Does the not-so-well-oiled Healthcare machine cause frontline personnel to lose compassion

[Kharma711]

So let me start by saying this is definitely a "what I've learned" type of post combined with observations and reflection. Probably going to be long and perhaps a bit scattered since I've been awake 24 hours.

I have a several shifts in a row either being the code nurse and having a patient on the unit go bad or having the patient who is deteriorating, EACH SHIFT. It has been exhausting.

Just a little back story, I work at a large, safety-net, teaching hospital and have just over one year experience on step down/intermediate care and have had ACLS certification since May and attended exactly one true code.

The focus of this post is lack of compassion for the human experience of the patient. I will admit that I've had a few (though not many) nights that I coast through and find myself making excuses as I rush from room to room.

After nights such as those, I find myself reflecting on the care I have provided. I occasionally rehash scenarios where I know I could have done better and had a more positive impact on my patients.

The problem is, I look around at my fellow nurses, techs, transport personnel, ekg techs, xray techs, etc. And find a very common theme. Very few of them treat each experience with a patient as a first time experience. I know we are all busy and have to-do lists miles long, but what about the patient? They are vulnerable and at our mercy so to speak. They need guidance and explanations about what we are doing and why it is needed.

I endeavor to always be polite and professional. I want to be the nurse you can ask questions of and expect answers or at least a promise to try to find out. I want to be the nurse that you remember for little things like respecting your modesty, controlling your pain, and spending a little time with you not oriented to task work.

The problem is that everyone is overworked here at my hospital. We are more often than not expected to take responsibility for more patients than the standard ratio. I've seen as many as 7 or 8 patients be my responsibility in a single shift when our ratio is supposed to be 4:1. I feel unsafe practicing this way. I have barely enough time to register what is happening, let alone the intricacies of patient conditions and relations outside the hospital. On shifts like those I get lost in what I have to do and lose sight of my purpose.

I'm not the only one. There are nurses and techs (and others) that I would like to slap for the way they treat patients. Even on my craziest, busiest night I would never do some of the things that I see and just seem to be accepted because we are too busy to worry about anything but what else has to be done.

With changes to Healthcare, the focus is supposed to be on patient experience but it is not what I see in practice on my unit. I see barely veiled hostility at being asked to perform basic cares or even get a patient something requested by nurses and techs alike.

I can't help but feel that something has to give somewhere. I'd like to say that some of my coworkers should (rightfully) be fired, but that just makes the strain on the rest of us worse. I see nurses and techs who I would never let touch me or a family member continue to work day in and day out.

I guess my true frustration is that I am an idealist and maybe my expectations of nursing and frontline care is unrealistic. However, then I get the sincere thanks of patients and family who can tell I am committed and sincere. I can't help but to wonder if it's just me or if there are others out there who hate taking any sort of short cut, and I don't mean in ways that cause harm. I mean in the overall care of my patient.

I have been pushy and sometimes demanding with residents and interns when I feel I truly understand what the patient wants and needs and I get push back. I know they have not had the same experiences and gained the same trust that I have with the patient.

I guess what I'm looking for is some comraderie on the subject and perhaps some tips on how to survive without becoming another burn out like the many I see each shift. Can anyone else relate?

[Ruby Vee, BSN]

I can't say I've encountered all of these terrible people that you seem to have been saddled with as your co-workers. I haven't encountered them as a nurse. Oh, one or two here and there. There's always that ONE co-worker. But not as many as seem to be populating your workplace. I haven't encountered them as a patient, either, and I've been a patient a lot more than I would have liked to be. Nor have I encountered them as the family member of a patient. So either you work at a place full of really terrible people, or you need to take a second look at your standards.

[Kharma711]

I can't say I've encountered all of these terrible people that you seem to have been saddled with as your co-workers. I haven't encountered them as a nurse. Oh, one or two here and there. There's always that ONE co-worker. But not as many as seem to be populating your workplace. I haven't encountered them as a patient, either, and I've been a patient a lot more than I would have liked to be. Nor have I encountered them as the family member of a patient. So either you work at a place full of really terrible people, or you need to take a second look at your standards.

Perhaps I didn't put this into perspective as much as I had hoped. Again, forgive me because I've been awake too long.

I get along with most everybody. In fact I make an effort to be friendly to absolutely everyone, not just my unit staff. Be it housekeeping, ekg, xray, etc. I believe in being a positive influence. Some coworkers who I previously weren't too sure of have responded to my friendliness and willingness to help... others not so much.

