I recently had a spinal fusion surgery. Fourteen hours of anesthesia and positioned flat for 24 hours due to a CSF leak. It was a nightmare. The hospital nurses appeared at my bedside to administer medications and type on the computer mounted in the room. That's it.
Not once did a nurse ask if they could help me get comfortable, like put a pillow under my knees or bring a warm washcloth so I could wipe my face. No one offered to help me brush my teeth. I had to ask for a glass of water, since no IV fluids were running due to the nationwide shortage, but no one helped me drink it. Lying completely flat, I couldn't reach the water. No food was provided. After two days, when I asked if I was missing meal trays I was handed a menu and told to call nutritional services; apparently meals are delivered to order, but no one informed me. I felt like a wounded rat in a trap.
When I became a nurse a long, long time ago, patient care meant more than meds and charting. I understand hospital nurses are overworked and units are woefully short staffed. For this reason, I am resolved that no one I love will be a hospital patient without me or another family member at the bedside.
Specializes in Patient Safety Advocate; HAI Prevention.
During my husbands brief fight with esophageal cancer in 2023, his care was horrible. It started with and ER boarding experience. He was seen quickly, assessed, and stuff ordered, then placed back in the waiting room. I asked for a stretcher because he was in pain. He was ignored for the bulk of 11 hours. No blanket or pillow, nobody introduced themselves as his nurse. Nobody checked on him. His IV ran dry, the battery in his monitor died,...nobody noticed. Finally after hours of this neglect I went to the nurses station (we were tucked away in a back hallway all that time) and his nurse laughed when I said my husband was being ignored. Until that point..well into 6 or 7 hours of boarding..we had no idea WHO his nurse was. He was told he could drink and he was supposed to be NPO for an MRI, so he lost his ER priority for that test. His admitting hospitalist was going to discontinue his BP meds because his BP was normal...apparently nobody was watching his monitor remotely because his readings topped out at over 180 systolic. I WAS HIS NURSE THAT DAY. He was finally admitted and was inpatient for 12 days. Then they discharged him when he was at his sickest so far..premature discharge. Predictably, he collapsed at home 3 days later, and we had to call EMS to return him to the ER. The triage nurse immediately told the EMTs to put him in a W/C..with a BP of 60/? He had just collapsed at home. During that 28 hour boarding, his liver tube was dislodged and the skin on his coccyx broke open....and that became a baseball sized bedsore before he died a week later. His nurse (after he got critical ER care), was a new graduate nurse and didn't know how to care for my complex needs husband.
His care was atrocious, but the worst of it was the ER care. He was bathed ONE time during all of his time in the hospital, except when I helped him to wash. He never brushed his teeth, unless I got him the necessary things to do it. So, yes, nursing care has gone downhill horribly. There are no excuses for it. Patients are human beings with physical needs that must be met. Nurses need to help patients to stay comfortable and infection free and lack of oral care an bathing is not conducive to that. All patients deserve respect and should feel that their dignity is preserved.
I will never forget or forgive the hospital for the awful care he got....but I will always be grateful for the special nurses who actually did care and did their level best in bad circumstances. There is always good mixed in with the the bad.
I'm so sorry you had to experience this. Like others have said here...never ever go into the hospital without a trusted advocate (family or friend) to help you with basic needs.
I always teach my patients how to order and definitely would be assisting a flat patient to drink and make sure they have access to their bedside table.
That being said I always get kind of annoyed when AOx4 patients with the ability to speak don't just ask for things. Instead some of them wait and the say we have been neglecting them. If I have confused and total patients I kind of hope/assume my with it patients will let me know what they need instead of expecting me to constantly ask them. It is already hard enough to keep track of those patients who actually can't properly communicate their needs to me.
OK, so to give you an idea of what it is now like...
On a medsurg floor the RN has 5-7 patients. There are no LPNs, they usually only work in nursing homes. Techs, or CNAs, have about 15 patients on a medsurg floor. Working on a surgical floor myself, I will not move you or even put your legs up fresh out of surgery till I get the all clear from neurosurgery. Figuring you were a tech in the 1970s, you're either in your 70s or 80s now. Based on that alone, it would be reasonable to believe they made you an aspiration risk, I'm not letting you have anything PO lying flat. They more than likely gave you fluids while under anesthesia or in the PACU. If you needed your face wiped, please tell me. For food, again, I'm not letting you eat till you can sit up. I'm not putting any water or food in your mouth due to aspiration risk. It sounds like the doctors could've explained this to you better, they should tell you this preop. However, the nurse could have also told you this postop. I'm not saying that everything that happened to you makes sense. There is some rational to the process though.
