Lack of basic care--appalling!

No Stars In My Eyes · Jul 28, 2011

Thank you for doing the right thing!
Just today I was giving meds to my patients. It has been my habit to have some small talk with my patients. I ask them about how thier day was, how thier lunch is etc. I ask them if they are comfy, are they in pain, etc. I usually do this for like ten minutes, then give them thier meds, stay a little bit more before moving to my next patients. Well today, while talking to my patient, my perceptor called out to me from outside the room. I rushed out and saw her waiting for me. And she was like "Dont talk to the patients. You are wasting time. No wonder it takes u so long to give medications. Just go in, do what u have to do, then come out. I was surprised on how she acted. I tried to reason out by saying I need to check on the patients and i need to develop trust and a relationship. And she was "Theres no time for that. You have ten patients. If u wanna do that then good luck. Be prepared to stay around while everyones left for home". Sigh. Its really sad how nursing is today.

Did the same and was told the same. Disgusting!

canigraduate · Jul 28, 2011

Devil's advocate:

I only have 12 hours to take care of my patients.

I have approximately 12-15 mins to spend with each patient every two hours. Sometimes I have to prioritize between what should be done, what must be done, and what must be done RIGHT NOW.

Oral care should be done every 2 hours on our total care patients. So should passive ROM. Patients must be positioned, pottied, pain managed, and personal items placed in reach. Incontinence must be dealt with RIGHT NOW.

Usually the incontinence takes up the whole 12-15 minutes, plus some. And if I have two or more patients with diarrhea (which happens every other shift), then they often take up everybody's 12-15 minutes. And if I have a patient go downhill, they come first and all of the must's and should's are out of luck.

And in what time I have left somewhere, I have to do accuchecks, vitals, restock linen, restock gloves, restock isolation, chart, fill out redundant paperwork that is already done on the computer, answer call lights, assist the nurses, and various other things like change feeding bags, foley care, in and outs, inserting foleys, admits, transfers, yadda, yadda, and YADDA. Some of these things are more critical than others, but if any of them don't get done and done by a certain time, I get chewed out and written up.

So if the oral care doesn't get done but the butt stays clean, I'm happy. If my patient that has desatted and turned gray gets down to the Unit without coding but Mr. Jones' has crapped himself, I'm still happy. If I get yelled at because Mr. Jones crapped himself while I was transporting Mr. Gray, then I am unhappy. And going to yell back.

And if my day was awful and the next PCT comes in and starts yelling at me for skipping oral care, I'm sending them straight to the charge nurse for answers. After giving them a hole in their butt that matches the one chewed in mine.

ETA: I'm not saying all of the should's are unimportant. I wish with all my heart I could have perfect shifts where all of the should's get taken care of. I'm just saying, before slamming the entire profession, think about WHY things aren't getting done.

Oh, and I left out feeding people. And hair care. And baths. And ambulation. Holy crap, I do a lot of stuff. And nail care. And foot care. And skin checks.

Sigh.

Up2nogood RN, RN · Jul 28, 2011

I recently transferred to a new unit and my new nurse manager commented, "I hardly ever see you to talk, you're always in your patients rooms"..... um yeah, working.

I don't mind doing the basics and always make a wholehearted attempt at keeping my patients as I would want a family member cared for.

nola1202 · Jul 28, 2011

I know how tough it is to do barely adequate care with high acuity and high pt loads. Still I got tears in my eyes when Koolaide and others described their patient's esp. the poor little lady with arthritis...God I so hope you are there to care for my mother if she needs help, or me! I rmember finding the same thing years ago when I was an agency nurse at a nursing home (my first assignment in a nursing home ever) I almost cried when I saw that and the pressure sores.

I keep wondering will health care ever get any better? Where are all the lawyers, judges, congressmen, MD's kids? I keep wondering when the riots will break out, but they never do. someday maybe.

MassagetoRN · Jul 28, 2011

I think that its a combination of being burned out by heavier and heavier loads, with more extra stuff to do, and not having the support staff.

I work on a tele/ med-surg floor at night, with 6 patients and we rarely have an aide. When we do, that aide has 20+ patients to do q4h vitals, admitts, and other things. We get a large population of homeless/druggie/ETOH patients. Many nurses and all our docs are desensitized to their needs, including need for pain meds. I had one homeless CIWA patient who had been there for 3 days, and was a pain in the backside at the beginning of his stay. By the time I had him, he was pretty A&O, so on my initial assessment I asked my standard "Do you have any sores or open wounds on your body?" He said yes, leaned forward, and showed me an open sore that was crusted to the waistband of his filty pants (that no one had offered to have him remove and give him a gown). Those pants could have stood in the corner by themselves! Yes, this man was filty, stinky, and altered due to CIWA, but he's still a human being and a patient. I am a new nurse, who runs around like crazy, trying to keep up and get it all done. But in the morning, I made time to change this man's filty linens, and fill a tub with hot soapy water and give them man a bedbath. I cleaned and dressed this wound that had been ignored for 3 days because noone wanted to spend the time in his room to talk to him. I gave him a comb, toothbrush, and toothpaste. I made him brush his teeth, which became a running joke between us for two days. When it came time to talk to him about ending the ETOH abuse, he listened to me with respect. Its the simple things that can do more than the fanciest medicine we have!

