Obstacles to providing care

purplemania, BSN, RN · Aug 20, 2001

I agree with all the previous answers. The hospital where I work creates obstacles by issuing notices to the staff about new methods/protocols that directly interfere with the patient. For instance, to decrease laundry costs we were told to deny patients more than one blanket. If we give them a second blanket we can get written up. If we deny them and they complain, we can get written up for not making the customer unhappy. Either way the nurse is in the middle. I give them the blanket and ask them to respond to the posthospital survey with remarks on how impt. it is to be comfortable.

oramar · Aug 20, 2001

This is what is going on in a place that still has hand written orders going on a yellow copy to pharmacy usually by fax. I will just describe problems with 8 am meds. You begin by checking drawers to see if drugs are missing. Of course they are so you call pharmacy. By rights you should look up the individual meds first on the orginal orders but by now a good many doctors are in and charts can be hard to get a hold of. You say "where is the heart med for this patient, the diabetes drug on the other(there are several others missing)?" Sometimes the pharmacist has a copy of the original order sometimes he does not. So you have to begin hunting through the charts for the orginal order. Don't forget you are climbing over a hundred other people who are struggling to get hands on the charts. Not to mention the poor unit clerk who is trying to take off orders from the late night shift admissions. When and if you find the orginal order if you are lucky you can get it up to the pharmacist and get the medication in an reasonable amt of time. However you still need to wait for next delivery rounds. Like as not there will be other problems like something peculiar with the dose of the insulin on the new patient. It says 80units reg, that is high so you double check and find the ER physician wrote 8 u reg insulin and everyone mistook it for a zero. Now you just saved someones life but you are two busy to crow. You have people to get to the OR, PT and all kinds of scans and invasive proceedures like Bronchs and ERCP. Somewhere you are supposed to squeeze in time to go over every chart to check for things that are not done on these people going for procedures. Do not forget before you even started passing meds you were supposed to have all the accucheks done and called to the endoncrinologist. By now it is 10am and you just pray the aid was able to feed you patients and bath them cause you sure as hell are not even getting into do assessments on the ones requiring less attention. All the while you are fielding phones calls from everyone on the planet on every subject on the planet not to mention the nursing office that keeps asking you to work 3-11. This is just an average morning, you should see the bad ones with multiple admissions, the aid coming to you and saying someone is laying in the hall with no pulse and admissions office demanding you discharge people cause ER is backed up. If anything goes wrong with any of this you know you will be hauled into the nursing office and grilled like a criminal and blamed heartily. You know all this because you have gone through it all before. Is this what you want?

Talldi · Aug 23, 2001

The main problem facing nurses today is the lack of staff and the increasing acuity of the patients. The average age of nurses is 45. I dont find that hard to believe at all. Being one of the graying panthers of nursing at 49 yrs I can tell you its true.

We have a few nursing students on our unit, and I would like to say that they are being short changed when it comes to being taught time management and creativity. When you are dealing with very ill people, too little staff and cheap, unreliable supplies, the ability to improvise is needed. The reality crunch will be painful. Going from 1-2 patients to 7 or more will be beyond shock.

Burn't out? You bet. If my home was paid for I'd be gone. There is not enough money in this field to keep me here. Even after 28 years. There is no longer enough gratitude coming from the patients for my help and the attitude of managemnet is more work from less people means more profit. This is unlikely to change until a major lawsuit is lost. I am treated like a personal body slave who is in rebellion, as I don't have enough time to stay at the bedside. It makes for a lot of undeserved guilt on my part and a lot of anger on the patients and families. I would gladly go back in time to the caps and white shoes and dresses to have the time to give a complete bed bath (with soap and water and not paper towels soaked in a "biochemical") and followed by a back rub with a fresh draw sheet.

By the way diploma nurse dinosaurs and 2 year grads are the ones teaching the 4 year grads how to survive. Some how the extra training in philosophy of nursing misses how to give an enema, pass narcotics and hang an IV med all on different patients at the same time.