Figuring you were a tech in the 1970s, you're either in your 70s or 80s now. Based on that alone, it would be reasonable to believe they made you an aspiration risk, I'm not letting you have anything PO lying flat.
I'm sixty-nine, athletic, normal weight, and sharp mentation. I find it concerning that you would take it on yourself to place a patient on "aspiration precautions" without consulting with the physician, and simply be OK with insufficient fluid intake for 24 hours. There was no concern about aspiration, since I was taking PO medications with water. The water would then be placed on a bedside table that I couldn't reach.
And for nurses who share the opinion, "if you want something, ask for it," please put yourself in your patient's situation. Many hours hours of anesthesia, grinding pain, nausea, grogginess...someone in this situation just feels terrible, and the nurses appear to be rushed and overworked. It shouldn't be the patient's responsibility to ask for comprehensive nursing care.
Specializes in NICU, PICU, Transport, L&D, Hospice.
WhirlyGirlNurse said:
I'm sixty-nine, athletic, normal weight, and sharp mentation. I find it concerning that you would take it on yourself to place a patient on "aspiration precautions" without consulting with the physician, and simply be OK with insufficient fluid intake for 24 hours. There was no concern about aspiration, since I was taking PO medications with water. The water would then be placed on a bedside table that I couldn't reach.
And for nurses who share the opinion, "if you want something, ask for it," please put yourself in your patient's situation. Many hours hours of anesthesia, grinding pain, nausea, grogginess...someone in this situation just feels terrible, and the nurses appear to be rushed and overworked. It shouldn't be the patient's responsibility to ask for comprehensive nursing care.
It's always someone else's fault in a for profit health system. That's why USA health outcomes are in the toilet.
I think part of the quality of care depends on the nurse and aide as well as the rest of the care team. However the management (the floor and upper management) plays a major role. I had open heart surgery (bicuspid aortic stenosis so I knew I would need this surgery eventually) in March 2022 at a local hospital which is part of a large healthcare system. The care I received in the ICU was excellent. No complaints at all with any of the nurses who were working 12 hour shifts. They all provided excellent care and were very personable. However on the cardiac progressive unit the patient to nurse ratio was higher so I didn't see the nurses as frequently. Some of the nurses just came to administer medications but there were other nurses who took the time to do the nursing assessment and provide quality care. I also had another hospital admission when I had a small bowel obstruction in July 2022 (Unfortunately I was a "frequent flyer" with ER visits and hospitalizations in 2022). This hospital stay was at another local hospital associated with a smaller healthcare system. The general surgeon was so sweet (later I learned that their entire practice's doctors are very caring and personable). I had one nurse who stood out in providing excellent care and was very personable. One evening an aide stopped by my room and asked me if I wanted a bed bath. Since I had an NG tube attached to suction, I took her up on the offer. She mainly just needed to gather the supplies and water, exchanged the water PRN and wash my back. She was very personable and she was actually going to be starting nursing school in the fall. She was very friendly and personable each time she came into my room to get VS and always asked me if I needed anything. I had other aides and nurses who were like human robots coming in to do their minimal assigned tasks (VS, administer medications, document on the computer). The staffing issues were the same for each shift (shortage of staff related to the pandemic).
What really gets me about hospital nursing at the hospital I worked at for a short time is the shortcuts done like not doing the nursing assessment yet they had to document on the computer the findings of the nursing assessment. I personally did the nursing assessment (yes, listened to the heart, lungs, all 4 quadrants of the abdomen for bowel sounds, check for PERRLA, etc.) yet was criticized for taking too long in the patients' rooms. Bluepen, it sounds like your hospital management is taking the right steps to improve staffing ratios and consequently improving quality of care.
I'm sixty-nine, athletic, normal weight, and sharp mentation. I find it concerning that you would take it on yourself to place a patient on "aspiration precautions" without consulting with the physician, and simply be OK with insufficient fluid intake for 24 hours. There was no concern about aspiration, since I was taking PO medications with water. The water would then be placed on a bedside table that I couldn't reach.
