Question for nurses from an aide

FancypantsRN · Dec 5, 2011

I think it really depends on what type of nursing you go into. In my experience (hospital only), I think you are correct. We spend more time charting than with the pt's, I don't think this is something apt to change.

kool-aide, RN · Dec 5, 2011

On a medsurg floor, maybe. But as a general rule, the nurses at my hospital spend about as much time w the pts as I do… and on progressing care floors and ICUs they see the pts even more.

xtxrn, ASN, RN · Dec 5, 2011

This goes back a while, but I agree it depends on the type of nursing....from my experience:

LTC- definitely not the amount of time I'd like, but I made it work. Things got done- but I would love to have talked more to the residents, just because they were interesting.

Neuro med-surg- started with 14 patients on 11-7... very busy, everything got done- but would like to have had more time with some. Most wanted to rest- many were comatose so needed more ADL stuff. HIV (overflow from pulmonary) were generally where the nurses hung out on breaks - the guys didn't have anybody visit (sadly), and liked the company- this was when smoking in hospitals was allowed- so we'd take our breaks with them.

Med-Surg/Ortho- I was in charge, so no patients assigned to me for direct care, on the 27 bed floor- and I was the only RN (had 3-4 LVNs depending on what part of the 7p-7a). I saw every patient, and actually did have some time to spend with those who seemed to need more time. Most were the "RN Assessment" contact, or admissions assessments - or emergency/change in condition management (along with the paperwork, all MD calls on the floor, chart checks, MAR checks, etc). But it was an ok system. I had great co-workers- which made ALL of the difference.

Psych (adolescents)- my assignment was "the floor"....LOL. It was a 40 bed unit- the med nurses dealt with meds, so I was more on the crisis intervention, consequences, and chart check end of things- if patients needed 'time'- they got it. Or, if that wasn't "enough"and they were unsafe, they ended up in the quiet room- which took a lot of 1:1 time - even if a door between us.

Drug/Alcohol Rehab= I was the only RN at a 90+ bed rehab facility; the detox unit was 12 beds (14 in a pinch). One med nurse for the campus. One tech in the detox unit (did all vitals, lab draws -though I did some of those, and general running around- all admission paperwork ) and then there were counselors on campus who dealt with more of that. IF I got involved in something after they left detox, it was either a severe behavioral problem that may need the judge to come sign transfer papers to the state facility or jail, or a medical emergency (varices, muscle strains, a rare fracture, etc). There were adolescents on campus as well as adults.

MDS/Care Plan Coordinator- I got the time I needed since what I did was so focused on the individual resident. I had more trouble getting my computer to keep up - and ended up with several before getting one that worked consistently.

It's always NICE to have more time- but it becomes a matter of what is necessary; with some patients, the in and out of assessments and meds is "enough"...for those with bad news or bad prognoses, they got more time.

Pediatrics- staffing was such that there was plenty of time....I was used to a LOT more than 3-4 patients- so saw no time issues there UNLESS I got stuck with the preemie 'boarders' (just needed to eat consistently and gain weight- 4 pounders)... 3 of them were a nightmare- the runts on the floor took up the most time They'd put 3 in one room with a portable monitor for one of them- other two used the in-room monitors. And there I'd be....All. Dang. Night. Twelve hours of runt music.... :clown:

Esme12, ASN, BSN, RN · Dec 5, 2011

Not being able to spend time with patients was what sent me to critical care units.

Jess_Missouri_RN · Dec 5, 2011

I have only worked med-surg and yeah, seems to be the normal. I have anywhere from 5-8 patients on nights, so it all depends on my assignment. If I have patients that need the extra time, I try to give it. One reason I'm looking into home health.... more 1:1 time.

pchs052010 · Dec 5, 2011

On my floor, I work on night shift. I spend as much time as my pt needs me. Charting can always done last:) hopes this helps!

Perpetual Student · Dec 5, 2011

In both of my nursing jobs I have had plenty of time to give to my patients. While it's easy to get caught up in the cool-guy (or girl) stuff like drugs and tools, reassuring words and kindness often make the biggest impact on patients.

BluegrassRN · Dec 5, 2011

On my floor, I work on night shift. I spend as much time as my pt needs me. Charting can always done last:) hopes this helps!

