Is there any help for this old nurse lost in new age nursing??

[coolnurseclub]

I have been a med surg nurse for 20 plus years. I worked at the same hospital for 20 of those years. I was terminated because I simply cannot keep up any longer. I have accepted and learned CPOE. med scanning,computerized charting, etc. BUT...I cannot go completely "paperless" and always chart in "real time" . ( just to mention two out of many gripes).

The last year of my employment at this facility that I loved and grew up with, changed administration when 2 new hospitals opened in the area. During that time most of us "older" nurses (highest paid) either mysteriously left or retired early after years of employment, all being replaced by new grads. No offense to new grads, you are very much needed and have been trained in the new ways.

I feel like an old dog being kicked to the curb. I am a good, caring nurse. Spent "too much time with my patients". Forgot twice to document if smoking cessation education was given and no flu and pneumonia vaccine status documented. That won't happen again!

So what if I was trying to keep my patient from coding trying to get a transfer to ICU all by myself while all the docs and charge nurses and supervisors were at their morning meetings and not responding to pages "in a timely manner" sooooo... I didn't chart or give all my meds in that "timely manner" many times and have been doing the same since I was a new nurse. That is fact and I'm sure many of you will agree you've had to do the same.

I guess I just don't know how to be a nurse any longer. Can anyone relate to this?

I don't know what to do. I can't retire (lost most of it in the '90's) and had to live off the rest when I lost my job. Its a dog-eat-dog world out there and new nurses are in demand. I am 53 years old and never thought the career of my dreams would end up this way.

I do start a new job in a LTC facility next week. Maybe this will work out. I'm too old and poor to go back to school now.

My greatest advice to all you new nurses is, hang in there and take good care of me when I need you, and start putting in a lot for your retirement right from the start. I truly have been traumatized to the point I feel incompetent and I know that is not the case.(PTSD)

Please help me guys! I need feedback!

[Elle23]

I'm 43 and left the hospital a few years ago because the computer charting, etc just got overwhelming.

I work PDN now and have exactly 2 pieces of paper (plus the MAR) to fill out each shift. It is wonderful!!

Of course, the company will be transitioning to computers soon, so the glory days will be over, and I will have to adjust, but for now I am loving it.

[Oceanpacific]

What you're seeing as hospital nursing becomes more computerized are attempts to introduce metrics into nursing management. Older nurses are right to sense that that data doesn't measure the quality of their work. Some younger nurses are, I fear, being seduced into thinking that doing all the proper data entry is what constitutes good nursing.

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The principle has been around for a long time, but it has been held back the difficulty of measuring how productive white-collar workers are. It is that this wealth of new data that computerization makes possible gives far more information to administrators and thus enables them to better hassle their subordinates for failures to do this or that. That is where the danger lies.

Not so with the new computerized systems. They can (and probably are) being designed to collect all sorts of niggling task data and, with that data readily available to administrators, they can use it as a weapon to threaten and even fire. This discussion illustrates that.

I can't write more here, but I think many of you realize that the most important work a nurse does isn't easily quantified by computerized metrics. Changing bed linens and the like can be a check box that is easily tabulated. Taking the time to calm a frightened child or encourage a depressed older patient isn't something that can be measured and thus isn't a part of these metrics. And often, to do the latter, you must slight the former, passing some niggling task to the next shift or doing it later that some arbitrary time.

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One final note. Computerized metrics is clearly a "coming thing" in nursing administration. You find it everywhere. Elsewhere on this site, I blasted IBM's new nursing apps. They make it easier for administrators to track certain types of nursing activity, I wrote, but they do nothing to help nurses accomplish more in the time they have. If anything, by putting work into clumsily prioritized to-do lists, they slow nurses down. Spending more time accounting for how they spend their time means less time actually working. .

