A big part of the core of nursing has gone missing

[HeartRN13]

I've noticed a lot lately my patients have been saying "The nurse didn't have time." It's true, with heavy patient assignments, limited help, and a list of things to chart for your shift, nurses really don't have the time. However, I know I became a nurse because I wanted to help people. As nurses we are taught that treatment is not just curing, but it's the therapeutic component that nurses proved that makes the difference. It seems lately that part is lacking. I never leave work on time. The reason why is because I will make the time for my patients needs. If I can spend 30 minutes of my time educating someone about their condition, the plan of care, and help alleviate any of their stresses, that means more to me than recognition from management. Of course that 30 minutes will never be uninterrupted. I just don't feel like I am a good nurse unless I make my patients feel better in every sense.

My thoughts for today.

[Asystole RN]

Nursing is evolving as patients become sicker and the roles of the registered nurse expand. Acute care nursing is extremely busy and is losing the traditional primary care portion of the profession.

I started a new job in home infusion a few months ago and was surprised at how much "nursing" I can now do. It is one on one, I can spend time with the patient, and really focus on what the needs of the patient are.

Yesterday I spent 4 hours with a single patient infusing Ambisome. The day before I spent 8 hours infusing IVIG. Only a couple pages of charting that is mostly checkbox.

Healthcare is changing and shifting, if you want to spend more time with a patient then go to where the patients are now receiving the majority of their care, in the home.

[Meriwhen, ASN, BSN, MSN, RN]

The irony is that managment would stroke out if they hear patients complain that the nurse was too busy or--even worse--hear a nurse tell a patient, "I'm sorry, but I don't have the time"...yet management isn't willing to provide the staff and resources to help the nurse make that tme.

[ArtClassRN, ADN, RN]

"I just don't feel like I am a good nurse unless I make my patients feel better in every sense."

This is a completely unrealistic expectation that will lead to severe burnout fast.

[anon456, BSN, RN]

If I did that in my setting I would be fired. I am expected to bounce back and forth between two or three rooms to do hourly assessments on PIV's, sometimes hourly neuro checks, hourly glucose checks, Q2H turns on my total care patients, and check and change diapers regularly. Oh, and hourly vitals (temps can't be taken by a machine usually). I am expected to weigh and bathe the kids under age 2 on night shift, and sometime I have to bathe the bedbound big kids, too, if day shift didn't get around to it. I have to change trach ties, do oral care Q4H on the vented kids, change out suction tubing for everyone, and other endless small tasks.

I miss what you are talking about and I wish it was easier to spend more time with the patients. Nurses are more task-oriented these days than people-oriented. Sometimes I do have an easy shift where I can spend time talking to a patient or family and I really enjoy it. But it happens probably once in two months.

As far as clocking out late because I stayed late to chart, I actually got a talking to at my first annual review to make it a goal not to do that. They gave me a specific time they wanted me to aim for.

[applewhitern, BSN, RN]

I can't get any over-time, either. Simply not allowed. I personally do not mind staying over after my shift ends to chart and tie up loose ends, but that is a big no-no at my hospital, and will get you in trouble fast. If it wasn't charted, it wasn't done, but one can only cram so much into an 8 or 12 hour shift.

[HeartRN13]

I don't spend too much time with any particular patient. If one patient needs something like education I have to split it up and I also have rounding to do in between. All five of my patients are tele, so I can't just stay put. I wasn't implying that's what I do, and I wasn't implying that I NEED to make them feel better like magic. What I meant was I often come in for my shift to find annoyed/angry patients and/or family members because no one even takes the time to update them on the plan of care. I personally always ask the patients and families if they have any questions or is there anything they would like to know that hasn't been answered. Transport is showing up to the rooms for tests and scans and no one even tells the patient that they have been ordered and for what. Doctors will come and see a patient for a consult, and don't tell them what their plan is going to be. It's just communication and taking that extra initiative to help the patient feel better psychologically and physically. It seems that the nurses lately don't even want to do that much. I have seen more and more that they don't really want to spend any time with patients at all. Get in and get out, and make the aides do the rounding.