Nursing as maid of all trades

MultipurposeRN · Sep 9, 2005

I always loved the memos sent out by various departments: "Such and such department will no longer provide X service. Nursing will be expected to assume this responsibility." I wonder when nurses get to send out similar memos?

jsteine1 · Sep 9, 2005

I always loved the memos sent out by various departments: "Such and such department will no longer provide X service. Nursing will be expected to assume this responsibility." I wonder when nurses get to send out similar memos?

Wait till this one comes out: :rotfl:

Surgeons will no longer perform appendectomies and tonsillectomies. Nursing will be expected to assume this responsibility. :uhoh3:

hipab4hands · Sep 10, 2005

Yes...the last hospital I worked at was going to have the nurses serve those special dinners the OB patients get, lobster, steak, china, etc. I was totally against it. No one signs up as a nurse to become a waitress.[/QUOT
I had one patient, who demanded that I get him a cheeseburger, way after the kitchen had closed for the night. He told me that the dietician told him, he could have anything he wanted to eat.
I politely told the pt, there was a Mcdonald's just down the street, and he was more than welcome to have a family member go pick him up something from there.
Obviously, he was not happy with my answer, and kept threatening to report me.

DusktilDawn · Sep 10, 2005

I always loved the memos sent out by various departments: "Such and such department will no longer provide X service. Nursing will be expected to assume this responsibility." I wonder when nurses get to send out similar memos?

Funny how that never happens. Funny how we're always on the receiving end of the "we should work as a team" lecture. I'd love to send out a memo:

To: whom it may concern.

From: The NURSES

Subject: Nursing workload.

In answer to the impossible demands concerning patient care, we feel it is inappropriate for nursing staff to be doing xyz, since it does not require a nursing license to perform xyz, we feel it is more appropriate for your department to assume responsiblity for xyz since it clearly falls within duties that should be assumed by your department.

Contrary to popular beliefs by other departments in this facility, nursing staff do not sit on their butts with their feet up drinking coffee throughout their shift. They are responsible for the care and well-being of the patients, first and foremost. Doing xyz hinders and compromises this responsibility.

Remember, we all need to work as a team here.

At one facility I was working at, dietary decided to serve "Continental breakfasts," and sent the bread/bread product up untoasted with the idea that the nursing staff should toast it if requested. Yea, brilliant idea, have 5-6 nurses waiting on a toaster (regular kind found in stores) to toast bread for 30 patients. Believe me, this did not last very long.

A huge problem that I see is the idea that it "only takes a minute so therefore it shouldn't be a problem" being used as an excuse to continue to dump more work onto nursing staff. Rarely does anything added only take a minute to do, and the end result is nurses who are more overworked and frustrated and patient's whose needs are not met.

It's amazing how clueless other departments can be when it comes to exactly what nurses are required to do and how dumping responsiblities onto nursing staff is actually a big deal. As far as I'm concerned it just shows how disdainful and disrespectful an attitude that they have towards nurses.

Pediatric Critical Care Columnist · Sep 14, 2005

Canoehead, you've hit a very raw nerve with me on this topic. In our very busy PICU the nurses wear so many hats that I often forget which one I've got on. We have a 16 bed mixed CV, trauma, burn and resp unit; we are the only complex congenital heart surgical/ multi-organ transplant unit west of Toronto. BC Children's does some ECLS, mainly on neonates and we do the rest. We are a teaching hospital and educate residents and fellows from all over the world.

The nursing assistants seem to be employed mainly to stock the bedside carts, run specimens to the lab and pick up blood products from the blood bank, and to fold linen. There are many shifts when we don't have anyone on as nursing assistant, so a nurse takes on these roles. The NAs provide no patient care, not even to help with turns. God forbid one asks for help with the teenaged MVC who has bypassed her Foley while soiling herself and the bed...

