Med Surg Then and Now

OCRN3 · Mar 26, 2014

More paper work, hourly rounding paper work, core measure paper work, pressure ulcer paperwork, sitter paper work, and now computer charting. They are removing our nursing assistants due to lack of money and more working primary instead of having help.

vintage_RN, BSN, RN · Mar 26, 2014

Yikes! I also work on a busy surg floor that sounds exactly like yours....but our ratio is 1:3 and 1:4 if we're short. Thinking about 1:6 makes me want to cry!

RNperdiem, RN · Mar 26, 2014

The white uniforms are almost completely gone. The amount of charting we do has gone up. Computer charting often takes longer, especially if you have lots of patients. The computer makes the charting easier to audit, and with Medicare payments linked to charting, you had better believe that the charts are being audited.

The "big brother is watching you" feeling is something I have noticed more of. Every click of the mouse and every swipe of your badge is being recorded.

The new emphasis on not using restraints means that there are more CNAs being pulled in for sitter duty. My hospital has responded to the increased demand by hiring a pool of CNAs available for sitter cases. Usually the demand outstrips the supply.

Text paging is something I wish was available 20 years ago. You need to communicate about something that is important but not urgent, text page the appropriate doc and leave a message and callback number. Done.

People are people and I haven't found much change in patient demands. Family demands have gone up especially since more hospitals have gone to full open visitation. Visiting hours were more restricted in the past.

Lev, MSN, RN, NP · Mar 26, 2014

Family demands have gone up especially since more hospitals have gone to full open visitation. Visiting hours were more restricted in the past.

I think if there were restricted visiting hours for families my days would be a lot smoother. Restricted to...say...2 hours a day. When the families are there they expect your full attention to their loved one then. You are expected to stop what you're doing and cater to their needs. Even if you were going to give Mrs Smith pain medication in 15 minutes after you head into your moaning post ops room who just came out of recovery room, you may have to ignore your more needy patient at the moment and head to the one with family visiting for customer service purposes.

Been there,done that, ASN, RN · Mar 26, 2014

"confused sitter patients" Dang I hate that when the sitter is confused :)

As you noted, patients require more nursing care . The medical necessity requirements for reimbursement is jacked higher every year.

As far as patient demands, it all depends on if they are aware of the customer service business model.

Many will then run you ragged to please them.

I found that documentation, and responsiveness of physicians depends on the facility. I quit a travel assignment on the spot , when a doctor yelled at me at the desk. In a different facility, said doctor would be required to apologize to me ... at the desk, where I was humiliated.Never know what to expect from any doctor, anywhere.

Ratios also vary by facility. My most recent med-surg assignment was 8:1 on afternoons, with very sick peeps. ( one on an insulin drip).

Lev, MSN, RN, NP · Mar 26, 2014

@been there, done that

Sitter patients can be compared to "garden vegetables" in context. Fresh garden vegetables. Confused sitter patients. If I had written confused sitter's patients, it would be understood that the sitter was confused.

Esme12, ASN, BSN, RN · Mar 26, 2014

Well I am older than dirt. When I started out in nursing we had 22 patients med surg/post op/telemetry. With one LPN and an aide. It's hard to compare acuity as in those days every one was an open surgery with drains up the wazoo, sumps drains, JP's, penrose, NGT, T-tubes, chest tubes (and I mean 3 bottles on the floor) massive drsg changes. All preops were admitted the night before and IV's foleys NGT were to be inserted on the floor before OR. NO PCA pumps so everyone got pain meds as needed.

We would get morning med pass done and group together and get AM care done by noon. We worked our behinds off. But we worked together. The aide would do the call bells and all the C&A's (urine dips for insulin coverage) while I charted on my 10 or 11 patients. Then at 2 we would go and fluff and tuck every one else.

Side rails were a safety measure and we restrained people for their safety. Alcohol drips prevented DT's and we medicated for confusion. Heck some patients got a shot of whisky at hs. The only people watched were SI.

We hourly rounded and double checked everything.

I do think though that the acuity has increased and the work has increased with all the regulations. I also think all this real time charting is a HUGE time vacuum for nurses. Although we didn't have our cell phone distracting us all day either. I have always had good physician interactions with a few donkey's thrown in here and there.

I think patients are living longer with more interventions which actualy make them sicker patients. I liked visiting hours restricted for it allowed us to do our jobs in a timely manner.

imintrouble, BSN, RN · Mar 26, 2014

The changes I see in the hospital, are simply reflections of changes in our society as a whole. My sister, who is not a nurse, calls it the Wal Mart affect.

Customers are encouraged to whine, negotiate, lie, cheat, and disrespect.

The disrespect is one of the biggest differences in how I was treated as a patient's nurse then and now.

Technology. Dare I say I LIKED paper charting better? Computers are like people. Some days they're slow, some days they're not. Some days they work, and some days they don't. Has any other facility had HOURS, when you're dead in the water because the computers are down?

I became a nurse when there was a shortage, and employers treated us well.

If they didn't, I'd just move on. I could have another job in days if I chose to. Now, I can be replaced in minutes, and my boss and I both know it.

Less staffing. We're expected to do more with less. The nurse to patient ratio is not that different. 1/6, 7. However, the "customer" demands more. Families demand more, and the CNA jobs are being eliminated.

I keep editing and adding.

Lev, MSN, RN, NP · Mar 26, 2014

Technology. Dare I say I LIKED paper charting better? Computers are like people. Some days they're slow, some days they're not. Some days they work, and some days they don't. Has any other facility had HOURS, when you're dead in the water because the computers are down?

Beeping slow computers with dying batteries make me want to scream! Unplug the computer, 2 minutes later...beep.beep.beep.beep. shutdown. There goes your assessment, there goes your MAR with the 15 meds you just scanned and weren't so careful about tearing open so the bar code is still intact. Been there done that!

Lev, MSN, RN, NP · Mar 26, 2014

We would get morning med pass done and group together and get AM care done by noon. We worked our behinds off. But we worked together. The aide would do the call bells and all the C&A's (urine dips for insulin coverage) while I charted on my 10 or 11 patients. Then at 2 we would go and fluff and tuck every one else.

Teamwork is huge. I don't know why we don't all have that level of camaraderie. Are we too stressed to be nice and helpful? My unit happens to have fairly good teamwork, but there are always your black sheep.

Been there,done that, ASN, RN · Mar 26, 2014

Thought ' I 'was cold as a stone.

Patients requiring sitters are experienced a variety of issues. Interfering with treatment( pulling at tubes),High fall risk,etc.

Rarely found that a patient in a vegetative state would require a sitter.

But, that's another thread.