Ruthiegal · Jul 28, 2011

Saw a poor resident once in LTC working nights who apparently had not had oral care even though it was charted. Also noted was the fact she was refusing to eat...I had been off a couple of nights... upon opening her mouth that night I found a very abscessed tooth that must have been very painful...no wonder she didn't want to eat. We cleaned up her mouth gave her PRN pain medication and got a dental referral right away... now I wish I could have known who left her like that... and it wasn't just CNA's there were nurses that ignored it as she just didn't want to eat

N.U.R.S.E. · Jul 28, 2011

To kool aid and others I say on some things we can do bet5ter but ur anger and frustration is misplaced ur anger needs to be with those in management I have approx 30 pts everyday when I leave I am exhausted both mentally and physically I can not and will not do everything. I dcan only do my very personal best I prayed for Jesus to lead me and guide me to take care of my pts. Somedays I aqm frustrated by the understaffing to gaqin more profits at s9ome point u divide aqnd conquer in an ideal world everybody would work as a team a well oiled machine prime ex. Had pt. Who had infection ordered med pharm called stating insurance wouldn't cover med social worker and am nurse called insurance com0pany to get med approved anyway we have an e kit where different meds are stored coworker fused because there was no way we could bill pt ekit is us ed until said med is received from pharm. Anyway I was determined he would get those med even if I had to get everyone of those pills out of the e kit a shame a d shame how profit oriented healthcare has become so do we let said pt get sicker until insurance decide to pay anyway am nurse and social worker got it approved but coworker was willing to let pt get sicker unbelievable. Sometimes u have to pick ur battles writing staff up. For not doing their job only works if management supports u and not flip the script on u

HurricaneCasRN · Jul 28, 2011

New grad. I went tonight to "change" collagen and border gauze to two pin point open areas on the sacrum. There was no change, since their was no dressing. Two open wounds open to ****. Even with awesome CNAs an incontinent pt will end up exposed for a bit of time before the next round or

the pt calls them. THAT is why we use protective dressings. And just nothing. Open areas bathing in ****. I changed the pad, washed the wounds and applied the dressing. I'd NEVER get on the CNAs about it, pt wasn't sure she was wet. It seemed "fresh", but I'm ****** that the previous shift left the wound open TO ****! We're not talking LE where you can leave it open to air. A pt that refuses to get up and has bil weakness needs protective dressings on their ASS! I'm so angry.

sweet~revenge · Jul 28, 2011

Let me describe a typical night for you on my med surg unit:

8 patients per nurse

1 CNA from 7-2:30 am

3 sitters that each get 15 min breaks x 2 and a 30 min lunch break=3 hours the CNA is off the floor to break the sitters plus the CNA's breaks so I only have a CNA for 4 hours

2 legal holds

2 confused agitated totals complete with trachs, PEG tubes, and dressing changes on contact isolation

1 400 pound woman having chest pain and needs a foley put in (took 3 nurses and 4 hours to do it)

2 people who need pain meds q2-3hrs, one of whom needs 2 units of PRBCs

1 patient with TPN, abx every hour and a fever of 102 that just won't go down also on isolation

Plus all the charting we have to do that we'll get written up for if we don't get it done, calling doctors, transferring patients to the unit, dealing with family members, putting in IVs that got pulled out, doing 5 accuchecks, oh and don't forget the new admission that will replace the one I transferred and will take me 2 hours to complete. And did I forget to mention that the sitters are only sitters, they're not CNA's so they're not allowed to touch the patient if the patient tries to get up or pull anything out. They tell me and I get there in time to stop the bleeding.

There's one of me and 8 of them. The CNA doesn't have any more time than I do. So yeah, oral care isn't exactly at the top of my list of priorities. If I can get it done, great. If not, last I heard this was a 24 hour job so the next shift can take a crack at it if they get the time.

Oh, but all that time I was probably sitting on my butt gossiping and waiting to collect my paycheck right?

OP glad to hear you "reported these incidences to the appropriate parties". Why didn't you try talking to the nurses/CNA's who had these patients before you instead of tattling on them? This is one of the biggest problems in the world of nursing right now. We need to work together and realize that the hospital administration, nurse managers, CEO and CNO are the problem, not each other. Once we realize that, we can make real change for the patients and for the future of nursing.

