Nurses leaving in droves...

shell911rn · Nov 14, 2004

It is too bad that is hard to find good CNA's let alone CNA's period. I worked med-surg for many years and a good CNA can make all the difference. As a former CNA do you know any friends still holding that position that you might encourage to come to work at your facility? Possibly you should go to management and advocate for better circumstances and a harder push to get CNA's in house. Possibly if you as nurses pull together and make your issues known and that you are all feeling the severity of the situation this will put a bug up their butt to find and hire more CNA's. Maybe worth a try, I know a lot of people will say you can't accomplish anything this way but you never know if you don't try.
If you can't get the assistance you need possibly you should look into CCU/ICU or Stepdown or intermediate care. We don't use CNA's at my CCU but it is much better to do total care for 2 Pt's than 5. Perhaps it is your facility, you may have to look elsewhere in the long run but don't let this spoil nursing for you. I am a true advocate of "Find your Niche" I think most nurses take a little time to find their niche in the career and once you do your career is a much happier thing.

I agree that everyone in nursing needs to find their own "niche," but that is not addressing the issues being faced by thousands of registered and licensed nurses across the country, issues that at one time were tolerable, but now are unbearable under the weight of sicker patients and a nursing shortage. We all can't, don't, or won't be CCU/ICU nurses. At my hospital, the med/surg floor nurses have a minimum 6 patients and a new, simplistic acuity system that always seems to error on the side of the hospital, not patients and nurses. Similar acuity systems have been employed at other hospitals I worked or did my clinicals in. And now, decreasing patient to nurse ratios (thus far mandated in the state of California, although the governor is toying with the idea of throwing them out) is giving hospitals the excuse to let go of CNA's, b/c they believe that we should be able to be the primary nurse for our team since we have less patients. Even when I've worked with nurses who were providing "primary care," they've needed the help of a CNA. I can recall working at a hospital for 2 months only because I felt abused by the staff. The nurses at this hospital provided primary care on all floors and had an extra RN as a resource, another idea hospitals are trying while getting rid of CNA's. Yet, as a student nurse, I would float to the floor, they'd have me doing all there bed baths, changing linen, etc. I spent 6 hours straight one shift doing basic nursing care on a floor and they didn't want to let me go have lunch! That's how in desperate need of help they were that they couldn't bear to let me go for a half an hour. I wondered how much of their tasks they were actually completing such as passing their meds, bed baths for altered patients, feeding patients, in addition to handling individual patient issues that arose throughout the shift, plus fielding family and physician calls. I should have gotten out of nursing then, but I guess I had hope. Our efforts should be focused on providing safe nursing care, completing assessments, and critical thinking, and if we have time, basic nursing care. Nurses bear the weight of responsibility for catching pharmacists and doctors' mistakes. I can't even keep up with all the new medications that are coming out and I'll never have down what PO meds are and are not compatible with each other, yet it falls under my list of responsibilities or "standards of care". Yet, who really has time to research issues or medications? I do a lot of my research AFTER work (when I'm no longer getting paid). I believe in creating a safer environment for all nurses to work in, not pushing nurses out of certain specialties b/c administration doesn't want to provide more support. This is a problem on a national level, not just individual hospitals. We all want the luxury of 1 to 2 patients in ICU, because then we'd know we could provide our patients with ideal, textbook care. Instead, patients and nurses, are being shortchanged. I don't know what the answer is, but it amazes me that I see more managerial and administrative positions being created at the expense of nursing. We don't need more managing. We need more nurses.

Nellie Nurse · Nov 14, 2004

This thread is depressing as well as relieving because I know that I am not alone. I have been a nurse for 6 months. After 5 years of working as a CNA I thought, oh boy, I get to do something new and different now that I am a nurse.... boy was I wrong. I feel like I never left that role but now I have added 10x more responsibility.