Nursing eats its young and drives out the "old" with ridicule. If my facility ever says I need a BS to be a "better" nurse, I will reply I have seen enough B.S. to sink the hospital and it comes from above, and like all S--- it rolls down hill.

debbyed · Aug 23, 2001

Every year it becomes more difficult to find time for patient care when faced with never ending regulations and forms.

We frequently see psyc. patients. We have 3 seclusion rooms and frequently have 4-6 psyc patients. New "RESTRAINT" regulations have become impossible. Now when you put a patient in seclusion there must be constant observation for the first hour. Thats one staff member taken out of staffing, each time you put someone in seclusion.

The little old folks who come in from nursing homes with contusions, abrasions, lacs and broken bones because they are constantly falling. The documentation for using a posey on these patients is enought to keep one person busy for 4 hours.

The violent drunks who pull out their IV's, foleys etc can't be put in seclusion and are not supposed to be tied down.

The staff is so busy with these types of patients it leaves little time for the critically ill patients.

Now we have to do chart reviews on 10% of our patients to satisfy JCAHO, thats about 15 charts a day which takes from 10-20 minutes each.

Add required QA each staff member is expected to do each month, the excessive documentation regarding age appropriate behavior, cultural issues etc at least 40% of our nurses time is spent in non-patient related activities.

Many times the Senior Clinical Nurses (our management team) come in on days off to try to keep up. Sure we are paid for it, but this is on our own time, and to be honest the hospital is paying big bucks for paperwork.

Add to all of that the multiple committee meetings. We are currently building a new ER (brand new seperate structure), we have several H-works projects, QA etc.

Patient care is what we want to do. All these other things seem to be thought up by people who do nothing but sit behind a desk.

Sorry just worked by 4th shift, I'm a little tired and got off track. The truely successful nurse is quite good at instant problem solving when it comes to patient care. It's all the other "stuff" that get us down.

night owl · Aug 24, 2001

oramar,

And while climbing over 100+ people in the NS to get to the charts that everyone else has, the phone rings someone answers it and it's for you. The person on the other end says, I'm calling in regard to the July payment on the "suburban" which is my husbands responsibility since it is his vehicle and I tell this person

" speak to him he's the one paying it!!!" and slam the phone down. So while being stressed with the job at hand, now you're double stressed with problems from the home front and embarrassed to say the least and want to go home and choke your husband. Now your day is really off to a great start! It's a wonder we all don't just stroke out!

And Talldi,

Our LTC facility says, A BSN within ten years. If you aren't trying to get one and it's promation time, management says, "Well, you're a good nurse, but you're not qualified for a promotion!" You bust your hump and bust it somemore. You're so damn tired by the end of the day and stressed to the max that going to school at night just isn't humanly possible!!! We need to unwind...

suzannasue · Aug 24, 2001

AMEN,AMEN AND AMEN...AD INFINITUM. I WHOLLY AGREE WITH ALL THE POSTS AND HAVE A FEW DETERRENTS TO PATIENT CARE TO VERBALIZE...AHEM...WE HAVE COMPUTERIZED OUR ENTIRE SYSTEM AND ARE ABLE TO PULL UP REPORTS FRON THE LAB,RADIOLOGY,ETC...YET,SOME OF THE MD'S JUST CANNOT BRING THEMSELVES TO ACTUALLY GO INTO THE SYSTEM AND FIND THE LATEST RESULTS OR WHATEVER THEY NEED!!!!!!! SO THEY COME GET US AND ASK "WILL YOU PULL UP THE REPORT FROM THE CARDIAC PANEL FOR ME?" ABSOLUTELY DRIVES ME UP THE WALL!!!!! THEIR ENACTED HELPLESSNESS ADDS TO THE USUAL FRUSTRATIONS OF EVERYONE'S SHIFT!!!!! I WORK NIGHTS AND THERE ARE THE MD'S WHO WANT TO ASK IF THE PT ATE LUNCH,AMBULATED,URINATED AFTER AM DOSE OF LASIX,ETC... AND I DO WANT TO BE A SMARTA$$ AND SAY " DAMNED IF I KNOW,I WAS SLEEPING WHEN ALL THAT WAS GOING ON!!!!!!"

