Obstacles to providing care

wmf · Jan 31, 2000

There are many different obstacles that are

created in a nurses 8 or 12 hour shift. Where I work the Doctors depend on the nurses to not only carry out their orders but write them. There is good and bad to this - the good part is at least we are able to read them and the bad part is that there is a large chance to make a mistake as far as what the Dr. actually wanted to order and it takes away from pt. care.

DIDI · Feb 1, 2000

home care:not having supplies you need,pts. not taking meds even though they say they have,family not being suportive of pts. needs, 2:nursing home, not enough staff,not enough supplies, docs not returning calls,hosp:not enough staff for pts needs,not enough time for same,//this is just a start,hope it gives you some Ideals

[This message has been edited by DIDI (edited January 31, 2000).]

Rae · Feb 2, 2000

Acting as many different roles deters from patient care (cleaning, looking for equipment, monitoring tools required by administration, screening patient needs for other disciplines such as dietary, physical therapy). Family members can take up so much of your time especially if there are end of life issues. Doctors frequently expect that the nurse communicate with others for him (i.e. consulting other physicians, talking to families, talking with other departments). Paperwork, not only documentation on the patient's medical record, but also forms that are expected as an employee that is needed for regulatory agencies, JCAHO, state health. I could go on and on.

jkh · Feb 5, 2000

Short staffing.

High staff turnover.

Breakdown in communication between shifts and departments.

Increasing number of acutely ill residents.

Declining work ethics.

Oldtimer · Feb 9, 2000

1. REDUNDANT DOCUMENTATION(4 forms to put a fingerstick glucose result on). (2 forms to document the coverage) AND THE LIST GOES ON!

2. Insane Restraint Policies

3. Illegible Doctors orders.

4. Inept Computer Programs

5. Open Unlimited Visiting - Families and phone calls disrupt patient care when allowed to excess. Especially in dysfunctional families.

6. Supplies/Stock

7. Staffing Issues

8. Follow thru for other disclipines not doing their job.

9. Having to frequently cover for any hospital job.

*Housekeeping not avail. The Nurse cleans. *Central Supply on voice mail again (and its full) The nurse runs around and borrows from other floors.

*Maintenence not answereing. (I have a small tool kit)

*Pharmacy says it delivered the drug - an endless headache. Then to be told 2 hrs. later we never got the order.

askater · Feb 9, 2000

oldtimer...WOW you said it....and better than I ever could!

MQ Edna · Feb 10, 2000

I'm assuming you're in the US 'Oldtimer'. I'm in the UK. Sounds much the same on this side of the pond. I could identify with most of what you said. There just aren't enough RNs to go around on the wards and we're spreading ourselves and our skills too thinly. No wonder burn-out is such a problem, but what worries me most is the effect this is having on patient care. I think I have high standards of nursing care, but it's hard to keep them sometimes. This makes me feel bad.

The biggest problems are:-

Too few staff.

Constantly answering phones.

Too much documentation.

Families lining up to speak to me (even when it's obvious I'm in the middle of a critical procedure with another patient).

There are, of course, many other distractions to the delivery of patient care, but I'm sure other nurses out there are only too aware. I just want to get on with giving care. There are times when I could scream at the interruptions (but of course I can't - it wouldn't be professional would it?

Does anyone else feel like this?

NightOwl · Feb 12, 2000

AHHHH! Hence is why I work nights. We still have just as many but sometimes different tasks to do but fewer interruptions.

MollyJ · Feb 12, 2000

Hi Anita, I don't really have anything to add about what problems we face as nurses. My colleagues have eloquently said it all. The "true focus" of nursing is supposed to be patient care and we are supposed to focus on things like teaching, doing for a client until they can do for themselves (much of the day to day bedside care that occupies our time) based on specific nursing needs. As you can see, the pressure of the hospital system itself often creates many obstacles to us doing our jobs. The framework for nursing decision making is to assess the client (based on the knowledge of nursing problems), plan care and implement care and then evaluate. It is an ongoing and circular process and it is highly interactive. The patient/family and other disciplines are integrated into care provision.

I write this rather hoity-toity posting because nurses are often seen as doers and not thinkers, but everyone of the nurses who posted here wrote about what they do. Above is the thinking framework for what we are trying to accomplish.

You may have heard the saying, "When your up to your *ears* (body part of your choice) in alligators, it's hard to remember that the original objective was to drain the swamp." I think that this most accurately describes nursing. We operate under constant interruption (and those interruptions are part of our job) and try to accomplish a cohesive whole that is organized and targeted care for a patient.

Oldtimer · Feb 16, 2000

You were right on target Molly. This profession is people oriented not just patient driven. We will always find this our greatest frustration and our greatest job satisfaction. Since this is true for me, I know I still care!

Oldtimer · Feb 16, 2000

I work with a very assertive/agressive group of MICU nurses. We have started a program in our unit to reduce some of these issues.

We are now demanding other disciplines involvement and accountability for the whole patient. This is accomplished by Interdisciplinary Rounds each Monday.

The team includes the Nurse, PT/OT, Dietary, Resp. Therapy, Social Worker, Case Manager, Clergy, Pharmacy and Nurse Manager.

Each patient is discussed and any issues involving the patient/family are addressed, including discharge planning. Each discipline is required to address their end of the patient need and follow thru.

We have a RED paper that goes on the chart and any issues needing Dr. orders goes on this form. This has made a huge difference.