We have 1 NA on nights, so I am basically doing total care. On night shift we also do not have any transporters so if a patient needs an MRI, X-ray, CT, etc guess who gets to go take them there, and bring them back! We also have no food service, so if a patient is hungry I have to go to the kitchen and make them a sandwich. I guess I am naieve but I thought that things would be different in a level I trauma big city hospital. I never leave on time, and then when the day shift comes in they gripe and complain about the little things that I was not able to get to because I was so busy (ex: putting a care plan in a chart). I am alway scared spitless that one of my patients will code and I won't know it until hours later because I was too busy to get into that room.

I will be moving in 6 months and I am definately NOT going to be working in Med/Surg. I am already too stressed out. I did not work my butt off for the past 3 years in school to have a job like this. The sad thing is that I really love nursing, I just hate the job. I know that there is a place for me in this profession, and I am going to find it early, not after 10 yrs of back breaking thankless work. I admire all of you nurses who have worked in this setting for years. Thank you for your dedication, you are awesome!

Rachel2004RN · Nov 14, 2004

"Possibly you should go to management and advocate for better circumstances and a harder push to get CNA's in house.......
"I am a true advocate of "Find your Niche" I think most nurses take a little time to find their niche in the career and once you do your career is a much happier thing."

I have gone to management about this. I'm always told "well there are some floors that don't have any CNA's" (THAT would be a floor I'd never ever work on in a million years) or I'm shown the census and how the numbers work out and hear "you only have 5 patients and have to wash up 2". What they don't realize is if THAT was all we had to do, it would likely be a little less challenging.....BUT you know how it goes. Since there's only 1 CNA in the hallway....the CNA needs SOMEONE to help her turn the heavy patients, needs someone to help her hoyer up the heavy patients into chairs. With 1 CNA in the hall and 2 feeds....a nurse always has to feed the second patient....ALWAYS at the same time when meds need to be passed. Not to mention the fact that while I am actually passing meds I get sucked into the black hole of certain rooms.....often my patient's roomate won't even be my patient but since I'm standing there I get called over and given a list 20 minutes long to take care of. (can't delegate to CNA's and passing it off to the patients nurse will earn you a reputation of being not a team player). And the call lights never stop. In the short time I have been working there, there's been at least 1 fall caused by a patient on 11-7 who had her call light on for a long time waiting to go to the bathroom and no one ever came so she got up herself. They are real big on "safety" on my floor....be sure patients are in low beds and a sign on the door, etc......what good does it do if the safety gap occurs because of not enough eyes, ears and hands to tend to needs???

As for finding a niche, I agree with you for sure on that one. I refuse to believe that my current job represents the entire world of nursing. I'll keep looking and hoping I find the right place. I have been so bummed out and disappointed lately as I've been realizing my current job isn't going to work out, because I truly like the floor and I like my co-workers (for the most part). It's an excellent learning experience, and it has the potential to be an awesome unit.....all it needs is 2 CNA's in each hallway every day instead of 2 for the entire floor......but I have a sinking feeling I shouldn't hold my breath.

Rachel2004RN · Nov 14, 2004

And now, decreasing patient to nurse ratios (thus far mandated in the state of California, although the governor is toying with the idea of throwing them out) is giving hospitals the excuse to let go of CNA's, b/c they believe that we should be able to be the primary nurse for our team since we have less patients.

I believe this is EXACTLY what is happening in my hospital. I believe that upper management is reasoning we don't need more CNA's because we each have "only" 5 patients. Well let me tell you, I worked this past weekend and had 6 patients both days, BUT we had 2 CNA's in the hallway. I had a MUCH better, less stressful day with 6 patients and 2 CNA's than I have on the days I only have 4 patients and 1 CNA. That is saying something.

