Nickle and dimed!!!!!!

[Virgo_RN]

[rant] For time, that is.

I get so frustrated when I have a really busy patient, with multiple drips into a central line, piggybacks, IVPs, PO meds, incisions, and on and on, and I take my time to look through the chart, check the labs, check the meds, just so I'll have it somewhat together when I go in the room to do my initial assessment and hang a bag and give a couple of pills, ONLY to find half a dozen family members wringing their hands because grandma doesn't have any water, she's hacking up a lung and has no tissues, she doesn't have enough pillows and needs a warm blanket, etc. etc.

Now, in theory I don't mind at all doing these things for my patients. It's a part of nursing. I do these things all the time. BUT, come on!!!! The shift started an hour ago, the names on the board have not even been changed, the I&Os from the last shift are still up, vitals have not been done, where the H E double hockey sticks is the CNA????? I have a busy group of patients, I'm going to be lucky if I get out of here on time, I need to be able to get in and out and move on to the next patient. I cannot do that without help!

This wouldn't bother me if it happened every once in a while. As a former CNA, I know how busy it can be, and how you really have to hit the floor running 99% of the time. But this happens so frequently, I'm doing total care anyway. This is why I am running my tail off for the first six hours of my shift, have to choose between taking a dinner break and staying late, and can't get my assessments charted until the last hour of my shift.

I'm not blaming the CNAs. I blame inadequate staffing. But it's still frustrating, and I absolutely HATE having to "track down" a CNA to get help with a two person assist to the BSC or to pull someone up in bed. I wish that the aides could just round on each patient at the beginning of the shift so we could get everyone fluffed and puffed together, or better yet, team up with the other aides to fluff and puff the patients that take two, so the nurses can get their assessments and pass their meds safely. Heck, I'd be happy to do my own vitals if I knew that the water, pillows, blankets, pottying, positioning, fluffing and puffing, would be done.

[/rant].

[Diary/Dairy, RN]

I feel your pain!!! I had a family demand that I give a bath at 2000 last week...when I had 5 patients, 2000 is when they ALL have their PM meds, and there was only one aid for 25 patients....... I love bathing people and making them look better, smell better, feel better......but I have other demands on my time..... There are times when families REALLY don't get it. We want to do the best we can, but we have other demands on our time. And I for one, am NOT going to allow unreasonable demands to compromise the time that I have to spend with my other patients.

[Ms Kylee]

I try very hard to get everyone pulled up, fluffed, puffed, bathed, and fed on time. Problem with my floor is that when sufficient aides are scheduled, one either calls off or gets pulled. The two that are left are left with 18 patients each. I would be more than willing to go room to room with the other aide to pull everyone up before breakfast, but we have to do blood sugars, chart them, and give report to the nurses on them. Then it's time for breakfast, and I have to feed. That usually takes a good hour, and then it's bath time, time for vitals, time for lunch blood sugars, time to chart (if I'm lucky). In between all of this, I have to make rounds to see if anyone is wet, need cleaned up, change briefs and beds, get patients ready for tests.

It really would be nice to be fully staffed for once, but since my floor can't rely on one to show up and someone is always getting pulled, I do the best I can.

[UM Review RN, ASN, RN]

[rant] For time, that is.

I get so frustrated when I have a really busy patient, with multiple drips into a central line, piggybacks, IVPs, PO meds, incisions, and on and on, and I take my time to look through the chart, check the labs, check the meds, just so I'll have it somewhat together when I go in the room to do my initial assessment and hang a bag and give a couple of pills, ONLY to find half a dozen family members wringing their hands because grandma doesn't have any water, she's hacking up a lung and has no tissues, she doesn't have enough pillows and needs a warm blanket, etc. etc.

Now, in theory I don't mind at all doing these things for my patients. It's a part of nursing. I do these things all the time. BUT, come on!!!! The shift started an hour ago, the names on the board have not even been changed, the I&Os from the last shift are still up, vitals have not been done, where the H E double hockey sticks is the CNA????? I have a busy group of patients, I'm going to be lucky if I get out of here on time, I need to be able to get in and out and move on to the next patient. I cannot do that without help!

This wouldn't bother me if it happened every once in a while. As a former CNA, I know how busy it can be, and how you really have to hit the floor running 99% of the time. But this happens so frequently, I'm doing total care anyway. This is why I am running my tail off for the first six hours of my shift, have to choose between taking a dinner break and staying late, and can't get my assessments charted until the last hour of my shift.

I'm not blaming the CNAs. I blame inadequate staffing. But it's still frustrating, and I absolutely HATE having to "track down" a CNA to get help with a two person assist to the BSC or to pull someone up in bed. I wish that the aides could just round on each patient at the beginning of the shift so we could get everyone fluffed and puffed together, or better yet, team up with the other aides to fluff and puff the patients that take two, so the nurses can get their assessments and pass their meds safely. Heck, I'd be happy to do my own vitals if I knew that the water, pillows, blankets, pottying, positioning, fluffing and puffing, would be done.

[/rant].

Exactly my problem as well. I come on shift and the vitals are done by the last shift's tech, so where is the tech assigned to my shift? I start to wonder when I've gotten my third or fourth patient fluffed and puffed. The day shift is long gone and I usually wind up pulling/pushing, and getting things by myself for the first hour. A couple of techs habitually come in up to a half hour late. Others dillydally at the nurse's desk, chatting up the Unit Secretary. One feels it is her personal mission to change the way things are done and chooses to write 20-page missives to the manager on our worst nights, which eats up even more precious time on those awful nights.

We are told that we cannot pass by a call light that is on, yet our BP meds might be hours late due to "creating a good customer experience"?????!!!

With the excellent techs, we've already at least had eye contact and can tackle several things at once so we both get out on time.

It's surprising how teaming with a great tech can make such a difference in the flow of a shift.

Techs, that is how important you are in the grand scheme of nursing. You are that important to the patient's continued well-being. I love the techs who understand the real significance of their work and do it well.

[aeauooo]

Yeah, run your butt off keeping somone alive and some family member thinks you have better thinkgs to do - been there.

I remember orienting a new nurse one night - night-from-hell-type nights - I was supposed to be preception this nurse, but I had to take an assignment, so essentially, she was flying on her own. She's dumping blood products into this patient all night - one right after the other - and the patient's sister demands to know when was the last time the patient got turned. Let's see: death or decub? Which do we really want to prevent?

I have found that the best way for things to go wrong is to let someone else - I don't care who - tell me what my priorities should be.