The unit clerks bring all the various parts of the chart to the bedside for the nurse to file. Their role seems to be to answer the phone and enter the diet orders into the computer. They don't process orders, call the lab for stat results, call the blood bank or the pharmacy for anything, thin charts, or fill out requisitions. And when we don't have one on for the shift, whoever's closest to the desk answers the phone.

The dietary staff brings us trays for the very infrequent patient we have who is eating, but they just drop them wherever there's a spot, then don't come back for them until the next meal, if at all. We have nowhere on the unit to store the trays after they've been used, so they stack up on the closest countertop.

The physiotherapist visits the unit once or twice a week to see if there's anyone in need of her services. Then she makes a little note on the chart that she's been there and goes on her merry way. I don't think I've ever seen her do chest physio on anyone, and maybe only twice have I seen her do ROM. If the kid needs physio, the nurse does it.

Our pharmacist attends rounds. Occasionally. On weekdays. We mix all our own drips and reconstitute all our own IV meds, fax orders to the pharmacy then follow up with a phone call to make sure they've seen the fax, call them again four hours later when the meds are still not there, take responsibility for auto stops and all refills on personal meds.

The RRTs are very territorial but only as it applies to the ventilators. They "monitor" every three hours, writing down all the vent settings and whatever info they can obtain from eyeballing the patient. They want to be called when the patient is turned, but then are usually "too busy" to come help. I've had many shifts when the RRT comes to me at the end and say, "Did we suction this kid at all this shift?" And I say, "No WE haven't, but I have... x number of times."

And our residents... sheesh. They sit at the foot of the bed during rounds writing down my assessment data verbatim, without even picking up a stethoscope. They just take whatever is told them as the Gospel and go with it. When the nurse is experienced and competent that's probably okay, but we have a lot of very green nurses who have no experience outside of our unit and they often don't know what they're seeing or if it's important. And then there's their inability to collect their own equipment and supplies for procedures. My response to the "I"ll need..." is to tell them which supply cart it's on. And none of them can clean up their messes when they're done.

Recently we got a memo from one of our managers that the bedside supply carts were sticky/had coffee spilt on them/dusty and that we were expected to clean the cart each shift. I'm happy to clean up my own spills, but someone else's? Our housekeeping staff is finished for the day at 1530, so anything that needs doing after that falls to the nurse.

I know there are other things that have been dumped on nurses that I've forgotten, but in the end it doesn't matter. The only time it's ever an issue is if the nurses are taking job action (which is illegal in this province) and refuse to perform non-nursing duties. Humbug!

Wise Woman RN · Sep 15, 2005

Get this........now we're going live with ROOM SERVICE in two weeks. Now, on top of everything else we have to do, we're supposed to explain patients' diets to them and help them fill out their menu choices (try this with your average 80-something Med/Surg patient who's seriously ill and/or demented ), then we're also expected to SERVE the food as soon as the order comes up to the floor........even if it's at 9 at night or 2 in the morning, not just at regular meal times.
Personally, I hate the whole concept.........IMHO, being forced to waitress, on top of everything else, just demeans what we do and reinforces that servile role nurses have worked so hard to escape. I swear, I don't know WHAT our management was thinking when they came up with this one. :angryfire

We have that now at our hospital, and it's a nightmare... the patients order what they want, then are told by the dietary staff they can't have it, it's not on the patients' diet... We explain ad nauseum to the patients about their dietary needs... but it doesn't seem to make any difference to them... especially since our hospital is now touting the idea that we will give the patients the service of a 5 star hotel... the patients, a lot of them, have taken to snapping their fingers and saying,"Oh, miss!! Can you get this for me??" and the trays MUST be delivered before any nursing duties are begun... which really slows us down, because most of the time, stuff is missing from the trays and we have to take care of that immediately...

and so on.... *sigh*

mattsmom81 · Sep 15, 2005

I did agency work at a hospital that had room service for meals, but luckily they did a very good job...had uniformed staff who delivered, picked up and also helped patients fill out menu choices too. When its done right it can save the nursing staff much trouble, altho inevitably the diabetics and renals would argue about their food limitations and the nurse would have to deal with them.. I can see where room service creates a big problem with BSG's, with the ordering at all hours.

