A floor nurse's rambling late night rant.

Nurses General Nursing

Published

Specializes in Infusion, Med/Surg/Tele, Outpatient.

I am proudly a 'floor nurse' and a generalist. I do my job well, I am caring, and advocate for my patients whose needs are met. I have 5 to 6 assigned patients at any given time. Why is the number of patients I have important? Well, each of my patients get only 10 to 12 minutes of my time every hour, including charting. It is impossible to be in more than one place at a time. So you or your loved one may really only have my physical presence for 5 to 7 minutes every hour. Really, if I spend more time with you, I'm actually taking time away from someone else. And this time does have to factor in my own physical needs. At least once or twice in my 12 or 13 hour shift, I do have to use the restroom. My employer deducts a 30 minute lunch break that I'm supposed to take to eat. In theory I should sit down and eat.

The health care industry really does need reform. It functions now for most people slightly adequately. There is lots of room for improvement. But all the talk of health care reform scares me. The Bottom Line. Nurses' salaries are the number one operating expense of a hospital. And it is an expense. Inpatient nursing care is not reimbursable, and is considered part of room and board; as opposed to a procedure, like an x-ray, that could be covered by your insurance. I fear that I'm going to be required to do more in the same amount of time with less support staff. I think of wages. A nurses' aide costs about ½ to 1/3 less than a nurse. If I'm to take a heavy load, why can they not get us more aides? Do I really need specialized, formal education and training to make a bed? Empty a bedpan or commode? Can unskilled labor not do a good portion of what I do? Leave me what tasks must be done by someone with my specialized, formal training.

'Pay for performance' is the standard. Soon, Medicare/Medicaid will be basing reimbursement on patient satisfaction. The theory is great. Good care is rewarded with more money; bad care is penalized with less money. I see the point. But patient satisfaction scores are not an objective measure of good, quality care. My cardiac patients are often on a low-salt diet, sometimes with a fluid restriction. I may not be allowed to bring them salt or water if requested. Often, I am left to explain why the doctor decides this and even inform the patient of the doctor's order for the diet. But these patients are usually dissatisfied, and that is the only measure of quality being judged. Take pain, for another example. Personally, I think pain sucks. The doctors decide which pain medication, how much medication, how often you can have it, and how it is given; not the nurse. We just follow the prescription as ordered. If it is not adequate, we call and bug the doctor and try to get them to change it. Pain medications also do have side effects. I tell quite a few of my patients this - "I am happy to bring your pain medications as liberally as ordered by the doctor. But you must do a few things for me: you must continue to breathe; you must maintain a blood pressure; you must have a pulse; and you must be awake or aware enough to communicate with me." It usually gets a laugh, but drives home my point. Alas, the survey only asks if you were satisfied with your pain management, not if we killed you with pain meds (a very real concern.) Which is the indicator of quality care?! Adequate pain relief is often not achieved for a certain percentage of the population for whatever reason.

Now I'm just rambling on. But I want to be judged on my care. Not the doctors, not the lab, not the other nurses, not anything other than what I am actually responsible for. I want to only be accountable for myself and my own actions. Maybe it's time to leave the bedside.

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Awww...I'm sorry and although I'm only a student I can understand how stressful it is. I agree with you as well. They care so much about money and customer satisfaction but what they fail to realize is if someone is there to help you with basics (making a bed) then you'll have more time for each patient, satisfaction will go up and less errors will be made... OH, and as a bonus, you'll get to pee and take your UNPAID lunch break. I find that the most ridiculous part to be honest. I don't know how you guys do it with an unpaid lunch but no time to take it. It should be mandatory and scheduled for someone to cover. You'd come back refreshed *somewhat* and able to take care of more things. :twocents:

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Specializes in PCCN.

I totally feel your pain.Everything you have said is truth.And I don't think anything will ever change.Good luck getting away from the bedside- I am jealous- I'd love to get away from nursing but am now too old to change.I have come to accept that when the time comes that I lose my license over some of this stuff that we have no control of, well, then I lose my license/job. Not a nice future either way.