WE HAVE NO WARD CLERK ON OUR SHIFT AND THE MD'S HAVE FOUND IT LESS CROWDED TO MAKE ROUNDS LATE IN THE EVENING...AND THEY WRITE ORDER AFTER ORDER PAGE AND SOMEONE HAS TO DEFER SOME TIME TO TRANSCRIBE THESE ORDERS. THEN THERE ARE THE PHYSICIANS WHO MAKE EVENING ROUNDS,WRITE ORDERS AND THEN PUT THE CHARTS BACK IN THE RACK!!!!!!! IT IS NOT VERY NICE TO FIND A STAT ORDER AT 0300 WHEN DOING 24 HOUR CHART CHECKS, THAT WAS WRITTEN AT 2100 !!!!!!!! WHEN ON MY ROUNDS I HAVE HEARD MY NAME BEING SCREECHED BY SOME MD WHO WANTS TO KNOW IF I CAN MAKE ROUNDS WITH HIM AND THEN HE WANTS TO JUST HAVE ME STAND IN THE ROOM AND WATCH HIM POUR THROUGH THE CHART BEFORE HE DOES AN ASSESSMENT...LUCKILY,MY FELLOW STAFF MEMBERS AND I HAVE DEVISED A SYSTEM TO GET ONE ANOTHER OUT OF THIS SITUATION...A SIMPLE HAND SIGNAL WILL GUARANTEE A "PHONE CALL" OR "SITUATION THAT NEEDS YOUR IMMEDIATE ATTENTION" WHICH GIVES US THE "EXCUSE" TO GET OUT OF THE ROOM AND CONTINUE PT CARE!!!!

THEN THERE IS THE SITUATION OF OUR STAFF BEING PULLED IN MID SHIFT TO HELP OUT IN ANOTHER DEPARTMENT AND THE SUPERVISORS CANNOT SEE THAT WE ARE A$$ DEEP IN THE SWAMP...WE HAVE TO DIVIDE THAT PERSON'S ASSIGNMENT AND CARRY ON AS USUAL...

AND THEN THERE IS THE HOSTILE FAMILY MEMBER WHO WANTS TO KNOW " WHY DIDN'T DADDY/MAMA/AUNT GERTIE/UNCLE BERTIE GET A DINNER TRAY?" UMMM...DID THEY NOT KNOW THIS AT DINNER TIME AND WHY HAS IT BECOME AN EMERGENCY AT 2200?????? I WOULD LOVE TO HAVE A NICKEL FOR EVERY TIME I HAVE MADE A MEAL FOR A PT FROM GRAHAM CRACKERS AND PEANUT BUTTER...AND IF THEY HAVE AN ALLERGY THAT PROHIBITS THEM FROM HAVING PEANUT BUTTER...THERE IS NOTHING TO OFFER THEM....WE DO NOT HAVE A 24 HOUR CAFETERIA!!!! THE DIETICIANS HAVE DEVISED A "BOXED LUNCH" THAT CONSISTS OF A MYSTERY MEAT SANDWICH,BAKED CHIPS,AN APPLE AND A CONTAINER OF JUICE. WE HAVE NO IDEA HOW OLD THE MEAT IS,NOR DO WE KNOW WHAT" FLESH" IT IS AND WE HAVE HAD PTS CALL US TO THE ROOM FOR THE SOLE PURPOSE OF THROWING IT AT US!!! AND I LOVE IT WHEN WE GET WRITTEN UP BY THE MD'S FOR NOT HAVING APPROPRIATE FOODS AVAILABLE FOR THE PTS!!!!!!! I FIND IT UNCANNY THAT WE NURSES ARE RESPONSIBLE FOR EVERY DEPARTMENT'S SHORTCOMINGS AND ARE EXPECTED TO PERFORM AS EVERY JOB DESCRIPTION IN THE BUILDING FROM COOK TO MAINTENANCE.

