Before I go on, a disclaimer. As a novice nurse, it’s entirely possible and even likely that my problem lies in my own ability to manage time or tasks. I accept that, but I will also stand behind the effort and thought I put in to solving for those issues on a daily basis.
I work as a Rehabilitative RN and am responsible for up to 15 patients per shift. I have found over the past 2 months of working here that the morning and afternoon med passes plus basic nursing skills (draining an abdominal Pleurx catheter, draining a Billie tube, changing colostomy bags, etc) take up the entire 8 hour shift, even when walking up and down the halls at full speed just shy of breaking into a sprint and when administering some medications earlier than scheduled when possible. That doesn’t include charting, which requires staying past the end of my shift to complete. That also doesn’t include admissions, which may add an extra 1.5-2+ hours of overtime to a shift. Finally, that doesn’t include weekly skin checks, which sometimes requires checking multiple patients on the same day and, to be done properly, requires time to be carved out of a day of doing med passes where barely enough time exists to begin with.
I imagine some of you may be reading this and thinking “yeah, that’s nursing.” Some may even think “suck it up, if you can’t handle it, get out.” My concern is with the patients. If we have created a system where our patients have to compete with our own families for time (which is what overtime really means), our patients will eventually lose.
Are we ok with this? Is this normal?
If, for example, a facility can scrounge up the cash to make sure a nurse is present, why can it not scrounge up the cash to make sure enough nurses are present to provide patient care without being in a constant state of full-bore rushing around and having to stay hours late regularly to catch up?
Is there an evidence based process for providing staffing based on patient care needs rather than census?
If we push our nurses to do more than is possible, the ones who make a good faith effort to try are the ones you will lose to turnover. The ones who don’t do the work will be unaffected. How do we create a system that rewards nurses who make a good faith effort to care for their patients without making them trade between time with their family beyond their shift and providing adequate care to their patients and fulfilling their professional responsibilities?
Does anyone have any positive experiences to share from their work places regarding this sort of thing?
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