Is it like this everywhere now?

TheMoonisMyLantern, ADN, LPN, RN · May 16, 2019

I don't know if it's like this everywhere but it sure as heck is a common tune many of us are singing. Do more with less is guiding philosophy of healthcare, outrageous expectations many of which have little to do with patient outcomes and we must meet these expectations with minimal resources. It's sad and scary, what will healthcare look like 20 years from now if we continue on this path?

Serhilda, ADN, RN · May 17, 2019

Sounds like an average day for me. Honestly, the only thing I document in terms of belongings are electronics, jewelry, and dentures. No complaints yet but I'm sure it'll happen.

On my floor, everything seems to conveniently fall back on the nurse. Not inadequate staffing, not insubordination by other staff. Just nurses. For example, our floor does daily weights of every single patient on the unit and it must be done before 6am, right around when we also have to do all the patient's lab draws. We have no house keeping, we have no phlebotomists, we have no unit secretary or free charge. We have CNAs that refuse to do brief changes, linen changes, answer call lights, blood draws, or do weights. Management is aware and none have been fired. Do you think every patient gets weighed, every linen gets changed, and every dressing is changed when we have up to 6 patients on drips (be it amio, heparin, argatroban, etc.) or continuous bipap/pulse ox monitoring? It isn't possible. But we had a physician complain that a patient wasn't weighed, so this became a top priority and the nurses are expected to pick up the CNA's slack on my floor.

On day shift, I recall one administrator going around to check if each IV tubing had been labeled with when to change it. She went around everyday with a clipboard documenting which nurse and which room didn't have labeled lines. In the time it took her to do this, she could've been the freaking designated line labeler. But no, just another mandatory task for nurses to complete.

That's the state of healthcare these days. If your floor doesn't seem similar, it will eventually, especially without a union.

kp2016 · May 17, 2019

And people wonder why droves of young nurses are going straight into NP/ CRNA schools!!

beekee · May 17, 2019

Yes. This is how it is now. Management will have pet projects that are low priorities, but easy to measure. Make sure you do those things to stay off their radar.

Everything else is optional because it just cannot be done in the time allotted. If you complain, you are (a) a trouble maker and (b) a poor time manager.

I passed by a quality board the other day one floor had achieved 100% compliance on one of these pet projects. My immediate thought was that 100% of the staff was making up charting, not “wow, good for them!”

Does this lead to extreme moral distress? Yup, definitely. But, that’s just how it is now. It’s just wrong, but I have no idea what to do about it. Hopefully, this post will foster some ideas, tips, strategies, etc to make it better. Our patients deserve better. We deserve better.

Guest219794 · May 17, 2019

My theory is that nursing tasks should be like a balanced budget. Like my budget, not like the federal budget. If I decide to do one thing with my money, I understand that there is something else I won't be doing, as I will run out of money. Time is no different, as no matter what you want, there are only going to be 60 minutes in every hour.

So- feel free to add a task. But either remove one of equal time value, or make a couple more efficient. But, if you think about your last two years, consider what tasks have been added, and what tasks have been removed. It is literally impossible, so stuff is either being faked or done to a substandard level.

While working in the ICU, I was asked what I thought of the new flowsheet. (somehow there is always a new flowsheet.) I asked my boss if she had decided what I should stop doing. I got the same quizzical look I often get from my dog- "I know those words somehow relate to me, but I can't really put it together." I explained in simple terms that at that point, my shift was already full of tasks. The only way to add a task would be to remove a task, or to do some of my existing tasks less diligently, and I would like her input on what to stop doing. She changed the subject.

I like analogies. I would like one day to go into an administrator's office with a pitcher of water and a glass, and explain the the glass is my 12 hour shift, and the water represents tasks. I would put the glass on the desk, ideally on top of some critical paperwork, then fill it to the brim with water. "As you can see, my my shift is full to the top with tasks. Take this pitcher, and lets see what happens when you add something to a container that is full."

Many administrators possess at least basic intelligence. They can perform basic tasks like getting dressed, starting a car. Some can even do higher level stuff like using a check book and baking cookies. I have seen some do complex stuff like planning a vacation, coordinating lodging, food, transportation and entertainment. How they can miss some of the most basic concepts is beyond me.

Guest219794 · May 17, 2019

And another thing.........

There is this silly axiom in nursing: "If it wasn't documented, it wasn't done."

The only thing less true than that is the assumption that "If it was documented it was done."

If you make somebody's livelihood dependent on documenting having done something that is impossible to do, they are going to document it.

panurse9999 · May 17, 2019

1 hour ago, hherrn said:
And another thing.........
There is this silly axiom in nursing: "If it wasn't documented, it wasn't done."
The only thing less true than that is the assumption that "If it was documented it was done."
If you make somebody's livelihood dependent on documenting having done something that is impossible to do, they are going to document it.