AT OUR FACILITY,WE NURSES ARE ALSO THE PHLEBOTOMISTS AND EACH AM AT 04OO WE START WITHDRAWING BLOOD FROM THE PTS AND THIS IN ITSELF TAKES AWAY FROM THE POSSIBILITY OF PERFORMING NURSING CARE...THEN LAB HAS THE GALL AND AUDICITY TO CALL AND TELL US, AT 0600, TO RE-DRAW "WHOMEVER" BECAUSE THE SPECIMEN HAS HEMOLYZED!!!!!!

WE ALSO GET THE TIMED SPECIMENS THROUGHOUT THE NIGHT AND IF WE HAVE THE TIME(?) ARE EXPECTED TO GET THE RESULTS FROM THE COMPUTER...RARELY ARE ABNORMALS CALLED TO US...

ONCE HAD A PT ON HEPARIN AND IT WAS A HECTIC NIGHT,2 CODES...YALL KNOW HOW THAT IS...WELL...THIS PERSON'S PTT WAS 333,PT WAS 78 AND INR WAS 25. DID LAB CALL ME????

NO. WAS I PISSED? YES. AFTER THE CODES I FINALLY GOT THE TIME TO LOOK IN THE DATA BASE AND NEEDLESS TO SAY I WAS

"PERTURBED"...LUCKILY THE PT HAD NO LONG TERM ILL EFFECTS FROM THIS SITUATION AND I TOOK THE TIME AWAY FROM PT CARE TO GO TO THE LAB AND RAISE THE ROOF,IN PERSON!!!!!!! I WAS WRITTEN UP FOR "HAVING A BAD ATTITUDE"... GEE WHIZ...SPELL MY NAME RIGHT IS ALL I ASK!!!!!!!

OK..I HAVE GONE ON AND ON...WE ALL HAVE BEEN TAKEN AWAY FROM THE BEDSIDE AND OUR JOB DESCRIPTIONS ARE CHANGED BY THOSE WHO HAVE NO IDEA HOW TO BE A NURSE AND WE ARE DICTATED TO BY AGENCIES THAT HAVE NOTHING BETTER TO DO THAN GIVE US MORE PAPER WORK TO COMPLETE. OUR NEW NURSES ARE RUDELY AWAKENED TO THE FACT THAT ALL THE THEORY AND NURSING CARE PLANS IN THE WORLD CANNOT REPLACE THE "HUMAN TOUCH" INVOLVED IN NURSING. WE HAVE ALLOWED THIS TO HAPPEN AND IT IS TIME WE TAKE BACK OUR PROFESSION!!!!!!

WAY TOO MUCH SAID...FORGIVE ME...BUT I KNOW YOU UNDERSTAND!!!!!!!!

Mary Cleaver · Sep 9, 2001

Nurses could sure get more done for their patients if they did not have to encounter obstacles, many of which are unnecessary. Here are some of the ones that come to mind: (1) Inadequate supplies to do job, (2) system problems,i.e., lab results not being posted in a timely manner, xray results not timely. For example, a nurse may have to wait to give meds or feed patient if dobhoff tube placement xray not done timely or result not posted timely., (3) Physician groups or consulting physicians not communicating with each other. Fragmentation causes poor communication with families, patients, and nurse, (4) Financial/Insurance related obstacles. For example, insurance and care planners have limits on days in hospital, where patient discharge to, etc.

Hope this helps some. Increased workload for nurses aggravates the present nursing shortage situation. Nurses want to do a good job and give quality care. Frustrations build when nurses encounter constant obstacles to deliverying quality care.

prmenrs, RN · Sep 10, 2001

I'm especially fond of attending "mandatory" inservices for stuff that doesn't apply to NICU. The most recent was restraints. Try to get a visual on using a posey waist restraint on a 3#premie? The instructor kept saying well this would apply to you!

