Jack of All trades

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Specializes in PCCN.

Hello. I was wondering if anyone else is noticing a trend towards acute care floors not being specialized anymore.

We used to have floors for just heme/onc, post pci intervention, vascular, etc. now it seems in the rush to make sure every bed is filled with a patient, any patient, that pts are put anywhere, not in a specialized unit.

I swear our acute care hospital is becoming one big 600 bed med surg hospital.

Ive been at my place for over 10 years, and now am getting all kinds of pt's ( mostly 99 year olds now:eek: ) With many problems that I and my coworkers haven't dealt with before , as we used to be specialized in a different area.

Just wondering if this is a trend anywhere else. Spoke to a off shift supervisor, and she noticed this, and said morale is at an all time low,and turnover very high throughout. :(

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Yep.

I work a floor that was as little as 6 months ago mostly renal/urology and weaning vents. We had the occasional TB pt as we have three negative airflow rooms, but typically that was our usual load.

Now, we have post CVA pts, post craniotomy pts, all sorts of ortho pts, oncology pts, and more acute psych pts.

I find it exhausting. How am I supposed to know all the possible sequelae to CVA and anticipate them, know all the different orthopedic devices, remember and perform c-spine flawlessly, maintain delicate vent pts, and keep a close eye on my brittle diabetics/hemodialysis folks?

So much for one human brain. Someone's going to get hurt.

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Specializes in PCCN.
Yep.

I find it exhausting.

Someone's going to get hurt.

You got that right.It really sucks. I feel like handing in my license at the door sometimes:(

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Specializes in Hospice.

Ah, the more things change, the more they stay the same. Not exactly what you're going through, but just to bring home the point that hospitals have ALWAYS been about the money, and really don't think about what's best for patients or staff.

Twenty five years ago, I was a Pediatric nurse, and the Peds unit was experiencing a reduction in patients (Peds was becoming more of an outpatient specialty, and cases serious enough for admission were going to actual Pediatric hospitals, not the local community hospital).

Someone came up with the brilliant idea of us taking "adult MedSurg overflow". Because kids are just mini adults, right?

Never mind the asshat young male who refused to stop sleeping in the nude because that's how he did it at home (yeah, right). Or the confused 86 year old male who wandered into a 14 year old girl's room, with his Foley bag held chest high and his junk swinging in the breeze. The day I handed in my resignation was the day I was in charge and Admitting tried to write me up for refusing to let them place a 66 year old male with an 8 month old baby.

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I find it used to be all Med Surg. Then got Specialized. Now, I guess it's coming back around.

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Specializes in Critical Care, Education.

This is probably an issue that needs to be discussed at a staff meeting so that everyone can have a better idea of what is going on. My guess? It could be part of the organization's efforts to improve efficiency in patient throughput (yeah, those non-clinical paper pushers really do talk like that). From their (non clinical) point of view, it's much more efficient to just clump everyone in the same place... easier to staff, provide resources, etc. Because they haven't a clue .... to "them", nurses are completely interchangeable. Because, all we do is follow doctor instructions, right? :geek:

If this is going to be a permanent 'thing', your manager should be taking steps to ensure competency development and safe patient care. I have worked with many multi-specialty departments.... including a 45 bed Critical Care Unit that handled all ages & all specialties. It's unrealistic to expect ALL staff to become proficient at ALL things but. . . You and your co-workers could actually help improve the situation by suggesting some creative solutions. For instance, some staff members could choose to become the 'experts' for particular types of skills or patient situations and act as the 'go team' whenever needed.

It worked in that 'everything' CCU. Whenever we needed to do something out of the ordinary (like cranial burr holes or assisting with an emergency bronch), there was someone on staff who had those skills. We'd cover his patients to free him up or just switch assignments if needed. It's actually do-able. Working with a greater variety of patient types will also help stave off boredom.

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I hear about how people are living longer with more and more chronic medical problems, so in a way even specialty units deal with basic "med-surg" problems- diabetes(especially), COPD, dementia etc.

Where I work, the nursing floors and units are very specialized, and there is little overlap. My old hospital was built with huge wards (45+ beds) labeled "medical", "surgical" "cardiac". These are more mixed in patient population.

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Specializes in ICU, LTACH, Internal Medicine.

There were no such patients 30 years ago, to begin with.

30 years ago, no one in the right mind would do open heart on 90+ y/o patient already on life support (dialysis, that is). Nowadays, it happens daily in some places. So where this patient (who, in addition to the above, is half-paralyzed because of recent stroke, profoundly demented and dangerously aggressive, as well as morbidly obese) should be put as for ICU transition? Such patients commonly sent in LTACH just because neither ICU, nor any other unut in hospital can "accomodate" their multiple needs.

I caught myself thinking recently that our treatment tactics toward highly complex patients with borderline multiorgan failure are not that different from the said tactics used, say, in XV century for a guy who got an arrow into his belly. The guy would be brought somewhere, given as much comfort as possible, maybe a doctor would be called and said some funny-sounding words, and then everybody would pray the Lord on his behalf, and if the guy somehow made it, then hallelujah, if he would not, then may his soul rest in peace. Likewise, although we (kind of) know a whole lot more about etiology, patho, etc., we usually can offer little more than temporary alleviation of some symptoms and care which offers some degree of comfort but no hope for the cure.

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Specializes in ICU.
Likewise, although we (kind of) know a whole lot more about etiology, patho, etc., we usually can offer little more than temporary alleviation of some symptoms and care which offers some degree of comfort but no hope for the cure.

And this is my biggest problem with healthcare - although, I don't see the comfort aspect much. Just the part where we wake 85yo grandma dying of metastatic cancer, heart failure, and COPD in the middle of the night for ABGs... and let's throw the BiPAP on her and then tie her arms down when she gets too anxious to keep it on and keeps trying to take it off.

I just can't even handle it some days. I wish we would just let some of these people go. They don't have any quality of life at all by the end. I will personally hunt down and haunt anyone who tries to do that crap to me when I'm dying. Violently haunt, at that. The pushing down the stairs type of haunting.

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Specializes in PCCN.

I just can't even handle it some days. I wish we would just let some of these people go. They don't have any quality of life at all by the end. I will personally hunt down and haunt anyone who tries to do that crap to me when I'm dying. Violently haunt, at that. The pushing down the stairs type of haunting.

OMG!! I literally said this last week to my husband, as I had taken care of a 90+ y/o pt who's family was just not going to let her go( they bullied her into dialysis, etc) she eventually had a heart attack ( probably a broken heart) and passed away. I told him if you EVER torture me like that I will haunt you in your dreams!!

I see it so much now. Those elderly give clear signs that they are done( stop eating, etc) yet their families just won't stop.

When did this " no one can die of old age "thing come into effect? Since when are people expected to live past their 90's?I understand if they have good QOL, but usually that's not the case.

And then the suits thing - no bedcover left unturned .jeez- sometimes the beds and floor are still dam as the next pt is placed into them...

If only I had known this when I went to nursing school >10 yrs ago.

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...When did this " no one can die of old age "thing come into effect? Since when are people expected to live past their 90's?I understand if they have good QOL, but usually that's not the case...

See this a lot in HD. The pt can decline to a near zero QOL but it's such a slow progression the family doesn't recognize it, it just becomes the new normal.

As far as caring for the HD population there's a good thread about what every nurse needs to know about dialysis, but I would just add that it's pretty hard to kill a dialysis pt.

https://allnurses.com/dialysis-renal-urology/what-should-every-513867.html

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