How many would love nursing if?

TheCommuter, BSN, RN · May 28, 2015

If you could go before administration and list one or two request/rules that administration would have to follow, what would it be? And if they followed your commands, would you love nursing and be willing to stay on the job until retirement?

My one request is to please refrain from slamming our floor with eight, nine or ten new admissions within a one-hour time frame. Cramming all the new admissions within a narrow window of time creates tremendous stress for all who participate in direct nursing care. It also deprives each newly admitted patient and their families of an optimal admissions process.

My second request is to stop assigning eight, nine or ten patients to each nurse. Administration complains about the low Press Ganey patient satisfaction scores, seemingly oblivious to the high nurse/patient ratios that rob us of the time to actually provide a satisfying experience to patients.

If the admissions were more organized and the nurse/patient ratios were lower, I'd think about sticking it out in nursing. But for now, I'm planning my exit away from the bedside and into a desk job (utilization review, case management, etc).

Here.I.Stand, BSN, RN · May 28, 2015

I'm very fortunate to work somewhere where nurses are respected. My manager hasn't bought into the extreme, County Hilton customer service mentality. She supports her staff if we need to have family removed, or even just with setting boundaries (no family member, we cannot make ourselves scarce so that you can speep peacefully. We're in the ICU.) She goes to bat for us if residents act the fool.

But the biggest thing for me is staffing. My last job was in an LTACH, where we'd routinely have 4-5 pts--most on the vent, tele, tubefed, and many with very complex wounds. We RNs drew all our own labs, too. I hardly ever left on time, and usually felt I was providing shoddy care.

Now occasionally floating to medical stepdown, I see a fair amount of DKA; of these, many were newly diagnosed. They have among the most complex education needs...but it's really hard to do when so busy. Between the q1hr BGs, q 4 hr BMPs, the insulin and NS and D5W gtts, q 4 hr KCl replacements....oh, yeah. The other two patients. :rolleyes:

Speaking of floating, since we're dreaming big, I'd like some kind of orientation to the floors we float to. Maybe after the "grace period" but before actally floating.

JLV5646 · May 28, 2015

I would love nursing if the patient's were all sedated!

Farawyn · May 28, 2015

Good co workers and a good manager.

Patients are patients, so meh.

(I left a higher salary job for a lower, so I can't say the money.)

mmc51264, BSN, MSN, RN · May 28, 2015

The biggest problem that I have found is that there are no consequences for those that call out. I work weekends and we are ALWAYS short. Worst is the weekend after payday. The whole hosp is short and we end up with the entire spectrum pf pts (we are an ortho floor) from gyn/onc to psych pts. I like learning about other areas, but the acuities of some of the pts are too much for our productivity #s. Having 5 total care pts and maybe one aide for 25+ pts is very difficult. I know some see it as a job and nothing else; I do my best not leave them short. I don't call out unless it is a true emergency.

gcupid · May 28, 2015

My one request is to please refrain from slamming our floor with eight, nine or ten new admissions within a one-hour time frame. Cramming all the new admissions within a narrow window of time creates tremendous stress for all who participate in direct nursing care. It also deprives each newly admitted patient and their families of an optimal admissions process.
My second request is to stop assigning eight, nine or ten patients to each nurse. Administration complains about the low Press Ganey patient satisfaction scores, seemingly oblivious to the high nurse/patient ratios that rob us of the time to actually provide a satisfying experience to patients.
If the admissions were more organized and the nurse/patient ratios were lower, I'd think about sticking it out in nursing. But for now, I'm planning my exit away from the bedside and into a desk job (utilization review, case management, etc).

This sounds dangerous. I'd never accept an assignment of 8,9, or 10 admitted acute care acuity level patients working on a medical/surgical floor. And if I was charging, I'd never accept those many admissions around the same time without having three extra float RN's just to help out with the admissions alone.

Here.I.Stand, BSN, RN · May 28, 2015

Re: consequences for calling out, according to some here on AN, some have excessive consequences. I don't agree with that because it is really bad practice to work sick. You can't focus 100% on patients if you're sick yourself, you risk spreading it, and sick time is *earned* compensation. Plus if we don't rest, we are sick longer. Viral illnesses need rest and fluids...that's what we teach patients, anyway.

I'm not referring to playing hookey, I'm referring to honest sick calls...which *can* happen on weekends and holidays. Last time I checked, our immune system is oblivious to the Gregorian calendar. :yes:

Farawyn · May 28, 2015

This sounds dangerous. I'd never accept an assignment of 8,9, or 10 admitted acute care acuity level patients working on a medical/surgical floor. And if I was charging, I'd never accept those many admissions around the same time without having three extra float RN's just to help out with the admissions alone.

Way back in the day on nights the 11pm nurse would call out sick, and me and the other 12 hour nurse would have to take 18 patients per nurse.

We once had 2 codes at once, and got yelled at for borrowing a code cart from the floor above...okay???

gcupid · May 13, 2017

Way back in the day on nights the 11pm nurse would call out sick, and me and the other 12 hour nurse would have to take 18 patients per nurse.
We once had 2 codes at once, and got yelled at for borrowing a code cart from the floor above...okay???

that is crazy