Quote from Bumashes
Ok. I'm putting my cards on the table. Putting my money where my mouth is. My boss asked all of us, physicians and nurse practitioners alike, to give ideas on what we can do to help with the flow of patient care at my hospital. In my opinion, right now the biggest problem that we have is that well over half of the staff on each floor have less than one year experience as nurses. New nurses are training new nurses. It's horrible. They leave in droves, and who can blame them? We do not have much of an education system set up for them. The only specialty that has an actual educator specifically for it is the ICU. Everyone else is relegated to one educator who is overwhelmed. So the new nurses go through a kind of rushed two week orientation that includes their computer training, facility orientation, and a series of power points that are pretty much useless. Then they are put out on the floor for only a few weeks with their "mentor" before being cut loose. The reason for the rush is because of the severe shortage of nurses in the facility. It really is a terrible situation. However, I am willing to throw myself into it and help if I can.
So I told my boss that I believe that nursing education and orientation is the main problem with patient care and patient flow in our facility. He said he's going to speak with the system educator about possibilities for me to assist with nursing education. This is great because I love to teach clinical concepts. However, I am uncertain how I could be best utilized. I do not think that classroom time would be cost-effective or as educational as actual on-the-floor learning. What I envision is more of me going to a floor and sort of mentoring and guiding new nurses through their day. Maybe showing them how I look at things such as labs and how to prioritize. I worked as a floor nurse for two years and then an ER nurse for five years before I became a nurse practitioner. So I have a basic understanding of how these things need to be done, and I am not so far removed from it yet as a nurse practitioner that I cannot relate to them. But I am reaching out to you all to see if you have any ideas on what I could do as an individual to assist with this. We are a pretty large hospital. Our facility has about 550 beds that stay full. I work as a nurse practitioner hospitalist, so I see all of the nurses from the ER and on up through most of the floors. So they already kind of know me, and I am familiar with the layout of their work areas.
I am willing to do this on my days off as well. I really don't mind. It is a problem that has bothered me for a long time now. And I would consider it volunteer work to the betterment of the nursing profession to be able to improve the situation in my facility. There are many things, of course, that I cannot solve. Staffing ratios, pay rates, etc. But the thing that I CAN help with is the every day function and basic working knowledge of the average staff nurse. Now, there still are some experienced nurses on these floors. And I would like to incorporate them as well if I can. However, on some floors it is so bad that the most experienced nurse among them has only two years of experience on some days. And I know that floor nurses have a tough workload, so it is difficult for the experienced nurses to take time out of their already busy day to help train the newbies.
Just for an example of what I am talking about :
I asked for a JP drain to be pulled on a surgical patient. Unfortunately, the only nurse who knew how to do that was at lunch. So, I instructed the three nurses who were present on how to do this procedure. This is the type of thing that I envision would work best. Going to their floor and being a resource to them. As well as looking into their pts charts and finding teachable items. Not really sure if that is realistic or not. So please, if you have a suggestion, post it. I am open to almost anything. I really want this facility to get better. I love my job, and it makes me very sad that many of my floor nurse colleagues are struggling.
Things I see often:
Not knowing when to call the doctor/NP.
Not knowing what labs correspond to what conditions.
Procedural knowledge deficits, such as with the JP drain.
Prioritization-the ice can wait, but the BP med cannot.
Drawing labs out of an IV line that has had fluids running in it for days just b/c the pt asked why not.
Not knowing the appropriate nursing interventions for follow up: example is that if you give IV insulin then you need to actually RECHECK the pts BG (that was a new ER nurse).
So you see what I mean? These are kinks that usually get worked out with a normal 3 month paired orientation and some good solid experienced nurses around you. But here they are literally thrown to the wolves and have very little resources in the way of experienced colleagues.
So, please help?
I too think it's great that you want to help this situation, but have conflicting thoughts about how you can do that.
On the one hand, voicing your concerns carefully may help generate some motivation for change.
On the other hand - admin absolutely does
know about this. Asking for suggestions about some other issue ("flow of patients") seesm like a move from a play book, doesn't it? They have massive turnover and they are calling far and wide for suggestions about what to do about something other than that
? That is some game-playing.
As to your specific suggestion that you might offer inservices or real-time tidbits of info here and there...unfortunately these nurses have missed the opportunity to form the foundation and knowledge base that is usually begun during an appropriate (and supported) orientation process. Learning a random thing or two here and there when you happen to be around is nice of you
to offer, but I'm not sure how much it will help. Sure, if you are there and can teach a thing or two (such as how to remove a JP drain) you should do that, but I sincerely don't think those things (alone) will put a dent in this problem.
This is an administration issue to its very rotten core. Their options are to get some educational support and floor support for these nurses ASAP. And that is it.
Sorry to be a Debbie Downer. This is unacceptable.