NOT!!

I keep thinking that the Mother-Infant Division (L&D, NICU, and Family Maternity Care) should get together an inservice and require everyone else to come to it!!! Let's see, peri-care? Lactation? Corificeats!!! Maybe that's it?

Look out, you med-surg folks, we're gonna get you yet!!!

frustratedRN · Sep 11, 2001

first off management has to back the nurses.

if we are complaining about a certain assistant...and the same assitant gets multiple

complaints from multiple nurses then THEY SHOULD

BE DICIPLINED. IF THAT DOESNT WORK THEY NEED TO

BE DISMISSED.

it really chokes that i might only see mine twice

during an 8 hour shift. i spend more time looking

for them than doing the task myself. and yeah everyone disappears when you need to lift or boost a patient. and i complain and so do the other nurses on the unit but they stay.

fellow staff members who refuse to answer call bells or help other nurses OR ASSISTANTS if they need help. they get overwhelmed too...or those who are more interested in hospital politics than their patients or coworkers.

(these people should actually be electricuted or shot in a firing squad but since i dont think ill have many backers on that maybe they should just be written up and get the kind of raise they deserve.)

the doctors handwriting is another big issue with me. i dont care that they are in a hurry. most of them write as tho they have a broken hand or are mentally retarded. sometimes both.

they should be turned in and have to pay a fine for a certain number of offenses. bet theyd stop doing that.

crazy admission forms. nearly everything on them they ask in the er....now i know that the er nurses are up to their necks. they should have someone enter the data er collects and put it in the comp. im not talking about vital data...im talking about who came with them to the hospital. what time it was. do they want a pastorial consult. do they live in a house or apartment. do they live alone. things like that that any clerk can do.

they let ASSITANTS draw blood and put in foleys but ONLY an RN can do an admission history. makes a lot of sense.

and my number one pet peeve:

COMPUTER CHARTING...

i am computer literate but ill tell you what...this is such a pain in the ass for nursing notes. meds should be computerized and so should orders and consults but NOTES should be computerized voluntarily. we should go back to the old system of handwriting..its faster and very seldom will your hands or brain freeze like the computer does. and you can always go back and pick it up. when you hit save on our system thats it...it cant be changed (at least not that i know of) so ive found myself forgetting which patient im charting on and putting the wrong information on the wrong assesment....had to go back and document a new one that declared the old one was incorrect.

so there are some of my obstacles AND the solutions.

suzannasue · Sep 11, 2001

FRUSTRATED!!!!!!

DO WE WORK AT THE SAME FACILITY!???????!!!!!!!! BLESS YOU,COMRADE!!!! I AGREE WTH YOU WHOLEHEARTEDLY!!!!!

RNforLongTime · Sep 12, 2001

Had a little old lady admitted to our unit last week. Hadn't had a BM in a week and now that she is in the hospital, she is ADAMANT that we contact her doctor for a laxative. All of the sudden it is now an emergency that she get a laxative! Hello! Fleets enemas can be purchased at Walmart for peet sakes!

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Sep 20, 2001

Frustrated hit it right on the nose.

My big obstacle. I could do my job so much easier if I could stop having to track down people to make them do their job. This is for nurses and nurse aids and nurse interns. If I didn't have to spend so much time making sure that x,y,z were completed by this nurse, or if I was sure that my aides were around to actually answer light when they went off. Instead I have to stop what I am doing to answer the light because the aide is too busy talking about whatever at the desk. I am tired of having to go around and verify that so and so gave the right med to this person. (we are encouraged to use nurse interns to assist us in our med pass so that we are more INVOLVED in our patient's care. I am tired of making sure that my CHF'er was weighed appropriately. I am tired of answering stupid questions like

"My heart cath patient is bleeding, what should I do"

Hello- anybody there?

My venting :) better....