How much time do you spend at bedside per shift..10 minutes???

SmilingBluEyes · Jun 26, 2003

It' s sad, but an eye-opener. I realize I work in OB, not ICU or Med-Surg or ER, but I get some of the same problems coming my way.

Some days I spend a LOT OF TIME At their bedsides (esp. labor patients) and I mean HOURS....others it is merely minutes cause I cannot catch up. Some shifts I come on, and people are in so much pain or emotionally needing so much, that I spend HOURS trying to gain their trust in me as their nurse. I convince them that I will answer their lights when they ask and I will do all I can to keep them comfortable.

It's very complicated. Priorities shift all the time. Moms need help w/breastfeeding problems at 2 a.m. and they have BIG problems ---beyond me at times......women bleeding after complicated deliveries...women in extreme pain after csections or gyn surgeries.....women who won't sat beyond 80% even with O2 after surgery.....women with ever-increasing health problems.....yes it goes on and on.....

so I go home feeling GUILTY cause NO ONE GOT WHAT THEY NEEDED FROM ME that shift.

Conversely, I do have shifts where I go home feel WONDERFUL, like "SUPER-NURSE" cause I DID touch someone's life, help a pain get much better, help them become new families and take on their new responsiblities, with confidence, as parents. There are some days when I did so well by them, they said they wanted to be a nurse like ME (yes I had 3 or 4 patients like that)...and I think WOW----this is an AWESOME career.

But those days get fewer and fewer as more and more is asked of us. Especially the PAPERWORK...now if ANYTHING keeps me from "being there" it's that. And every month, it seems some new form is thrust at us to be done ("for the State, for statistics, for you-name-it). If anything will make me leave bedside nursing, it will be this damned paperwork. THAT is the BANE of my existance.

Well, I rambled sufficiently. you touched a sore spot in me today. I always wish I could be better...do more...

Sometimes I think that is what drove so many good nurses away in the 1st place....

mattsmom81 · Jun 26, 2003

It's sad but true that the workload has increased so much that some nurses limit their patient contact. We must sometimes in order to get out at a reasonable hour. If the patients don't need anything and you have no dressings or asessments to perform, many will tend to do the essentials and leave them be. With 7-8 patients on the floor, you only have so much time for them. I try to give my patients what they need, whether they are demanding or require frequent visits for tasking/ care. Others actually prefer to be left alone.

I float from ICU to PCU occasionally, and I find it hard to average time spent...as some patients may only see me for about 45 minutes of my time in a 12 hr shift (head to toe and vitals q 4, meds, basic care needs) while others in distress or confused may need me at the bedside for more than half my shift time. Time spent with patients will vary greatly shift to shift, also with the acuity of the patients. (which management ignores altogether...LOL...we are staffed by census)

The demands of paperwork are indeed getting worse and worse.

A new form every week...I sure can relate, Deb.

live4today, RN · Jun 26, 2003

Report: 0700 to 0730

Look up lab draws taken at 0600 for my five to six assigned patients

Check five to six charts for stat, now, recent order changes

Begin my patient assessments

In the process of beginning my patient assessments, I may get held up in one patients room for over thirty minutes to an hour due to that patient either being on isolation and very very sick and needing pain meds, respiratory treatments, etc., or the patient who was suppose to be "stable during nights" is no longer "stable" but going down fast......more time involved at the bedside, and a possible to definite transfer to ICU. A situation like that took over an hour from start to finish.

Running around looking for pulse ox machines, dinemaps that work, wall blood pressure cuffs that work, running to pharmacy for meds that have not arrived, or needed stat or now; ordering IV pumps for new admits, or IV pumps to change out the pumps that aren't working any longer on patients. Running around trying to find Bedside Commodes for those who can't make it past their beds to potty. Dealing with the "Visitors" who think I should roll out the red carpet for them and their loved one which ends up becoming a PR issue. Answering call lights because no one else can do it. Feeding the patients who can't feed themselves because there aren't any other hands to call on to do it for them....the techs are at lunch or on break.....

Calming an upset patient, listening to a doctor baffle on about what "he/she" wants, yaddy yaddy yaddy..........

One day I had two patients on isolation and three others to care for with discharges to do, and report to take for the incoming patients that I'm being assigned before the discharged ones are gone........ Isolation patients alone are one on one and time consuming.

Let's not forget the patients who have to take a cupful of meds, yet can only swallow one at a time....veryyyyyyy slowwwwwly at that. :rolleyes: I've stood by some patients bedsides for ten minutes alone until they swallowed their meds with the three cups of water I've had to fetch in between time because the water "didn't taste right" or they needed "more water to swallow one pill with...".........and so forth.

Then, the constant ringing of the phones we have to carry around wanting this or that from us, etc. and our having to go fetch it, or call a doc for it, etc.

Every department coming to see the patient wanting to know things that nurses used to have time to know about way back when...

Then.....those darn Acuities that don't do any good anyway. :rolleyes: Don't forget the acuities......have you put your acuities in yet?......update the board?..........discharge a patient who is having a fit because they have to wait their turn to be seen.....where does it all end? :confused:

All this and then some while telling my bladder it doesn't have to pee, or my stomach that it doesn't need to eat, and my emotions that I can wait until I get home to "let loose" and scream, cry, etc.

I can continue if you like........ :eek:

fergus51 · Jun 26, 2003

I did OB and now am in NICU and spend almost all my time at the bedside because our meds, supplies and charts are there, so there isn't too much reason to leave.

I've said it before, and I'll say it again: GOD BLESS MED SURG NURSES!!! I could never do what you all do!

altomga, ADN, BSN, MSN, DNP, RN, APRN · Jun 26, 2003

It would greatly depend on the shift and the patient. On average I probably spend about 1-2hrs with each pt over the 12hrs (I have a 1-4 ratio) Sometimes though if the pt is really circling the drain I could spend up to 4hrs or more in and out of their room! But I do have to say, if the patient is stable I only bother them when I have to or when they call out. I work nights and try to keep the patients on a day/night schedule.

mattsmom81 · Jun 26, 2003

Altomga, nights are such a blessing to me...to be honest if I had to work days I could not handle being a nurse in this day and age.

Renee, have you considered nights for these reasons? It really is a MUCH more tolerable atmosphere than days....

live4today, RN · Jun 26, 2003

mattsmom.......for years I worked eight and/or twelve hour nights. Then my health caused me to go to days. I still think of nights as being a shift where a nurse is allowed to be more autonomous without all the "chief wannabes" hanging around sniffing for trouble to get their noses in just to feel important. :chuckle

It's dayshift for me from now on. I might possibly try 3 to 11 part time next year, but for now will stick with dayshift.....crazy as it is. :)

Genista, BSN, RN · Jun 26, 2003

I work pms on a med/surg type floor. How much time do I spend? It all depends on the patients...

Some of them are stable & semi-ambulatory, so after my initial assessment, they only see me for meds & to check on them here & there. We only have one nurse aid for the floor, so I can spend a lot of time changing wet linens, getting CVA pts (90 kg wt & on Lasix of course) up to commode 5-6x/shift, etc.

I have a 1RN:5-6 patient ratio. No unit secretary= at least 1-2 hrs at the desk putting in orders, answering phones, printing up lab labels, ordering supplies from central, etc.Then sometimes you have complex dressing changes that take 30+ minutes, or isolation, ostomy bag changes, tube feeding care,etc. and those patients get more time. Some nights I am spending what feels like 90% of my time in one room with a real sick one, and barely have time to check on the rest. I usually don't have time to chart my routine assessments until end of shift (I do document emergent actions taken as I go, though).

Interesting question!