I recently had a bilateral L3-4 laminectomy with foramenotomies for severe stenosis (the neurosurgeon said he'd never seen nerve roots so compressed in a 44 year old before). Before I get into the care issues, I should preface this story by saying that this is occuring in a "world-class" hospital and that I was on the unit I formerly managed during my post-op stay.
The doc and his nurse were terrific--no complaints there--everything went smoothly and I was prepared well for the surgery. Of course, as often happens, my period started with a VENGEANCE the morning of surgery. Post-op, I had a 6 hour stay in the recovery room due to no beds on the unit. The nurse kept me well-medicated, got me an inspirometer, and helped me change my peripad when I asked. When I got to the unit, I was still feeling pretty good from the Marcaine they inject into the operative area before they close, so I got up and voided, changed my pad and walked the length of the hall and back. Well......all that changed when the local anesthetic wore off several hours later and I began having the most unimaginable nerve pain and spasm in my right hip (due to retraction of the nerve root) and down the leg, as well as in my left leg. I couldn't get into or out of bed using good body mechanics and was absolutely miserable. My IV was also phlebotic and extremely painful. It took 8 hours to get the IV site changed and the resident "wouldn't order anything for the spasm because I had been under anesthesia that day". What a bunch of BUNK! I asked to see the resident, but he never came in. Through that horrible night and into the next day, I couldn't even turn myself over despite q4 hour Percocet. My urine hat was full, and no one ever emptied it--I just would struggle to get into the bathroom (it took WAY too long for anyone to respond to a call light) and sit down in the puddle of urine and let it overflow into the toilet. I asked 3 aides and a RN to help me with pericare since my pad hadn't been changed since the recovery room and I had bled all over and had clots everywhere. Everyone said--"oh, OK, sure, be right back." Of course no one ever bothered to show up. I never received a water pitcher, bath basin, but was finally given a pack of OB pads after asking for help with changing my pad. The day shift RN walked in as I was getting out of bed the morning after surgery and just looked at me like I was a bug and said, "Oh my God....you are a neuro nurse and your body mechanics are just terrible. You know better than that." I promptly growled at her, "RIGHT NOW I AM NOT A NEURO NURSE--I AM THE PATIENT IN SEVERE PAIN, AND I SUGGEST YOU SHOW ME WHAT TO DO!" She jumped back about 5 feet and coached me through getting up and down out of bed. She ran in hurriedly about 2 hours later, gave me some Percocet and had me sign the D/C orders. I never saw her again. When my surgeon showed up the morning after surgery, I simply said, "Fred, when I am not in so much pain and can put a little distance between me and this situation, you and I will talk. Please discharge me--I will get better care at home." He obliged, ordered me Valium, Vicodin, and Flexeril (use whatever works) and put me on a Medrol dosepak when none of the above decreased the pain. The first time I got any care was when I got home and my husband and parents saw the excruciating pain I was in and met my needs. I was so embarrassed that my 70 year old mother was cleaning my perineum and putting a clean pad on me, that I just cried like a big old baby. My family members were awesome in providing me with everything I needed once I got home, and as soon as I started the dosepak, I had relief of the extreme pain within 12 hours so I was able to provide most of my own care.
Now for the best part......some statistics that may blow your mind as much as it blew mine......
The unit was at 22 patients when I was there (23 is max census). Neuromedical, neurosurgical and complex ENT (there were no ENT pts. during my stay). I used to run the unit with the following:
7-3: 4 RNs/3 NAs
3-11: 4 RNs/2 NAs
11-7: 4 RNs
I had to fight for that staffing and went to all the upper management with statistics supporting the addition of RN staff and NAs on nights, but could never get anything for my floor. I left after 2 years because I couldn't take the headbashing anymore. The killer is, this was and is the current staffing on the unit while I was there:
7-3: 6 RNs/3 NAs plus a unit based Case Manager and Social Worker
3-11: 5 RNs/3 NAs
11-7: 4 RNs/2 NAs
My point in all of this is that staffing doesn't always have direct bearing on the care that will be given. Just like the patient who needs their hair washed to feel better (I spent three weeks in a hospital on bedrest while pregnant without washing my hair, so I have some knowledge of how atrocious this feels), controlling pain and making the patient feel cared for is an enormously critical part of what we do. I have worked many shifts "short-staffed", but tried never to let a patient or family member with questions feel as though I didn't have time for them or couldn't meet their basic needs at least. I assure you, the staffing on my former unit allowed for very reasonable ratios, but I felt like I was alone and on my own to meet my own needs. All I know is that we never did that with our patients on that unit when I managed it.
Thanks for those of you who have been patient enough to allow me my rant. It feels good to get it off my chest, and I hope it will make us all a little more sensitive to the needs of our patients.