I actually agree with you on several of the things you said in your post. Our ability to obtain data is now so powerful that it is tempting to try to look at everything and to create endless check boxes and clinical reminders without stopping to consider the time the nurse and the patient have available to go into areas that have little to do with the patient's chief complaint. However, we do differ pretty drastically on this topic otherwise

As an infection control nurse, an electronic health record is probably the most important tool I have. Here are just a couple of examples:

A physician told me that nursing staff on the floors often do not collect the specialized tests he orders such as Legionella urine antigen or Legionella sputum culture. The comment was made in a meeting and it suggested a big problem with nursing staff. But the electronic health record saved the day! I was able to get a list instantly of all the Legionella tests ordered in the past year and how many of those had results available. The overwhelming majority of the tests were done. For the few uncompleted tests, I read the electronic health record for each patient. It turns out that the uncompleted tests were for patients who were discharged or were transferred to another facility very shortly after the tests had been ordered. I made a report and shared it with the meeting group. The physician was very gracious and apologized and said he was obviously wrong. Good ending.

I often need to follow up about clusters of patients whose symptoms are suggestive for C. Diff or norovirus or influenza. Often I am trying to find out when the symptoms first started. Some of our patients are acute care others are long term care. One patient can easily have over 1000 nursing notes. But, since it is on the electronic health record, I can refine my search and see only those notes which contain a keyword I am interested in such as fever or chills or diarrhea. This ability to find information quickly lets me know the true scope of the problem and allows me to implement transmission based precautions sooner.

It is this type of information that caused a pediatric cardiac surgery program to be shut down this week because the numbers made it clear that children at this hospital were dying at horribly high rates

So, I think nurses need to embrace this technology and to be at the table when these programs are developed. When nurses are not at the table, then some non-clinical IT person guesses about the way the system should be built. Electronic health records can show our failings, but they can also show the many different ways in which nurses shine

[brandy1017, ASN, RN]

I too have been a nurse for over 20 years. I've had no problem learning and using the computer charting, but it is a hassle and takes longer than paper charting. I've been told part of it is the cheap program and we will be moving to EPIC which some claim is easier. I dislike computerized charting and med pass because it takes longer and the stupid computer questions everything you do, why the med is a minute late or early, etc, etc not to mention the many times a med or patient ID band doesn't scan properly and mgmt expects you to stop everything and get pharmacy to fix it rather than bypass scanning, like that is going to happen in the real world! The only thing I will acknowledge is I get computer med pass is safer and does prevent med errors many times so it is a safety factor that is the only consolation to a frustrating situation. We've gotten emails to look at our patients because as you know you spend so much time looking at the computer to chart and pass meds. The worst of it is the micromanagement where the computer like KRONOS can be used to harass employees. While that hasn't been an issue for me or most of the staff, just the thought of it is frustrating and disrespectful.

It doesn't sound like you did anything wrong. Of course meds are going to be late if you have an emergency situation you have to prioritize patient safety first! Looks like the new management was just using micromanagement to get rid of the older, experienced, read expensive nurses so they could hire new grads cheaper who they can mold to their whims! I work with some coworkers though that have the bad habit of not charting on time and wait till the end of the shift. This makes no sense, just chart your assessment right away, sit in the patient's room and do it to make sure it's done. We get little email suggestions on how to improve patient satisfaction and have even been encouraged to sit with the patient to make them feel more cared for. I don't mind the emails they are suggestions, some places mandate and script us so at least it's not like that. Still I'm aware that I am expendable so watch my back, save my money in a Roth IRA because one can access it in an emergency without tax or penalty.