And for nurses who share the opinion, "if you want something, ask for it," please put yourself in your patient's situation. Many hours hours of anesthesia, grinding pain, nausea, grogginess...someone in this situation just feels terrible, and the nurses appear to be rushed and overworked. It shouldn't be the patient's responsibility to ask for comprehensive nursing care.
Anyone who is ordered to lie flat on their back is considered an aspiration risk when taking anything PO, I don't care if you're 9 to 99. Add on top of that that you're 69, less than 24 hours from anesthesia, and just had spinal surgery messing with various nerve responses... I stand by my reasoning. I will be happy to supervise your PO intake to make sure you don't choke, that is my job as a nurse. I can intervene if something happens, but I am not going to let my patient eat or drink alone. There is such an order as "NPO except for medications.” Again, until neurosurgery tells me otherwise, I'm not going to move you. I am more concerned about you having full function. I am going to avoid any potential injury to the surgery like my patient trying to extend to reach for water or trying to sit up right after spinal surgery. Once the all clear is given by the neurosurgeon, I'll help you do cartwheels in the shower. The first hours after spinal surgery are very important. I wish the doctors or nurses explained this to you. You deserved better.
I find it concerning that you would take it on yourself to place a patient on "aspiration precautions" without consulting with the physician.
And also, are you kidding me? YES! 100% Yes! I will initiate aspiration precaution without hearing back from neurosurgery first. The patient is lying flat! That is responsible nursing judgment. I don't need an order. What world are you living in?
And for fluid intake, 90% of the time, fluids are given while under anesthesia in PACU. You should know as a nurse that PRN pain medication is only given if the patient asks for it or if there are very obvious signs of pain.
I find it all strange that I need to explain all of this to you since you are supposed to be a nurse. I'm not saying that to be insulting. I have new nurses that I've precepted that understand this. Why is all of this such a foreign concept to you? Has scope of practice and care plans changed that much? If you had a patient lying flat, you would need an order to initiate aspiration precaution? What if they had seizures? Did you need an order before placing bed padding?
KathyDay
3 Articles; 98 Posts
During my husbands brief fight with esophageal cancer in 2023, his care was horrible. It started with and ER boarding experience. He was seen quickly, assessed, and stuff ordered, then placed back in the waiting room. I asked for a stretcher because he was in pain. He was ignored for the bulk of 11 hours. No blanket or pillow, nobody introduced themselves as his nurse. Nobody checked on him. His IV ran dry, the battery in his monitor died,...nobody noticed. Finally after hours of this neglect I went to the nurses station (we were tucked away in a back hallway all that time) and his nurse laughed when I said my husband was being ignored. Until that point..well into 6 or 7 hours of boarding..we had no idea WHO his nurse was. He was told he could drink and he was supposed to be NPO for an MRI, so he lost his ER priority for that test. His admitting hospitalist was going to discontinue his BP meds because his BP was normal...apparently nobody was watching his monitor remotely because his readings topped out at over 180 systolic. I WAS HIS NURSE THAT DAY. He was finally admitted and was inpatient for 12 days. Then they discharged him when he was at his sickest so far..premature discharge. Predictably, he collapsed at home 3 days later, and we had to call EMS to return him to the ER. The triage nurse immediately told the EMTs to put him in a W/C..with a BP of 60/? He had just collapsed at home. During that 28 hour boarding, his liver tube was dislodged and the skin on his coccyx broke open....and that became a baseball sized bedsore before he died a week later. His nurse (after he got critical ER care), was a new graduate nurse and didn't know how to care for my complex needs husband.
His care was atrocious, but the worst of it was the ER care. He was bathed ONE time during all of his time in the hospital, except when I helped him to wash. He never brushed his teeth, unless I got him the necessary things to do it. So, yes, nursing care has gone downhill horribly. There are no excuses for it. Patients are human beings with physical needs that must be met. Nurses need to help patients to stay comfortable and infection free and lack of oral care an bathing is not conducive to that. All patients deserve respect and should feel that their dignity is preserved.
I will never forget or forgive the hospital for the awful care he got....but I will always be grateful for the special nurses who actually did care and did their level best in bad circumstances. There is always good mixed in with the the bad.
I'm so sorry you had to experience this. Like others have said here...never ever go into the hospital without a trusted advocate (family or friend) to help you with basic needs.