My facility, like many, has increased staffing ratios in all departments in response to the economic pressures. Meanwhile, the Joint Commission continues to mandate supposed safety concerns, with mostly extra documentation demands and other inconveniences. They fail to address the elephant in the room, nurse/patient ratios.
I think bedside nursing has become less safe. From the ER point of view, we are less able to safely monitor patients, there is more friction with the inpatient nurses as they are too bogged down to receive patients. There is a cold war going on between some of our ER nurses and floor nurses, causing a big distraction and detracting from teamwork for the greater good.
Meanwhile, we're getting ready for the Joint Commission inspection and are going to be temporarily inconvenienced by their nonsensical edicts. No IV buckets to be left out on the counters of the nurses station, and other rules that are so minor compared with the real problems that we are dealing with. Of course, like other facilities, we have to spend money to hires nurses to make sure that our charting pleases them, that we fill in the many mandatory charting prompts to their satisfaction.
Nursing has become a bureaucratic mess, bogged down in more and more red tape than ever before. All this to be accomplished with fewer nurses at the bedside, and more nurses behind the scene. Insurance companies and the government are running things, and hospital administrators focused on the bottom line. If we keep going down this road, I think we are going to implode.
I really enjoyed working in acute nursing but was getting caught up in too much 'he did that, she did that". I was fretting about my registration purely because I didn't have the resources to give the standard of care I wanted to. So I left that area and now work in a different area of nursing and haven't looked back. Its a shame but you have to decide what you want to be a part of when the s**t is hitting the fan and they're looking for an escape goat!
So I left that area and now work in a different area of nursing and haven't looked back. Its a shame but you have to decide what you want to be a part of when the s**t is hitting the fan and they're looking for an escape goat!
I left nursing altogether and I haven't looked back...until now. I really miss caring for elders, and the whole industry really seems to be all about looking for a scapegoat, and job security for all the suits.
Read through all the posts, too. Thanks for the links.
The evidence for better nurse/pt ratios is out there for institutions to read but they pick and chose what they want. Right now they think it's better to push for BSNs everywhere due to cherry picking the research on best pt care. They totally ignore the more impressive, and more easily measured, statistics of increased nurse/pt ratios in regards to readmissions, falls, infections, decubs, etc. due to costs. It's easier for them to force the costs of BSN on the RN. They aren't paying the BSN any more, either, to clean take care of 6-8 pts on a med/surg floor, and itt looks like they are following best practice.
I agree with another poster about catering to noncompliant pts and using pt satisfaction scores as an accurate measure of outcomes. Hospitals are not a hotel/spa. Don't expect to get a massage every night. Satisfaction should not be a measure of reimbursement, outcomes should.
My post is addressing only my workplace...not all of your workplaces. I work in an environment of "blame the nurse."
What could make the life of the nurses easier in my hospital is encouragement of teamwork among all staff--and enforcing it among a handful of nurses and CNAs.
Let's take one example. Falls. The other day, as I and another nurse were running to a bed alarm, I passed three residents, two housekeepers, an RT, a dietary tech, and a CNA. No explanation needed.
Another: patient needed frequent suctioning and mouth care, on a continuous pulse ox, and I had been helping out the assigned nurse with it. Patient properly positioned at 90 degrees and watched as closely as possible on a floor. As I was walking down the hall, a housekeeper had come out looking frantic, and told the charge (with a rep for being a selfish, unhelpful, unaccountable *****) that the patient needed a nurse. I heard the charge say, "That's not my patient and start walking away. Really, the charge?! I whisked past the charge and saw the patient with a frothy phlegm ball in her mouth. Suctioned, she was fine for the time being. Called the assigned nurse to come in, which she did.
A quarter of the nurses spend a lot of time texting.
CNAs on one shift on one of the floors are always "too busy" to answer call lights or do delegated tasks, but they take a 1 hour lunch (on an 8 hour shift) and stand around talking about an hour before their shift change.
