Obstacles to providing care

NurseRachet · Apr 16, 2000

Been a nurse for 29 years, and have worked just about everywhere. I can not add one thing to the dialogue that "beano" and "oldtimer" didn't already say. Good luck with your question - it must be a hot topic.

emhkirkpatrick · Apr 20, 2000

AMEN TO ALL THE ABOVE REPLIES SO TRUE.

The paperwork is atrocious and though chartingby exception is catching on,the institution i work at now insists on narrative on several of the things that are already on flowsheets such as there is a spot to check that the iv is secure and site is okay but then yu have to chart the same thing in the narrative why?

The computer systems are unfriendly to put it mildly--and instead of everything being available in one system we have one system for orders and another for scheduling and another for labs so we have to log off one and log in to another to get info.

Then there is the ancillary services issue--the housekeepers can't clean the room until you have stripped it. If there isn't a housekeeper then guess who gets to clean--the last institution i worked at the housekeepers weren't allowed to touch the monitors at all so we had to find a dust mop to clean off the top of the monitors. why?

As for Tara's comment about different expectations for male and female nurses----boy is she right. The last institution i worked for did!!!!!! Unfortunate but true.

The female nurses were expected to be more thorough in patient care, more flexible in respect to schedule changes, more accountable for everything, quieter, more polite, more respectful. should i go on.

The male nurse were always having excuses made for them--they could tell the raunhiest jokes within patient hearing and never have a thing said to them--a female nurse making a mild off color comment at the desk that the patients could not hear was reprimanded.

when asked why the difference, the unit manager's response was "boys will be boys" attitude was also directed to noisy behavior, work not done, anger, irresponsible behavior, not coming to work after being on call because they were tired but female nurses were penalized if they didn't work their regularly scheduled shifts

after being on call. I could go on and on. The double standard is alive and well and living in several hospitals. This is part of the reason i left my last employer and my new one seems to be a lot better in equal expectations for male and female nurses. I'm not saying that all hospitals have different standards for male and female nusrses but that some do and it's sad. at the last institution i worked at the female nurses had been complaining about the conditon we received the patients from OR for years--things like the patients arriving in PACU with blood and betadine all over them and their patient gowns, the gowns soaked with irrigation solution and God knows what else, on a cart with another patient's name on it, no ID band the list goes on--we were repeatedly told that the OR

staff was too busy to worry about the little things. A new male nurse went and compained to the manager and the next day there was a

comittee set up between the OR staff and the PACU staff to investigate this problem and do something about it. One time i approached the manager about getting OT and

the social worker to see a female doctor's axiallary node dissection patients preop because she was sending so many of them home post op and those two departments were frequently gone by the time the patient was a wake enough to talk with them. It was a patient care issue and made sense to me. The unit manager went off about being tired of spoon feeding doctors and she should take care of it from her office etc. Two days later i got in trouble with the same manager because i didn't have a male physician's billing forms available on the unit for him. This was a female manager.

JillR · Jun 1, 2000

Ditto everything oldtimer said and my biggest pet peave is the 18 family memebers that call to discuss 1 patients condition every shift, (This doesn't include the family memebers of the other 7 patients I have) saying "I just talked to my brother Bob (who by the way just called me fifteen minutes before), the question I have is "is there anything new with my mother"? Drives me nuts!!!!!

bunky, BSN, RN · Jun 3, 2000

Anita, the medication issue is minimal in comparison to the rest. If we can't read a doctors writing, we call and ask them to spell it, and if the doseage seems incorrect for any reason, either the pharmicist will call the MD, or the nurse will. Medications are only a fraction of what we do in a days work, and they don't represent any real delays or obstacles. You aren't a nurse, but if you want to write a correct and factual document, you need to go beyond the issue of medications as that is typically what the public focuses on yet it is a very narrow minded portrayal of what the job is all about.

Mijourney · Aug 15, 2000

Hi,

Well done by all the previous posters. I'm going to stick my neck out and add that an obstacle that occurs during my work experience is disunity, antagonism, and the like. In every place that I have worked, there has always been one, two, or more nurses causing strife as if it were a sport. Needless to say, it makes already difficult work more unpleasant for everyone.

ozbunji · Aug 15, 2000

Obstacles that I view to providing pt care include:

Indecision by allied health professionals and doctors

Lack of time - being expected to be in three places at once

Inappropriate environment and educational methods...many of our clients are traditional Aboriginal people who hate being shut up in an airconditioned hospital and are a long way from their land and ppl

Some patients are just not interested in changing lifestyles...for example ppl with COAD or cardiac conditions racing down for a cigarette as soon as they've finished their nebuliser or got out of CCU respectively

Completing stupid computer statistics that dont seem to be used in our every day work

Paperwork ... seems to be more and more trial papers which never get cancelled

Oh well thats my gripe, hope its useful

pickledpepperRN · Oct 2, 2000

All the previous posts have me in the "Amen Corner".