I had a senior RN with 25+ years experience who was my night shift preceptor tell me basically "no thanks" when she was looking for her tech to help reposition a patient and I offered to help. Like I always would.

Likewise, there is a tech I can't stand who refuses to hold up her end and will literally raise her voice and argue rather than do her job. It also met other people (xray etc) that comes to the floor with poor attitude and are just short of rude to patients....

I want to say a lot of things but I bite my tongue because most of them have been there longer than myself but I can't help but to wonder why we have perpetually low scores.

There is one or two nurses on the opposing shift that are practically incompetent and have left me and the patient in precarious situations more than once but yet they continue to practice. I should speak up more, but again our situation is precarious at best with staffing.

Honestly I'm frustrated and feel like I want to leave when my 2 year residency contract is up. Currently looking to change units to MICU to gain more experience but find management blocking my way because of staffing.... it's rediculous

[Sour Lemon]

So let me start by saying this is definitely a "what I've learned" type of post combined with observations and reflection. Probably going to be long and perhaps a bit scattered since I've been awake 24 hours.

I have a several shifts in a row either being the code nurse and having a patient on the unit go bad or having the patient who is deteriorating, EACH SHIFT. It has been exhausting.

Just a little back story, I work at a large, safety-net, teaching hospital and have just over one year experience on step down/intermediate care and have had ACLS certification since May and attended exactly one true code.

The focus of this post is lack of compassion for the human experience of the patient. I will admit that I've had a few (though not many) nights that I coast through and find myself making excuses as I rush from room to room.

After nights such as those, I find myself reflecting on the care I have provided. I occasionally rehash scenarios where I know I could have done better and had a more positive impact on my patients.

The problem is, I look around at my fellow nurses, techs, transport personnel, ekg techs, xray techs, etc. And find a very common theme. Very few of them treat each experience with a patient as a first time experience. I know we are all busy and have to-do lists miles long, but what about the patient? They are vulnerable and at our mercy so to speak. They need guidance and explanations about what we are doing and why it is needed.

I endeavor to always be polite and professional. I want to be the nurse you can ask questions of and expect answers or at least a promise to try to find out. I want to be the nurse that you remember for little things like respecting your modesty, controlling your pain, and spending a little time with you not oriented to task work.

The problem is that everyone is overworked here at my hospital. We are more often than not expected to take responsibility for more patients than the standard ratio. I've seen as many as 7 or 8 patients be my responsibility in a single shift when our ratio is supposed to be 4:1. I feel unsafe practicing this way. I have barely enough time to register what is happening, let alone the intricacies of patient conditions and relations outside the hospital. On shifts like those I get lost in what I have to do and lose sight of my purpose.

I'm not the only one. There are nurses and techs (and others) that I would like to slap for the way they treat patients. Even on my craziest, busiest night I would never do some of the things that I see and just seem to be accepted because we are too busy to worry about anything but what else has to be done.

With changes to Healthcare, the focus is supposed to be on patient experience but it is not what I see in practice on my unit. I see barely veiled hostility at being asked to perform basic cares or even get a patient something requested by nurses and techs alike.

I can't help but feel that something has to give somewhere. I'd like to say that some of my coworkers should (rightfully) be fired, but that just makes the strain on the rest of us worse. I see nurses and techs who I would never let touch me or a family member continue to work day in and day out.

I guess my true frustration is that I am an idealist and maybe my expectations of nursing and frontline care is unrealistic. However, then I get the sincere thanks of patients and family who can tell I am committed and sincere. I can't help but to wonder if it's just me or if there are others out there who hate taking any sort of short cut, and I don't mean in ways that cause harm. I mean in the overall care of my patient.

I have been pushy and sometimes demanding with residents and interns when I feel I truly understand what the patient wants and needs and I get push back. I know they have not had the same experiences and gained the same trust that I have with the patient.

I guess what I'm looking for is some comraderie on the subject and perhaps some tips on how to survive without becoming another burn out like the many I see each shift. Can anyone else relate?

You're so vague and all over the place that it's hard to pinpoint the actual issue(s). You do seem to be more idealistic than most, though.

I don't mind "spending a little time" with patients, but concrete life-and-death tasks will always take priority over feelings.

