Best quality care cannot be provided

uniqueguy34, BSN, MSN · Jun 9, 2016

It's true there are codes.. Things can deteriorate quickly and patients may die. But I feel that it's not as intensive as patients in university hospitals.. Yet there are lots to learn if the pace was slower, and we weren't running around trying to catch up.. Also, it's very sad to be caring for patients that have very slight chance of recovery.. Lots of them either die or go to a nursing home and their life will deteriorate even further

benharold1, BSN · Jun 9, 2016

I left bedside nursing after 30 years to work in a non-clinical position. However,

the work is very tedious and I found that all the talk about by upper level management is exactly that. All about improving survey scores, but what about pt care?

They have all these ideas but can't understand that staffing is paramount to excellent care.

Working a non-clinical position has its perks, but after a year I am tired of sitting all day and no longer feeling like a nurse. I hope to return to clinical position soon.

Please don't give up hope! Perhaps a management job might be good in the sense in your organization you might be able to change management mind to improve staffing and result in quality care.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Jun 9, 2016

Thanks to all of you for the replies.. I'm just very chocked. I've done homecare.. It wasnt bad depending on the case of course. What I really liked is school nursing.. You don't chart at all.. You sit there and students come to u. Not overwhelming.. However the downside to not working in a hospital is that you do not keep up with skills.. But again I think about it.. That I worked so hard for my license.. And I have paranoia about losing it.. But in homecare or school settings.. U almost can never lose your license.. In the hospital you're prone to mistakes.. Lots of interruptions.. I agree with all of you.. I guess. Eventually it's about finding that perfect balanced position.. Maybe lab cath, or ER, or specialty unit.. But working on the floor is not easy.. Ugh. Also sometimes dealing with rude co-workers..

i equate med-surg nursing to a bull-riding rodeo. It takes a strong will, back, and gluteus maximus to stay on that thing!

If they disclosed this in nursing school, it wouldn't be long before there would no longer be a need for an MSN in education...no students.

Leonardo Del Toro, RN · Jun 9, 2016

Yes welcome to corporate health care. The bottom line is money but let's not forget that we are all in it too. The moment you take a assignment you are part of the whole thing. On another note this problem is very...very complex. In part it was created by the public that became focused on litigation galore. Hospitals and SNF's are just trying to protect themselves and your job by creating obsessive documentation (created by you the nurse). Now there is a new thing...patient satisfaction. Now we are educating patients to think they are in a hotel...this is going to suck more then anything.

RatherBHiking, BSN, RN · Jun 9, 2016

As a school nurse, yes we chart on every student even if it's minor. We have to prove we weren't negligent and didn't miss something that may have been serious. No it's not a head to toe assessment twice a shift. Being a school nurse entails so much more than "just sitting waiting as they come to you".That's the perception that is insulting. Most school nurses are required to have a BSN, school nurse certification, and 5 yrs experience. Reason being, we're the only medical person in the building. If a staff member or student has a heart attack, concussion, broken bone, trach pull out, anaphylaxis, etc we are it until EMS arrives and yes all of those things have happened in my district. Even though that's not a daily thing thankfully we have to be ready. We have to teach the staff on what to do until we get there. We have to try and figure out if daily stomach aches are due to boredom in class, a medical reason, or some type of abuse at home. Between the visits and emergencies, we have to make sure kids have all their immunizations, do screenings and physicals, do care plans along with 504 plans and IEP's, do wellness programs, teach occasional classes, etc all while getting paid less and being at the bottom of the totem pole in an educational system because in schools education is #1. This is just some of what we do. Even with all of that I still find it less overwhelming than the hospital but I sure do miss working with other nurses, getting to use hands on skills, and the money so it's not perfect. Yes I get summers off but I don't get paid for it. I've worked many different areas and there are none that are perfect but this is can live with.

JerseyTomatoMDCrab, BSN · Jun 9, 2016

I know the aforementioned statement may have sounded terrible to some readers, but hear me out. 70 percent is still passing. 80 percent is still passing. In addition, when I didn't put my all into the job, it led to self-preservation since I didn't burn out or take the negative aspects of the job home with me.

If you give 100% at work, what does that leave for you? Nurses are still human beings and we cannot bleed ourselves dry for a job that gives us back so little.

calivianya, BSN, RN · Jun 9, 2016

Once I came to that realization, I became fine with putting 70 percent to 80 percent of my efforts into providing the care.
I know the aforementioned statement may have sounded terrible to some readers, but hear me out. 70 percent is still passing. 80 percent is still passing. In addition, when I didn't put my all into the job, it led to self-preservation since I didn't burn out or take the negative aspects of the job home with me.
Some would say, "I don't want a nurse caring for me or my family who gives less than 100 percent!" However, that outlook is unrealistic because no stranger in healthcare cares about you or your loved ones as much as you.

I can't even tell you how much I love this. The like button is not enough.

I see plenty of my coworkers giving 100%... and they are all leaving and either transferring to different units, where I have been trying to tell them it won't be any better, but they have their heads so far up their butts about our job being terrible that they won't listen. Many of them have never worked this type of unit anywhere else and I have worked in this same specialty in four different places. They don't even know what we have here, and what we have is GOOD compared to other places. I am just waiting to see them come back in a couple of years...

