Nurses who Nurse Patients

Psychtrish39, BSN, RN · Jan 25, 2012

I have a job right now as an oversight nurse. While I do not do daily care as I did when I was a staff nurse in positions I have had before I am responsible for all calls and assessing for clients to go to the ER, physical assessments, COPEs assessments, physical assessments before the clients return to the facility from acute care meaning to assess if they are ready for a lower level of care. Pure assessment skills. I agree with QI/QM how would you even be a nurse if you are not assessing people and listening to breath sounds and talking to them? That is at the heart of our profession and "assessment" is part of the nursing process. It is taught in first semester of nursing school. Thats sad some nurses don't and also very unsafe. :down:

garnetgirl29, BSN, RN · Jan 25, 2012

I'm in my 2nd semester of LPN school & from what my instructors are telling me, I fully expect to do hygiene care as well as physical assessments at the bedside, which involves talking to the pt, touching the pt, etc., passing meds, or whatever else my pt needs to feel comfortable and promote physical/emotional wellness. We have to do a physical assessment on a pt every week. Just yesterday, one instructor said she's seen students try to assess pt's from across the room and lectured us on how important it is to touch your client, adequate lighting while doing assessments, asking questions, etc. We had a NP come in and lecture us on the proper way to give an assessment (yes, according to our instructors -one of which is on the BON-in NC, LPN's do assessments, we just report our findings to the RN) While I was assisting a pt to her bed from her bedside potty the other day, the RN emptied/cleaned the potty and charted. (this was a med-surg floor) I was surprised to see it finished before I had a chance to get to it. That is the type of nurse I want to be and the type of coworkers I hope to have. BTW, I did notice how willing her aid was to help with whatever was needed. Great learning experience for a soon to be nurse!

Quickbeam, BSN, RN · Jan 25, 2012

I definitely blame the overselling of nursing as a bomb-proof career. Everyone and their brother is calling me now asking if their adult kid should go to nursing school. The questions they ask are all financial. When I ask about how their kid's interest in hands on care has manifested in the past, I get "huh?". No CNA or any other type of similar experience.

In my class, the ones who hated hands on care didn't last a year after school. Now it seems people take the jobs for the check but have no heart for the job. With a crummy economy, people are staying where they have no business working. It is a shame.

cdsga · Jan 25, 2012

I think you are right. I went to a Diploma (yes diploma) program where we actually staffed the hospital as student nurses. We did what nursing assistants do and we saved the hospital alot of money by filling those positions all the while learning what hands on care means, and we also performed more procedures than assistants did because we were students and we were expected to do more. When I think about our class size at the beginning and what we ended up with-the education and expected work load during school certainly gave all the student nurses an idea of what was expected. Many dropped out and our class size was small at the end. It is definitely sad that the diploma programs have gone the way of the dinosaur, because if you made it to graduation, you really new what nursing care was about, and those nurses probably stayed in the profession alot longer than others. It would be interesting to see the stats concerning 1 year post grad nurses who are actually stayed in the career. I am sure that it would be enlightening information. The new nurses, with whom I work, tell me that there education was more related to paper writing and observation not a lot of hands on care. That is sooooo sad. There is nothing better than caring for people at their most vulnerable state. They rely on the expertise and caring of educated healthcare providers. And nurses certainly add to the quality outcomes of patient care. That is statistically significant. Good nursing care provides an untold and undervalued service to many.

Five&Two Will Do · Jan 25, 2012

I've seen nurses "assess" breath sounds from the doorway, on a cardio pulmonary floor, no less. Absolutely unconscionable.

I have seen this kinda thing too. It is pitiful! I think they came up with those funny stethescope covers to prevent sores from forming around the neck kinda like the little foam pieces that go behind the ears while wearing a nasal cannula. LOL!

No offense to any sensitive people out there that may have a cute little elephant or furry bunny around your neck right now.

fltnrse2, ASN, RN · Jan 30, 2012

Dear QI/QM,

Yes I have seen it and may I say I had a similar reaction to it. The "nursing" is being done by CNA's. The nurse does a 15 second head to toe, gives a few po meds and then back at her desk signs on to her computer and opens her charts for the day. NOW I FINALLY GET HOW SO MANY NURSES JUST LOVE THE 12 HOUR SHIFTS! Let me be clear here. This isn't the case in all nursing units. The ICU's, ED, LDR, OR, PACU for an example actually do nurse thier patients and many times without a break in the 12 hour's. My cap is off to them. The other thing I noticed was the nurses who actually worked as opposed to showing up seemed more satisfied, thier focus was on tier patient and not each others business. Thanks for the article! FLTNRSE2

chevyv, BSN, RN · Jan 31, 2012

I follow a nurse who sits at the computer for most of the day. I come in to find charts with orders sitting since 10am. I can't figure out what a nurse can do sitting at the computer all day long when we still use paper charting.