Oh, and I had one of those patients where they wanted to be so snowed that they had no idea what was going on-seriously- would need to be aroused with more than a nudge, but then would say since you woke them up that they needed more dilaudid- and we were talking 4mg iv ! I refuse to participate in that.But then we get the " my pain isnt controlled" . Oh, and this was not a cancer patient.ugg i digress, sorry.

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I got called a ***** tonight, because instead of doing what the patient's daughter wanted me to do, I used my critical thinking and judgment to determine that what she wanted was not a priority and did not need to be done. It seems to me that how quickly we can bring sandwiches and warm blankets is far more important to patients than the actual life saving medical care that they are receiving. It seems to me that the Not Very Sick are the most demanding, self centered people. It seems to me that I spend more of my time waiting on people hand and foot than I do actually using my brain, and that this is what our "customers" value. If I had known this is what nursing is like, I might have chosen a different profession.

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I dont work in a hospital anymore because of the same issues you are having. Hospitals preach quality care and give you enough time for so so care at best then the nurse is penalized for not performing. You are only one person you cant be in 6 places at one time no matter how good a nurse you are. It doesnt even relate to how good a nurse you are because you never have a chance to show what you know in between call lights.

Proud Hospice Nurse RN/DON

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Wow, you've nailed it! I disagree about the role of the nursing assistant...they have to be trained as well, even though their tasks may seem menial. There are good assistants out there and bad ones....just like good and bad nurses. I appreciate all the hard work our nursing assistants do , so we can do all of our CHARTING! It's interesting b/c it seems like this is not just in the US, but all over the world. I am a Registered Nurse in the US, but have gone to the UK to further my nursing education. My classmates are nurses from the UK, India, Africa, and China and it sounds like this is the case all around. Fortunately for us, it sounds like the US has it best. So I guess we will all just have to keep doing what we're doing...caring for others :)

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

OP go do agency work. Then you could probably pretty much choose when and where you want to work. And you don't always have to do bedside nursing.

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Specializes in ICU, Telemetry.

Wait until you've had a CVA pt who is hysterical, you work all shift to get them calmed down with meds and love, and then the family shows up and shoots their BP thru the roof...and then they're mad because YOU won't let "maw maw" get discharged long enough to go home and sign her checks over to them. And, yeppers, we reported that bunch to social services. It can make you despair about humanity....

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Oh wow, this really strikes a chord with me. I can understand exactly how you feel... I work in ER, so my situation may be a little different, but the same types of people still come through there. For example, the "not so sick" want more and more blankets, seirra mist, sandwhich, more pain meds, etc. Meanwhile in the next room I'm trying to keep a critical patient from crashing on me. I love my job. I love interacting with patients and there families. I see such a lack of common sense and love for humanity in general. If I had sprained my wrist, I could understand why my nurse would be taking care of the guy having an active MI, or is unconscious, or the baby who is dehydrated and needs IV fluids, etc. I have resorted to telling my patients that. "I just want to give you a heads up, I have a very sick patient next door and I'm going to be tied up for a little while, is there anything I can do for you before I leave?" Most times this satisfies them and they are understanding. Our hospital recently started this policy that we have to round every 15 min. In theory this is great. In practicality, Oh my!! I can be stuck in a code room longer then 15 min. I can be initiated 3 iv's and hanging heparin, nitro, integrillin and giving asa and plavix for longer then 15min. I can be trying to calm down a pediatric patient so that I can assist with splinting their fracture for longer then 15min. How do you tell management all of this? I've only been a nurse for a little over a year... I can only imagine what the "politics" will be like in 30 years from now!!

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Specializes in Med/Surg & Hospice & Dialysis.
I have 5 to 6 assigned patients at any given time. Why is the number of patients I have important? Well, each of my patients get only 10 to 12 minutes of my time every hour, including charting. It is impossible to be in more than one place at a time. So you or your loved one may really only have my physical presence for 5 to 7 minutes every hour. Really, if I spend more time with you, I'm actually taking time away from someone else. And this time does have to factor in my own physical needs. At least once or twice in my 12 or 13 hour shift, I do have to use the restroom. My employer deducts a 30 minute lunch break that I'm supposed to take to eat. In theory I should sit down and eat.