Yet, as a student nurse, I would float to the floor, they'd have me doing all there bed baths, changing linen, etc. I spent 6 hours straight one shift doing basic nursing care on a floor and they didn't want to let me go have lunch! That's how in desperate need of help they were that they couldn't bear to let me go for a half an hour. I wondered how much of their tasks they were actually completing such as passing their meds, bed baths for altered patients, feeding patients, in addition to handling individual patient issues that arose throughout the shift, plus fielding family and physician calls. I should have gotten out of nursing then, but I guess I had hope. Our efforts should be focused on providing safe nursing care, completing assessments, and critical thinking, and if we have time, basic nursing care. Nurses bear the weight of responsibility for catching pharmacists and doctors' mistakes. I can't even keep up with all the new medications that are coming out and I'll never have down what PO meds are and are not compatible with each other, yet it falls under my list of responsibilities or "standards of care". Yet, who really has time to research issues or medications? I do a lot of my research AFTER work (when I'm no longer getting paid). I believe in creating a safer environment for all nurses to work in, not pushing nurses out of certain specialties b/c administration doesn't want to provide more support. This is a problem on a national level, not just individual hospitals .

Oh my gosh we LOVE to see the student nurses coming!!! I don't know HOW I'd get through some days without them there...and the days they are there I always think to myself "how do we do this when they aren't here?"

And YES, my thoughts exactly.......as lisenced staff our focus SHOULD be on "providing safe nursing care, completing assessments, and critical thinking, and if we have time, basic nursing care.".....I feel in my current position it is impossible to do my job. You mentioned "standards of care".......wouldn't it be nice to have the TIME to do everything the way it was meant to be done?? It's like we're set up to fail or something.

CCU NRS · Nov 14, 2004

I agree that everyone in nursing needs to find their own "niche," but that is not addressing the issues being faced by thousands of registered and licensed nurses across the country, issues that at one time were tolerable, but now are unbearable under the weight of sicker patients and a nursing shortage. We all can't, don't, or won't be CCU/ICU nurses. At my hospital, the med/surg floor nurses have a minimum 6 patients and a new, simplistic acuity system that always seems to error on the side of the hospital, not patients and nurses. Similar acuity systems have been employed at other hospitals I worked or did my clinicals in. And now, decreasing patient to nurse ratios (thus far mandated in the state of California, although the governor is toying with the idea of throwing them out) is giving hospitals the excuse to let go of CNA's, b/c they believe that we should be able to be the primary nurse for our team since we have less patients. Even when I've worked with nurses who were providing "primary care," they've needed the help of a CNA. I can recall working at a hospital for 2 months only because I felt abused by the staff. The nurses at this hospital provided primary care on all floors and had an extra RN as a resource, another idea hospitals are trying while getting rid of CNA's. Yet, as a student nurse, I would float to the floor, they'd have me doing all there bed baths, changing linen, etc. I spent 6 hours straight one shift doing basic nursing care on a floor and they didn't want to let me go have lunch! That's how in desperate need of help they were that they couldn't bear to let me go for a half an hour. I wondered how much of their tasks they were actually completing such as passing their meds, bed baths for altered patients, feeding patients, in addition to handling individual patient issues that arose throughout the shift, plus fielding family and physician calls. I should have gotten out of nursing then, but I guess I had hope. Our efforts should be focused on providing safe nursing care, completing assessments, and critical thinking, and if we have time, basic nursing care. Nurses bear the weight of responsibility for catching pharmacists and doctors' mistakes. I can't even keep up with all the new medications that are coming out and I'll never have down what PO meds are and are not compatible with each other, yet it falls under my list of responsibilities or "standards of care". Yet, who really has time to research issues or medications? I do a lot of my research AFTER work (when I'm no longer getting paid). I believe in creating a safer environment for all nurses to work in, not pushing nurses out of certain specialties b/c administration doesn't want to provide more support. This is a problem on a national level, not just individual hospitals. We all want the luxury of 1 to 2 patients in ICU, because then we'd know we could provide our patients with ideal, textbook care. Instead, patients and nurses, are being shortchanged. I don't know what the answer is, but it amazes me that I see more managerial and administrative positions being created at the expense of nursing. We don't need more managing. We need more nurses.

I posted this on another board for a nurse experiencing burnout, perhaps it will help with question at hand.

When I worked med-surg this was my routine.