While it's tempting and I know you do it so that you can spend more time with your pts, you shouldn't save your charting until last. This results in charting errors and overtime. What happens if your pt crashes and it sent to the ICU, and you haven't charted a thing on them? If you are writing everything down so that you can remember it six hours later, you're double charting and wasting your valuable time. If you aren't writing it down, you are simply NOT going to be able to remember everything, and therefore your charting will be inaccurate.

However, it's a concern that many nurses raise, and for that reason many facilities offer "point of care" charting. We have hand held devices that double as a bar code scanner and a simple computer. We can chart vitals, i/o, and certain other information from this device. We have COWs (computers on wheels) that we can take into the rooms...however, these are bulky and unwieldy, and do not lend themselves well to routine charting, only for prolonged charting activities, like admissions. All the units that have been remodeled have a wall mounted computer in each room, so that the nurse can chart while still in the room, talking to the patient. Whenever I float over to one of those units, I love this; you really can spend a lot more time in the room, and charting there helps prompt you to ask any questions you might have forgotten. When we are finally remodeled, we will have computers in every room, too.

PCHS, that's something to advocate for, if your floor nurses have any say in what sort of technology is used on the floor. Between the hand held devices and the actual computer in the room, nurses like you get to have the best of both worlds...more time with the patients AND the ability to chart in a timely manner.

I agree with you about night shift, though; I feel that I can spend significantly more time with my patients. You always get a couple who are night owls or just having some insomnia, and particularly with these patients, you can take extra time to do all sorts of additional education, or just chat and relieve their boredom or anxiety for a while. I have better control over how I use my time than the day shift nurses, and I like that.

Jenni811, RN · Dec 5, 2011

honestly, the answer is i feel like the CNAs know our patients better on a personal level. I work on a Cardiac-pulmonary med surg floor, and it can get very very busy. With everything i have to do, i don't get to spend alot of time with my patients and their family. i can tell they crave my attention and crave for me to be in there to discuss medications and intrpret what the doctors say, and listen to their stories of their grandchildren or whatever. But honestly, the truth is i don't have time.

I would LOVE to do that.

part of me misses my job as a CNA, and the only thing that keeps me going as an RN is the pay is almost twice as much. if a CNA made as much as an RN, i would stay a CNA. It is very frustrating when i can't spend time with them, and get to know them. i do my very very best, even try to give them 5 minutes of my time of just talking, but sometimes i can't even do that.

yuzzamatuzz · Dec 5, 2011

I do spend a good amount of time giving meds/charting, it's just part of the job. But I also spend a lot of time doing patient/family education. I work in peds and I never have time to sit down and "play" with my patients, although the CNAs usually don't either. In general I feel like the CNAs are just as busy as I am. Depending on my patient's needs I will spend more time with some and less with others. For example, yesterday I had a stable patient admitted just for IV antibiotics and his parents were very involved/active with him. I did periodic assessments on him and gave his q8hr antibiotics but spent very little time in the room. I had another patient yesterday who was a month old, no parents, and had a slew of medical problems. I spent most of my day with her, and because of the assessments I had to do on her I was responsible for feeding and changing her too (usually the CNAs are responsible for that on my floor). Even when I was charting I had her at the nursing station with me because she had no parents at the bedside. As someone else said, my patients always come first and charting comes last. If I have to, I will stay late to do charting. Having worked as a CNA while I was in nursing school, I don't feel like I have that much less interaction with my patients than I did back then.. it is just a different kind of interaction. A lot of it also has to do with your personality too. There are nurses on my floor who are great nurses, but they do what they have to do and then get out of the room. I enjoy talking to my patients' families a lot, doing patient education, etc. so I tend to spend more time in my patient's rooms (but that also means I tend to be a little bit slower about getting my charting done). Personally I love being a nurse and don't feel like my biggest role is giving meds/charting, it is what you make of it.

carolmaccas66, BSN, RN · Dec 5, 2011

No it seems I don't get to spend much time with patients, unless it's in psych (even then we can't some days and that's part of psych nursing!). If it's HDU & it's 1:1 then it's good, but I get very little interaction with patients.

Sometimes that's not always a bad thing as some people want to tell you not only THEIR life story, but their whole families as well, and the relatives want to go into all their health history as well! It can get wearying at times.