Obstacles to providing care - Page 4

All the previous posts have me in the "Amen Corner".

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I think a study about medication admin is a good idea. At my facility I spend the majority of my time giving medication. If one is not available then I have to stop what I am doing and call the pharmacy or call the nursing supervisor in order to get the med sent. Usually there are several different meds I have to call for and it ends up putting me behind with everything else I need to get done. It is very frustrating.

#1 BIGGEST OBSTACLE is the VISITOR/FAMILY MEMBER,
at least in ICU anyway. Especially the ones who
stay the entire shift or sleep the night. The ones who are know-it-alls are the worst, telling you how to do nursing and when to do what, and always finding something to complain about or be distrustful about. But even the nice, sweet ones are time-consuming and distracting.And those are usually the ones who also want to follow you around, or hang out with you at the nurses station when you finally get a chance to chart.
Even worse than these two are the hyper-vigilant visitors, who never look at the pt. they supposedly came to visit, and stare at the monitors, screaming for the nurse when one bleep goes off, or if the heart rate changes from 84 to 88. You try to educate these people, but they seem to thrive on drama.
I sometimes feel that all those nurses who back up the 'studies' proving open-visiting is absolutely wonderful, are nurses who do not take full-time bedside assignments in hospitals.

there are so many obstacles that i don't know where to begin. but to me the the biggest obtacle is the lack of team work. i can remember when nurses truely did help each other out, each shift helped the next shift. an example of this used to be when day shift saw that our insulin supply was running very low and the next shift would most likey not have enough, the daytimers would just go ahead and order it from pharmacy before they closed at 4:30 and could have it delivered to the unit by 3pm. now a days, if the insulin supply is low, the next shift no doubt will not have enough and nocs will not have any at all so that means nocs will have to go to all the units and find it themselves which we usually do. even when you tell the daytimers that we have no insulin and ask them to order some, you come back the next night and no one still had not ordered it so now you have to go "hunting" around again which takes away from all of the other things that you could and should be doing...hate when that happens. no one ever restocks their med carts anymore, so now you have to go get the med cups, the paper cups, the tongue blades, the alcohol wipes, the straws. and after all that, now you have to clean up the mess that they left behind. garbage bags full on the carts, sticky juice on the top, powder and spanules all over the tops, sticky lactulose spilled in the drawers, filthy morters and pestals and they just leave it and go home. come on.....i wouldn't want to see what their homes look like! so now i've wasted 30 min. cleaning, wiping, restocking just so i can get in there and do my job. the nurses station is a total wreck and you can't find the counter top to make out assignments. another 15 minutes putting away whatever was left all over the place. in the nourishment room the evening shift left the microwave with spilled whatever from their dinner breaks and never bothered to wipe up their messes, spilled coffee from making coffee, another ten minutes cleaning up that room. so between, running around looking for insulin, restocking and cleaning the med cart, cleaning up the nurses station, and wiping up the nourishment room, and oh, i forgot the tx carts, no 4x4's, no tape, no kling, no nothing , another 15 minutes getting that together when whoever used it last should have done that. so after doing all that, i've wasted at least an hour. i could have done so many other little things for my residents, but now, i've got to run to the xerox machine and make 50 copies of the restraint flow sheets because the evening shift ran out so now i need them and i don't have any! but, i have to go to another unit to get one to copy...another 15 minutes...

At least one of the reasons I became an agency nurse was to get away from the politics of the facility I worked in.

The DON's favorite phrase when we would complain about something was:
"You have to do MORE, FASTER, with LESS"

I hated her.

I think my biggest obstacle always was the DON, supervisor, or other "management" telling us to do something that was so totally out of whack that it was laughable.

I think the "management" should spend a shift or two on the floor, getting back into the feel of things, and REALLY know what it going on in the unit.

I think a lot of the "Management" problems would disappear if THEY had to go through what WE go through.....

Just my humble opinion....

Anita,

I think that short staffing and high nurseatient ratio numbers would be the best avenue to study. Most of the problems in nursing revolve around this.
I have been in the profession for 10yrs in ICU and ER. If staffing is adequate than pt care and nurse sanity is of much higher quality. But across the board all nurses know the insanity of working whats supposed to be a 12 hour shift that turns into a 14 or 15 hour nightmare.
Nurses are the patients first line of defense against all the above listed problems. I have seen the breakdown and incontinuity of care that results from having an overstressed and overworked nursing staff. We are the coordinators. We are the ones who spend the most time with the patients, it is our eyes and ears and minds that find the problems and demand solutions from all others.
We as nurses take care of all others except ourselves and most times we do this at our own expense. I know I've had many UTI's from not even feeling I could stop to go to the bathroom for 12plus hours. Lunch, whats that???????
This I try to remember when I get stressed or when an MD gets an attitude: Patients come to the hospital, nursing home or any inpatient facility for 24 hour a day NURSING CARE!!!!!! If not for us they would not be there. Physicians depend on us to assess, implement, evaul, and re-assess pt status at all times and to let them know whats going on. This is a dynamic process.
Answers ?????? Solutions??????
Kat

I agree with all the previous answers. The hospital where I work creates obstacles by issuing notices to the staff about new methods/protocols that directly interfere with the patient. For instance, to decrease laundry costs we were told to deny patients more than one blanket. If we give them a second blanket we can get written up. If we deny them and they complain, we can get written up for not making the customer unhappy. Either way the nurse is in the middle. I give them the blanket and ask them to respond to the posthospital survey with remarks on how impt. it is to be comfortable.