It's sad because the ones leaving are some of the best coworkers we have. One is just straight up quitting everything for a while she is so burned out - not even working at all, just living off of her husband's salary for a while.

I like my job and I am more than competent at it, but I am not going to kill myself for it. Sorry, just not going to happen. Maybe that's why I actually say I like my work environment while every else is fleeing left and right.

calivianya, BSN, RN · Jun 9, 2016

It's true there are codes.. Things can deteriorate quickly and patients may die. But I feel that it's not as intensive as patients in university hospitals.. Yet there are lots to learn if the pace was slower, and we weren't running around trying to catch up.. Also, it's very sad to be caring for patients that have very slight chance of recovery.. Lots of them either die or go to a nursing home and their life will deteriorate even further

You should transfer to ICU. You're already used to all the death and suffering, but some of our patients actually get better enough to go home for real. The ones that get to you are the ones that don't, usually.

Not to mention we have better ratios.

RunnerNurse09, BSN, RN · Jun 9, 2016

This is why I left the hospital, and why I am going back to school. I want to help somehow to change things. People are realizing how grim things are and there are some waves of change happening, but it will be a long time before we see a huge overhaul of the system.

Horseshoe, BSN, RN · Jun 9, 2016

As a school nurse, yes we chart on every student even if it's minor. We have to prove we weren't negligent and didn't miss something that may have been serious. No it's not a head to toe assessment twice a shift. Being a school nurse entails so much more than "just sitting waiting as they come to you".That's the perception that is insulting. Most school nurses are required to have a BSN, school nurse certification, and 5 yrs experience. Reason being, we're the only medical person in the building. If a staff member or student has a heart attack, concussion, broken bone, trach pull out, anaphylaxis, etc we are it until EMS arrives and yes all of those things have happened in my district. Even though that's not a daily thing thankfully we have to be ready. We have to teach the staff on what to do until we get there. We have to try and figure out if daily stomach aches are due to boredom in class, a medical reason, or some type of abuse at home. Between the visits and emergencies, we have to make sure kids have all their immunizations, do screenings and physicals, do care plans along with 504 plans and IEP's, do wellness programs, teach occasional classes, etc all while getting paid less and being at the bottom of the totem pole in an educational system because in schools education is #1. This is just some of what we do. Even with all of that I still find it less overwhelming than the hospital but I sure do miss working with other nurses, getting to use hands on skills, and the money so it's not perfect. Yes I get summers off but I don't get paid for it. I've worked many different areas and there are none that are perfect but this is can live with.

As I suspected. School nurses aren't always given proper credit for what they do. From what I understand, they are seeing more and more complicated cases as children are mainstreamed. Kudos.

peacockblue · Jun 11, 2016

Gotta to chime in as a school nurse. Not to bash you, but to let you know what goes on at a school. First of all, we are NOT as busy as a med surg or other hospital floor. I would have never left the hospital, gone to 3 more years of college and take a pay cut if that were the case. That being said, I am responsible for over 1300 students. That means every year they need height, weight,vision and hearing screenings. I document on every student that comes through my office. I have had to learn tons of mental health care stuff that my education did not prepare me for. I have to make sure all immunizations are done. I go into classrooms and teach. I need to be aware of what agencies are in the community to refer students to for things such as drug and alcohol treatment, mental health care, pregnancy care. I help students get insurance who have none. And don't forget the all consuming 504 plans. Every snowflake that has not just diabetes, asthma etc. but ADHD, Anxiety, etc and doesn't qualify for an IEP gets a 504 plan written and maintained by the school nurse.

All that being said, it is still the best job I ever had and I love that I feel like I make a long term difference in my students' and their families lives, but no, we don't just sit there and wait to put on bandaids. That is insulting.

HeySis, BSN, RN · Jun 11, 2016

What I was taught in nursing school cannot be applied in real situations.

This is so true. School teaches us the "NCLEX world"..... which is so far from the "real world" that instructors point out the difference all the time. They talk about in NCLEx you always have enough time, resources, staff... which is our first indicator that it's not like this in the real world... And I believe that's true no matter what area you go into, it's just different pro's and con's in each area and you have to decide which pro's outweigh the ons for you.

After working as an RN at a hospital for a month, I came to a realization that providing quality healthcare to patients is a total BS in this kind of setting.. When we as nurses, always in that rush mode.. We're being on charting, passing meds.. We have 5+ patients to chart on.. And dealing with unexpected disruption all day long.. Is there anyway to cut on the charting and make more time available to actually be more attentive to patients?

I do have to say that a month into a new job is not enough time to judge. (this is just my opinion) there is such a steep learning curve on a new job (area, floor, speciality). Over six months some things get easier.... you learn the charting system better and can get that done quicker, you know where all your supplies are so it doesn't take you as long to hunt things down, you learn your own time management skills (do I dare say shortcuts??) and you find ways to be proactive before a disruption becomes a nightmare.

Somedays will still feel like he**, and you maybe working in a facility that is totally broken. But I think you need to give yourself some more time before making that decision.