I agree. Back in the day when hospitals still employed ADN RNs (a long time ago) I was constantly guided by "not documented, not done" mentality, as I sat in front of a portable computer module, that kept disconnecting me as I charted. On average, per shift, to the best of my recollection, I had about 100 check marks per patient, times 6, so that meant checking off 600 things in 8 hours. Divide that , and its 75 documented task completed per hour, which is greater than one task per minute. Now, try pointing out this absurdity to top level managers, and you will be drop kicked from your job.

panurse9999 · May 17, 2019

1 hour ago, hherrn said:
My theory is that nursing tasks should be like a balanced budget. Like my budget, not like the federal budget. If I decide to do one thing with my money, I understand that there is something else I won't be doing, as I will run out of money. Time is no different, as no matter what you want, there are only going to be 60 minutes in every hour.
So- feel free to add a task. But either remove one of equal time value, or make a couple more efficient. But, if you think about your last two years, consider what tasks have been added, and what tasks have been removed. It is literally impossible, so stuff is either being faked or done to a substandard level.
While working in the ICU, I was asked what I thought of the new flowsheet. (somehow there is always a new flowsheet.) I asked my boss if she had decided what I should stop doing. I got the same quizzical look I often get from my dog- "I know those words somehow relate to me, but I can't really put it together." I explained in simple terms that at that point, my shift was already full of tasks. The only way to add a task would be to remove a task, or to do some of my existing tasks less diligently, and I would like her input on what to stop doing. She changed the subject.
I like analogies. I would like one day to go into an administrator's office with a pitcher of water and a glass, and explain the the glass is my 12 hour shift, and the water represents tasks. I would put the glass on the desk, ideally on top of some critical paperwork, then fill it to the brim with water. "As you can see, my my shift is full to the top with tasks. Take this pitcher, and lets see what happens when you add something to a container that is full."
Many administrators possess at least basic intelligence. They can perform basic tasks like getting dressed, starting a car. Some can even do higher level stuff like using a check book and baking cookies. I have seen some do complex stuff like planning a vacation, coordinating lodging, food, transportation and entertainment. How they can miss some of the most basic concepts is beyond me.

Exactly! I worked in a nursing home where the MARs were so massive, that no nurse could actually complete a medication pass. Yet, the doctor group who ran the facility would come in daily, write more orders, add more medication, add more treatments, and write for more tests. At which point, it was so bad, that the facility required that each time they added something, they had to discontinue something else. Of course, it went in one ear and out the other. I often reacted to this by saying (to myself of course) I do not grow a second set of hands and feet, each time you add on to an already impossible workload.

ruby_jane, BSN, RN · May 17, 2019

1 hour ago, hherrn said:
My theory is that nursing tasks should be like a balanced budget. Like my budget, not like the federal budget. If I decide to do one thing with my money, I understand that there is something else I won't be doing, as I will run out of money. Time is no different, as no matter what you want, there are only going to be 60 minutes in every hour.
So- feel free to add a task. But either remove one of equal time value, or make a couple more efficient. But, if you think about your last two years, consider what tasks have been added, and what tasks have been removed. It is literally impossible, so stuff is either being faked or done to a substandard level.
While working in the ICU, I was asked what I thought of the new flowsheet. (somehow there is always a new flowsheet.) I asked my boss if she had decided what I should stop doing. I got the same quizzical look I often get from my dog- "I know those words somehow relate to me, but I can't really put it together." I explained in simple terms that at that point, my shift was already full of tasks. The only way to add a task would be to remove a task, or to do some of my existing tasks less diligently, and I would like her input on what to stop doing. She changed the subject.
I like analogies. I would like one day to go into an administrator's office with a pitcher of water and a glass, and explain the the glass is my 12 hour shift, and the water represents tasks. I would put the glass on the desk, ideally on top of some critical paperwork, then fill it to the brim with water. "As you can see, my my shift is full to the top with tasks. Take this pitcher, and lets see what happens when you add something to a container that is full."
Many administrators possess at least basic intelligence. They can perform basic tasks like getting dressed, starting a car. Some can even do higher level stuff like using a check book and baking cookies. I have seen some do complex stuff like planning a vacation, coordinating lodging, food, transportation and entertainment. How they can miss some of the most basic concepts is beyond me.

BEAUTIFUL. We won't do more with less. We'll only do less with less. Unfortunately the supervisor is responding to a complaint from a family member. No amount of logic is going to help here.

Serhilda, ADN, RN · May 17, 2019

1 hour ago, panurse9999 said:
I agree. Back in the day when hospitals still employed ADN RNs (a long time ago) I was constantly guided by "not documented, not done" mentality, as I sat in front of a portable computer module, that kept disconnecting me as I charted. On average, per shift, to the best of my recollection, I had about 100 check marks per patient, times 6, so that meant checking off 600 things in 8 hours. Divide that , and its 75 documented task completed per hour, which is greater than one task per minute. Now, try pointing out this absurdity to top level managers, and you will be drop kicked from your job.

Sorry, off topic, but every single one of my ADN classmates works in a hospital setting, if they so desired. It really depends on your location. We aren't particularly rural either.

umbdude, MSN, APRN · May 17, 2019

Yes. It was exactly like that when I was working inpatient psych. On top of that, management laid off the unit secretary shortly after I started and RNs and MHWs had to answer phone calls. The volume of phone calls during the day is insanely high (I only worked day shift). When staff asked management to re-hire a secretary, we were threatened with written warnings.