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Redeye · Jan 13, 2001

I think a study about medication admin is a good idea. At my facility I spend the majority of my time giving medication. If one is not available then I have to stop what I am doing and call the pharmacy or call the nursing supervisor in order to get the med sent. Usually there are several different meds I have to call for and it ends up putting me behind with everything else I need to get done. It is very frustrating.

Goofball · Jul 14, 2001

#1 BIGGEST OBSTACLE is the VISITOR/FAMILY MEMBER,

at least in ICU anyway. Especially the ones who

stay the entire shift or sleep the night. The ones who are know-it-alls are the worst, telling you how to do nursing and when to do what, and always finding something to complain about or be distrustful about. But even the nice, sweet ones are time-consuming and distracting.And those are usually the ones who also want to follow you around, or hang out with you at the nurses station when you finally get a chance to chart.

Even worse than these two are the hyper-vigilant visitors, who never look at the pt. they supposedly came to visit, and stare at the monitors, screaming for the nurse when one bleep goes off, or if the heart rate changes from 84 to 88. You try to educate these people, but they seem to thrive on drama.

I sometimes feel that all those nurses who back up the 'studies' proving open-visiting is absolutely wonderful, are nurses who do not take full-time bedside assignments in hospitals.

night owl · Aug 20, 2001

there are so many obstacles that i don't know where to begin. but to me the the biggest obtacle is the lack of team work. i can remember when nurses truely did help each other out, each shift helped the next shift. an example of this used to be when day shift saw that our insulin supply was running very low and the next shift would most likey not have enough, the daytimers would just go ahead and order it from pharmacy before they closed at 4:30 and could have it delivered to the unit by 3pm. now a days, if the insulin supply is low, the next shift no doubt will not have enough and nocs will not have any at all so that means nocs will have to go to all the units and find it themselves which we usually do. even when you tell the daytimers that we have no insulin and ask them to order some, you come back the next night and no one still had not ordered it so now you have to go "hunting" around again which takes away from all of the other things that you could and should be doing...hate when that happens. no one ever restocks their med carts anymore, so now you have to go get the med cups, the paper cups, the tongue blades, the alcohol wipes, the straws. and after all that, now you have to clean up the mess that they left behind. garbage bags full on the carts, sticky juice on the top, powder and spanules all over the tops, sticky lactulose spilled in the drawers, filthy morters and pestals and they just leave it and go home. come on.....i wouldn't want to see what their homes look like! so now i've wasted 30 min. cleaning, wiping, restocking just so i can get in there and do my job. the nurses station is a total wreck and you can't find the counter top to make out assignments. another 15 minutes putting away whatever was left all over the place. in the nourishment room the evening shift left the microwave with spilled whatever from their dinner breaks and never bothered to wipe up their messes, spilled coffee from making coffee, another ten minutes cleaning up that room. so between, running around looking for insulin, restocking and cleaning the med cart, cleaning up the nurses station, and wiping up the nourishment room, and oh, i forgot the tx carts, no 4x4's, no tape, no kling, no nothing , another 15 minutes getting that together when whoever used it last should have done that. so after doing all that, i've wasted at least an hour. i could have done so many other little things for my residents, but now, i've got to run to the xerox machine and make 50 copies of the restraint flow sheets because the evening shift ran out so now i need them and i don't have any! but, i have to go to another unit to get one to copy...another 15 minutes...

MRed94 · Aug 20, 2001

At least one of the reasons I became an agency nurse was to get away from the politics of the facility I worked in.

The DON's favorite phrase when we would complain about something was:

"You have to do MORE, FASTER, with LESS"

I hated her.

I think my biggest obstacle always was the DON, supervisor, or other "management" telling us to do something that was so totally out of whack that it was laughable.

I think the "management" should spend a shift or two on the floor, getting back into the feel of things, and REALLY know what it going on in the unit.

I think a lot of the "Management" problems would disappear if THEY had to go through what WE go through.....

Just my humble opinion....

katrina hays · Aug 20, 2001

Anita,

I think that short staffing and high nurse:patient ratio numbers would be the best avenue to study. Most of the problems in nursing revolve around this.

I have been in the profession for 10yrs in ICU and ER. If staffing is adequate than pt care and nurse sanity is of much higher quality. But across the board all nurses know the insanity of working whats supposed to be a 12 hour shift that turns into a 14 or 15 hour nightmare.

Nurses are the patients first line of defense against all the above listed problems. I have seen the breakdown and incontinuity of care that results from having an overstressed and overworked nursing staff. We are the coordinators. We are the ones who spend the most time with the patients, it is our eyes and ears and minds that find the problems and demand solutions from all others.

We as nurses take care of all others except ourselves and most times we do this at our own expense. I know I've had many UTI's from not even feeling I could stop to go to the bathroom for 12plus hours. Lunch, whats that???????

This I try to remember when I get stressed or when an MD gets an attitude: Patients come to the hospital, nursing home or any inpatient facility for 24 hour a day NURSING CARE!!!!!! If not for us they would not be there. Physicians depend on us to assess, implement, evaul, and re-assess pt status at all times and to let them know whats going on. This is a dynamic process.

Answers ?????? Solutions??????

Kat