Changes in Nursing over the past decade?

Computer charting is the biggest change in nursing. If I had known I would attepted to be more computer knowledgeable in school. Also the amount of paper work is OUTRAGIOUS :roll

more acute complex patients

Laporascopic procedures for everything, short hospital stays creating a swinging door,administration wanting less than 2 hour turnaround on discharged to admitted patient and more and more joint commission requirements.

this is great! thank you guys. i am researching this topic and your responses are definitely matching and confirming those i am encountering in the literature. thanks again

more acute complex patients

Why do you think the patients are more acute and complex muffie?

Here's another: Increased ER traffic r/t higher number of uninsured people without primary care providers.

Also, the availability of NPs in most areas of practice, more nurse-owned businesses...

Why do you think the patients are more acute and complex muffie?

not sure kenny, but i've seen much sicker patients with many active disease processes in my 20 year career

nowadays we seem to have to "save" everybody

what happened to natural selection and survival of the fittest ?

nature just doesn't fit into healthcare anymore

talk to someone who has been doing icu nursing for a while[i don't]

I'd have to say we've earned respect followed by the IV pump and pulse oximeter.

HIV and AIDS pts aren't as sick and hospitalized as often as they were 10 years ago

Oh- here's another: More attention is paid to quality and outcome measures now, and nursing research & practice tends to focus more on those things than it used to (i.e. evidence-based practice).

1. The rise of evidence based practices has standardized care more or less nationwide. At least, there are nationwide standards of care for many disease processes. Fear of lawsuits will keep the local systems in line.

2. 10 yrs ago, Medicare allowed for 'unbundling' of charges for skilled nursing facilities within hospitals: they all had them. Now that has been repealed, most don't have them anymore.

3. Waitlists for nursing school are more pronounced.

4. Ratio law in California and more attn towards that.

5. Repeal of mandatory overtime in many locales and more attn towards that.

6. Pay has improved.

7. The concept of an entrenched 'shortage' has taken hold.

8. Rapid response teams have been initiated.

9. MRSA has moved from being the 'boogeyman' to being all too commonplace.

10. Rise of magnet hospitals and shared governance.

11. Insulin drips have become more commonplace and not just for diabetics.

12. Move from volume cycled ventilators towards pressure cycled ventilators. More use of non-invasive ventilation: BiPAP.

13. JCAHO introduced 'Sentinel Events'.

14. More paperwork.

15. More focus on eliminating 'toxic' doctor interactions: hospitals are more willing to 'write docs up' for their abuses.

16. Invention of 'continuous cardiac output' monitors in CCU. No more 'shooting' COs.

17. The move towards making all private hospital rooms.

18. HIPAA.

19. Move towards 'open visitation' in CCU and 'family presence' during codes.

20. Concept of NP complete with prescriptive authority has come into its own.

21. More aggressive use of cardiac cath labs for acute MIs.

22. Thrombolytics for non-hemorrhagic CVAs.

23. Introduction of more targeted cardiac makers (Troponin I) and platelet aggregate inhibitors (Plavix, Integrillin, Reopro) for MIs.

24. Much better stents and now, drug eluting stents.

25. Swan catheters now out of favor; Levophed back in good graces.

26. Introduction of human genetic derived insulins.

27. Rise of the internet: now everybody's a lay 'professional'.

28. Creation of accelerated RN programs for prior bach degree holders.

29. JCAHO standards for pain management.

~faith,

Timothy.

Why do you think the patients are more acute and complex muffie?

Patients are more complex because most less complex things are done as outpatients now. Plus we have saved patients with conditions from which people in previous decades would already be dead. Think diabetics with more aggressive insulin regimens, dialysis and renal failure patients, cardiac patients who have implanted pacemakers and defibrillators etc.