When I was in nursing school, I had a fellow student (with no experience) tell me she was going to delegate everything she could to the CNA. I, being a bit older and having been both a CNA and LPN, just looked at her certain she had grown a second head! I didn't say a word because I knew she would be thrown under the bus in a matter of weeks. She didn't last long at her first job I heard.

I love pt care! I will toilet, bathe, ambulate, feed and dive in whenever I can. Not only does this help my staff, it also helps me to assess skin, bowel and bladder, gait, swallowing, etc. I also know the importance of thanking my staff at the end of the night for their hard work! Lord knows management doesn't say it enough!

fltnrse2, ASN, RN · Jan 31, 2012

Dear Chevyv,

I like you began as an LPN for 20 years, then RN for the next twenty. I had to take some time off for health reasons and had to take a "Refresher" course. It FINALLY dawned on me why so many of the younger generation love those 12 hour shifts. I also love to be at the bed side. What I observed were the RN's checking thier personal email, texting, making and taking personal phone calls and the two nurse managers just ddn't seem to care. So who was doing the patient care? The CNA"S!!! except for treatments and meds. I have had cancer and a heart atatack, and all I pray for after seeing what I call "the point and click' generation of nursing is that I just drop dead.

Now in all fairness there are some stellar nurses in the ICU's and some ED's, and I want to give them all props. I have to say that I am deeply saddened by the fact of how I began my career to where it will end. So eat your veggies and stay well!!

FLTNRSE

dudette10, MSN, RN · Jan 31, 2012

It's easy to spot who assesses and who makes judgements on each system based on the diagnosis and co-morbidities (or even worse...continuing the admission assessment charting that took place five days ago). I'd like to know why the previous nurse charted "weakness" when it takes three people to clean my AMS patient up due to combativeness. I'd like to know why there is a rhythm charted when tele was d/c'd two days ago. For longer-stay CHF patients, it looks like nothing ever improves because their edema is still there, and then magically, it's not there on my shift. I'm a freakin' miracle worker!

dudette10, MSN, RN · Jan 31, 2012

double post

fltnrse2, ASN, RN · Jan 31, 2012

Dudette10,

I feel you! The one that drives me insaine is " well we have a 20g in the LFA, it does flush to well, there is a little edema, But we didn't want to dc it because that was the only IV access she had." It's all I could do to restrain myelf, I was as tactful as I know how to be, and I replied "it's a good line or it isn't, period". By the way this was a pt with a patient with a cardiac hx. The way I see it, it was nothing but lazy, and not on the job, but on her smart phone! My next comment is all you are doing is settng up a faily good situation for an infection, and just what is youor plan if she should code? I just wonder if she went to nursing school on the Internet? FLTNRSE

chevyv, BSN, RN · Feb 2, 2012

Dear Chevyv,
I like you began as an LPN for 20 years, then RN for the next twenty. I had to take some time off for health reasons and had to take a "Refresher" course. It FINALLY dawned on me why so many of the younger generation love those 12 hour shifts. I also love to be at the bed side. What I observed were the RN's checking thier personal email, texting, making and taking personal phone calls and the two nurse managers just ddn't seem to care. So who was doing the patient care? The CNA"S!!! except for treatments and meds. I have had cancer and a heart atatack, and all I pray for after seeing what I call "the point and click' generation of nursing is that I just drop dead.
FLTNRSE

You have been through so much! To be able to see how nursing has changed and also to be able to have the experience of being the pt too! Although its sad to see the change in nursing and more and more charting taking us from the bedside, there are still those of us who believe in hands on care and that will carry on. I have to say that I tell my coworkers if I fall out, leave me until I start stinking in the corner. I've seen codes in that place and I'm better off dead, lol! They laugh and promise me they'll do exactly that. Here's to our veggies :lol2: