I work on an extremely busy surgical floor with frequent admissions and discharges. We get ortho, plastics, and GI surgical patients, plus a host of medical patients. Our ratio is 1:5, but very often we go up to 1:6 on day shift because we are short on nurses. We are also frequently short on techs and often have confused sitter patients, so sometimes an available tech has to sit with a patient. Our standard vitals and I&Os are q8h, but we do post op vitals and about 1/3 the patients have q4 vitals and/or q4 I&O. Patients are often really sick.
For experienced med surg nurses, what have you seen change about Med/Surg in the past 10-15-20 years. Documentation, staffing, patient demands, acuity, responsiveness of doctors and physician assistants are all things I'm interested in hearing about.
from the more experienced nurses on our floor the acuity of the patients has changed. Such as patients with insulin or heparin drips used to be ICU patients - no exceptions, now we get those on a non tele floor.
I haven't been a nurse very long but have seen lots of changes. More requirements with charting. Higher acuity, sicker patients, less resources. The ratios are horrible especially at night. The patient surveys and customer service became huge within my 2nd year as a nurse.
One change I enjoyed was the introduction of hospitalists where I used to work. We no longer had to call mean crotchety doctors that had been working all day at home.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.[/quote']We didn't really have a choice. There were so few of us. You could NEVER care for 22 acute patients alone. You'd hash it out in the dirty U and go back to work.
from the more experienced nurses on our floor the acuity of the patients has changed. Such as patients with insulin or heparin drips used to be ICU patients - no exceptions, now we get those on a non tele floor.
We also get heparin drips. Insulin drips they keep on the step down floors.
I haven't been a nurse very long but have seen lots of changes. More requirements with charting. Higher acuity sicker patients, less resources. The ratios are horrible especially at night. The patient surveys and customer service became huge within my 2nd year as a nurse.[/quote']
Yes! There is too much emphasis on customer service. When will hospital administrators figure out that if they want happy patients they need to have happy nurses who are not overwhelmed with double and triple documentation requirements and poor staffing?
We didn't really have a choice. There were so few of us. You could NEVER care for 22 acute patients alone. You'd hash it out in the dirty U and go back to work.
And anywhere you went it was the same thing, so you couldn't just leave...
Ah yes the days of patients being admitted the night BEFORE surgery and staying in the hospital POST surgery.....Now you have to practically be dead to be an inpatient!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
We used to have 15 patients on the day shift with an LPN and an aide or with two aides. (On weekends, it was one aide.) Night shift we had 30 patients with an LPN or an aide. We used to pray the LPN would be on our team so she could give prn pain meds and Valium.
Standard admission orders included "Valium 10 mg. PO q 4h prn" and we gave it. (I remember the little blue tablets with a "V" cut into them.)
There were ashtrays at the nurse's station for visiting doctors. Nurses had to go to the break room to smoke.
Patients smoked in their rooms.
No blood glucose testing -- we dipsticked urine instead.
Metal bedpans, glass thermometers. (We used to play with the mercury when we broke a thermometer.)
One box of exam gloves for the whole floor -- it was used by interns doing rectal exams. If you were giving a suppository, you used a finger cot and if you were cleaning up poop you did it bare handed.
Years and years ago, We had a structure in place in the hospital setting which was called "team leading". One RN worked with one CNA and you had 15-18 patients at night on a med-surg floor. You would work together, and it truly was a blessing on your back, and your sanity.
Fast forward 20 years later and I found myself back in a hospital setting, but this time, ICU and Telemetry. Aughhh.. Things have truly changed: No team leading and when I worked tele, I was the only RN for 6-7 patients, no tech, no LPN. I did my own VS, Passed meal trays and feed patients, did all the bathing, and got all medications to the patients, though sometimes all-be-it late. (And heaven forbid you just received a patient back from the cath lab!) Then, lunch rolled around and you "rinsed and repeated. " This last hospital stint was 15 years ago, and since then, I'm determined NOT to set foot in another hospital as a caregiver. Too old, to tired..LOL.
Twinmom06, ASN, APN
1,171 Posts
from the more experienced nurses on our floor the acuity of the patients has changed. Such as patients with insulin or heparin drips used to be ICU patients - no exceptions, now we get those on a non tele floor.