Nurses leaving in droves...

shell911rn · Nov 15, 2004

I just wanted to thank everyone who has posted input on this thread. It really helps to know I am not alone in the way I am feeling, and that others can relate. I'd worry if I WERE the only one feeling this way.......at least I know the problems and issues I'm perceiving are widespread and are not accepted by my fellow nurses as "OK".
What is it going to take to change things? It seems like a problem with such a simple solution.....better staffing.....but how many different ways can we explain our working situations to those in a position of changing things before things get better??? What's it going to take??
You know, I worked as a nursing assistant alongside LPN's and RN's for 8 years before deciding to go to school. Part of the reason I waited so long to go to school was because every nurse I ever worked with HATED nursing with a raging passion and urged me not to pursue the career. From the outside looking in, I didn't and couldn't see what they were so unhappy about and I thought they just had attitudes or they didn't like nursing in general and should have chosen a different career. It took me 3 days on the floor, working as an RN, to see what they were talking about. I love nursing.....I love caring for patients, I love the skills, I love nursing in general but I do NOT like the current atmosphere and work environment in which apparently so many nurses are finding themselves. It's now more understandable to me what those nurses were talking about. And it's also clear to me WHY there is a nursing shortage nationwide. The burnout rates couldn't be anything BUT astronomical considering the conditions nurses are expected to function in these days.
I don't mean to sound negative or whiny and I definitely don't want to be discouraging to current and prospective nursing students. Nursing itself is an awesome profession with so many different positive aspects to it. I am proud to be an RN and I do not regret my decision to follow this career path. I am, however, very disappointed in what I've seen and learned in a very short time related to the REALITY of our roles on a day to day basis. I imagine that a good percentage of nurses who leave the profession did so due to the same disillusionment I am already feeling. This is not what I bargained for. While in school, I was so excited and so determined to provide exceptional, high quality care for my patients. Excrutiatingly thorough physical assessments, interpeting labs daily, therapeutic communication, etc.....these are all things I recognize as being integral parts of quality, competent nursing care and I am more than a little upset that I am not able to do half of what I SHOULD be doing because I don't have the time. The thing that aggrevates me the most about this fact is that the solution is as simple as staffing the floor with another 1 or 2 CNA's to free up the lisenced staff to do their job properly.
Sorry for the rant. I'm feeling at a bit of a crossroads here. It's clear to me I won't be happy at my current job, but I am afraid if I move on I'll find myself in the same situation (or worse). Thanks for listening.

Your post reminded me of nurses I worked with while still a student who would say to me "You see what nursing is like. So why are you still pursuing it?" My response to them is that it was too late to change career paths (not to mention, I have no idea what else I want to do) and I would make the best of it. I worked 4 shifts this week and I've only ever had time to take a 30 minute lunch break on a 12 hour shift and a lot of the time I have to hold meeting my own needs such as going to the restroom or going to lunch (sometimes till 8 or 9 hours in to my shift), because I have patient's needs to meet first. A nurse yesterday had already gotten permission to leave work after 10 hours on the shift so she could attend a family birthday party, but when the supervisor said "It's ok, you can go ahead and leave. The staff can handle 5 patients." in an ER with a ratio of 3 to 4 patients per nurse (where the weight of being an MICN, providing direction to paramedics in the field, falls on all nurses in between providing their patient care), the nurse felt obligated to stay, but she was angry that she was guilted in to staying after already having been given the clear to leave weeks before. It's the variables of changing patient conditions and ever present patient needs that makes it difficult to manage one's time in nursing. Placing charts on the door is a no-no and considered a violation of patient privacy. That's why they haven't been on the front of patient's beds for a number of years. I've been yelled at for having the MAR's in my hand when the Unit secretary or MD needed access to them (considering I'm the one who really needs access to them as the nurse passing meds). And now we've got a doctor in the ER who wants access to our nurse's notes at all times, who became angry that a nurse had all her patient's nurse's notes on a clipboard. And let's not forget how much time it takes for an admitting assessment, with the pages of paperwork that outlines a patient's religion and nutritional habits, among other things, and those pesky careplans (one reason I'm glad I'm in the ER and don't have to do those). Those take roughly 30 minutes to an hour and throw a monkey wrench in to anybody's shift. Hence, why nurses hate getting an admission. And then there's the variable of patients needing pain medications at different times. Or the patient who needs preparation for surgery or who has just returned from surgery. Or the patient receiving blood. Or the patient who is being discharged who needs patient teaching. These tasks are time-consuming and no amount of time management will reduce this fact. And it's really a bad day when you get all of those patients. Hence why delegation was developed. Most nurses I know don't open up their charts until the afternoon and there are charts of patients I've discharged that I don't finish up until hours after they've left because in the ER, as soon as one leaves, another one comes in, and as part of prioritizing, this new patient is a priority, not one who has left. I told my charge nurse yesterday who said I chart too much that not only was I charting a lot to cover my butt, but that it was the only opportunity I had to sit down and catch a breather. He understood. And nobody likes a nurse who leaves a lot of unfinished business for the next shift. Oh, and I hate going to lunch now b/c my work piles up, and understandably so. How could the nurse covering for me meet her patient's needs and requirements for care while trying to meet all my patients' needs? Thus, I take my lunches later to make sure I am caught up and pain meds have been given. Otherwise, I'll return to total chaos. I'm still going well and above what other nurses I work with do. A lot of them hardly even chart or do a thorough assessment. I'm not trying to be an angel or a martyr to nursing. I'm just trying not to get sued or have a family all over my backside placing my job in jeopardy. I remember when I thought nursing school was tough. I didn't realize that actually being a nurse was tougher.

CCU NRS · Nov 15, 2004

I seem to be angering a certain few people which for some reason also feel I have an obsessive need for the last word. I will make these them.

