One of mymost memorable experiences was more than a decade ago while working for a Level One Trauma Center on the East coast. I was sitting in a hospital break room during one of my breaks as an inventory coordinator when a nurse walked in. I simply asked how her day was going and she fell into the chair next to me crying. Surprised by her reaction I asked "What's going on?" and she replied "I just lost my third patient today!" The impact of her personal experience stuck with me. Even now, looking back, I can't help but think how difficult a day it must have been for her.
Until that moment, my only experience with nursing had been as a patient. Seriously injured while serving on active duty, it was a nurse who saw me first and it was a nurse who discharged me from the hospital. It was a nurse who was responsible for all of my care. Like an air traffic controller, it was a nurse who coordinated my care as well as the care of many others.
The Most Overwhelming Parts of Nursing
What I didn't know at the time, but more than a decade later I would learn that the most overwhelming parts of nursing are the constant system failures. More than 30 percent of nursing time is spent hunting, fetching, and clarifying work not patient care. This is not the cause of any one person or processes, patient care has just evolved this way over time.
Fast forward more than decade and those experiences of stress and disappointment still exist for nurses. The reality here is that Health Care Organizations/Hospitals (HCO's) function in a way that requires nurses to focus more of their limited time and attention diagnosing systems needs rather than focusing on patients care. Nurses scrambling for linen, supplies, equipment, or waiting to clarify a medication prescription are just a few examples. It's all the unrelated system needs and its failures, not patient care, that adds real cost. Overburdened, a single nurse could be caring for as many as five to six patients struggling in a system that's failing him/her.
Between 2000-2007 Healthcare Spending Grew at Nearly 6%/Year
In recent years, the cost of healthcare has gotten a great deal of attention and with good reason. Between 2000 and 2007, healthcare spending grew at nearly six percent per year, a much steadier growth rate than inflation or wage growth. Future healthcare costs has even been a security concern--increases in healthcare spending are and will increasingly take money away from military readiness. Many scandalous stories about the costs of healthcare have been told. And while we share Americans' outrage at the cost of healthcare, there is some good news on the cost front: healthcare spending has been leveling off in recent years.
The Real Scandal of Healthcare
Progress on the cost of healthcare notwithstanding, there is a serious scandal in healthcare--the toll that healthcare takes on the people who deliver it. The burdens of regulation, cost reductions, and quality initiatives piled onto nurses and other clinicians are undeniable. The biggest current and future risk to health care is shortages of nurses and doctors. Especially in nursing, "there is growing evidence that the job people are asked to do is unreasonable and consequently moving people out of the profession"; emerging shortages are weighing down further the workload and feasibility of already overworked doctors and nurses.
In a recent study of forty hospital units, more than one third of nurses reported that they intended to leave their position within the next year; sighting emotional exhaustion and lack of personal accomplishment, two key indicators of nurse-burnout. "And as growing evidences has shown, nurse-burnout dramatically influences how satisfied patients are with their care."
The performance of nurses and their impact on quality is determined by many factors.
In the end, though, all research on the quality of nursing care either concludes the absolute necessity of support departments providing nurses with what they need, or assumes that these departments will do so. Put another way, treating nurses as customers is at the heart of all work on the quality of patient care by nurses.
Efficiency--how hospitals must operate--will loom large as the Affordable Care Act (ACA) is rolled out and sequestration cuts continue. Efficiency will equal profitability; without it continued financial pressures will mount. Leaving only two choices for HCO's/Hospital; open or closed!
On a typical day, a nurse will walk an average of three miles per 8 hour shift. Up and down the same thirty-foot stretch of hallway over and over again--hunting for and fetching the many things she needs to care for her patients. In fact, she'll do this 528 times in 8 hours, with no confidence that the healthcare organization will ever change or an expectation that it should. In a typical hospital, the constant hustle required of nurses is a testament to their continued drive to serve patients
Healthcare organizations fail to support nurses' efforts to provide precise patient care.
The scandalous lack of coordination is bad for us all. All nurses should be able to expect more from the healthcare organizations that employ them. The Scandal of Healthcare is real and it is negatively impacting nurses and many other healthcare workers. Most importantly, it's impacting the patients they serve.
