Quote from Mike A. Fungin RN
Should probably add that I had my med/surg and peds clinicals at Kaiser Oakland. I also have a good friend who works in their ER, and have taken my father-in-law there for care. Overall, folks seem pretty happy working there. At least as much as anywhere else.
I gotta say I also had my final M/S clinical there and I had an entirely different experience. Mine was this spring so maybe things have changed since Mike has been there. Where to begin, first I guess would be that the ratio is less 1, 4-1 vs 5-1 which sounds great, but with that they stripped out ALL the support staff. Since the nurse has one less person to care for she/he can take care of all the little stuff... Not!
There is 1 PCT per unit, no lvns, dietary doesn't deliver food trays to the bed side. They come cold and are put in the unit fridge for the nurse. If the unit has multiple confused patients the PCT is sitting for 1, the rest are hogtied to the bed. If the PCT isn't sitting she/he doesn't have a defined role and does random things like delivering food trays to feeders, dumping finished trays or putting people in chairs without telling you.
The shift typically began with a "huddle" meeting where the manager would discuss whatever he thought was important for the day (0700-0715). Shift reports (0715-730+). So now you have 30 mins or less for vitals, accuchecks, 0800 meds, insulin, microwaving and delivering breakfasts. Have feeders or confused pt's? too bad someone isn't getting breakfast on time. Niceties like refilling water pitchers was non existent. Most days meds were late, even with the seasoned vets. Same went for lunch time, have a noon med, feeder, etc? either deliver lunches way early or late. Following the trend, bathing, ADLs, and ambulation.. yes walking our pt's never happened or was extremely rare. from the greenhorn to the veteran. After a 3 or 4 day stay, Im shocked more pt's didn't complain about sitting in their own stink.
On any given day 1/2 the dynamaps and workstations on wheels were broken, so there was usually a free for all looking for working equipment. The pyxis was always missing medications, daily, every day. Which meant walking to the next unit hoping they had some, "borrowing" someone else's insulin or a call and wait for the pharmacy. Setup for a med error anyone?
I made friends with a traveler who told me it was the most disorganized unit he had ever worked on. I also hung out with one of the most competent staff nurses and I had to ask her what the heck she was doing there. She admitted she needed the prime benefits and insurance for her kids, and she got her malpractice insurance as soon as she started.
When clinicals were over I thanked god no one was hurt and ran for the door.