I'm sorry to say that you are not alone and I've heard of many older nurses being fired or laid off to save money on both wages and healthcare costs. I hope your next job works out. If it is any consolation it is not your fault, you were targeted and fired to save the hospital money. It could happen to any one of us. It's not just happening in healthcare, this is happening in many corporations around the country and with the blind eye from govt and the supreme court that has made it harder to file an age discrimination lawsuit. When the supreme court raised the bar to prove age discrimination it was sending a message loud and clear to corporate America to feel free to lay off their older workers. Just today I read a NY Times expose about Amazon how they mistreat their white collar workers and have a habit of getting rid of anyone with a medical issue such as miscarriage or cancer and so far have gotten away with it. Plus they like other infamous companies like the defunct ENRON and GE when Jack Welch was the CEO, dump a percentage of their workers every year, ranking them and firing their "low performers" to rule by fear, competition and mistrust. Amazon even has an internal system from Workday called Collaborative Anytime Feedback to encourage coworkers to rat each other out to management. These anonymous complaints are used against workers so workers band together to give out positive compliments to their friends, but turn around and complain about those they don't like. Also there was an expose a few years back about one of Amazon's warehouses in PA where workers were working in 100+ temperatures without air conditioning where the company had ambulances sitting outside on standby waiting to take employees to the hospital for heat exhaustion rather than provide air conditioners. So one thing we can do is boycott organizations like Amazon that treat their workers with such inhumanity. Check out the NY Times article Inside Amazon: Wrestling Big Ideas in a Bruising Workplace!

[fieldRN]

Thank you for your honesty. I too am an older nurse. I'm 65 and trying to reenter the workplace after battling severe depression for two years. My retirement money is gone. I live on Social Security and charity. I have faced foreclosure threats twice during the 2 years that I haven't worked.

Perhaps it is a bit of paranoia, but I suspect that potential employers are researching me online and determining my age, despite laws against age discrimination. All I can do is continue my job search and hope that there is an employer that will appreciate my many skills and my innate compassion.

Good luck with your new job. Most importantly, I hope your new employer appreciates how valuable you are.

Sincerely, Nancy Nurse

[Carrie RN]

I am sorry as well that this happened to you. I have noticed a trend where there is less assessment occurring. Technology is being traded for good patient care. Keep up the good care when you transition to LTC.

[Spidey's mom, ADN, BSN, RN]

As others have said, you are not alone.

I'm 58 and have been a nurse for 18 years. I hate with a purple passion electronic medical records.

It truly does impact patient care in a negative way, in my opinion.

We've lost some wonderful NP's and one physician due to this and one doc hired a scribe to follow him around to chart in the computer so he can actually spend time with the patients.

I too work hospice. We have a computer charting system as well - it isn't a very good one but they are so expensive and we are a small rural hospital. It is unwieldy at best. We have notebooks to take into the homes and are supposed to chart then, but I use my old-fashioned paper assessment and then come back to the office and chart. One of our docs does the same thing when seeing patients in his office. He does not take a computer into the room. He charts in his office after each visit.

We started keeping a paper back-up chart - we have a volunteer who does that for us. Sometimes our computers are down and sometimes the program itself is down and I need to write an order or I need to look up meds and I don't have access. So, that paper chart is a Godsend. And I write an order on the old paper charting form!

Our hospital bought one system for the ER, one for the acute care area, one for wound care, one for hospice. There is one nurse who works in two of these areas and was expected to learn two different charting systems.

I worked in the ER and L&D for this hospital for 9 years when it was still paper charting. I can't imagine working there now. I enjoy spending time with my patients . . .not a computer.

I had an experience that I shared before about a new MA coming in to do VS and ask questions before the doc came in. He turned his back to me after VS and typed my answer to his questions on the computer.

I could go on and on . . . . but I'll stop here. Rant over.

Just realize OP, you are NOT alone.

[Gray Fox]

I started my career back in 1977. Navigated thru grad school into positions of increasing responsibility. Took a sabbatical back to the bedside around the time I turned 50. Made me realize why I love nursing and healthcare. I was renewed by caring for patients again, and by all the new technology. As I critical care nurse, I saw the value of mastering the new tools of CPOE, BCMA, MEWS etc. we teach our patients new skills for health management every day...are we not able to learn too?

