Patients need a nurse, not a computer

[herring_RN]

http://www.youtube.com/watch?v=YthF86QDOXYHealthcare is changing. And not for the better. Behind all the pretty pictures on billboards showing a world where everyone "Thrives" there is a sinister reality. As local hospitals and clinics are gobbled up by giant corporations, the theme is cut costs (by which they mean your care) and raise their profits.

TV ads tell you that you can get your diagnosis at home via Telemedicine without ever setting foot in the emergency room. And, if you go to the hospital, be prepared to get pushed out soon, often when still at your most sick and vulnerable, to a nursing home or your own home where the burden for complex medical care falls on your family.

Hospitals spend your patient care dollars on Wall Street investments, unproven technology, marketing or buying up other hospitals, while cutting those staff at the bedside, registered nurses, who are your first line of protection and your last line of defense.

[vlk70lpn2RN]

More and more often I and other nurses are finding that the increased use of computer programs, electronic MARS, and other ways of complying with electronic health records is taking us (RNs and LPNs) away from the bedside.

[NewYorkerGirl]

More and more often I and other nurses are finding that the increased use of computer programs, electronic MARS, and other ways of complying with electronic health records is taking us (RNs and LPNs) away from the bedside.

Except those hospitals who put computers in patient rooms to require bedside charting. Then the patient gets to feel awkward as we pay more attention to the computer than the patient. Ugh. I prefer the old fashioned way: pay attention to the patient while in the room, and chart at the nurse's station.

[rnforforty]

Boy, does this ever make me yearn for the days of paper nurse's notes and medication cards on a tray full of meds in medicine cups! Back then we could get an order from the doc for Demerol 25 - 75 mg IM q 2 - 4 hours PRN. We then used nursing judgment to determine how much and how often to administer the drug based on our knowledge and our patient assessment. And we were only lowly diploma grads! BSNs rare and MSNs practically non-existent. Now, even the MSN can't use her nursing knowledge and judgment to do this because the COMPUTER will not allow it. Amazing! So, someone explain to me how we need so much more education so we can do so much less? Back in 1974, I was routinely placing 12 - 18 inch PICC lines (again, just a lowly diploma nurse). Now, in my area, I don't know of any nurses doing this. When did we get stupid? My friend, an LPN, who worked at the VA, would tell me how he would be sent to the lab for a unit of blood where he would verify all the appropriate info for the unit with the blood tech. Then, as he put it, 'I got stupid in the elevator on the way up and now it took 2 RNs to do exactly the same thing'. That's just how I feel now, the more computerization takes over, the dumber we get. Don't get me wrong, I LOVE computers, and feel strongly they can improve care BUT they must leave room for humans, especially nurses, to do what they do best, treat with heart and instinct. To err is human, to really f**k up requires a computer. Garbage in, garbage out. And my favorite: a computer is only as good as its human programmer.

[vlk70lpn2RN]

We can chart at bedside, computer in every ICU room. Of course that's if you can get it to pull up your paragon system. ( Took 20 minutes to get computer to reboot and paragon to come up the other morning for a admit that came in at 0600 right before shift change. UGG)Then you might get to chart, even though you are still being asked questions and involved in conversations from family, visitors and patients, but make sure you document everything correctly, concisely, and in triplicate.:***:

[SubSippi]

Those changes might be specific to your hospital. At my facility, I routinely have orders for things like 5-15mg oxycodone q4-6 hours prn. Additionally, RNs place the majority of PICC lines. They do have to be certified to do so, but it doesn't matter what sort of degree they have.

[rnforforty]

Those changes might be specific to your hospital. At my facility, I routinely have orders for things like 5-15mg oxycodone q4-6 hours prn. Additionally, RNs place the majority of PICC lines. They do have to be certified to do so, but it doesn't matter what sort of degree they have.

Well, the change to most of the drug orders occurred due to JCAHO. It was claimed that with an order written like that we were 'prescribing'. And the PICC lines placed by nursing stopped because hospitals can't charge a fee for procedures done by a nurse, could only charge for the supplies. Not nearly enough money for the greedy SOBs -why, have a doc do it and you can haul the patient to the OR and charge for the time there, and the doc can bill a couple $100 for his 5 minutes of time. And then the bloody hospital can charge a couple $100 as a procedure fee! So, eventually that PICC, whose supplies cost $59 are now costing somewhere in the neighborhood of $800 - $1000. Pretty sleazy. And the US wonders why the cost of healthcare is so high! And it just keeps getting more outrageous.

[SubSippi]

I didn't know about the prescribing thing, I've never heard of that. I just we haven't gotten caught yet...

Also, at my hospital the patients are charged the same for PICC placement (at least that's what I've been told). The doctor puts in an order for a PICC and they get charged for the procedure. Just like how patients can get charged for an EKG done by a nurse/tech, as long as the doctor puts in an order for it.

[emtb2rn, BSN, RN, EMT-B]

PICC team at my facility is all RNs.