Change...good or bad?

Davey Do · Feb 21, 2011

Excellent question, Karylea. Off the top of my head, I would have to say there seems to be less freedom, meaning more restrictions, in the Nursing Practise.

I'm not saying that's bad, and I'm not saying that's good. We all need to toe the line when it comes to implementing care in order to meet certain standards. But things just seemed more hang loose, I'm Okay-You're Okay, in the past. But then again, it could be just me romantisizing the past. Or confabulating.

Dave

llerkl, ADN · Feb 21, 2011

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 :)

allnurses Guide · Feb 21, 2011

I don't think there has been a huge increase in the number of patients someone is assigned, but California has ratio laws so we may not be the norm.

I do think the acuity levels are increasing. One reason for that is that the average stays for just about everything have been drastically cut back, meaning your patients will be discharged to home sooner, making space for more of the same.

Advances is medical care are a double-edged sword, as laparoscopic surgeries make recovery easier but also means more things are done in outpatient surgery centers, the more complicated go to the hospital by default.

Another offshoot of that would be that technology makes it easier to know what is going on inside (CT, MRI, PET, telemetry or even the pulse ox ) which is good, but turns up more things that will need to be addressed. Advances in ventilators now mean (and I've heard this from nurses here) stable vent patients are increasingly found in LTCs. Ventilators were pretty much the size of refridgerators when I started :)

Before CTs they would actually shine a strong light through a baby's head to guess what may be missing or in the wrong place, or for hydrocephalus. Transillumination. (just checked and supposedly it's still used!)

Just a couple there that I've noticed -- I am sure others will have different observations. I really don't think the "nuts and bolts" change all that much. One thing I never heard - customer service slogans. I guess they must have assumed that we were all adults, and how we communicate with patients is part of the job of a nurse.

Just a few observations from my viewpoint - I am sure others will have different ones.

EmergencyNrse · Feb 21, 2011

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...

RNperdiem, RN · Feb 21, 2011

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.

evolvingrn, BSN, RN · Feb 21, 2011

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

llg, PhD, RN · Feb 21, 2011

1. The push towards higher standards of practice are a good thing -- even though they put a strain on nurses to meet those standards. The fact that more hospitals are seriously engaging in research, research application, and evidence-based practice both improves patient care and advances the nursing profession. It's not always easy to accomplish, however, and that makes life harder for some nurses.

2. The same can be said about educational standards

3. Fewer new grads are being thrown into practice with minimal orientation than in the past. The trend is towards longer orientation programs, internships, residencies, etc. While current and future new grads may not always appreciate those programs -- they are a big improvement over being thrown in with minimal orientation and allowed to "sink or swim."

4. The development of professional certification standards and credentials allows nurses who chose not to further their formal education with a way of documenting their professional expertise that was not available in the past. Clinical ladders and similar programs provide a mechanism to reward those nurses financially -- as well as those nurses who take on extra responsibilities such as Charge Nurse, Preceptor, committee member, etc. In the past, senior members of the staff were expected to take on those responsibilities without being given any financial reward or recognition. Once again, I think many younger nurses don't realize that and don't appreciate this advancement and the work nurses before them did to get that acknowledgement of their extra contributions.

Ruby Vee, BSN · Feb 21, 2011

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.

systoly · Feb 21, 2011

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