I lead by example, and my patients, my peers, and anyone else can see that; it hasn't wavered regardless of what setting in nursing I worked in of the 8 years I have been a nurse.

Specializes in Pediatrics, Emergency, Trauma.
Absolutely I assess every single one of my patients head to toe! I get out by 1930 90% of the time at night. My time management skills are excellent and my patient satisfaction scores are noted regularly by management as being exemplary. It is NOT impossible to have excellent time management, provide excellent patient care AND keep the patient happy. Every single patient every single time? Probably not. But the vast majority of the time? Definitely. I love being a nurse and am proud of being good at it in today's nursing environment. We work our butts off. I hate seeing nurses cutting at other nurses.[/quote']

I think the perception of quantity vs quality time is in play...vs nursing knowledge and practice.

Its not just time management, its keeping yourself from tearing your hair out when you're understaffed (amongst other issues, but that's a big one for me). Usually so busy even the basic care doesn't get completed on occasion let alone...

Way to label a bunch of nurses with great time management skills incompetent! Good going.

You're defensiveness tells a different story. Everyone knows with the acuity level of patients today, it's just not possible to get it all done. If you have tons of free time during most of your shifts, you're not doing everything that needs to be done.

Specializes in ER.
I just attended a mandatory inservice that was about patients being "delighted" with their care as opposed to "satisfied". In order to make that happen, again with the scripting. So if a nurse follows the script, they are hitting key words and phrases enough times hopefully the patient will get the illusion of being overwhelmingly delighted, and the nurse could spend in essence of 4 minutes per room....

I want to thank you. I've been sitting in triage and just had the stinkiest crabbiest old guy come through, but I read your post and got a warm feeling all over. I am positively delighted with that post.

My time management improved once I got enough experience so I could talk and do physical tasks at the same time. I try to anticipate requests, like water, pain meds, bathroom needs and get it all done in one go. And make sure supplies are in the room, minimize hiking back and forth. I really needed time to develop that skill, I was a bit slower than most until about ten years had passed. Now I'm 25 years in and very grateful for anything that save s my poor aching feet.

Sometimes I give great patient care, and sometimes it's good enough. It just depends on the day, and I'm okay with that.

I want to thank you. I've been sitting in triage and just had the stinkiest crabbiest old guy come through, but I read your post and got a warm feeling all over. I am positively delighted with that post.

I was a bit apprehensive that the inservice was a waste of time. Seemingly it WORKED....and as they stated, it doesn't take a lot longer, just a positive glow in the nurse's attitude.....;)

Indeed.