This is what is going on in a place that still has hand written orders going on a yellow copy to pharmacy usually by fax. I will just describe problems with 8 am meds. You begin by checking drawers to see if drugs are missing. Of course they are so you call pharmacy. By rights you should look up the individual meds first on the orginal orders but by now a good many doctors are in and charts can be hard to get a hold of. You say "where is the heart med for this patient, the diabetes drug on the other(there are several others missing)?" Sometimes the pharmacist has a copy of the original order sometimes he does not. So you have to begin hunting through the charts for the orginal order. Don't forget you are climbing over a hundred other people who are struggling to get hands on the charts. Not to mention the poor unit clerk who is trying to take off orders from the late night shift admissions. When and if you find the orginal order if you are lucky you can get it up to the pharmacist and get the medication in an reasonable amt of time. However you still need to wait for next delivery rounds. Like as not there will be other problems like something peculiar with the dose of the insulin on the new patient. It says 80units reg, that is high so you double check and find the ER physician wrote 8 u reg insulin and everyone mistook it for a zero. Now you just saved someones life but you are two busy to crow. You have people to get to the OR, PT and all kinds of scans and invasive proceedures like Bronchs and ERCP. Somewhere you are supposed to squeeze in time to go over every chart to check for things that are not done on these people going for procedures. Do not forget before you even started passing meds you were supposed to have all the accucheks done and called to the endoncrinologist. By now it is 10am and you just pray the aid was able to feed you patients and bath them cause you sure as hell are not even getting into do assessments on the ones requiring less attention. All the while you are fielding phones calls from everyone on the planet on every subject on the planet not to mention the nursing office that keeps asking you to work 3-11. This is just an average morning, you should see the bad ones with multiple admissions, the aid coming to you and saying someone is laying in the hall with no pulse and admissions office demanding you discharge people cause ER is backed up. If anything goes wrong with any of this you know you will be hauled into the nursing office and grilled like a criminal and blamed heartily. You know all this because you have gone through it all before. Is this what you want?

The main problem facing nurses today is the lack of staff and the increasing acuity of the patients. The average age of nurses is 45. I dont find that hard to believe at all. Being one of the graying panthers of nursing at 49 yrs I can tell you its true.
We have a few nursing students on our unit, and I would like to say that they are being short changed when it comes to being taught time management and creativity. When you are dealing with very ill people, too little staff and cheap, unreliable supplies, the ability to improvise is needed. The reality crunch will be painful. Going from 1-2 patients to 7 or more will be beyond shock.
Burn't out? You bet. If my home was paid for I'd be gone. There is not enough money in this field to keep me here. Even after 28 years. There is no longer enough gratitude coming from the patients for my help and the attitude of managemnet is more work from less people means more profit. This is unlikely to change until a major lawsuit is lost. I am treated like a personal body slave who is in rebellion, as I don't have enough time to stay at the bedside. It makes for a lot of undeserved guilt on my part and a lot of anger on the patients and families. I would gladly go back in time to the caps and white shoes and dresses to have the time to give a complete bed bath (with soap and water and not paper towels soaked in a "biochemical") and followed by a back rub with a fresh draw sheet.
By the way diploma nurse dinosaurs and 2 year grads are the ones teaching the 4 year grads how to survive. Some how the extra training in philosophy of nursing misses how to give an enema, pass narcotics and hang an IV med all on different patients at the same time.
Nursing eats its young and drives out the "old" with ridicule. If my facility ever says I need a BS to be a "better" nurse, I will reply I have seen enough B.S. to sink the hospital and it comes from above, and like all S--- it rolls down hill.

Every year it becomes more difficult to find time for patient care when faced with never ending regulations and forms.

We frequently see psyc. patients. We have 3 seclusion rooms and frequently have 4-6 psyc patients. New "RESTRAINT" regulations have become impossible. Now when you put a patient in seclusion there must be constant observation for the first hour. Thats one staff member taken out of staffing, each time you put someone in seclusion.

The little old folks who come in from nursing homes with contusions, abrasions, lacs and broken bones because they are constantly falling. The documentation for using a posey on these patients is enought to keep one person busy for 4 hours.

The violent drunks who pull out their IV's, foleys etc can't be put in seclusion and are not supposed to be tied down.

The staff is so busy with these types of patients it leaves little time for the critically ill patients.

Now we have to do chart reviews on 10% of our patients to satisfy JCAHO, thats about 15 charts a day which takes from 10-20 minutes each.

Add required QA each staff member is expected to do each month, the excessive documentation regarding age appropriate behavior, cultural issues etc at least 40% of our nurses time is spent in non-patient related activities.

Many times the Senior Clinical Nurses (our management team) come in on days off to try to keep up. Sure we are paid for it, but this is on our own time, and to be honest the hospital is paying big bucks for paperwork.

Add to all of that the multiple committee meetings. We are currently building a new ER (brand new seperate structure), we have several H-works projects, QA etc.

Patient care is what we want to do. All these other things seem to be thought up by people who do nothing but sit behind a desk.

Sorry just worked by 4th shift, I'm a little tired and got off track. The truely successful nurse is quite good at instant problem solving when it comes to patient care. It's all the other "stuff" that get us down.