I got dressed down the other day by a second year because a stat lab wasn't drawn, although I saw the order a minute after it was put in and immediately called the lab to tell them it was stat. They didn't pull it until two hours later, after I got yelled at and called them again. In the back of my mind, I blamed myself. I should have followed up earlier, but another part of me was completely ****** off that I have to babysit ancillary staff ALL THE TIME.
Ok, where am I going with this? Yes, I believe that ratio and acuity need to be addressed. Yes, I feel that acuity is going up. Yes, I feel that administrators only care about the bottom line. However, it is clear to me that not everyone in healthcare possesses an extraordinary work ethic or commitment to teamwork. I'm not the smartest in the bunch nor the most knowledgeable, but I do know that if everyone worked as hard as I do and helped out as much as I do, all nursing environments would be much better.
dudette10, i swear we are the same person :) i'm sorry to hear that my exact experiences are shared by you, and likely many others.
i once heard that there is something called an "all nurse" model in which an inpatient unit has no ancillary staff whatsoever (but perhaps a secretary and meal deliveries) and relies only on RNs. the RN does all of his/her vitals, blood draws, meds, respiratory treatments (within reason - rapid response or code is different). however, this RN only has 3 patients. i would be VERY interested to see those nurses feel about patient safety and care, and maybe even the $bottom line$ that seems to be the only point of interest these days.
Also, dudette, you ARE probably one of the smartest in the bunch!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
My post is addressing only my workplace...not all of your workplaces. I work in an environment of "blame the nurse."
What could make the life of the nurses easier in my hospital is encouragement of teamwork among all staff--and enforcing it among a handful of nurses and CNAs.
Let's take one example. Falls. The other day, as I and another nurse were running to a bed alarm, I passed three residents, two housekeepers, an RT, a dietary tech, and a CNA. No explanation needed.
Another: patient needed frequent suctioning and mouth care, on a continuous pulse ox, and I had been helping out the assigned nurse with it. Patient properly positioned at 90 degrees and watched as closely as possible on a floor. As I was walking down the hall, a housekeeper had come out looking frantic, and told the charge (with a rep for being a selfish, unhelpful, unaccountable *****) that the patient needed a nurse. I heard the charge say, "That's not my patient and start walking away. Really, the charge?! I whisked past the charge and saw the patient with a frothy phlegm ball in her mouth. Suctioned, she was fine for the time being. Called the assigned nurse to come in, which she did.
A quarter of the nurses spend a lot of time texting.
CNAs on one shift on one of the floors are always "too busy" to answer call lights or do delegated tasks, but they take a 1 hour lunch (on an 8 hour shift) and stand around talking about an hour before their shift change.
I got dressed down the other day by a second year because a stat lab wasn't drawn, although I saw the order a minute after it was put in and immediately called the lab to tell them it was stat. They didn't pull it until two hours later, after I got yelled at and called them again. In the back of my mind, I blamed myself. I should have followed up earlier, but another part of me was completely ****** off that I have to babysit ancillary staff ALL THE TIME.
Ok, where am I going with this? Yes, I believe that ratio and acuity need to be addressed. Yes, I feel that acuity is going up. Yes, I feel that administrators only care about the bottom line. However, it is clear to me that not everyone in healthcare possesses an extraordinary work ethic or commitment to teamwork. I'm not the smartest in the bunch nor the most knowledgeable, but I do know that if everyone worked as hard as I do and helped out as much as I do, all nursing environments would be much better.
In many places the teamwork is much better, but working conditions still suck because the teams are getting smaller. In your workplace, there is definitely a lack of accountability. (When you're the charge, they're ALL your patients.) This lack of accountability starts with management and rolls downhill from there. You're working in a poorly-run place. Hats off to you for just being there.
Specializes in Just starting out in a Nursing Home..
Yup. It has happened to me in homecare situations..no one person should have to lift anyone that big alone. Unsafe..I mean unless it is just repositioning..