This is a huge eye opener for me. We typically have 5-7 acute surgical pts. I have never thought of the time each pt is alloted. Of course you don't really spend that amount of time each hour, but collectively, you get about 1 hour of "face time" per pt per shift. Let them have a super complex dressing change, or a transfer, that takes significant time away from the other pts.

I just found the time breakdown interesting!

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I am proudly a 'floor nurse' and a generalist. I do my job well, I am caring, and advocate for my patients whose needs are met. I have 5 to 6 assigned patients at any given time. Why is the number of patients I have important? Well, each of my patients get only 10 to 12 minutes of my time every hour, including charting. It is impossible to be in more than one place at a time. So you or your loved one may really only have my physical presence for 5 to 7 minutes every hour. Really, if I spend more time with you, I'm actually taking time away from someone else. And this time does have to factor in my own physical needs. At least once or twice in my 12 or 13 hour shift, I do have to use the restroom. My employer deducts a 30 minute lunch break that I'm supposed to take to eat. In theory I should sit down and eat.

The health care industry really does need reform. It functions now for most people slightly adequately. There is lots of room for improvement. But all the talk of health care reform scares me. The Bottom Line. Nurses' salaries are the number one operating expense of a hospital. And it is an expense. Inpatient nursing care is not reimbursable, and is considered part of room and board; as opposed to a procedure, like an x-ray, that could be covered by your insurance. I fear that I'm going to be required to do more in the same amount of time with less support staff. I think of wages. A nurses' aide costs about ½ to 1/3 less than a nurse. If I'm to take a heavy load, why can they not get us more aides? Do I really need specialized, formal education and training to make a bed? Empty a bedpan or commode? Can unskilled labor not do a good portion of what I do? Leave me what tasks must be done by someone with my specialized, formal training.

'Pay for performance' is the standard. Soon, Medicare/Medicaid will be basing reimbursement on patient satisfaction. The theory is great. Good care is rewarded with more money; bad care is penalized with less money. I see the point. But patient satisfaction scores are not an objective measure of good, quality care. My cardiac patients are often on a low-salt diet, sometimes with a fluid restriction. I may not be allowed to bring them salt or water if requested. Often, I am left to explain why the doctor decides this and even inform the patient of the doctor's order for the diet. But these patients are usually dissatisfied, and that is the only measure of quality being judged. Take pain, for another example. Personally, I think pain sucks. The doctors decide which pain medication, how much medication, how often you can have it, and how it is given; not the nurse. We just follow the prescription as ordered. If it is not adequate, we call and bug the doctor and try to get them to change it. Pain medications also do have side effects. I tell quite a few of my patients this - "I am happy to bring your pain medications as liberally as ordered by the doctor. But you must do a few things for me: you must continue to breathe; you must maintain a blood pressure; you must have a pulse; and you must be awake or aware enough to communicate with me." It usually gets a laugh, but drives home my point. Alas, the survey only asks if you were satisfied with your pain management, not if we killed you with pain meds (a very real concern.) Which is the indicator of quality care?! Adequate pain relief is often not achieved for a certain percentage of the population for whatever reason.

Now I'm just rambling on. But I want to be judged on my care. Not the doctors, not the lab, not the other nurses, not anything other than what I am actually responsible for. I want to only be accountable for myself and my own actions. Maybe it's time to leave the bedside.

Been there and done that. Agree with many of your points. Only thing is pay for performance uses well researched evidenced based clinical quality measures from AHRQ http://www.ahrq.gov/ as does CMS requirements like drg about to be replaced with meaningful use). the patient satisfaction surveys are used by the hospital for marketing, tho sometimes the state mandates they're published, and yeah, maybe to whack you over the head with but they're not used for pay for performance - at least if so it's news to me.

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Specializes in Public Health, TB.

I use this time breakdown alot to explain to docs when they don't want to transfer a pt to ICU, and just say "just keep a close eye on them".

Hello, how will I do that when Grandma Moses keeps setting off her bed alarm, Uncle Bob's family keeps calling for updates, pharmacy wants to verify if Aunt Betty had her B12 shot this month, ED is on the phone trying to give you report.

Each pt gets 5 min of face time an hour, period, unless you can change the laws of physics.

And no overtime, please!

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