DusktilDawn · Sep 15, 2005

Canoehead, you've hit a very raw nerve with me on this topic. In our very busy PICU the nurses wear so many hats that I often forget which one I've got on. We have a 16 bed mixed CV, trauma, burn and resp unit; we are the only complex congenital heart surgical/ multi-organ transplant unit west of Toronto. BC Children's does some ECLS, mainly on neonates and we do the rest. We are a teaching hospital and educate residents and fellows from all over the world.
The nursing assistants seem to be employed mainly to stock the bedside carts, run specimens to the lab and pick up blood products from the blood bank, and to fold linen. There are many shifts when we don't have anyone on as nursing assistant, so a nurse takes on these roles. The NAs provide no patient care, not even to help with turns. God forbid one asks for help with the teenaged MVC who has bypassed her Foley while soiling herself and the bed...
The unit clerks bring all the various parts of the chart to the bedside for the nurse to file. Their role seems to be to answer the phone and enter the diet orders into the computer. They don't process orders, call the lab for stat results, call the blood bank or the pharmacy for anything, thin charts, or fill out requisitions. And when we don't have one on for the shift, whoever's closest to the desk answers the phone.
The dietary staff brings us trays for the very infrequent patient we have who is eating, but they just drop them wherever there's a spot, then don't come back for them until the next meal, if at all. We have nowhere on the unit to store the trays after they've been used, so they stack up on the closest countertop.
The physiotherapist visits the unit once or twice a week to see if there's anyone in need of her services. Then she makes a little note on the chart that she's been there and goes on her merry way. I don't think I've ever seen her do chest physio on anyone, and maybe only twice have I seen her do ROM. If the kid needs physio, the nurse does it.
Our pharmacist attends rounds. Occasionally. On weekdays. We mix all our own drips and reconstitute all our own IV meds, fax orders to the pharmacy then follow up with a phone call to make sure they've seen the fax, call them again four hours later when the meds are still not there, take responsibility for auto stops and all refills on personal meds.
The RRTs are very territorial but only as it applies to the ventilators. They "monitor" every three hours, writing down all the vent settings and whatever info they can obtain from eyeballing the patient. They want to be called when the patient is turned, but then are usually "too busy" to come help. I've had many shifts when the RRT comes to me at the end and say, "Did we suction this kid at all this shift?" And I say, "No WE haven't, but I have... x number of times."
And our residents... sheesh. They sit at the foot of the bed during rounds writing down my assessment data verbatim, without even picking up a stethoscope. They just take whatever is told them as the Gospel and go with it. When the nurse is experienced and competent that's probably okay, but we have a lot of very green nurses who have no experience outside of our unit and they often don't know what they're seeing or if it's important. And then there's their inability to collect their own equipment and supplies for procedures. My response to the "I"ll need..." is to tell them which supply cart it's on. And none of them can clean up their messes when they're done.
Recently we got a memo from one of our managers that the bedside supply carts were sticky/had coffee spilt on them/dusty and that we were expected to clean the cart each shift. I'm happy to clean up my own spills, but someone else's? Our housekeeping staff is finished for the day at 1530, so anything that needs doing after that falls to the nurse.
I know there are other things that have been dumped on nurses that I've forgotten, but in the end it doesn't matter. The only time it's ever an issue is if the nurses are taking job action (which is illegal in this province) and refuse to perform non-nursing duties. Humbug!

God, Jan for a moment I thought you were describing the unit I work on, except it's not a PICU, it's an adult med/surg unit. Very similar problems with ward clerks, NAs, pharmacy, RTs, dietary, housekeeping, and physio.

I'm willing to bet everybody but the nurses has a clearly defined job description and are not the least bit shy making it known "That's not my job." Interesting how "That's not my job" always translates into the nurses picking it up. I think if I hear "That's not my job" once more I may go ballistic.