[Kharma711]

Again, I'm on very little sleep at the moment, but I always prioritize life and death over touchy-feels so to speak... but I have been pushed to the max the last couple weeks.

I realize I've been vague and scattered but that is truly how I feel and it affects the care I give to my patients. When every shift is a chore, it is hard to focus on my goals of providing care that I'm proud of...

The last shift I did have a patient going south but he was within normal limits most the shift, even if I knew he was going bad. I felt as if I had this one patient going bad so I focused on him to a point of exclusion to my other patients once he fell out of WNL criterion. The intern actually argued against a bolus to the patient who had no history of CHF and was septic....

I feel like I spend too much energy arguing with interns and spending time filling ice bc my tech is avoiding high needs rooms. It is just rediculous.

I'm mostly commenting on what I see and wondering what others have seen and if what I am experiencing is kind of a new norm.

Please I'm hoping you all will tell me that what I see is not normal. So then I know what to look for in future employment. I want to be an idealist but I understand priority.

[NurseGirl525, ASN, RN]

I saw though your wanting to go to MICU. Many of those patients go south. I'm trying to understand what you are getting at, I guess.

In ICU, you constantly have to be on top of it. You can have a patient fine one moment, next you look up and their pressure is tanking. You are constantly watching vital signs and titrating drips. I know I can get frustrated knowing that day I got a pt off the Levophed one shift, only to come in and see them maxed out the next.

I can understand your frustration with one shift doing absolutely nothing and leaving you a mess. I have had that happen more than once. I just do my best to clean up their mess and make my own progress. Believe me, if they are back I make it a point to show them it can be done. But, you encounter laziness in every profession out there. It's not your job necessarily to judge. Let that up to management. I had one nurse say I needed to report what I came into one shift. I didn't. I forgave her laziness one time on maybe personally having a bad night. One freebie is all she gets with me.

As far as positioning, why are you upset about that? She was using a tech for the job they were hired to do. Let that roll off your back.

I think you are being too sensitive here and need to learn to go with the flow. Stop taking it all so personally.

[Susie2310]

Good post and very well articulated. You sound like a very conscientious, caring nurse, who is trying their best to practice competently/safely and be a good patient advocate. I very much hope that you continue to keep the attitude you have now towards your patients.

As patients/family members I/my family have experienced the attitude from health care professionals and other health team members that you described. The situation you describe is not normal, but in my experience unfortunately is not uncommon.

For what it's worth, and this is just my experience and opinion, I have noticed an increase in what I would describe as uncaring, even hostile behavior towards patients in the last few years, by both nurses and physicians. Some of the behavior looks like burn-out to me.

Please continue to be/become the best nurse you can be. I'm sure you give a lot to your patients and I'm sure they appreciate you.

[Kharma711]

I saw though your wanting to go to MICU. Many of those patients go south. I'm trying to understand what you are getting at, I guess.

In ICU, you constantly have to be on top of it. You can have a patient fine one moment, next you look up and their pressure is tanking. You are constantly watching vital signs and titrating drips. I know I can get frustrated knowing that day I got a pt off the Levophed one shift, only to come in and see them maxed out the next.

I can understand your frustration with one shift doing absolutely nothing and leaving you a mess. I have had that happen more than once. I just do my best to clean up their mess and make my own progress. Believe me, if they are back I make it a point to show them it can be done. But, you encounter laziness in every profession out there. It's not your job necessarily to judge. Let that up to management. I had one nurse say I needed to report what I came into one shift. I didn't. I forgave her laziness one time on maybe personally having a bad night. One freebie is all she gets with me.

As far as positioning, why are you upset about that? She was using a tech for the job they were hired to do. Let that roll off your back.

I think you are being too sensitive here and need to learn to go with the flow. Stop taking it all so personally.

As far as the tech part, the tech was unavailable, but rather than accept my help with repositioning, she left the patient sprawled in what looked to be a terribly uncomfortable position until the tech came back from break. It didn't hurt my feelings per se as this nurse can be prickly, but my focus was on patient care.

It didn't matter to me that it wasn't my patient. As long as I am able, no matter what is needed I will help whomevers patient. I don't believe in "tech jobs" as far as toileting patients, cleaning up messes or fetching a snack or more ice/water.

Besides the very rare (I have had 2) nights where my focus is not at its sharpest, I stay busy and on top of everything going on to the best of my ability, which is darn near impossible with 6 patients. At my hospital, we always have patients that would be in the ICU at other hospitals. We just don't have enough beds in ICU (even though I think we have 50/60+).

