Nursing issues that need change

sjoe · Dec 9, 2003

7. Is your supervisor even reasonably competent--or even interested in becoming competent? If interested, exactly what is she/he doing to increase his/her competence.

8. Is management at your facility even reasonably competent--or even interested in becoming competent? If interested, ....

9. How much management or supervisory training have any of your managers had? How extensive was the training program provided them when they were promoted to, or inserted into, their present positions? How well did this program develop their leadership skills?

10. How close does management come to its stated goals, mottos, and mission statements, etc.? What tools does it consistently and ruthlessly use to measure and improve its own performance.

11. Is there any real leadership present anywhere in your facility?

(hint #1: if your facility does not work together as a team to promote and deliver excellent healthcare as well as protect, develop, and support its own team members, the answer is "NO.")

(hint #2: if your facility were a football team, where would it be in the national standings? This reflects the quality of its supervision, management, and leadership.)

In My Humble Opinion

efy2178 · Dec 9, 2003

Good questions Joe. My last job was full of undereducated supervisors and managers who were out to please the physicians only. The turnover is high. In fact, a bunch of RN's were let go from their cardiology office and replaced with LPNs to save money.

cannoli · Dec 9, 2003

I think the biggest problem is the nurse/patient ratio. I think if the ratio was safe and manageable and so that staff could get out on time, ie. complete their work in the time allowed, I think some other problems would resolve themselves. Other problems such as some of the horizontal violence, nurses dumping on each other.

webbiedebbie · Dec 9, 2003

Managers who don't listen or work with you. They are part of the team too.

Administration who have not walked in our shoes every day. Some may be RN's who only have "book learning" and have not traveled the miles that we have.

Outdated equipment.

Inadequate staffing measures. We are professionals and should be treated as such. Acuities of patients should be considered with staffing. Use of "float staff" within area of expertise should be considered. Creative shift staffing can be effective. Health professionals also get sick and we should not be taking care of our patients if we are sick and this should not count against us.

We need our CNA's and secretaries back!

Health care insurance premiums are outrageous for us. Other major companies do not charge their employees for health insurance. The health industry is considered a "business" now and should be functioning as such.

Nurses are professionals and we should be compensated for our skills. Phlebotomists charge for "sticks". How about all of the injections or IV's that we start that we don't get to charge for. Nurse's salaries come from the "room charges".

Insurance companies (malpractice and health) are making a killing from us. I don't know how to fix this, but there has to be a better way of doing it.

Administration making the big bucks with their plush offices and holidays and weekends off. At one hospital I worked at, the CEO makes more than the President of the United States! That kind of money needs to be spread down through the hospital to their nurses and ancillary staff! I understand that their jobs are very important, but so are ours! If it weren't for nurses and their assessment skills, patients would not stand a chance of surviving in a hospital.

I know I didn't answer your questions as posted, but the above response is what is important to me as a nurse.

SmilingBluEyes · Dec 9, 2003

I think you can answer your own questions by taking the time to peruse the archives. There are VOLUMES sharing what needs to change....and what is.

Good luck.

efy2178 · Dec 9, 2003

Very true SmilingBlueyes. I just wanted to get things a little more together if you will.

I agree that there is a problem with the trickle down of cash. But this is true in so many companies. there is a larger and larger division in pay between the higher ups and the front line nurses. I personally don;t believe the majority of nurses go into nursing for the money. This is not what motivates them. And money will not necessarily keep you in nursing if you are strung out everyday after work.

Dr. Phil talks about different kinds of pay. Nurses want to payment of respect and appreciation, not the BS kind that manipulates us to keep on but sincere appreciation. We are willing to stick it out for the occasional difficult day or occasionaly short staffed day but not the constant everyday shorting of resources that rob nurses physically and emotionally. Once sucked dry we want out because there is no other option. Or we become apathetic.

More and more nurses are going to jobs requiring nursing skills but are not direct hands on nursing. Who can blame them?

The idea to keep nursing is to define the problems, suggest ways to remedy the problems and then find a voice and be heard to get the ball rolling. I also personally believe that United American Nurses is a voice for RN's and will go along way to helping. Also joining your nurses organization is a good step.

bellehill, RN · Dec 9, 2003

The first thing that came to mind when I read this thread....not having to fight to give my patients good care.

Having x-rays done in a timely matter (that includes being read and the report faxed to the floor),

having all the pt's meds on the floor when it is time to give them,

phlebotomy drawing blood when it is scheduled to be drawn not when they feel like it (0500 does not mean 0730)

adequate supplies on the floor (this includes silly things like blankets, sheets, BP cuffs...)

doctors that calls back in a timely manner and thank me for taking care of his/her pt instead of telling me not to bother them again.

If I could come to work and have EVERY department work together to give good patient care without controversy I would be a very happy person. Until that happens I will continue to fight to give good care and eventually I will burnout just like all the other nurses who left bedside nursing. I still love nursing and my patients, I don't love the healthcare system.

CCU NRS · Dec 9, 2003

1. What problems are you confronted with on a regular basis that keeps you from performing the kind of nursing you think is needed today?

The most common problem (in my facility) is not enough nurses to meet census, even though Agency nurses are being utilized.

