Change...good or bad?

Yes, I agree ..........GREAT question!

I think the focus of care delivery has changed.......since 1978 when I started nursing. I mean, think about the fact that a patient having surgery for cataracts might be hospitalized > a week, on strict bed rest, and with sandbags on both sides of his/her head!!!......that was back then. NOW the patient comes in for procedure and returns home the same day!!! In this regard, WAY more patient education is necessary. Most surgeries, in the "old days" would come in the night before, have a prep done and hopefully get some pre-op teaching. So I would call this change, an opportunity for greater patient education (now I mean).

Another positive change which is advantageous to nursing (but not ALL would agree!) is computerized records and documentation. It was overwhelming to learn and adjust to at the time, but now I LOVE it!! You can find out everything......like who gave exactly what medication at what time, current lab values, patient health history, which MDs ordered what test or med and what time!!! These facts are very helpful to me, working on an interdisciplinary team and communicating with nurses all over the hospital.

I do agree there seems to be a bit more "scripting" of practice by management types. I think this translates to less freedom of practice. This is unfortunate, but falls under the old "patients and families first, RIGHT after the computerized documentation!!!".

Family focus is more prevalent these days. We are also working with internet savvy patients and families.........many read all about their diagnosis and treatment of same on the internet. This makes them question us more, which is fine.

Over all......there are days that I say to myself, "I am glad to be at the top of the hill, looking down, than at the bottom climbing up"..........regarding nursing. Usually the days of feeling happy and satisfied with my job and how I am able to do it, out number the other days :)

Changes for the good? Can't come up with any.

Bad-

Government intervention, Medicaid/Medicare, Joint Commission,

loss of autonomy, loss of critical thinking, lower standards, less respect, medical shorthand, increased tasks/workload, decreased patient care, less interpersonal interaction, Press-Gainey/Gallup, pressing #1 for english...

There has been an increased emphasis on patient safety.

When I started, vials of concentrated potassium and sodium were kept in patient rooms for additives to dialysis bags. Those are long gone.

We used to use restraints a lot more freely and prn. Not anymore.

Insulin drips were titrated without any nomograms. That worked fine only with the nurses posessing good judgment.

Time out before procedures confirming the right patient, the right site and the right procedure didn't exist when I was a student.

I think there has been an increase in the drive for pt satisfaction and more holistic care.

i think there has been an increase in the drive for pt satisfaction and more holistic care.

are you saying that's good or bad?

i go with bad. "customer service" and "patient care" are two very different concepts, and i prefer patient care. i'll save your ass, but i don't want to kiss it.

just a few over the past 20 years:

use of physical/chemical restraints much decreased - awesome

pain control much improved - awesome

what I call AYDS, the Ask Your Dr. (if this is right for you) Syndrome

adding yet another pill to the regimen without trying conservative or alternative measures even as an adjunct - a step back

drowning in bureaucracy, meaning I now have to get an order to put lotion on a patient, because this pt. may be the 1 in 100,000,000 who has a reaction

I spend about 2 to 2.5 times as much time on paperwork, this time is taken away from communicating with the patient - a huge step back