Immediately after report go and assess each Pt and do the charting for that assessment right then (doorside charts where I was not sure if this is your case), go and pull all 0800 and 0900 meds (always check MARS during report and take 0700-30's with fopassing during assessment also FSBS's) check for neww orders while at desk prepare meds, crush, inject, etc and set up pass tray and mars, do 0800 meds and any insulin required from earlier fsbs's, return to desk check for new orders and then pass BF tays and assist with feeder and pass meds to feeder and crushed meds via NG-tube, then oral to those capapble, then eat my BF and then check for new orders, of course during each of these checks I am pulling any new meds or returning any D/C'd meds and calling pharmacy for anything that I may need to call for. Note orders and make initial note in progress note somewhere arond 0930-1000, after all orders caught up do any up to chairs or pulling lines ng's etc from orders. this usually takes you up to about lunch try to eat before trays arrive and then be back ntime to pass trays and 1100-1200-1300 in between and during this time. after lunch make any notes and check again for orders of course two things are really imperitive for success, good Unit clerk and good cna.

Time management, priortizing and time managment!

Mulan · Nov 14, 2004

I posted this on another board for a nurse experiencing burnout, perhaps it will help with question at hand.
When I worked med-surg this was my routine.
Immediately after report go and assess each Pt and do the charting for that assessment right then (doorside charts where I was not sure if this is your case), go and pull all 0800 and 0900 meds (always check MARS during report and take 0700-30's with fopassing during assessment also FSBS's) check for neww orders while at desk prepare meds, crush, inject, etc and set up pass tray and mars, do 0800 meds and any insulin required from earlier fsbs's, return to desk check for new orders and then pass BF tays and assist with feeder and pass meds to feeder and crushed meds via NG-tube, then oral to those capapble, then eat my BF and then check for new orders, of course during each of these checks I am pulling any new meds or returning any D/C'd meds and calling pharmacy for anything that I may need to call for. Note orders and make initial note in progress note somewhere arond 0930-1000, after all orders caught up do any up to chairs or pulling lines ng's etc from orders. this usually takes you up to about lunch try to eat before trays arrive and then be back ntime to pass trays and 1100-1200-1300 in between and during this time. after lunch make any notes and check again for orders of course two things are really imperitive for success, good Unit clerk and good cna.
Time management, priortizing and time managment!

Wow, you get paid to eat breakfast? That must be nice.

How can one check MARS and listen to report at the same time.

With computer charting and computer med administration, it's a whole other ballgame, and very time consuming.

"Time management, prioritzing and time management", I get sick of hearing that, and usually that means something, (probably a lot) isn't being done.

SmilingBluEyes · Nov 14, 2004

Wow, you get paid to eat breakfast? That must be nice.
How can one check MARS and listen to report at the same time.
With computer charting and computer med administration, it's a whole other ballgame, and very time consuming.
"Time management, prioritzing and time management", I get sick of hearing that, and usually that means something, (probably a lot) isn't being done.

It puts the blame squarely on nurses' shoulders and effects little change when staffing is dangerously low. The NUMBERS are what they are an no amount of "time management" will change them. Yes, there is a point at which "time management" no longer works. I read some posts here about how bad it is some places and I can see how nothing in the way of time management would change a damn thing for them. But hey, admonishing nurses to do more with less and be better time managers---sounds like A manager's and administrator's dream. :)

.

nursegoodlove · Nov 14, 2004

It puts the blame squarely on nurses' shoulders and effects little change when staffing is dangerously low. The NUMBERS are what they are an no amount of "time management" will change them. Yes, there is a point at which "time management" no longer works. I read some posts here about how bad it is some places and I can see how nothing in the way of time management would change a damn thing for them. But hey, admonishing nurses to do more with less and be better time managers---sounds like A manager's and administrator's dream. :)
.