It is getting dangerous, and that is why I have made a decison to leave. It is a visous cyle too. We are understaffed, they hire more nurses, the nurses get burnt out, then they are understaffed again. Then they feel the job was done with no major events understaffed, so they can keep it that way! It is crazy. All the while all this massive building and expansion is going on in most of the hospitals around here. If they cannot staff what they have, how is the new building going to be staffed? They have us drawing all the labs on our patients on a med/surg floor now. Then they just dropped the CNAs from 3-2 for 28 patients. Many times, they do not even have the 1900 vitals done until 2130! And I have no idea who thought that just because it is the weekend, that we need less staff. We still have the same amount of patients! Also, I am seeing more and more the complaint that physicians do not want to be called after 8 pm. What?! I would rather get yelled at then take that chance. Plus, add on all the tedious double charting, customer service scripts and paperwork. It is just overwhelming.
Specializes in critical care, ER,ICU, CVSURG, CCU.
my husband feels this position is necessary, and after his post bypass care on step down i would agree, but did feel for those young nurses with a decades experienced wife, i did try to teach rather than confront..... sometimes it was tuff. ie telling them they really needed to get a hold on his supravent tachy as he was loosing bp, or i was calling a rapid response myself, funny how quick some cardone and a drip got going.........it is scary,
Reading through all these posts futher confirms why I never want to go back to acute/hospital care. When I left the ICU I had been in for several years, it was partly due to the fact we were routinely being given three patient assignments. Sometimes, your patients were in two different pods, making it impossible to keep an eye on all three at the same time. I saw new grads being given Trauma Blue patients, where when I started at the facility, new grads were not allowed to take Trauma Blues for at least 6 months. My charge nurse at the time had about 2 years of experience out of school and was responsible for two different units that were on opposite ends of the hospital (about 40 some patients total). After the night he came up, asking if I knew how to put together a ventriculostomy because he needed help(which I did but shouldn't he have known that, being the charge nurse??), I realized I was working in unsafe conditions.
I've heard it's just gotten worse since I left. I am now working as a nurse inside the prison in the infirmary. I get to practice so many types of nursing and have substantial autonomy. Yes, I have to deal with the politics of the prison but they are no worse than what I was dealing with at the hospital. We are not govered by satisfaction polls and we don't have to deal with the crazy families. I leave work on time and the charting is minimal. I love my job and can see myself staying here for a long time, especially given the atmosphere of acute care these days. And the $25,000 pay raise didn't hurt either :-)
If I really think about it--go through my days and try to figure out what I get bogged down with--I can honestly say my ratio would be manageable IF I was allowed to prioritize based on patient condition. (You know, the way they taught us in nursing school!) However, floor nurses are always in fear of the stable squeaky wheel or the family member of the stable patient. The ones who demand the service and yell to anyone who will hear them because they aren't getting service fast enough.
The other day, I had a patient that was on the call bell for service-oriented requests. For a solid hour, I went into the room, did whatever she asked, asked her if there was anything else she needed, then left. I counted how many times she hit the call bell, even after all her "needs" were addressed. Seven times. SEVEN. In a single hour. It was her discharge day, if that gives you an indication of her stability. Anywhere from 21 to 28 minutes in that hour were spent on a needy, stable patient. I wished I could just tell her I will round on you every hour, so please do NOT misuse your call bell, ok? I was tempted---but didn't--to just walk in, eyeball her for two seconds to check distress, turn off the call bell, and forget about it. But, nope, we can't.
Another of my coworkers had a needy, stable patient, but she was also extremely forgetful, so going in her room multiple times by multiple staff members was a safety issue. I don't count that patient among the stable, service-oriented folk because it was a safety issue. But, it goes to show how one forgetful/confused patient can throw a wrench into your day.
I blame being unable to prioritize the way we should as nurses. I'm not saying I would never peek in on stable patients...of course I would! We do need to provide education to them, after all, especially as their discharge day approaches. That said, I'm convinced that ratio is not the issue here, at least where I work.
zingyrocks
4 Posts
I really enjoyed working in acute nursing but was getting caught up in too much 'he did that, she did that". I was fretting about my registration purely because I didn't have the resources to give the standard of care I wanted to. So I left that area and now work in a different area of nursing and haven't looked back. Its a shame but you have to decide what you want to be a part of when the s**t is hitting the fan and they're looking for an escape goat!