kool-aide, RN · Jul 28, 2011

Let me describe a typical night for you on my med surg unit:
8 patients per nurse
1 CNA from 7-2:30 am
3 sitters that each get 15 min breaks x 2 and a 30 min lunch break=3 hours the CNA is off the floor to break the sitters plus the CNA's breaks so I only have a CNA for 4 hours
2 legal holds
2 confused agitated totals complete with trachs, PEG tubes, and dressing changes on contact isolation
1 400 pound woman having chest pain and needs a foley put in (took 3 nurses and 4 hours to do it)
2 people who need pain meds q2-3hrs, one of whom needs 2 units of PRBCs
1 patient with TPN, abx every hour and a fever of 102 that just won't go down also on isolation
Plus all the charting we have to do that we'll get written up for if we don't get it done, calling doctors, transferring patients to the unit, dealing with family members, putting in IVs that got pulled out, doing 5 accuchecks, oh and don't forget the new admission that will replace the one I transferred and will take me 2 hours to complete. And did I forget to mention that the sitters are only sitters, they're not CNA's so they're not allowed to touch the patient if the patient tries to get up or pull anything out. They tell me and I get there in time to stop the bleeding.
There's one of me and 8 of them. The CNA doesn't have any more time than I do. So yeah, oral care isn't exactly at the top of my list of priorities. If I can get it done, great. If not, last I heard this was a 24 hour job so the next shift can take a crack at it if they get the time.
Oh, but all that time I was probably sitting on my butt gossiping and waiting to collect my paycheck right?
OP glad to hear you "reported these incidences to the appropriate parties". Why didn't you try talking to the nurses/CNA's who had these patients before you instead of tattling on them? This is one of the biggest problems in the world of nursing right now. We need to work together and realize that the hospital administration, nurse managers, CEO and CNO are the problem, not each other. Once we realize that, we can make real change for the patients and for the future of nursing.

Sweetrevenge,

I don't know if it's just me, but you got AWFULLY defensive with this post...

You don't have to convince me that we're all very busy, believe me, I get it. But, pertaining to oral care, most pts that are dependent on us to provide them with oral care are also total care pts otherwise (incont, turn Q2 hours, etc), would you agree? It doesn't take but 5 minutes at the MOST for someone to swab out a pts mouth after peri-care and a turn is done. I refuse to believe that you can justify oral care not getting done AT LEAST ONE TIME IN A 16 HOUR PERIOD!!!

Also, I never claimed that I "tattled" on the previous shift! I told the nurse who was in charge of their care on MY SHIFT. What those nurses chose to do with that information, I don't know, but I followed chain of command.

I truly hope you have a better attitude when you're at work taking care of sick people.

churchsgirl · Jul 28, 2011

I have to honestly say that this is no surprise to me at all. Since starting nursing school and working as a CNA, I see this far too often. The hospital I worked for (54 bed med/surg unit) was one of the only places I saw give "good" care. However, nurses there only had 4 pts and CNAs 6-makes it much easier to do an affected job for sure. What makes me sad is almost anywhere else I have been is shameful. LTC facilites that have full urinals in the elevator, patients sitting for hours that are wet and need changed, patients never turned. Some hospitals I have been in are not much better...ICU didn't see why they should do "basic" care on a patient they were only keeping alive for organs. But let me tell you, if that was my mother and I walked in I would be pretty upset that her hair was greasy and matted to her face and she smelled like no one took the time to take care of her before her passing. I could go on all day.

I know that all hospitals and LTC facilities are like this, but this, unfortunently has been my experience for the last couple of years. IT MAKES ME WANT TO BECOME A BETTER NURSE...that is for sure!

allnurses Guide · Jul 28, 2011

Let me describe a typical night for you on my med surg unit:
8 patients per nurse
1 CNA from 7-2:30 am
3 sitters that each get 15 min breaks x 2 and a 30 min lunch break=3 hours the CNA is off the floor to break the sitters plus the CNA's breaks so I only have a CNA for 4 hours
2 legal holds
2 confused agitated totals complete with trachs, PEG tubes, and dressing changes on contact isolation
1 400 pound woman having chest pain and needs a foley put in (took 3 nurses and 4 hours to do it)
2 people who need pain meds q2-3hrs, one of whom needs 2 units of PRBCs
1 patient with TPN, abx every hour and a fever of 102 that just won't go down also on isolation
Plus all the charting we have to do that we'll get written up for if we don't get it done, calling doctors, transferring patients to the unit, dealing with family members, putting in IVs that got pulled out, doing 5 accuchecks, oh and don't forget the new admission that will replace the one I transferred and will take me 2 hours to complete. And did I forget to mention that the sitters are only sitters, they're not CNA's so they're not allowed to touch the patient if the patient tries to get up or pull anything out. They tell me and I get there in time to stop the bleeding.
There's one of me and 8 of them. The CNA doesn't have any more time than I do. So yeah, oral care isn't exactly at the top of my list of priorities. If I can get it done, great. If not, last I heard this was a 24 hour job so the next shift can take a crack at it if they get the time.
Oh, but all that time I was probably sitting on my butt gossiping and waiting to collect my paycheck right?
OP glad to hear you "reported these incidences to the appropriate parties". Why didn't you try talking to the nurses/CNA's who had these patients before you instead of tattling on them? This is one of the biggest problems in the world of nursing right now. We need to work together and realize that the hospital administration, nurse managers, CEO and CNO are the problem, not each other. Once we realize that, we can make real change for the patients and for the future of nursing.

I'm calling BS.

It takes seconds to provide oral care.

You or the tech will be in the room at some point anyway... just flippin' do it.