Repat · Nov 15, 2004

the CNA needs SOMEONE to help her turn the heavy patients, needs someone to help her hoyer up the heavy patients into chairs.

You lucky devils - you have hoyers???

Midwest4me · Nov 15, 2004

Your post reminded me of nurses I worked with while still a student who would say to me "You see what nursing is like. So why are you still pursuing it?" My response to them is that it was too late to change career paths (not to mention, I have no idea what else I want to do) and I would make the best of it. I worked 4 shifts this week and I've only ever had time to take a 30 minute lunch break on a 12 hour shift and a lot of the time I have to hold meeting my own needs such as going to the restroom or going to lunch (sometimes till 8 or 9 hours in to my shift), because I have patient's needs to meet first. A nurse yesterday had already gotten permission to leave work after 10 hours on the shift so she could attend a family birthday party, but when the supervisor said "It's ok, you can go ahead and leave. The staff can handle 5 patients." in an ER with a ratio of 3 to 4 patients per nurse (where the weight of being an MICN, providing direction to paramedics in the field, falls on all nurses in between providing their patient care), the nurse felt obligated to stay, but she was angry that she was guilted in to staying after already having been given the clear to leave weeks before. It's the variables of changing patient conditions and ever present patient needs that makes it difficult to manage one's time in nursing. Placing charts on the door is a no-no and considered a violation of patient privacy. That's why they haven't been on the front of patient's beds for a number of years. I've been yelled at for having the MAR's in my hand when the Unit secretary or MD needed access to them (considering I'm the one who really needs access to them as the nurse passing meds). And now we've got a doctor in the ER who wants access to our nurse's notes at all times, who became angry that a nurse had all her patient's nurse's notes on a clipboard. And let's not forget how much time it takes for an admitting assessment, with the pages of paperwork that outlines a patient's religion and nutritional habits, among other things, and those pesky careplans (one reason I'm glad I'm in the ER and don't have to do those). Those take roughly 30 minutes to an hour and throw a monkey wrench in to anybody's shift. Hence, why nurses hate getting an admission. And then there's the variable of patients needing pain medications at different times. Or the patient who needs preparation for surgery or who has just returned from surgery. Or the patient receiving blood. Or the patient who is being discharged who needs patient teaching. These tasks are time-consuming and no amount of time management will reduce this fact. And it's really a bad day when you get all of those patients. Hence why delegation was developed. Most nurses I know don't open up their charts until the afternoon and there are charts of patients I've discharged that I don't finish up until hours after they've left because in the ER, as soon as one leaves, another one comes in, and as part of prioritizing, this new patient is a priority, not one who has left. I told my charge nurse yesterday who said I chart too much that not only was I charting a lot to cover my butt, but that it was the only opportunity I had to sit down and catch a breather. He understood. And nobody likes a nurse who leaves a lot of unfinished business for the next shift. Oh, and I hate going to lunch now b/c my work piles up, and understandably so. How could the nurse covering for me meet her patient's needs and requirements for care while trying to meet all my patients' needs? Thus, I take my lunches later to make sure I am caught up and pain meds have been given. Otherwise, I'll return to total chaos. I'm still going well and above what other nurses I work with do. A lot of them hardly even chart or do a thorough assessment. I'm not trying to be an angel or a martyr to nursing. I'm just trying not to get sued or have a family all over my backside placing my job in jeopardy. I remember when I thought nursing school was tough. I didn't realize that actually being a nurse was tougher.

Well-written and all so VERY TRUE. I assume you work in a hospital? Your experiences sound like those I had when I worked in LTC. What a hellish environment...glad I'm working in group home environment now where there are only 3-5 patients and 2-4 staff--wonderful ratios--I SO wish I'd looked into this kind of nursing years ago.

SmilingBluEyes · Nov 15, 2004

I remember when I thought nursing school was tough. I didn't realize that actually being a nurse was tougher.

you said a mouthful there.

gutnurse · Nov 15, 2004

This is in extended care - one nurse to 50 patients (day and evening shifts with the "contingency plan") and one nurse to 100 patients (with the contingency plan on the night shift)

Those are horrible ratio's is this actually legal?

Are there med aids passing the meds? Are there CNA's for ADLs? What are the actual responsibilities, Surely one nurse can not pass meds for 100 pt's and be expected to do anything else?

nursegoodlove · Nov 15, 2004

Those are horrible ratio's is this actually legal?
Are there med aids passing the meds? Are there CNA's for ADLs? What are the actual responsibilities, Surely one nurse can not pass meds for 100 pt's and be expected to do anything else?

I agree - these are "horrible" ratio's...as to whether or not it's legal...I guess that will be ironed out when someone dies unnecessarily. The nurse works with one nurse aide at night and if it goes into this contingency - they bring one extra nurse aide in for each of the 2 floors. The nurse runs between the 2 floors - gives out any scheduled meds as well as prn's. She also admin. any tube feeds, IV's, care for the sick, those who fall and so forth. It's totally bizarre. The nurse aides give basic care, i.e.: changing and turning of residents...report anything unusual observed to the RN. :uhoh21:

xprtnrs · Nov 15, 2004

I agree - these are "horrible" ratio's...as to whether or not it's legal...I guess that will be ironed out when someone dies unnecessarily. The nurse works with one nurse aide at night and if it goes into this contingency - they bring one extra nurse aide in for each of the 2 floors. The nurse runs between the 2 floors - gives out any scheduled meds as well as prn's. She also admin. any tube feeds, IV's, care for the sick, those who fall and so forth. It's totally bizarre. The nurse aides give basic care, i.e.: changing and turning of residents...report anything unusual observed to the RN. :uhoh21:

wow!:imbar