2. Do you think your institution gives you enough inservices and continuing education to do your job well?

Yes

3. A. What one thing would you change right now that might encourage you to stay in nursing? B. What one thing is keeping you in nursing?

A. I would have facilities begin paying staff Nurses as much as they have to pay to use Agency Nurses and I beleive this would go a long way toward retention. I would also have them change policy about salary caps I will eventually reach a ceiling and at that time if it is not possible that I will ever make more money I will leave, I feel annual 3-5% raises based on job performance are mandatory no matter how high my hourly rate becomes. Again a retention issue.

B. There is not one single thing keeping me in Nursing, I enjoy Pt care and meeting new Pts and teaching them about the processes of what they will go through and comforting them or consoling them, I enjoy being around fellow nurses that can laugh about having bloody stool fly up and hit you on your chin (while eating their lunch standing in the crows nest)and can tell a story about getting something equally disgusting one themselves. I enjoy keeping up with curent procedures, medications, disease processes, and sharing that knowledge with others.

4. Is abuse from physicians, co-workers or administrators keeping you from doing your job well?

No not in my facility, there are a few Physicians that seem to always have a problem but since these are always the same it is basically their problem. Administration is localized through our Unit Manger and she is really trying harder than ever before to do everything she can to assist us including working when there is a critical shortness.

5. Do you believe you have a say and administration will listen to you without repercussions when you are confronted with a problem that you need admin help with?

I have personally run into this, regarding a recent situation, I feel that Adminstratioon did stand behind me in a very difficult situation, although others I work with felt differently, I believe they did what was both secure for the facility and supportive of me.

6. Any other relevent questions you want to add?

7. Is your supervisor even reasonably competent--or even interested in becoming competent? If interested, exactly what is she/he doing to increase his/her competence.

Mine is RN BSN, MSN, CCRN. She was previously very over worked and spread very thin but stepped back from many of her other responsibilties and took a more active interest in our unit.

8. Is management at your facility even reasonably competent--or even interested in becoming competent? If interested, ....

Again many other floors have Mangers that I have had personal problems with and many do not work when needed and will bury their head in the sand concering problems. This is an important issue that needs immediate attention. I feel that my Unit Manager is currently trying very hard to meet all the demands put to her.

9. How much management or supervisory training have any of your managers had? How extensive was the training program provided them when they were promoted to, or inserted into, their present positions? How well did this program develop their leadership skills?

In my faciltiy it is a Large Catholic facility and has Branches in three state and many cities, it is my experience that all Unit managers are RN BSN at least many also have Masters.

10. How close does management come to its stated goals, mottos, and mission statements, etc.? What tools does it consistently and ruthlessly use to measure and improve its own performance.

Again my facilty is working very hard to meet the mission statement and goals this is a matter of Unity we must all be what is expected of us in order for the mission statement, goals, mottos to come to fruition.

11. Is there any real leadership present anywhere in your facility?

Yes, as stated above. Nursing is however a largely self moderated and self motivated profession and as such we must make an effort to bring things about to the end result which we advocate, we can not sit by and expect others to always take command. By default the responsibility for outcomes and/or non-involvement ultimately falls to us the Pt advocate in charge of direct Pt care.

I feel that many nurses complain endlessly while procastinating about the job they should be doing. I also feel that if they would just do the job and stop complaining they would find the time they don't seem to have.

I feel that everytime you interact with your Pts you should take the time to answer any questions they have to the best of your ability and ghet them information about questions you can not answer.

I feel that Nursing as I stated is self moderated and self motivated, Med times and procedure time (dressing changes, IV tubing changes, New IV changes, trach care) are basically strong suggestions with a sort of time limit to help keep things in order, If you are passing morning meds and the first Pt you goto has an immediate probelm that requires immediate attention and providing this attention will cause the rest of your moring meds to be late that can not be helped, they willjust be late and you can always chart the reason for the problem.

I feel that Time management is the biggest factor in being a good Nurse because everything we do requires time and there are only so many seconds/minutes/hours in a day. If you can develop a good routine for performing you daily activities and then be able to flush that routine and improvise as needed when the time comes you will be better prepared to handle all situations.

I feel that Nursing is my lifes work and my calling and I hope most others in the field feel this way!

CCU NRS · Dec 10, 2003

If you have solutions to nursing problems and not just complaints come on and let it all hang out!!!!

cannoli · Dec 10, 2003

A real simple solution to an unsafe nurse/patient ratio is to change it to a safe one.

Salary and benefits too low, increase them both.

Corporations could easily do everything needed if they wanted to.

Nurses could organize and have a collective bargaining unit and negotiate with the hospitals, which could either meet the demands or do without the nurses until they can reach a mutually acceptable agreement. This is nothing new.

What type of solutions are you looking for?

CCU NRS · Dec 10, 2003

Originally posted by cannoli
A real simple solution to an unsafe nurse/patient ratio is to change it to a safe one.

Salary and benefits too low, increase them both.

Corporations could easily do everything needed if they wanted to.

Nurses could organize and have a collective bargaining unit and negotiate with the hospitals, which could either meet the demands or do without the nurses until they can reach a mutually exceptable agreement. This is nothing new.

What type of solutions are you looking for?

in a unionized state but Oklahoma is not Union! We don't really have a leg to stand on so we wouldliterally have to campaign on our facilities to make them make changes.