A nurse friend of mine had the day from hell at work the other day. He was telling me all about it. Patients moving, discharging, admitting and too many patients from the get go. Just chaos all day. Then he gets a call a couple of days later asking about a personal belonging of a patient that was missing, he didn't get the inventory sheet done on admit. So they are looking for this one item. He said he didn't feel that doing the inventory had a very high priority when insulin was past due and patients were asking for water and to go to the bathroom and admissions had to be done. So I guess the jist of it, he is being told this must be done, MUST on admission. I don't like what is happening to nursing, can't the nurse set priorities anymore? Is everything an absolute MUST? How are nurses supposed to get anything done that is important if inventory sheets are listed as a high priority?( just an example). I think the world has gone crazy sometimes. He says there are signs all over the place that the hospital is not responsible for valuables and families are to take them home. He did not unpack for her, her family did. So he thinks he may get fired for this. Seems a bit much to me.
He also said that most of the nurses don't change dressings, do actual assessments, etc, but chart that they do it because it is a must, because the work load is more than a human can handle. It is really scary to be a patient in a hospital I think. I wonder if it is like this everywhere?
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.
Um, I'm in the day now with my ADN at a job I've worked at for 5 years. They are still hiring ADNs.
A lot of hospitals have shifted in the direction panurse describes- if you don't have your BSN within 2 years in my system you're out; but they don't hire ADNs in the hospitals at all- only private practices and SNFs. The only way into a hospital as an ADN in my area is if you know someone who has a real hookup, otherwise you're starting in home care, dialysis, or subacute until you get your fancy BSN.
And the shift from hell in the OP is exactly what we see here. Worse in subacute settings.
I am not aware of any hospital in PA that will hire an ADN anymore. A very large mega-system that has been moving fast to purchase other hospitals, is forcing the ADN staff at those hospitals to get their BSN within 2 years, at their own cost, or lose their job. I know this from speaking with a friend of mine who was one of the unfortunate ones to be let go. She was unable to come up with the high cost of the online degree RN-BSN, and was dropped like yesterday's garbage, for no other reason that not having the degree, and she had been in her position 13 years. Gone. out. done.
He also said that most of the nurses don't change dressings, do actual assessments, etc, but chart that they do it because it is a must, because the work load is more than a human can handle. It is really scary to be a patient in a hospital I think. I wonder if it is like this everywhere?
When hospitals and nursing homes moved from paper charting by exception to EMR, which was required by an act of congress in 2009, which then spent billions of dollars to roll it out, I'm not sure they really envisioned what is going on today. We spend more time checking boxes to generate revenue, than we spend at the bedside, and that to me has been a deal breaker in some jobs. The point of EMRs was to reduce redundancy for ease of portability, but the outcomes have been shocking . Read this article if you have a few minutes:
"During that time, thousands of reports of deaths, injuries and near misses linked to digital systems have piled up in databases — while many patients have reported difficulties getting copies of their complete electronic files."
According to Rehm, the average-sized community hospital (161 beds) spends nearly $760,000 a year on information technology investments needed to meet federal regulations. He said the costs “are crushing our industry where margins are already thin.”
Its food for thought, when we are discussing a thread about the shift from hell, the constant stress place on nursing to do more, and do everything, and do it all to perfection. Its called "Death by a Thousand Clicks"
Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 5/24/2019 at 8:21 AM, Woodenpug said:
PROTECT YOUR OWN BUTT AND LICENSE FIRST.
Not sure I agree with this part. I feel we should protect the patient first. They are the most vulnerable. Even, if not especially, the wealthy/VIP patients.
A nurse friend of mine had the day from hell at work the other day. He was telling me all about it. Patients moving, discharging, admitting and too many patients from the get go. Just chaos all day. Then he gets a call a couple of days later asking about a personal belonging of a patient that was missing, he didn't get the inventory sheet done on admit. So they are looking for this one item. He said he didn't feel that doing the inventory had a very high priority when insulin was past due and patients were asking for water and to go to the bathroom and admissions had to be done. So I guess the jist of it, he is being told this must be done, MUST on admission. I don't like what is happening to nursing, can't the nurse set priorities anymore? Is everything an absolute MUST? How are nurses supposed to get anything done that is important if inventory sheets are listed as a high priority?( just an example). I think the world has gone crazy sometimes. He says there are signs all over the place that the hospital is not responsible for valuables and families are to take them home. He did not unpack for her, her family did. So he thinks he may get fired for this. Seems a bit much to me.
He also said that most of the nurses don't change dressings, do actual assessments, etc, but chart that they do it because it is a must, because the work load is more than a human can handle. It is really scary to be a patient in a hospital I think. I wonder if it is like this everywhere?
Hospitals started to become hotels.
There is a reason why people started hanging around shopping malls with expensive goods during a rain storm.
Tell your friend to start sending in resumes somewhere else. That place sounds toxic, and there is no reason why a professional nurse would spend time to go through "inventory" of a new admissions.
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.
A month or so ago I lost it with a nursing "educator" who was complaining about documentation not being done a certain time when I had six patients who needed me and I ended up telling her off by saying that patient care comes before charting.
Know what she did? She went ***ing to my manager and my manager backed her.
I think there are many places that are like this and some places that aren't. I think it all depends on ratios/staffing. This MAY be(I stress "may") less common in ICU or other specialties so I recommend looking into other specialties where turnaround isn't is as high or the amount of patients one cares for at a time is low. I think this issue stems from unsafe ratios/staffing. If ratios improve, patient care improves, staff satisfaction improves, and everyone is happy! So unfortunate that this occurs in many places but hoping for a positive change with respect to ratios/staffing.
A month or so ago I lost it with a nursing "educator" who was complaining about documentation not being done a certain time when I had six patients who needed me and I ended up telling her off by saying that patient care comes before charting.
??♀️"Thank you for letting me know." [Good bye.]
Never, never feed this. Like, never. Don't dignify it by getting defensive. Just dismiss it by any pleasant means. Of course this person went to your boss - she wasn't there to be helpful or useful and was just up to no good.
This is good advice for a lot of different situations. Just aim for being as pleasant and otherwise non-reactive as possible.
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.
The last facility I worked at, we had an individual who was not a nurse, CNA, or management in a medical department walk around every morning during AM med pass and check that oxygen tubing was labeled as well as IV tubing and feeds. During one instance, she unhooked oxygen from my patient with serious respiratory issues, brought it to me to throw in the garbage all while I was dealing with a patient going majorly south.
jmtndl
129 Posts
Um, I'm in the day now with my ADN at a job I've worked at for 5 years. They are still hiring ADNs.