The graduate nurses fromall 3 levels of nursing . In my hometown are going to work having never so much as started an IV. They ate oriented for a couple of weeks, mostly in hospital required meeting in localdogma as ndsigning papers for insurance, then are assigned to be the charge nurse at night with only a roaming supervisor for backup. The LVN$ are often actuallu running the floor!
"Students who spent the majority of their nursing clinical time in simulation labs, or spent the majority of their clinical time "observing" patient care, or spent time in the conference room on the unit during clinical time working on their care plans."
1000x this! I'm an LVN, when I was in nursing school I did a rotation in a large hospital. There were RN students from 2 other schools rotating through the hospital at the same time. We LVN students were encouraged, by our teachers and the hospital staff to be hands on with patient care. The RN students were forbidden by their schools to interact with patients. I would overhear the RN instructors telling their students to stay back, out of the way, during patient procedures. Nursing is hands on and your first day on the job should not be your first experience with hands on care, in my opinion.
What is the best way to get involved? How do we get the message out? Nurses ARE the backbone of healthcare and the key to reducing cost but most significantly increasing the value for patients..
I agree with your post. Nurses are expected to "do it all" without proper support systems in place for them. There are may hospitals who will short staff, not only nursing, but other departments as well, in order to prop up the bottom line profits. This leads to serious strain on all departments and begets a divisive environment (e.g., "it's not MY job" mentality). Unfortunately, the brunt of the liability in the care of patients does lie with the nurses. They are trusted and expected to take on so much responsibility. It is the world's hardest job, but we still have a lot to be proud of as nurses. The decision to leave such a dysfunctional environment still weighs heavy on those who really care about, and love providing care to people in need.
I agree with your statement on this. I was one of the lucky ones who had a lot of on hands clinical experience in school, and I was encouraged to do so. I think a lot of it depends on two things: 1) the level of liability the school holds for their students, and 2) How much students are willing to "get their hands dirty". I was terrified during clinicals, but I also knew that I was going to have to do it as an employee someday. Better to get the experience in as much as I could while under the guidance of instructors and preceptors. The floor nurses I worked with seemed (mostly) to appreciate those of us with the initiative to at least try. On the other hand, I do think that too many new nurses should be given much more time under preceptors when they do land that first job. I am not a believer that new nurses should be starting in the ER or the ICU unit. Definitely not a place for newcomers.
Specializes in orthopedic/trauma, Informatics, diabetes.
I am an older new grad (relatively, been a nurse for 4 years, I became a nurse at 48). I had no disillusions about what this was going to be like. Until lately. We have more pts, higher acuity, off service pts, and an apathetic administration that is as overwhelmed and overworked as we are.
I too wear a fit bit and I walk about 10K steps each shift. I ran a 1/2 marathon and that was 34K steps. So each shift I am walking the equivalent of 1/3 of a half marathon. No wonder I didn't need as much training as the average person.
Most days I can hold it together. I am slightly ADD, so I am good at multi tasking, but there is not room for anything to go wrong. No late meds from pharmacy, no call outs from other nurses or aides. One little thing gets messed up, the day is ruined. Everyone is on edge and this feeling permeates everything. The pts sense it, the nurses, we snap at each other and we LIKE each other. I couldn't imagine a group that didn't get along!
It is just too much. I LOVE being a nurse, but it is becoming too difficult to manage. There is no nursing shortage, they just want us all to do the work of two. I am back in school, but I am having a hard time getting enthused about that. I could NOT imagine being a young new grad and be plunged into this. We are losing, and going to lose, some potentially great nurses. Very sobering.
arthurbaird0
15 Posts
On a typical day, a nurse will walk an average of three miles per 8 hour shift. Up and down the same thirty-foot stretch of hallway over and over again--hunting for and fetching the many things she needs to care for her patients. In fact, she'll do this 528 times in 8 hours, with no confidence that the healthcare organization will ever change or an expectation that it should. In a typical hospital, the constant hustle required of nurses is a testament to their continued drive to serve patients
Healthcare organizations fail to support nurses' efforts to provide precise patient care.
The scandalous lack of coordination is bad for us all. All nurses should be able to expect more from the healthcare organizations that employ them. The Scandal of Healthcare is real and it is negatively impacting nurses and many other healthcare workers. Most importantly, it's impacting the patients they serve.