[jmca110]

I'm really sorry to hear that. I am an Informatics nurse and am over 50. I left the floor when the computers started to infiltrate the hospitals in 1998. I was a pioneer!! The other thing is I'm a contractor so I don't work in a clinical setting. I can tell you that computers are not the end all be all yet. I think we were better off with paper if you want to assess the patient and patient care. Computers are to assist in litigation which is where everything is focused now. Computers have a long road ahead of them if they are to be efficient and SAFE in the patient setting. My first choice would be not to work in a clinical setting in the technology age. I'm very skilled in computer technology but I don't think it has any place in patient care. My husband had a stroke in 2013, a massive MI in 2015 and a sub arachnoid hemorrhage last month. I'm appalled at the lack of nursing care. Or should I say quality nursing care. The kind of nursing care that gets a patient well and the family a peace of minding knowing they are being taken care of. Computers make it too easy to "check the box". Since I work full time I make sure the staff knows I'm a nurse. Not because I'm watching their every move but to let them know I understand the terminology and want the information straight up. I professed to not know about strokes or SAH from the start. I was comfortable after his MI since I started my career in a cardiac step down unit and he had previously had a Quad bypass. Family should not have to care for the patient. I am a constant advocate for my husband. When he had his stroke I took FMLA thankfully. The inpatient stroke rehab unit he was transferred to was like a nursing home! It was loud, dirty, and the RNs didn't have time for anything but passing meds and documenting in the computers. Many of them were there 2-3 hours after their shift. Techs were put in the place of the nurse. Getting a bath with a wipe is not acceptable. It's called nursing care for a reason. Maybe it's time to call it nursing business. Hospitals are much too focused on their bottom line. The rehab facility he was in was filthy, noisy, and just plain obnoxious. There is no excuse for hospitals not to be remodeled and clean. If we are to make HIPAA so important, why do we still have shared rooms? That is a HIPAA violation as far as I'm concerned. If you step back and look at this big picture, it's not about the patient anymore. The patient's are lucky to get out of a hospital alive. It scares me to death to think about what our future holds as an aging society. When the young nurses get to be our age, they'll understand. I'm not sure how a person can say they got into nursing for the "patient care" or the "patient". It surely wasn't for the money. They don't pay nurses nearly enough for the liability they are faced with. You can't base a salary on that! I don't even understand why anyone wants to go into the medical field anymore. I'm thankful that I have the education so I can be an advocate. If I were you, I'd look to an office environment where you can maybe do some patient education. Working in a LTC facility is sure to break your heart. Where ever you work just know you'll make a difference to the patient, not the facility. It's sad but true.

[judihh]

I am sorry, this is a bad rap! However you must recover from this---there are other jobs out there----think longterm care or perhaps direct care in homes--even hospice. You are needed and will again be a valuable team member!. I am now retired and was happy in my career----however do not be afraid to try new fields. You are quite young and have many good years ahead!

[Spidey's mom, ADN, BSN, RN]

If you step back and look at this big picture, it's not about the patient anymore. .

I like your entire post but this says it all really. Very sad.

[blinkrn]

I have been a nurse for 24 years and have seen so many changes in nursing. I also think that time spent with patients is so important and am usually the last to leave. The hospital where I work is hiring mostly new nurses too. It is important that new nurses are able to find employment and infuse a new energy and current knowledge to practice. There still is a need for more experienced nurses to mentor the newer nurses. I am a little older than you, and the 12-hour shifts seem to be getting longer. I have been back in acute care for quite a few years now, but did do home care in the past (for 10 years). Have you ever tried home care? It has also changed over the years like everything else, but you get to spend more time with patients, and it is not as physically demanding as acute care or long term care. It can be a more flexible schedule too. Good luck with your new job!

[cmariemcev]

Hi

Regarding your comment re changes in nursing I think its time for nurses to fight back against the paperless era as personally electronic drug charts are unsafe as changes cannot be easily made. Takes 5 mins to log on and a doc could rewrite a drug chart in that time as have seen them do it in a hurry !!

What happens when the system crashes ? Have seen this several times and all hell breaks loose as you cant give drugs in a "timely" manner.

Its all a joke really !!

There is a new global nurse register being set up so nurses are in control not the state !!

Thanks