Wise Woman RN · Sep 15, 2005

Make sure, then, that the dietary people deliver the trays. We do the order on your own thing and it is no extra work for us. Of course we have healthy young people as patients. They have a menu and they call and order their food. We nurses have little to nothing to do with any of it.

The nurses here have to make sure the patients all have their meals called in... then, they have to call when the trays come up, if there are errors... the kitchen staff were supposed to help with the patients filling out menus, but, that didn't happen... and our unit is a neuro rehab unit, confused, stroke, aphasia, head injured... etc. etc... lots of pureed diets, thick liquids... and of course the patients don't like it... and the liquids are supposed to come up properly thickened... that doesn't happen... so we have to run around and make sure that all of the liquids are correctly thickened...

I don't think that this has been a good thing at all...

Deidre Shiobhan · Sep 18, 2005

I am so often (almost continually) frustrated at work by all the people that feel they can delegate to nursing or dictate how we do our thing. One of our docs treats us as "her" nurses, and refers to us as such to patients. If equipment is in the room she will write an order for us to pull it from the drawers, and leave rather than get it out herself. She is BUSY you know!
RT dept, maintenance dept and materials dictate what we keep in our crash cart and where we put everything. Doesn't matter that the nurses who work in the dept all agree that items we use most often should be easier to access. Their order sheet is listed like so, and thats how they want the supplies stored. And why should they go to the trouble of changing their sheet because the nurses want to change something?
Our thermometers are routinely 2-3 degrees off, we have only one that is accurate. We steal BP cuffs from another unit, and pharmacy crabs that our narcotic count is sometimes not in temporal order, but the Pyxis has been sitting unprogrammed for months.
Yes, the NM is aware of all this, yes she promises to do something about it, but the lag time between promises and action means there is more building up (for me) than is getting solved. I'm trying to look at it as a challenge- how much can I get done safely without optimum equipment, but it is wearing on me.
I LOVE the people I work with, I'm not thinking of leaving, but does anyone have a different mind set to approach this from? Of course, a little co-venting is great to hear too!

Don't ever let the docs treat us like their "handmaidens"! Be firm, this happens everywhere. It happens in my department too, we even bring up such issues to the HOD. However old habits and being stubborn are something difficult to change. It takes time, all of you need to stand together and do it.

If equipment are not working properly, get it changed or fixed up otherwise our patient's safety may be jeopadised. Don't be disheartened there's problem in every place even if u choose to go, can u be very sure that history will not be repeated?

Have faith....... :saint:

**canoehead, BSN, RN** · Sep 29, 2005

I've made up 2 workorders on the moniters, spoken to the head of maintenance, and then to my manager. Two of the three moniters we have are without alarms. Although they are unsafe it would be worse to be completely without them. I have observed a 3 month wait on fixing equipment- it has to be sent out of the hospital if more than 2 tools are needed- so just doing without for a day is not an option. Even worse, no one else has mentioned this as being a problem!!! And JCAHO has come and gone, we passed(!) and I am pretty much reeling. That will tell you how much their survey depends on paperwork and not on actual patient care needs.

JCAHO SUCKS

Hellllllo Nurse, BSN, RN · Sep 29, 2005

i agree.
i would absolutely refuse to unload deliveries. i would encourage all my peers to refuse.
what would they do? fire all of you?? how would they replace all those nurses at once??? won't happen.
they have you unloading deliveries bc of one reason only...
YOU DO IT.

This is typical of dialysis units. There are no other staff there besides the nurses and techs. There is no one else to do the grunt work.

At the last unit I worked at before I became a traveler, housekeeping was cut down to only 3 days a week. So after a 12 hr days of azz busting w/ the pts, we were assigned to MOP FLOORS and CLEAN TOILETS.

Only when I was charge did I get out of doing it. But,I still had the enviable task of deciding which techs and nurses had to stay over to do it.

One of the many reasons I quit.