We lost one whole ECU (67 beds) and gained a manager (go figure). There is 1 RN for 25 pts. on the D & E shifts in our ECU & 1 RN to 50 @ N. The management/admin. are now looking at deleting the RN's & replacing them with "full-scope" LPN's as their "bottom line". When disasters hit and nurses fill out professional responsibility forms...management usually ask the nurses: "what is it that YOU could have done better?" There are times they cannot replace a nurse and they go into their "contingency plan"...which allows that 1 RN on D & E to then have double the pt. load (50) & the N nurse to oversee 100 pts. (on 2 different floors with an elevator in between). Give me a break...there is NO time - managed or not. :angryfire

Rachel2004RN · Nov 14, 2004

It puts the blame squarely on nurses' shoulders and effects little change when staffing is dangerously low. The NUMBERS are what they are an no amount of "time management" will change them. Yes, there is a point at which "time management" no longer works. I read some posts here about how bad it is some places and I can see how nothing in the way of time management would change a damn thing for them. But hey, admonishing nurses to do more with less and be better time managers---sounds like A manager's and administrator's dream. :)
.

You just hit the nail on the head.

mattsmom81 · Nov 14, 2004

A 'schedule'; is nice, but I am yet to keep with it...the patients call me, pharmacy, docs call me, the case managers need to speak with me, shyt happens...patients go bad....yada yada...and the schedule goes to heck in a handbasket.

some days very little gets done 'on time' and we just do our best. Minimizing nurses' concerns is a management tactic and it not helpful IMHO. Nurses who downplay the legitimate concerns of other nurses likely work in good facilities with decent managers; their success is not likely due to superior skills at work. Not all nurses have this at their disposal.

I'm lucky to get a bathroom break in my ICU most shifts and it doesn't have anything to do with my 'time management skills'. It has to do with trying to do too much with too little resources. Good hearted people try to 'do it all' but there are only so many hours in the shift and we must prioritize...realistically this means some things won't get done on most days.

So what is the answer?? We find somewhere optimal for us, with likeminded people where we can do the best we can and go home and (hopefully) sleep at night.

We speak out as much as we can to management and still keep our jobs. We prioritize by doing our best for our patients. We play the game and walk the line and pray nobody dies.

This thread is a testimony to why good nurses leave nursing and I can't disagree with the whys...I've been a nurse too long and can relate too well. But I WILL speak against those who downplay our feelings of dissatisfaction with our work environments and imply it is because we are not 'good enough' in some way.

CCU NRS · Nov 14, 2004

Wow, you get paid to eat breakfast? That must be nice.
How can one check MARS and listen to report at the same time.
With computer charting and computer med administration, it's a whole other ballgame, and very time consuming.
"Time management, prioritzing and time management", I get sick of hearing that, and usually that means something, (probably a lot) isn't being done.

Hey I am just telling you how I did it. I did it for years and yes I get paid to eat BF an 8 hour shift gets 2 15/min breaks and a 30/min lunch and I take them all. And yes I time manage welll enough to do this.

As for checking Mars during report I assume there are more than your Pts and you sit in report for all 20-25 so while report is being given on other Pts you check your MARs.

No I did not have computer MARs or Computer charting as I mentioned doorside charts. Can you not print a copy of the MAR to check I am not in a computer facility we have been fighting with the exact things you seem to be complaining about, it does not assist nursing care but hinders it. MAR must be available at bedside to check the 5 rights is it not?

I always take my breaks and my lunch and yes I always get my work done.

I simply offered my routine to assist others in an attempt to plan care if it does not apply to you then I guess it won't help you.

If you look around and there are others that are able to complete their assignments while you are not then ask them how they do it. Perhaps you can gain some insight from them.

CCU NRS · Nov 14, 2004

We lost one whole ECU (67 beds) and gained a manager (go figure). There is 1 RN for 25 pts. on the D & E shifts in our ECU & 1 RN to 50 @ N. The management/admin. are now looking at deleting the RN's & replacing them with "full-scope" LPN's as their "bottom line". When disasters hit and nurses fill out professional responsibility forms...management usually ask the nurses: "what is it that YOU could have done better?" There are times they cannot replace a nurse and they go into their "contingency plan"...which allows that 1 RN on D & E to then have double the pt. load (50) & the N nurse to oversee 100 pts. (on 2 different floors with an elevator in between). Give me a break...there is NO time - managed or not. :angryfire

I do not understand many of the terms you are using. ECU? N nurse? I don't understand the setting you describe a 50:1 ratio is this an LTC?