I've had shift where I have a full load of step-down patients and am holding an ICU patient on top of it. Sure it's stupid busy and crazy, but even then I don't let myself get burned out over it. I make my way through the shift doing as much as possible while respecting the patient/family experience.

Now, I've had patients complain when they haven't seen me (but never pressed the call bell) and refusee my apology when I am sincerely sorry they needed something and I couldn't be there due to whatever was going on down the hall.

I have so many thoughts and feelings regarding many of these issues but my point is that so many people in Healthcare don't seem to care past getting through the shift. They never offer to help others and will actively dodge patients that need something or hide at the desk/break room, etc. The "it's not my job" mentality is huge here. Heck, even if it is their job, they just don't feel like it/don't care. And it scares me that these people care for patients at thier most vulnerable and scared states.

[missmollie, ADN, BSN, RN]

It sounds to me like you are questioning why others don't feel the same as you. No one can answer that, but I can tell you that the only person you can change is yourself. You have standards that you hold yourself to, but how long can they last in a position where you have 6 patients? When do you decide to become short with a patient because another patient has more concerning issues? Is it possible that your reaction to patients may change after time?

There are always going to be people who do not match our own idealizations of what healthcare is, and the only thing you can personally do is try to remain constant to your own beliefs. Your experiences will change how you see and interact with people and you won't be the same person in five years that you are today.

[calivianya, BSN, RN]

I have seen units like what you're describing. It comes from (IMO) being chronically short staffed. It's one thing if you have too many patients twice a month. It's another if you're above your ratios every shift for weeks. It wears you down. We had a two month period on my unit where nearly every nurse had a three patient assignment every shift (we are supposed to be 1:2), and it was NOT pleasant being around my coworkers. Having too much work to do in too little time frays people at the edges. It's starting to work on you, but not to the point that your ability to care about what's happening is impacted. Yet.

The thing is, something is going to give. If the situation never improves, either you will relax your standards and not be as thorough/caring as you are now and adjust your expectations, or you're going to snap. You can't care about doing things the right way that much and be forced to do them the wrong way and have that sit well on your conscience.

[Ruby Vee, BSN]

As far as the tech part, the tech was unavailable, but rather than accept my help with repositioning, she left the patient sprawled in what looked to be a terribly uncomfortable position until the tech came back from break. It didn't hurt my feelings per se as this nurse can be prickly, but my focus was on patient care.

It didn't matter to me that it wasn't my patient. As long as I am able, no matter what is needed I will help whomevers patient. I don't believe in "tech jobs" as far as toileting patients, cleaning up messes or fetching a snack or more ice/water.

Besides the very rare (I have had 2) nights where my focus is not at its sharpest, I stay busy and on top of everything going on to the best of my ability, which is darn near impossible with 6 patients. At my hospital, we always have patients that would be in the ICU at other hospitals. We just don't have enough beds in ICU (even though I think we have 50/60+).

I've had shift where I have a full load of step-down patients and am holding an ICU patient on top of it. Sure it's stupid busy and crazy, but even then I don't let myself get burned out over it. I make my way through the shift doing as much as possible while respecting the patient/family experience.

Now, I've had patients complain when they haven't seen me (but never pressed the call bell) and refusee my apology when I am sincerely sorry they needed something and I couldn't be there due to whatever was going on down the hall.

I have so many thoughts and feelings regarding many of these issues but my point is that so many people in Healthcare don't seem to care past getting through the shift. They never offer to help others and will actively dodge patients that need something or hide at the desk/break room, etc. The "it's not my job" mentality is huge here. Heck, even if it is their job, they just don't feel like it/don't care. And it scares me that these people care for patients at thier most vulnerable and scared states.

It sounds as if you're spending your energy judging everyone else around you. It must be horrible to be the only perfect person among so many seriously imperfect people.

You cannot control anyone else's practice and at one year, or thereabouts, you have much to learn in your OWN practice. Your time and energy would be better spent worrying about that. You are always going to work with other people who have different standards and work ethic than your own. Time to learn how to deal with that.

[SmilingBluEyes]

Maybe, get some good sleep and come back. I see a lot of (understandable) emotion but very little concrete. It would appear, to me anyhow, your opinion is virtually everyone BUT you gives substandard care. I have to wonder about your clarity and perspective.